Viral Hepatitis

Viral Hepatitis is a topic covered in the Washington Manual of Medical Therapeutics.

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The hepatotropic viruses include hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV) (Tables 19-1 and 19-2). Nonhepatotropic viruses, which indirectly affect the liver, include Epstein–Barr virus (EBV), cytomegalovirus (CMV), herpesvirus (HSV), measles, Ebola, and others.

Table 19-1: Clinical and Epidemiologic Features of Hepatotropic Viruses
OrganismHepatitis AHepatitis BHepatitis CHepatitis DHepatitis E
Incubation15–45 d30–180 d15–150 d30–150 d30–60 d
TransmissionFecal–oralBlood
Sexual
Perinatal
Blood
Sexual (rare)
Perinatal (rare)
Blood
Sexual (rare)
Fecal–oral
Organ transplantation
Risk groupsResidents of and travelers to endemic regions
Children and caregivers in daycare centers
Injection drug users
Multiple sexual partners
Men who have sex with men
Infants born to infected mothers
Health care workers
Injection drug users
Transfusion recipients
Any person with hepatitis B virus
Injection drug users
Residents of and travelers to endemic regions
Zoonosis: workers in pig farms
Fatality rate1.0%1.0%<0.1%2%–10%1%
Carrier stateNoYesYesYesNo
Chronic hepatitisNone2%–10% in adults; 90% in children <5 yr70%–85%VariableRare
CirrhosisNoYesYesYesNo
Table 19-2: Viral Hepatitis Serologies
HepatitisAcuteChronicRecovered/LatentVaccinated
HAVIgM anti-HAV+NAIgG anti-HAV+IgG anti-HAV+
HCVAll tests possibly negative
HCV NAT+
HCV RNA+
Anti-HCV Ab+
Anti-HCV
Ab+
HCV RNA+
Anti-HCV Ab+
HCV RNA−b
NA
HDVIgM anti-HDV+c
HDV Ag+c
IgG anti-HDV+cIgG anti-HDV+cVaccination against HBV
HEVIgM anti-HEVNAIgG anti-HEVNA

aFor hepatitis B virus serologies, see Table 19-3.

bNegative HCV RNA results should be interpreted with caution. Differences are found in thresholds for detection among assays and among laboratories.

cMarkers of HBV infection are also present because HDV cannot replicate in the absence of HBV.

Ab, antibody; HAV, hepatitis A virus; HCV, hepatitis C virus; HDV, hepatitis D virus; HEV, hepatitis E virus; NA, not applicable.

Acute viral hepatitis is defined by an array of symptoms that may vary from mild, nonspecific symptoms to acute or fulminant hepatic failure. This condition may resolve or progress to chronic hepatitis, in certain cases, or to liver failure as a consequence of diffuse necroinflammatory liver injury.

Acute or fulminant hepatic failure (FHF) is defined as the rapid development of severe liver injury with encephalopathy, jaundice, and coagulopathy in a patient without preexisting liver disease within <6 months from the onset of the acute illness.

Chronic viral hepatitis is defined as the presence of persistent (>6 months) virologic replication, as determined by serologic and molecular studies, with necroinflammatory and fibrotic injury. Symptoms and biochemical abnormalities may vary from none to moderate. Histopathologic classification of chronic viral hepatitis is based on etiology, grade, and stage. Grading and staging are measures of the severity of inflammation and fibrosis, respectively. Chronic viral hepatitis may lead to cirrhosis and HCC.

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