Hepatitis A

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

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
  • 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

Disposition
  • Typically discharge, admit if:
    • INR >2
    • Unable to tolerate PO
    • Intractable pain
    • Bilirubin >30
    • Hypoglycemia
    • Significant comorbidity/immunocompromised

See Also

References
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