Caplans syndrome differential diagnosis

2021-07-13T05:02:56Z

Javaria Anwer:

__NOTOC__

[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Caplans syndrome]]

{{CMG}}; {{AE}}
==Overview==
[[Caplan's syndrome|Caplan syndrome]] must be differentiated from [[asbestosis]], [[silicosis]], and [[tuberculosis]].

==Differentiating [[Caplan syndrome]] from other Diseases==

[[Caplan's syndrome|Caplan syndrome]] must be differentiated from [[asbestosis]], [[silicosis]] and other [[respiratory]] [[diseases]] with [[lung]] [[lesions]].

{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 400px;" |{{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Bacterial pneumonia]]
| style="padding: 5px 5px; background: #F5F5F5;" |Sudden onset of symptoms, such as high [[fever]], [[cough]], [[purulent]] [[sputum]], [[chest pain]], [[leukocytosis]], chest X-ray shows consolidation.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Bronchogenic carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |may be asymptomatic, usually at older ages (> 50 years old), [[cough]], [[hemoptysis]], [[weight loss]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Brucellosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Fever]], [[anorexia]], [[night sweats]], [[malaise]],[[back pain]] , [[headache]], and [[depression]]. History of exposure to infected animal
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Hodgkin lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Fever]], [[night sweats]], [[pruritus]], painless [[adenopathy]], [[mediastinal mass]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Mycoplasmal pneumonia]]
| style="padding: 5px 5px; background: #F5F5F5;" |Gradual onset of [[dry cough]], [[headache]], [[malaise]], [[sore throat]]. Diffuse bilateral infiltrates on [[chest X-ray]].
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Sarcoidosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |Non-[[caseating]] [[granulomas]] in lungs and other organs, bilateral [[hilar]] [[lymphadenopathy]], mostly in African American females.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Caplan syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" |Initially [[asymptomatic]] but advanced stages are associated with [[shortness of breath]], [[cough]] and [[wheeze]] in the [[chest]]. Mostly in miners with preexisting [[rheumatoid arthritis]].
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |Adapted from Mandell, Douglas, and Bennett's principles and practice of infectious diseases 2010 <ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> 
|}

{| class="wikitable"
!Causes of
lung cavities
!Differentiating Features
!Differentiating radiological findings
!Diagnosis
confirmation
|-
|
*[[Malignancy]] ([[Lung cancer|Primary lung cancer]]<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>)
|
*Elderly male or female <ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
*Chronic smokers
*Presents with a [[low-grade fever]], absence of [[leukocytosis]], systemic complaints [[weight loss]], [[fatigue]]
*Absence of factors that predispose to [[gastric content aspiration]], no response to [[antibiotics]] within 10 days
*[[Hemoptysis]] is commonly associated with [[bronchogenic carcinoma]]
|
*A coin-shaped lesion with a thick wall(>15mm) is seen on CXR with fewer ground-glass opacities
*[[Bronchoalveolar lavage]] [[cytology]] shows malignant cells
|
*[[Biopsy]] of lung
|-
|
*Pulmonary [[Tuberculosis, pulmonary|Tuberculosis]]
|
*Mostly in endemic areas
*Symptoms include [[productive cough]],[[night sweats]], [[fever]] and [[weight loss]]
|
*CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung
|
*[[Sputum]] smear-positive for [[acid-fast bacilli]] and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
|-
|
*[[Necrotizing Pulmonary Infections|Necrotizing]] [[Pneumonia]]
|
*Any age group
*Acute, [[fulminant]] life threating complication of prior infection
*>100.4F fever, with [[Hemodynamically unstable|hemodynamic]] instability
*Worsening [[pneumonia]]-like symptoms

|
*CXR demonstrates multiple cavitary lesions
*[[Pleural effusion]] and [[empyema]] are common findings
|
*[[Complete blood count|CBC]] is positive for the causative organism
|-
|
*Loculated [[empyema]]
|
*Children and elderly are at risk

