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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.
|Organism||Hepatitis A||Hepatitis B||Hepatitis C||Hepatitis D||Hepatitis E|
|Incubation||15–45 d||30–180 d||15–150 d||30–150 d||30–60 d|
|Risk groups||Residents 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|
|Any person with hepatitis B virus|
Injection drug users
|Residents of and travelers to endemic regions|
Zoonosis: workers in pig farms
|Chronic hepatitis||None||2%–10% in adults; 90% in children <5 yr||70%–85%||Variable||Rare|
|HAV||IgM anti-HAV+||NA||IgG anti-HAV+||IgG anti-HAV+|
|HCV||All tests possibly negative|
|IgG anti-HDV+c||IgG anti-HDV+c||Vaccination against HBV|
|HEV||IgM anti-HEV||NA||IgG anti-HEV||NA|
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.