VIRAL HEPATITIS
Acute viral hepatitis is a systemic infection predominantly affecting the liver. Clinically characterized by malaise, nausea, vomiting, diarrhea, and low-grade fever followed by dark urine, jaundice, and tender hepatomegaly; may be subclinical and detected on the basis of elevated aspartate and alanine aminotransferase (AST and ALT) levels. Hepatitis B may be associated with immune-complex phenomena, including arthritis, serum sickness-like illness, glomerulonephritis, and a polyarteritis nodosa–like vasculitis. Hepatitis-like illnesses may be caused not only by hepatotropic viruses (A, B, C, D, E) but also by other viruses (Epstein-Barr, CMV, coxsackievirus, etc.), alcohol, drugs, hypotension and ischemia, and biliary tract disease (Table 155-1).
FEATURE | HAV | HBV | HCV | HDV | HEV |
---|---|---|---|---|---|
Incubation (days) | 15–45, mean 30 | 30–180, mean 60–90 | 15–160, mean 50 | 30–180, mean 60–90 | 14–60, mean 40 |
Onset | Acute | Insidious or acute | Insidious or acute | Insidious or acute | Acute |
Age preference | Children, young adults | Young adults (sexual and percutaneous), babies, toddlers | Any age, but more common in adults | Any age (similar to HBV) | Epidemic cases: young adults (20–40 years); sporadic cases: older adults (>60) |
Transmission Fecal-oral Percutaneous Perinatal Sexual | +++ Unusual − ± | − +++ +++ ++ | − +++ ±a ±a | − +++ + ++ | +++ − − − |
Clinical Severity Fulminant Progression to chronicity Carrier Cancer Prognosis | Mild 0.1% None None None Excellent | Occasionally severe 0.1–1% Occasional (1–10%) (90% of neonates) 0.1–30%c + (neonatal infection) Worse with age, debility | Moderate 0.1% Common (85%) 1.5–3.2% + Moderate | Occasionally severe 5–20%b Commond Variableg ± Acute, good Chronic, poor | Mild 1–2%e Nonef None None Good |
Prophylaxis | Ig, inactivated vaccine | HBIG, recombinant vaccine | None | HBV vaccine (none for HBV carriers) | Vaccine |
Therapy | None | Interferon Lamivudine Adefovir Pegylated interferonh Entecavirh Telbivudine Tenofovirh | Pegylated interferon ribavirin telaprevir,i boceprevir,i simeprevir, sofosbuvir, ledipasvir, paritaprevir/ritonavir ombitasvir, dasabuvir daclatasvir, velpatasvir, grazoprevir, elbasvir | Pegylated interferon ± | Nonej |
aPrimarily with HIV co-infection and high-level viremia in index case; more likely in persons with multiple sex partners or sexually transmitted diseases; risk ∼5%.
bUp to 5% in acute HBV/HDV co-infection; up to 20% in HDV superinfection of chronic HBV infection.
cVaries considerably throughout the world and in subpopulations within countries; see text.
dIn acute HBV/HDV co-infection, the frequency of chronicity is the same as that for HBV; in HDV superinfection, chronicity is invariable.
e10–20% in pregnant women.
fExcept as observed in immunosuppressed liver allograft recipients or other immunosuppressed hosts.
gCommon in Mediterranean countries; rare in North America and western Europe.
hFirst-line agents.
iNo longer recommended.
jAnecdotal reports and retrospective studies suggest that pegylated interferon and/or ribavirin are effective in treating chronic hepatitis E, observed in immunocompromised persons; ribavirin monotherapy has been used successfully in acute, severe hepatitis E.
Abbreviation: HBIG, hepatitis B immunoglobulin. See text for other abbreviations.
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Citation
Kasper, Dennis L., et al., editors. "VIRAL HEPATITIS." Harrison's Manual of Medicine, 19th ed., McGraw Hill Inc., 2017. harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623375/all/VIRAL_HEPATITIS.
VIRAL HEPATITIS. In: Kasper DLD, Fauci ASA, Hauser SLS, et al, eds. Harrison's Manual of Medicine. McGraw Hill Inc.; 2017. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623375/all/VIRAL_HEPATITIS. Accessed September 15, 2024.
VIRAL HEPATITIS. (2017). In Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L., Jameson, J. L., & Loscalzo, J. (Eds.), Harrison's Manual of Medicine (19th ed.). McGraw Hill Inc.. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623375/all/VIRAL_HEPATITIS
VIRAL HEPATITIS [Internet]. In: Kasper DLD, Fauci ASA, Hauser SLS, Longo DLD, Jameson JLJ, Loscalzo JJ, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2017. [cited 2024 September 15]. Available from: https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623375/all/VIRAL_HEPATITIS.
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