Hepatitis A natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
[[Hepatitis A]], caused by [[infection]] with [[HAV]], has an [[incubation period]] of approximately 28 days. [[HAV infection]] produces a self-limited disease, rarely leading to [[acute liver failure]]. 10-15% of patients experience a relapse of [[symptoms]] during the 6 months after acute illness. The risk for symptomatic [[infection]] is related to the age of the patient, with >80% of adults showing [[symptoms]] compatible with [[acute viral hepatitis]], such as [[fatigue]], [[malaise]], [[nausea]], [[vomiting]] and [[anorexia]]. Most children have either [[asymptomatic]] or unrecognized [[infection]].<ref name=MMWR>Sexually Transmitted Diseases Treatment Guidelines, 2010. Centers for Disease Control and Prevention. Recommendations and Reports December 17, 2010 / 59(RR12);1-110 [http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm?s_cid=rr5912a1_e]</ref> Possible [[complications]] of [[hepatitis A]] include: [[dehydration]], [[electrolyte imbalance]], [[bleeding]], and rarely fulminat [[hepatitis]]. The [[prognosis]] depends on the age of the patient, and underlying liver condition: children are often [[asymptomatic]], while elder patients with [[chronic liver failure]] have a higher risk for fulminat hepatitis.
[[Hepatitis A]] is caused by [[infection]] with hepatitis A virus ([[HAV]]) which has an [[incubation period]] of approximately 28 days. [[HAV infection]] produces a self-limited disease, rarely leading to [[acute liver failure]]. The risk for symptomatic [[infection]] is related to the age of the patient.  While children most commonly have either [[asymptomatic]] or unrecognized [[infection]], more than 80% of adults exhibit [[symptoms]] of [[acute viral hepatitis]], such as [[fatigue]], [[malaise]], [[nausea]], [[vomiting]], and [[anorexia]].<ref name=MMWR>Sexually Transmitted Diseases Treatment Guidelines, 2010. Centers for Disease Control and Prevention. Recommendations and Reports December 17, 2010 / 59(RR12);1-110 [http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm?s_cid=rr5912a1_e]</ref> Possible [[complications]] of [[hepatitis A]] include [[dehydration]], [[electrolyte imbalance]], [[bleeding]], and rarely fulminant [[hepatitis]]. The [[prognosis]] depends on the age of the patient and the underlying liver condition.  Approximately 10 to 15% of patients experience a relapse of symptoms during the 6 months following acute illness.


==Natural History==
==Natural History==
[[Hepatitis A]] is caused by the [[hepatitis A virus]] ([[HAV]]). The [[virus]] replicates in the [[liver]] and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. It is primarily spread through fecal-oral transmission, commonly after ingesting food or water that is contaminated with the [[virus]]. The [[infected]] patients have a peak [[infectivity]] during the 2 week period before onset of [[jaundice]] or elevation of [[liver enzymes]].<ref name="pmid3014009">{{cite journal |author=Tassopoulos NC, Papaevangelou GJ, Ticehurst JR, Purcell RH |title=Fecal excretion of Greek strains of hepatitis A virus in patients with hepatitis A and in experimentally infected chimpanzees |journal=[[The Journal of Infectious Diseases]] |volume=154 |issue=2 |pages=231–7 |year=1986 |month=August |pmid=3014009 |doi= |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=3014009 |accessdate=2012-02-28}}</ref>
[[Hepatitis A]] is caused by the [[hepatitis A virus]] ([[HAV]]) infection. Unlike other types of [[hepatitis]], [[HAV]] infection is always acute. The [[virus]] replicates in the [[liver]] and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. It is primarily spread through fecal-oral transmission, commonly after ingesting food or water that is contaminated with the [[virus]]. The [[infected]] patients have a peak [[infectivity]] during the 2 week period before onset of [[jaundice]] or elevation of [[liver enzymes]].<ref name="pmid3014009">{{cite journal |author=Tassopoulos NC, Papaevangelou GJ, Ticehurst JR, Purcell RH |title=Fecal excretion of Greek strains of hepatitis A virus in patients with hepatitis A and in experimentally infected chimpanzees |journal=[[The Journal of Infectious Diseases]] |volume=154 |issue=2 |pages=231–7 |year=1986 |month=August |pmid=3014009 |doi= |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=3014009 |accessdate=2012-02-28}}</ref>


