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Hepatitis A
From WikEM
Contents
Background
- Transmission by
- Fecal-oral route
- Most commonly transmitted from asymptomatic children to adults
- Can also occur with improper food handling, oyster consumption
Clinical Features
- Incubation period 15-50 days
- Prodrome of nausea/vomiting, malaise
- ~1 week into illness, may have dark urine (bilirubinuria), clay-colored stools, jaundice
- No chronic component
- ~1-2% of HAV infections in adults lead to fulminant hepatic failure
- Death from hepatic failure is rare
Differential Diagnosis
Acute hepatitis
- Viral hepatitis
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Acute alcoholic hepatitis
- Acetaminophen toxicity
- Mushroom toxicity
- Ischemic hepatitis
Evaluation
Acute Hepatitis Panel
| Anti-hepatitis A, IgM | Hepatitis B surface antigen | Anti-hepatitis B core, IgM | Anti-hepatitis C | Interpretation |
|---|---|---|---|---|
| Positive | Negative | Negative | Negative | Acute hepatitis A |
| Negative | Positive | Positive | Negative | Acute hepatitis B |
| Negative | Positive | Negative | Negative | Chronic hepatitis B infection |
| Negative | Negative | Positive | Negative | Acute hepatitis B; quantity of hepatitis B surface antigen is too low to detect |
| Negative | Negative | Negative | Positive | Acute or chronic hepatitis C; additional tests are required to make the determination |
Management
- Supportive care
- Antiemetics
- Oral or IV hydration
- Avoid hepatotoxic medications
- Patients with fulminant hepatic failure (1-2% of HAV infections) may be considered for liver transplant
- Postexposure prophylaxis recommend for non-immunized close contacts of patient
