ACUTE VIRAL

HEPATITIS
Fardah Akil

Centre of Gastroentero-Hepatology, Wahidin Sudirohusodo Hospital Teaching

Internal Medicine, Faculty of Medicine, Hasanuddin University
 HEPATITIS A
An enterically transmitted
RNA virus
The most common cause of
acute hepatitis worldwide
Infection : unsanitary living
condition or improper food
handling technique
Typically asymptomatic for
children (90%), adults more
likely to be symptomatic
(70-80%)
CLINICAL SYMPTOMS :
-1-week prodrome of malaise,
anorexia, nausea/vomiting,
abdominal pain, fever
followed by jaundice (1-2
weeks after onset), dark urine
- Sceleral jaundice, mild
enlargement of the liver
- Aminotransferase elevation
10-100xULR
DIAGNOSIS : IgM Anti-HAV
Resolution IgG Anti-HAV
TREATMENT : supportive
 Hepatitis A
No chronic phase, complete
clinical & biochemical recovery
within 2-6 months
Atypical course : cholestatic &
relapsing hepatitis A. The
prognosis is excellent
Postexposure prophylaxis :
hyperimmun globulin,
administered within 2 weeks of
exposure
Vaccination : child care
providers, food handlers,
individu with CLD & nonimmune
subject traveling to endemic
A recent study on healthcare
utilization in the USA showed
that the number of new
cases, deaths, and
hospitalizations declined by
87.0, 86.9, and 80.1% for
hepatitis A, Declines were
seen among all age groups
but were greatest among
children less than 15 years of
age.
HEPATITIS B
A recent study on healthcare
utilization in the USA showed
that the number of new
cases, deaths, and
hospitalizations declined by
80.1, 80.2, and 87.0% for
acute hepatitis B compared
with the prevaccination era.
Declines were seen among
all age groups but were
greatest among children less
than 15 years of age.
HEPATITIS E
Hepatitis E virus (HEV) is endemic in
some developing countries and has not
been reported to cause chronic hepatitis.
A recent study[40] reported that eight out
of 14 patients with acute HEV infection
who received solid organ transplantation
developed chronic hepatitis E.
 KEY POINTS
Virus HAV HBV HCV HDV HEV
Viral genom RNA(+) DNA RNA(+) RNA(+) RNA(-)
Screening test Anti-HAV IgM HBsAg or Anti-HCV Anti-HDV Anti-HEV
Anti-HBc
Main transmission Enteral Parenteral Parenteral Parenteral Enteral
Incubation period (days) 15-49 26-160 21-84 60-110 10-56
Acute hepatitis yes yes yes yes yes
Chronic hepatitis no yes yes yes no
Antiviral therapy during acute phase no no yes no no
Immune prophylaxis
-Passive + + - - -
-Active + + - - -
Thimme R et al. Clinical Gastroenterology and Hepatolo
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