Hepatitis A


Agent	VIRUS—RNA. Picornaviridae, Hepatovirus: Hepatitis A virus
Reservoir	Human Non-human primate
Vector	None
Vehicle	Fecal-oral Food Water Fly
Incubation Period	21 to 30 days (As early or late as 14 to 60 days)
Diagnostic Tests	Serology Nucleic acid amplification
Typical Adult Therapy	Stool precautions; supportive
Typical Pediatric Therapy	As for adult
Vaccines	Hepatitis A Hepatitis A + Hepatitis B Immune globulin
Clinical Hints	Vomiting, anorexia, dark urine, light stools and jaundice; rash and arthritis occasionally encountered; fulminant disease, encephalopathy and fatal infections are rare (case-fatality rate 0.15% to 2.7%, depending on age).
Synonyms	Botkin’s disease, Epatite A, HAV, Hepatite per virus A, Infectious hepatitis.

The prodrome is characterized by anorexia, asthenia, headache, myalgia and moderate fever.

Patients develop nausea, vomiting and right upper abdominal pain • and later overt jaundice.
Symptoms persist for 4 to 8 weeks, and the patient may remain asthenic and anorectic for several months thereafter.
As many as 90% of cases in children less than 5 years of age are asymptomatic; fewer 50% among adults.
Relapses may occur for up to 6 months following the initial infection.
Rare instances of acute disseminated encephalomyelitis, myelitis, meningoencephalitis, acute cholestatic syndrome, acalculous cholecystitis, urticaria, pancreatitis, pleural effusion or ascites, acute glomerulonephritis or renal failure, pure red-cell aplasia, cerebral venous thrombosis and rhabdomyolysis have been reported.
Concurrent HIV infection may prolong the duration of viremia in patients with hepatitis A.

Hepatitis A accounts for 3.1% of acute hepatic failure cases (United States, 1998 to 2005)

The case-fatality rate is 0.1% among children below age 4 years; 0.4% ages 5 to 29 years; and 1% above age 40.
55% of hepatitis A patients with acute hepatic failure recover the remainder either die of the disease or require transplantation.

A false positive serological reaction toward Epstein-Barr virus has been associated with Hepatitis A.

Hepatitis B


Agent	VIRUS - DNA. Hepadnaviridae, Orthohepadnavirus: Hepatitis B virus
Reservoir	Human Non-human primate
Vector	None
Vehicle	Blood Infected secretions Sexual contact Transplacental
Incubation Period	2 to 3 months (As early or late as 1 to 13 months)
Diagnostic Tests	Serology Nucleic acid amplification
Typical Adult Therapy	Needle precautions; supportive. For post-exposure or chronic infection: Peginterferon alfa-2a or Peginterferon alfa-2b ; OR Lamivudine; OR Adefovir
Typical Pediatric Therapy	As for adult
Vaccine	Hepatitis A + Hepatitis B Hepatitis B + Haemoph. influenzae Hepatitis B immune globulin Hepatitis B
Clinical Hints	Vomiting and jaundice; rash or arthritis occasionally noted; risk group (drug abuse, blood products, sexual transmission); cirrhosis or hepatoma may follow years after acute illness; fulminant and fatal infections are encountered.
Synonyms	Epatite B, HBV, Hepatite per virus B, Serum hepatitis.


Agent	VIRUS - RNA. Flaviviridae, Hepacivirus: Hepatitis C virus
Reservoir	Human
Vector	None
Vehicle	Blood Sexual contact Transplacental
Incubation Period	5 to 10 weeks (As early or late as 3 to 16 weeks)
Diagnostic Tests	Serology Nucleic acid amplification
Typical Adult Therapy	Needle precautions; supportive. If hepatocellular disease: Weekly Peginterferon alfa-2a 180 mcg SC or Peginterferon alfa-2b 1.5 mcg SC AND Ribavirin 400 mg in AM & 600 mg in PM daily AND Telepravir OR Bocepravir Duration per viral genotype
Typical Pediatric Therapy	Peginterferon alfa-2b 3 MU/m2 SC x1 weekly AND Ribavirin 15mg/kg
Clinical Hints	Vomiting and jaundice; may be history of transfusion within preceding 1 to 4 months; chronic hepatitis and fulminant infections are encountered.
Synonyms	Epatite C, HCV, Hepatite per virus C, Non-A, non-B parenteral hepatitis.


Agent	VIRUS - RNA. Deltavirus: Hepatitis D virus - a ‘satellite’ virus which is encountered as infection with a co-virus (Hepatitis B)
Reservoir	Human
Vector	None
Vehicle	Infected secretions Blood Sexual contact
Incubation Period	4 to 8 weeks (As early or late as 2 to 20 weeks)
Diagnostic Tests	Serology Nucleic acid amplification
Typical Adult Therapy	Needle precautions; supportive Interferon alfa 2-a has been used.
Typical Pediatric Therapy	As for adult
Clinical Hints	Vomiting and jaundice - biphasic course often noted; occurs as a coinfection or superinfection of hepatitis B; may be chronic or fulminant (combined hepatitis B and delta carries a worse prognosis than seen with hepatitis B alone).
Synonyms	Epatite D, Hepatitis delta


Agent	VIRUS - RNA. Caliciviridae: Hepatitis E virus
Reservoir	Human Rodent Pig
Vector	None
Vehicle	Fecal-oral Water Shellfish Blood (rare) Meat (rare)
Incubation Period	30 to 40 days (As early or late as 10 to 70 days)
Diagnostic Tests	Identification of virus by immune electron microscopy (stool) Serology Nucleic acid amplification
Typical Adult Therapy	Stool precautions; supportive
Typical Pediatric Therapy	As for adult
Vaccine	Hepatitis E
Clinical Hints	Clinically similar to hepatitis A - no chronic residua; severe or fatal if acquired during pregnancy (10% to 24% case-fatality rate).
Synonyms	Epatite E, Non-A, non-B enteric hepatitis.


Agent	VIRUS - RNA. Flaviviridae, Hepacivirus: Hepatitis G virus. HGBV-A, B and C appear to be related
Reservoir	Human
Vector	None
Vehicle	Blood Vertical transmission has also been documented Sexual transmission suspected
Incubation Period	Unknown
Diagnostic Tests	Serology Nucleic acid amplification
Typical Adult Therapy	Supportive. Alpha interferon has been shown to transiently eliminate the carrier state
Typical Pediatric Therapy	As for adult
Clinical Hints	Acute or chronic hepatitis acquired from blood (needles, etc); clinically milder than hepatitis C - most cases limited to anicteric elevation of hepatic enzyme levels; viremia documented for as long as 10 years.
Synonyms	Epatite G, Hepatitis GB.

Hepatitis G is characterized by acute or chronic hepatitis acquired from blood (needles, etc).

The disease is milder than hepatitis C, with most cases limited to anicteric elevation of hepatic enzyme levels.
Viremia has been documented for as long as 10 years.
A case of aplastic anemia complicating Hepatitis G infection has been reported.