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 |
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