VIRAL HEPATITIS Flashcards
Incubation Period (weeks)
Hepatitis A: 2-6 weeks
Hepatitis B: 1-5 months
Hepatitis C: 2-6 months
Hepatitis D: 1-3 months
Hepatitis E: 3-8 weeks
Transmission
Hepatitis A: Fecal-oral
Hepatitis B: Sexual > parenteral
Hepatitis C: Parenteral > sexual
Hepatitis D: Parenteral, sexual
Hepatitis E: Fecal-oral
Severity
Hepatitis A: Mild
Hepatitis B: Occasionally severe
Hepatitis C: Usually subclinical
Hepatitis D: Co-infection with B
Hepatitis E: Mild, except in pregnant women (10-20% death due to fulminant hepatitis)
Fulminant Hepatitis
Hepatitis A: Rare
Hepatitis B: Very rare (1%)
Hepatitis C: Extremely rare
Hepatitis D: Co-infection occasional
Hepatitis E: Rare (1-2%)
Symptoms
Hepatitis A: Fever, malaise, headache, anorexia, vomiting, dark urine, jaundice, RUQ pain, hepatomegaly
Hepatitis B: As with A, but 10-20% with serum sickness-like (joint pain, rash)
Hepatitis C: Only 20% acutely symptomatic
Hepatitis D: As with A
Hepatitis E: As with A
Carrier state
Hepatitis A: None
Hepatitis B: Yes
Hepatitis C: Yes
Hepatitis D: Yes
Hepatitis E: None
Chronicity (%)
Hepatitis A: 0
Hepatitis B: 5-10
Hepatitis C: 80
Hepatitis D: 5
Hepatitis E: 0
Associated with blood transfusions
Hepatitis A: Very rare
Hepatitis B: 5-10%
Hepatitis C: Almost negligible 2% to routine screening
Hepatitis D: Occurs, but frequency unknown
Hepatitis E: Rare
Serology
Hepatitis A: Anti-HAV, IgM fraction, IgG fraction
Hepatitis B: HBeAg, HBsAb, HBeAg, Anti-HBs, Anti-HBc, Anti-HBe
Hepatitis C: Antibody to hepatitis C, PCR-RNA
Hepatitis D: Anti-delta IgM Fraction IgG fraction
Hepatitis E: Anti-Hep E, IgM, IgG
Post-exposure prophylaxis
Hepatitis A: Immunoglobulin, Hep A vaccine
Hepatitis B: HBIg, Hep B vaccine
Hepatitis C: None effective
Hepatitis D: None
Hepatitis E: Unknown
Associated with Cirrhosis
Hepatitis A: No
Hepatitis B: Yes
Hepatitis C: Yes
Hepatitis D: Yes
Hepatitis E: No
Associated with primary HCC
Hepatitis A: No
Hepatitis B: Yes
Hepatitis C: Yes
Hepatitis D: Yes
Hepatitis E: No
Hepatitis B serologic markers- Hepatitis B surface antigen and antibody
- The serologic hallmark of HBV infection
- HBsAg: appears in serum 1 to 10 weeks after an acute exposure to HBV, prior to the onset of hepatitis symptoms or elevation of serum ALT (generally appears after 6 weeks and disappears around 3 months, anti-HBs usually appears at around 6 months; this creates a window of 3-6 months where neither the surface antigen nor antibody are positive
- In most patients, anti-HBs persists for life, conferring long-term immunity
Hepatitis B serologic markers- Hepatitis B core antigen
- Intracellular antigen in infected hepatocytes and NOT detectable in serum
Hepatitis B serologic markers- Hepatitis B core antibody
- Can be detected throughout the course of HBV infection
- During acute infection, anti-HBc is predominately of IgM class
- IgM anti-HBc is the sole marker of HBV infection during the window period between the disappearance of HBsAg and the appearance of anti-HBs