*Pleuritic [[chest pain]], [[dry cough]], [[fever]] with chills
*Dullness to [[Percussion of the lungs|percussion]] decreased [[breath sounds]], and reduced vocal resonance on examination
|
*[[Empyema]] appears lenticular in shape and has a thin wall with smooth luminal margins
|
*[[Thoracocentesis]]
|-
|
*[[Granulomatosis with polyangiitis]] ([[Wegener's granulomatosis|Wegener's]])
|
*Women are more commonly effected than man.
*Kidneys are also involved
*Upper respiratory tract symptoms , perforation of [[nasal septum]], [[chronic sinusitis]], [[otitis media]], [[mastoiditis]].
*Lower respiratory tract symptoms, [[hemoptysis]], [[cough]], [[dyspnea]].
*Renal symptoms, [[hematuria]], red cell [[casts]]
|
*Pulmonary nodules with cavities and infiltrates are a frequent manifestation of CXR

|
*Positive for [[P-ANCA]]
*Biopsy of the affected tissue shows necrotizing [[granulomas]] <ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
|-
|
*[[Rheumatoid nodule]]
|
*Elderly females of 40-50 age group
*Manifestation of [[rheumatoid arthritis]]
*Presents with other systemic symptoms including symmetric [[arthritis]] of the small joints of the hands and feet and morning stiffness are common manifestations.
|
*Pulmonary nodules with cavitation are present in the upper lobe ([[Caplan syndrome]]) on Xray.
|
*Positive for both [[rheumatoid factor]] and anti-cyclic citrullinated peptide [[Antibody|antibody.]]
|-
|
*[[Sarcoidosis]]
|
*More common in African-American females
*Often [[asymptomatic]] except for [[Lymphadenopathy|enlarged lymph nodes]]
*Associated with [[restrictive lung disease]]
*[[Erythema nodosum]]
*[[Lupus pernio]] (skin lesions on face resembling lupus)
*[[Bell's palsy|Bell palsy]]
*[[Epithelioid]] [[granuloma]]<nowiki/>s containing microscopic [[Schaumann bodies|Schaumann]] and asteroid bodies
|
*On CXR bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen.
*CT of the chest demonstrates extensive [[Hilar lymphadenopathy|hilar]] and mediastinal adenopathy
*Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.
|
*Biopsy of lung reveals non-[[caseating]] [[granuloma]]
|-
|
*[[Bronchiolitis obliterans]] ([[Cryptogenic organizing pneumonia]])
|
*Rare condition and mimics [[asthma]], [[pneumonia]] and [[emphysema]]
*It is due to [[drug]] or [[toxin]] exposure, [[autoimmune diseases]], [[viral infections]], or [[radiation injury]]
*Individuals working in industries are at high risk
*Presents with [[Fever|feve]]<nowiki/>r, [[cough]], [[wheezing]] and [[shortness of breath]] over weeks to months,
|
*Common appearance on CT is patchy [[Consolidation (medicine)|consolidation,]]<nowiki/>often accompanied by ground-glass opacities and nodules.
|
*Biopsy of the lung <ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
*[[Pulmonary function tests]] demonstrate low fev1/fvc
|-
|
*[[Langerhans cell histiocytosis|Langerhans]] cell [[Langerhans cell histiocytosis|Histiocytosis]]
|
*Exclusively occurs in smokers, with a peak age of onset 20-40 years.
*Clinical presentation is variable, but symptoms generally include months of dry [[cough]], [[fever]], [[night sweats]] and [[weight loss]].
*Skin is involved in 80% of the cases, scaly [[erythematous rash]] is typical.
|
*Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans.
|
*Biopsy of the lung
|-
|[[Caplan syndrome]]
|
*Mostly occurs in miners with [[rheumatoid arthritis]].<ref name="SchreiberKoschel2010">{{cite journal|last1=Schreiber|first1=J.|last2=Koschel|first2=D.|last3=Kekow|first3=J.|last4=Waldburg|first4=N.|last5=Goette|first5=A.|last6=Merget|first6=R.|title=Rheumatoid pneumoconiosis (Caplan's syndrome)|journal=European Journal of Internal Medicine|volume=21|issue=3|year=2010|pages=168–172|issn=09536205|doi=10.1016/j.ejim.2010.02.004}}</ref>
*Usually [[asymptomatic]] in the initial stages. [[Dyspnea]] and [[cough]] can occur in advanced stages.
*Miners with Caplan [[nodule]] without [[rheumatoid arthritis]] can develop [[arthritis]] after 5-10 years later.
|
* Well-defined, cavitating [[lung]] [[nodules]] of 0.5-5 cm is the usual finding in a [[chest x-ray]] and [[CT scan]].
|
* [[Biopsy]] of the [[lung]] [[nodules]].
|}
==References==
{{Reflist|2}}
[[Category:Pulmonology]]
[[Category:Rheumatology]]