The likelihood of having [[symptoms]] with [[HAV infection]] increases with age. Fewer than 10% of infections among children aged 0-4 years result in [[jaundice]]; this percentage increases to 30%-40% among children aged 5-9 years, 60%-80% among youths aged 10-17 years, and 80%-90% among adults aged ≥18 years<ref name="pmid11986444">{{cite journal |author=Armstrong GL, Bell BP |title=Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization |journal=[[Pediatrics]] |volume=109 |issue=5 |pages=839–45 |year=2002 |month=May |pmid=11986444 |doi= |url=http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=11986444 |accessdate=2012-02-28}}</ref>.
The likelihood of developing [[symptoms]] with [[HAV infection]] increases with age. Fewer than 10% of infections among children aged 0-4 years result in [[jaundice]]; this percentage increases to 30%-40% among children aged 5-9 years, 60%-80% among youths aged 10-17 years, and 80%-90% among adults aged ≥18 years.<ref name="pmid11986444">{{cite journal |author=Armstrong GL, Bell BP |title=Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization |journal=[[Pediatrics]] |volume=109 |issue=5 |pages=839–45 |year=2002 |month=May |pmid=11986444 |doi= |url=http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=11986444 |accessdate=2012-02-28}}</ref>


Unlike other types of [[Hepatitis]], [[HAV]] is always acute.
When signs and [[symptoms]] occur, they typically last less than 2 months, although 10-15% of [[symptomatic]] persons have prolonged or relapsing disease lasting up to 6 months.<ref name="pmid1312659">{{cite journal |author=Glikson M, Galun E, Oren R, Tur-Kaspa R, Shouval D |title=Relapsing hepatitis A. Review of 14 cases and literature survey |journal=[[Medicine]] |volume=71 |issue=1 |pages=14–23 |year=1992 |month=January |pmid=1312659 |doi= |url= |accessdate=2012-02-28}}</ref> [[HAV infection]] is usually acute and self-limited. The rare cases of fulminant [[hepatitis]] are more common among patients with previous [[liver disease]], such as [[chronic hepatitis C]].<ref name="pmid9445408">{{cite journal| author=Vento S, Garofano T, Renzini C, Cainelli F, Casali F, Ghironzi G et al.| title=Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. | journal=N Engl J Med | year= 1998 | volume= 338 | issue= 5 | pages= 286-90 | pmid=9445408 | doi=10.1056/NEJM199801293380503 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9445408  }} </ref>
 
When signs and [[symptoms]] occur, typically they last less 2 months, although 10-15% of [[symptomatic]] persons have prolonged or relapsing disease lasting up to 6 months.<ref name="pmid1312659">{{cite journal |author=Glikson M, Galun E, Oren R, Tur-Kaspa R, Shouval D |title=Relapsing hepatitis A. Review of 14 cases and literature survey |journal=[[Medicine]] |volume=71 |issue=1 |pages=14–23 |year=1992 |month=January |pmid=1312659 |doi= |url= |accessdate=2012-02-28}}</ref> [[HAV infection]] is usually acute and self-limited. The rare cases of fulminant [[hepatitis]] are more common among patients with previous [[liver disease]], such as [[chronic hepatitis C]].<ref name="pmid9445408">{{cite journal| author=Vento S, Garofano T, Renzini C, Cainelli F, Casali F, Ghironzi G et al.| title=Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. | journal=N Engl J Med | year= 1998 | volume= 338 | issue= 5 | pages= 286-90 | pmid=9445408 | doi=10.1056/NEJM199801293380503 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9445408  }} </ref>


