Hepatitis A natural history, complications and prognosis: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
*The United States [[Centers for Disease Control and Prevention]] (CDC) in 2010, reported that the mortality rate of hepatitis A was 0.03 deaths per 100,000 population. | * The United States [[Centers for Disease Control and Prevention]] (CDC) in 2010, reported that the mortality rate of hepatitis A 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. | * 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. | |||
*Many adults take up to 36 months and occasionally longer to recover entirely. | * 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. | ||
*[[Symptoms]] that may be experienced after the first month or two are low [[immunity]], with an increased risk of | |||
* 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. | * [[Symptoms]] that may be experienced after the first month or two are low [[immunity]], with an increased risk of opportunistic [[infections]] | ||
* 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. | * 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. | |||
==References== | ==References== | ||
Revision as of 17:54, 28 July 2014
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Hepatitis A |
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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, caused by infection with HAV, has an incubation period of approximately 28 days (range: 15-50 days). HAV 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. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease (CLD). However, 10-15% of patients experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and most children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection.[1]
Natural History
Hepatitis A is caused by the hepatitis A virus (HAV). The virus 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. This is the period when the concentration of virus in stools is highest.[2]
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[3].
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.[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:
- Jaundice
- Pruritus
- Dark urine
- Acholic stool
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:
- Severe dehydration
- Electrolyte imbalance
- Bleeding
- Fulminant hepatitis
- Death (particularly elderly and adults with chronic liver disease, such as hepatitis C)
Prognosis
- The United States Centers for Disease Control and Prevention (CDC) in 2010, reported that the mortality rate of hepatitis A was 0.03 deaths per 100,000 population.[7]
- 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.
- Many adults take up to 36 months and occasionally longer to recover entirely.
- Symptoms that may be experienced after the first month or two are low immunity, with an increased risk of opportunistic infections
- 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.
References
- ↑ Sexually Transmitted Diseases Treatment Guidelines, 2010. Centers for Disease Control and Prevention. Recommendations and Reports December 17, 2010 / 59(RR12);1-110 [1]
- ↑ 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) - ↑ 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) - ↑ 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) - ↑ 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.
- ↑ 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.
- ↑ "Hepatitis A".