2021-06-26T22:00:22Z

Javaria Anwer:

Caplans syndrome overview

2021-06-26T21:57:22Z

Javaria Anwer: /* Causes */

Caplans syndrome overview

2021-06-26T21:56:57Z

Javaria Anwer: /* Pathophysiology */

__NOTOC__
{{CMG}} {{AE}} {{SharmiB}}
{{Caplans syndrome}}

==Overview==
[[Caplan syndrome]] is known as [[Rheumatoid pneumoconiosis]]. This is a combination of [[Rheumatoid Arthritis]] and [[pneumoconiosis]]. It is a rare syndrome occurring mostly in miners exposed to silica, coal and asbestos. For the first time, Caplan, a British physician in 1953 first described this [[syndrome]]. It is hypothesized that [[silica]] get ingested by [[macrophages]]. [[Silica]] destroys the [[macrophages]] and again engulfed by another [[macrophage]]. This repeating process leads to [[chronic inflammation]] and [[fibrosis]]. Due to having the capability to move around, [[silica]] can travel to other organs away from [[lung]] and can induce autoantigens. [[Silica]] has an [[adjuvant]] effect on [[antibody]] production. In patients with [[silicosis]] , increased [[rheumatoid factor]] and [[antinuclear antibodies]] has been found. By producing [[TNF-α]] and [[Interleukin 1]] , [[silica]] induces [[joint]] destruction. [[Silica]] also plays a role in inducing both innate and [[adaptive immunity]]. Patients with [[Caplan syndrome]] are mostly asymptomatic but in advanced stages [[dyspnea]] and [[cough]] might occur. In [[Caplan syndrome]], increased [[inflammatory]] [[markers]] are found in [[serum]] study though there is no [[arthritis]]. [[Caplan syndrome]] with [[polyarthritis]] mostly [[positive]] for Anti citrullinated Peptide [[Antibodies]] (ACPA). Caplan [[nodules]] can appear with or before the onset of [[arthritis]]. In many cases miners have typical [[radiographic]] pictures of [[Caplan syndrome]] without any features of [[Rheumatoid Arthritis]]. [[Chest X ray]] findings of [[Caplan syndrome]] is characterized by well defined [[Lung|lung]] [[nodules]] of 0.5-5 cm throughout the [[lungs]] but predominantly in the peripheral areas. These [[nodules]] might appear as crops and later coalesce into a larger one. The onset of [[nodules]] are sudden, rapidly growing and can remain in the [[lungs]] for years longer. They might regress spontaneously unless get cavitated or calcified. [[Pleural effusion]] and [[pneumothorax]] are rare complications. [[CT scan]] findings are similar to [[chest x ray]] but provides more specific information such as mixed nodular infiltrative changes in [[lungs]]. But [[chest x ray]] or [[CT scan]] are not capable of differentiate between Caplan [[nodules]] and ordinary silicotic [[nodules]]. [[Biopsy]] is required to confirm the [[diagnosis]]. On [[histopathology]], Caplan [[nodules]] show [[central]] [[necrosis]] similar to rheumatoid [[nodules]] except the presence of dust particles. Surrounding the dust ring there is a zone of [[inflammation]] consisting of [[granulocytes]], [[macrophages]] and [[giant cells]]. This [[Inflammatory|inflammatory zone]] is the distinguishable criteria of Caplan [[nodules]] from rheumatoid nodules. There is no definitive [[treatment]] for [[Caplan syndrome]]. [[Lung]] nodules in [[Caplan syndrome]] usually do not require any treatment until any complication develop. Disease modifying anti rheumatic drugs ([[DMARDs]]) can be used to treat [[Rheumatoid arthritis]]. But [[DMARDs]] have no role in [[treatment]] of pulmonary [[nodules]]. In some cases, [[corticosteroid]] found to be helpful to stop the progression of [[pulmonary]] nodules. Anti TNF [[therapy]] are commonly used in [[treatment]] of RA but recent study showed that Anti TNF [[therapy]] may induce [[pulmonary]] [[nodules]]. Anti TNF [[therapy]] play role in activating [[latent tuberculosis]] and [[silicosis]] increase the risk of [[tuberculosis]] [[infection]] . So, it is strongly recommended to screen for latent TB in the patients with Rheumatoid [[Pneumoconiosis]]. In [[irreversible]] [[pulmonary]] [[fibrosis]] [[lung transplant]] can be the ultimate choice.{{reflist|2}}
==Historical perspective==
In 1953, the [[chest x ray]] findings of [[multiple pulmonary nodules]], in the [[coal miners]] with [[Rheumatoid Arthritis]](RA) of Welsh, was described by Caplan. In 1940 and 1955, rheumatoid nodules were described in [[autopsy]] study of [[heart]] and [[lungs]]. An [[epidemiological]] study was conducted by Miall and associates in 1955 to determine the validity of [[Caplan syndrome]]. J. Gough reported the [[histological]] [[diagnostic]] findings for Caplan Syndrome in 1958.
==Pathophysiology==
[[Caplan's Syndrome|Caplan Syndrome]] is known as Rheumatoid [[pneumoconiosis]]. In patients with [[rheumatoid arthritis]], [[lungs]] show increased [[immune response]] to the foreign materials. In coal miners with RA, exposure to [[silica]] causes the release of different [[cytokines]] as [[interleukin-1]],[[granulocyte colony stimulating factor]] and [[tumor necrosis factor-alpha]] by [[monocytes]] and [[macrophages]]. [[Lymphocytes]] get activated by the [[cytokines]] and leading to hyperactive [[autoimmune]] response.