The clinical manifestations commonly start after a 30 day [[incubation period]]. The disease manifests abruptly, with the following [[symptoms]]:<ref name="pmid3860002">{{cite journal| author=Lednar WM, Lemon SM, Kirkpatrick JW, Redfield RR, Fields ML, Kelley PW| title=Frequency of illness associated with epidemic hepatitis A virus infections in adults. | journal=Am J Epidemiol | year= 1985 | volume= 122 | issue= 2 | pages= 226-33 | pmid=3860002 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3860002  }} </ref>
The clinical manifestations commonly start after a 30 day [[incubation period]]. The disease manifests abruptly, with the following [[symptoms]]:<ref name="pmid3860002">{{cite journal| author=Lednar WM, Lemon SM, Kirkpatrick JW, Redfield RR, Fields ML, Kelley PW| title=Frequency of illness associated with epidemic hepatitis A virus infections in adults. | journal=Am J Epidemiol | year= 1985 | volume= 122 | issue= 2 | pages= 226-33 | pmid=3860002 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3860002  }} </ref>
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* [[Electrolyte imbalance]]
* [[Electrolyte imbalance]]
* [[Bleeding]]
* [[Bleeding]]
* After the first month of the disease, there may be low [[immunity]], with a consequent increased risk for opportunistic [[infections]].
* Fulminant [[hepatitis]]
* Fulminant [[hepatitis]]
* Death (particularly elderly and adults with [[chronic liver disease]], such as [[hepatitis C]])
* Death (particularly in elderly and adults with [[chronic liver disease]], such as [[hepatitis C]])


==Prognosis==
==Prognosis==
* The United States [[Centers for Disease Control and Prevention]] (CDC) reported that the mortality rate of hepatitis A in 2010 was 0.03 deaths per 100,000 population.<ref name=CDC>{{cite web | title = Hepatitis A | url = http://www.cdc.gov/hepatitis/Statistics/2011Surveillance/Commentary.htm#hepA }}</ref>
* Young children who are [[infected]] with [[hepatitis A]] typically have a milder form of the disease, usually lasting from 1-3 weeks, whereas adults tend to experience a much more severe form of the disease.
* Adults are often confined to bed and minimal activity for about 4 weeks and have to stop their work for one to three months or longer.
* Adults are often confined to bed and minimal activity for about 4 weeks and have to stop their work for one to three months or longer.


* Many adults take up to 36 months and occasionally longer to recover entirely.
* Many adults take up to 36 months and occasionally longer to recover entirely.
* After the first month of the disease, there may be low [[immunity]], with a consequent increased risk for opportunistic [[infections]]


* It is common for recovering patients to experience occasional "off" days, during which they need to rest more.
* It is common for recovering patients to experience occasional "off" days, during which they need to rest more.


* Approximately 15% of people diagnosed with [[hepatitis A]] may experience one or more [[symptomatic]] relapse(s) for up to 24 months after contracting this disease.
* Approximately 15% of people diagnosed with [[hepatitis A]] may experience one or more [[symptomatic]] relapse(s) for up to 24 months after contracting this disease.
* The United States [[Centers for Disease Control and Prevention]] (CDC) reported that the mortality rate of hepatitis A in 2010 was 0.03 deaths per 100,000 population.<ref name=CDC>{{cite web | title = Hepatitis A | url = http://www.cdc.gov/hepatitis/Statistics/2011Surveillance/Commentary.htm#hepA }}</ref>


* The case-fatality rate for [[HAV infection]] increases with age: 1.8% for adults older than 50 years of age, compared with 0.6% for persons below 50 years. The case-fatality rate is also increased among persons with [[chronic liver disease]], who are at increased risk for [[acute liver failure]].<ref>Williams I, Bell B, Kaluba J, Shapiro C. Association between chronic liver disease and death from hepatitis A, United States, 1989--92 [abstract no. A39]. IX Triennial International Symposium on Viral Hepatitis and Liver Disease. Rome, Italy, April 21--25, 1996.</ref>
* The case-fatality rate for [[HAV infection]] increases with age: 1.8% for adults older than 50 years of age, compared with 0.6% for persons below 50 years. The case-fatality rate is also increased among persons with [[chronic liver disease]], who are at increased risk for [[acute liver failure]].<ref>Williams I, Bell B, Kaluba J, Shapiro C. Association between chronic liver disease and death from hepatitis A, United States, 1989--92 [abstract no. A39]. IX Triennial International Symposium on Viral Hepatitis and Liver Disease. Rome, Italy, April 21--25, 1996.</ref>
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[[Category:Viral diseases]]
[[Category:Viral diseases]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
[[Category:Infectious disease]]
 
[[Category:Disease]]
[[Category:Disease]]


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Latest revision as of 17:55, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [3]

Overview

Hepatitis A is caused by infection with hepatitis A virus (HAV) which has an incubation period of approximately 28 days. HAV infection produces a self-limited disease, rarely leading to acute liver failure. The risk for symptomatic infection is related to the age of the patient. While children most commonly have either asymptomatic or unrecognized infection, more than 80% of adults exhibit symptoms of acute viral hepatitis, such as fatigue, malaise, nausea, vomiting, and anorexia.[1] Possible complications of hepatitis A include dehydration, electrolyte imbalance, bleeding, and rarely fulminant hepatitis. The prognosis depends on the age of the patient and the underlying liver condition. Approximately 10 to 15% of patients experience a relapse of symptoms during the 6 months following acute illness.

