Hepatitis A and E

Question 1

Define:

Answer 1

• Hepatitis caused by infection with the RNA viruses, hepatitis A or hepatitis E virus, that follow an acute course without progression to chronic carriage
• Acute infection only

Question 2

Aetiology/risk factors:

Answer 2

These are both transmitted by faecal oral route.

Hep A - uncooked poultry (usually picked up by travellers)
Hep E - uncooked seafood

• Both viruses are small non-enveloped single-stranded linear RNA viruses.

They replicate in hepatocytes and then are excreted in the bile leading to inflammation and tissue necrosis

Question 3

Epidemiology:

Answer 3

• HAV is endemic in the developing world
• Infection often occurs sub-clinically (no clinical findings)
• Better sanitation in the developed world means that it is less common, age of exposure is higher and, hence, patients are more likely to be symptomatic
• Annual UK incidence: 5000
• HEV is endemic in Asia, Africa and Central America

Question 4

Symptoms:

Answer 4

There is an incubation period of a couple of weeks.

• Malaise
• Fever
• Weight loss - smokers often no longer want cigarettes
• nausea and vomiting

Signs of jaundice:
Yellow sclera
Dark urine
Pale stools
itching

Question 5

Signs:

Answer 5

• Pyrexia
• Jaundice
• Tender hepatomegaly
• Spleen may be palpable
• ABSENCE of stigmata of chronic liver disease (although some spider naevi may appear transiently)

Question 6

Investigations:

Answer 6

Bloods:

• LFT’s - AST, ALT, ALP up and albumin down
• ESR
• platelets

Serology:
anti -Hep A antibody IG M = acute where IG G = CHRONIC
anti - Hep E antibody

urinanalysis:

• High urobilinogen
• positive for bilirubin

Question 7

Management:

Answer 7

These are acute and the management is often symptomatic - anti-emetics, anti-pyretics and cholestyramine ( for itchiness)

There can be control and prevention such as sanitsation and vaccination in hep A.

Question 8

complications:

Answer 8

fulminant hepatitis (usually in pregnant women, massive necrosis of liver parenchyma and a decrease in liver size)
•	Cholestatic hepatitis with prolonged jaundice and pruritus can develop after HAV infection 
•	Post-hepatitis syndrome: continued malaise for weeks to months

Question 9

prognosis:

Answer 9

usually recover in 3-6 weeks.

• Occasionally patients may relapse during recovery
• There are no chronic sequelae
• Fulminant hepatic failure has a mortality of 80%