==Causes==

[[Category:Pulmonology]]
[[Category:Rheumatology]]

Caplans syndrome overview

2021-06-26T21:44:04Z

Javaria Anwer:

Caplans syndrome overview

2021-06-26T21:43:04Z

Javaria Anwer:

2021-06-12T23:11:27Z

Javaria Anwer:

__NOTOC__
{{Hepatitis C}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]], {{MehdiP}}, {{JA}}
==Overview==
[[Hepatitis C]] is a major health problem that affects approximately 2 to 4 million people in the United States, 5 to 10 million people in Europe, and 12 million people in India. Approximately 150,000 new cases occur annually in the United States and in Western Europe, although accurate incidence rates are difficult to estimate given the asymptomatic nature of the early stages of the disease. While the prevalence of the disease appears to be declining, hepatitis C is still highly prevalent in certain areas of the world. Egypt is the country with the highest prevalence of [[HCV]], HCV-associated [[cirrhosis]], and [[hepatocellular carcinoma]], and the prevalence tends to increase with age, suggesting ongoing development of new cases of HCV. Approximately one-fourth of all cases of [[cirrhosis]] and [[hepatocellular carcinoma]] are attributed to HCV worldwide. Hepatitis C affects males and females equally.

==Epidemiology and Demographics==
===Incidence and Prevalence===
*According to the [[World Health Organization]] (WHO), approximately 3% of the global population are infected with chronic hepatitis C virus (HCV). More than 170 million people are infected chronically around the world. The prevalence of HCV varies among different nations; for example, 1.3% to 1.6% of the U.S. population are affected, while up to 30% of Egypt population are infected with hepatitis C virus.<ref name="pmid200735">{{cite journal |vauthors=Bryan JS, Krasne FB |title=Presynaptic inhibition: the mechanism of protection from habituation of the crayfish lateral giant fiber escape response |journal=J. Physiol. (Lond.) |volume=271 |issue=2 |pages=369–90 |year=1977 |pmid=200735 |pmc=1353577 |doi= |url=}}</ref>
*Figures in individual countries also vary greatly: Approximately 2-4 million persons are infected with chronic HCV in the United States, 5-10 million in Europe, and more than 10 million in India.<ref name="WHO">World Health Organization. Global Alert Response. Hepatitis C: Surveillance and control. Accessed online on July 27, 2014. http://www.who.int/csr/disease/hepatitis/whocdscsrlyo2003/en/index4.html</ref>