Natural History

Hepatitis A is caused by the hepatitis A virus (HAV) infection. Unlike other types of hepatitis, HAV infection is always acute. The virus replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. It is primarily spread through fecal-oral transmission, commonly after ingesting food or water that is contaminated with the virus. The infected patients have a peak infectivity during the 2 week period before onset of jaundice or elevation of liver enzymes.[2]

The likelihood of developing symptoms with HAV infection increases with age. Fewer than 10% of infections among children aged 0-4 years result in jaundice; this percentage increases to 30%-40% among children aged 5-9 years, 60%-80% among youths aged 10-17 years, and 80%-90% among adults aged ≥18 years.[3]

When signs and symptoms occur, they typically last less than 2 months, although 10-15% of symptomatic persons have prolonged or relapsing disease lasting up to 6 months.[4] HAV infection is usually acute and self-limited. The rare cases of fulminant hepatitis are more common among patients with previous liver disease, such as chronic hepatitis C.[5]

The clinical manifestations commonly start after a 30 day incubation period. The disease manifests abruptly, with the following symptoms:[6]

One week after symptom onset, patients experience:

The initial symptoms commonly diminish after the onset of jaundice, which is usually more intense on its second week.

Complications

Possible complications of hepatitis A include:

Prognosis

  • Adults are often confined to bed and minimal activity for about 4 weeks and have to stop their work for one to three months or longer.
  • Many adults take up to 36 months and occasionally longer to recover entirely.
  • It is common for recovering patients to experience occasional "off" days, during which they need to rest more.
  • Approximately 15% of people diagnosed with hepatitis A may experience one or more symptomatic relapse(s) for up to 24 months after contracting this disease.
  • The case-fatality rate for HAV infection increases with age: 1.8% for adults older than 50 years of age, compared with 0.6% for persons below 50 years. The case-fatality rate is also increased among persons with chronic liver disease, who are at increased risk for acute liver failure.[8]

References

  1. ↑ Sexually Transmitted Diseases Treatment Guidelines, 2010. Centers for Disease Control and Prevention. Recommendations and Reports December 17, 2010 / 59(RR12);1-110 [1]
  2. ↑ Tassopoulos NC, Papaevangelou GJ, Ticehurst JR, Purcell RH (1986). "Fecal excretion of Greek strains of hepatitis A virus in patients with hepatitis A and in experimentally infected chimpanzees". The Journal of Infectious Diseases. 154 (2): 231–7. PMID 3014009. Retrieved 2012-02-28. Unknown parameter |month= ignored (help)
  3. ↑ Armstrong GL, Bell BP (2002). "Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization". Pediatrics. 109 (5): 839–45. PMID 11986444. Retrieved 2012-02-28. Unknown parameter |month= ignored (help)
  4. ↑ Glikson M, Galun E, Oren R, Tur-Kaspa R, Shouval D (1992). "Relapsing hepatitis A. Review of 14 cases and literature survey". Medicine. 71 (1): 14–23. PMID 1312659. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  5. ↑ Vento S, Garofano T, Renzini C, Cainelli F, Casali F, Ghironzi G; et al. (1998). "Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C." N Engl J Med. 338 (5): 286–90. doi:10.1056/NEJM199801293380503. PMID 9445408.
  6. ↑ Lednar WM, Lemon SM, Kirkpatrick JW, Redfield RR, Fields ML, Kelley PW (1985). "Frequency of illness associated with epidemic hepatitis A virus infections in adults". Am J Epidemiol. 122 (2): 226–33. PMID 3860002.
  7. ↑ "Hepatitis A".
  8. ↑ Williams I, Bell B, Kaluba J, Shapiro C. Association between chronic liver disease and death from hepatitis A, United States, 1989--92 [abstract no. A39]. IX Triennial International Symposium on Viral Hepatitis and Liver Disease. Rome, Italy, April 21--25, 1996.

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