*Acute HCV infection follows an asymptomatic course, which makes the accurate determination of HCV incidence difficult. Additionally, many countries lack sufficient epidemiological data. Nonetheless, it is estimated that approximately 150,000 new cases are reported in the United States and Western Europe annually, whereas the incidence in Japan is as high as 350,000 new cases each year. More than 60-80% of patients with HCV infection become chronic carriers of the disease, with an overall number of chronic carriers reaching approximately 170 million patients. The trend today is marked by a progressive decrease in new HCV infections, characterized by a remarkable 80% decrease since the infection was first discovered in 1989-1990.<ref name="WHO">World Health Organization. Global Alert Response. Hepatitis C: Surveillance and control. Accessed online on July 27, 2014. http://www.who.int/csr/disease/hepatitis/whocdscsrlyo2003/en/index4.html</ref>
*In 2014, a total of 2,194 cases of acute hepatitis C were reported to the CDC from 40 states.
*The overall [[incidence]] rate for 2014 was 0.7 cases per 100,000 people, an increase from 2010–2012.<ref name="urlCommentary | U.S. 2014 Surveillance Data for Viral Hepatitis | Statistics & Surveillance | Division of Viral Hepatitis | CDC">{{cite web |url=http://www.cdc.gov/hepatitis/statistics/2014surveillance/commentary.htm#hepatitisC |title=Commentary | U.S. 2014 Surveillance Data for Viral Hepatitis | Statistics & Surveillance | Division of Viral Hepatitis | CDC |format= |work= |accessdate= October 5, 2016}}</ref>
 

[[Image:HCV_CDC.png|thumb|600px|center|CDC - Incidence and Prevalence of HCV - Source: https://www.cdc.gov/]] Prevalence of HCV rises significantly in specific populations<ref name="WHO">World Health Organization. Global Alert Response. Hepatitis C: Surveilance and control. Accessed online on July 27, 2014. http://www.who.int/csr/disease/hepatitis/whocdscsrlyo2003/en/index4.html</ref>:
*[[Intravenous drug users]]: > 70% (Accounts for most modern cases of HCV infection)
*[[Hemophilia]] patients: > 70%
*[[Hemodialysis]]: 20-30%

Of note, [[nosocomial]] sources of HCV infection, such as infected blood and surgical products, have been significantly reduced due to the increased testing of products prior to utilization.<ref name="WHO">World Health Organization. Global Alert Response. Hepatitis C: Surveilance and control. Accessed online on July 27, 2014. http://www.who.int/csr/disease/hepatitis/whocdscsrlyo2003/en/index4.html</ref> 
[[Image:Sources of Infection for Persons with Hepatitis C (CDC) US.png|thumb|600px|center|CDC figures for sources of infection in the US - Source: https://www.cdc.gov/]]
 
*The [[morbidity]] associated wth [[chronic]] hepatitis C, mainly due to complications is estimated to be 350,000 liver-related deaths per year.<ref name="CacoubLongo2021">{{cite journal|last1=Cacoub|first1=Patrice|last2=Longo|first2=Dan L.|last3=Saadoun|first3=David|title=Extrahepatic Manifestations of Chronic HCV Infection|journal=New England Journal of Medicine|volume=384|issue=11|year=2021|pages=1038–1052|issn=0028-4793|doi=10.1056/NEJMra2033539}}</ref>

===Age===
*The age of infected patients varies across regions. In the United States, Australia, and Western Europe, more than 65% of HCV infections are observed in patients between 30-50 years.<ref name="pmid17552026">{{cite journal| author=Alter MJ| title=Epidemiology of hepatitis C virus infection. | journal=World J Gastroenterol | year= 2007 | volume= 13 | issue= 17 | pages= 2436-41 | pmid=17552026 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17552026 }} </ref> These numbers suggest that most cases of HCV in these regions occurred before 1990. On the other hand, there is an increase of HCV prevalence with age in countries such as Turkey, Spain, Italy, Japan, China, and Egypt. Most patients in these countries are older than 50 years of age.<ref name="pmid17552026">{{cite journal| author=Alter MJ| title=Epidemiology of hepatitis C virus infection. | journal=World J Gastroenterol | year= 2007 | volume= 13 | issue= 17 | pages= 2436-41 | pmid=17552026 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17552026 }} </ref>
*In 2014, among all age groups, people ages 20–29 years had the highest rate (2.20 cases per 100,000 people) and people aged 0–19 and ≥60 years had the lowest rate (0.12 cases per 100,000 people) of acute hepatitis C.<ref name="urlCommentary | U.S. 2014 Surveillance Data for Viral Hepatitis | Statistics & Surveillance | Division of Viral Hepatitis | CDC">{{cite web |url=http://www.cdc.gov/hepatitis/statistics/2014surveillance/commentary.htm#hepatitisC |title=Commentary | U.S. 2014 Surveillance Data for Viral Hepatitis | Statistics & Surveillance | Division of Viral Hepatitis | CDC |format= |work= |accessdate= October 5, 2016}}</ref>

===Gender===
In 2014, rates of HCV among males and females in the United States were 0.8 and 0.7 cases per 100,000 people, respectively.<ref name="urlCommentary | U.S. 2014 Surveillance Data for Viral Hepatitis | Statistics & Surveillance | Division of Viral Hepatitis | CDC">{{cite web |url=http://www.cdc.gov/hepatitis/statistics/2014surveillance/commentary.htm#hepatitisC |title=Commentary | U.S. 2014 Surveillance Data for Viral Hepatitis | Statistics & Surveillance | Division of Viral Hepatitis | CDC |format= |work= |accessdate= October 5, 2016}}</ref>

===Morbidity and Mortality===
Approximately 27% of cases of [[cirrhosis]] and 25% of [[hepatocellular carcinoma]] (HCC) are attributed to chronic HCV infection.<ref name="pmid17552026">{{cite journal| author=Alter MJ| title=Epidemiology of hepatitis C virus infection. | journal=World J Gastroenterol | year= 2007 | volume= 13 | issue= 17 | pages= 2436-41 | pmid=17552026 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17552026 }} </ref>

===Geographic Distribution===
HCV is a global disease. The most highly endemic region of HCV—especially genotype 4a—is Egypt, due to a history of non-hygenic medical and paramedical practices in the country.<ref name="pmid17552026">{{cite journal| author=Alter MJ| title=Epidemiology of hepatitis C virus infection. | journal=World J Gastroenterol | year= 2007 | volume= 13 | issue= 17 | pages= 2436-41 | pmid=17552026 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17552026 }} </ref> As many as 25% of Egyptian blood donors are chronic carriers of HCV infection. In contrast, the United Kingdom and Scandinavia have a low prevalence of HCV compared to other regions.<ref name="pmid17552026">{{cite journal| author=Alter MJ| title=Epidemiology of hepatitis C virus infection. | journal=World J Gastroenterol | year= 2007 | volume= 13 | issue= 17 | pages= 2436-41 | pmid=17552026 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17552026 }} </ref>

In some countries, HCV is prevalent in specific regions rather than the entire counrty. Such patterns are observed in Italy, China, and Japan.<ref name="pmid17552026">{{cite journal| author=Alter MJ| title=Epidemiology of hepatitis C virus infection. | journal=World J Gastroenterol | year= 2007 | volume= 13 | issue= 17 | pages= 2436-41 | pmid=17552026 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17552026 }} </ref>

==References==
{{Reflist|2}}

[[Category:Gastroenterology]]
[[Category:FinalQCRequired]]
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Hepatology]]