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al hepatitis
Viral hepatitis
– S everal viral infectio ns o f the liver are gro up ed und er the head ing o f viral hep atitis:
hep atitis A , B , C , ∆ (d elta) and E .
– The d ifferent hep atitis viruses are p resent thro ugho ut the wo rld , but their p revalence
varies by co untry . H ep atitis A and B are co m m o n in d evelo p ing co untries wh ere
nearly the entire p o p ulatio n is infected d uring child ho o d o r ad o lescence.
– The clinical characteristics o f all five d iseases are sim ilar eno ugh to m ak e d ifferential
d iagno sis d ifficult; h o w ever, th ere are ep id em io lo gical, im m uno lo gical and
p atho lo gical d ifferences. P atients with hep atitis B , C and ∆ m ay later d evelo p chro nic
liver d isease o r even hep ato cellular carcino m a.
– The m ain ch aracteristics o f each ty p e o f viral hep atitis are sum m ariz ed in a table o n
the next p age.
Clinical features
– Asymptomatic forms
M ild o r anicteric fo rm s are the m o st co m m o n, irresp ective o f the causal virus. The
risk o f d evelo p ing later co m p licatio ns fro m hep atitis B , C and ∆ are the sam e as fo r
sy m p to m atic p atients.
– Classic forms
I nsid io us o r sud d en o nset with sy m p to m s o f vary ing intensity : fever, fatigue, nausea,
gastro intestinal d isturbance, fo llo wed by jaund ice, d ark co lo ured urine and m o re o r
less clay -co lo ured sto o l.
– Fulminant forms
H ep ato cellular failure with severe, o ften fatal, cy to ly sis. This fo rm is m o st frequent in
h ep atitis B p atients w ith seco nd ary infectio n w ith th e ∆ virus, and in p regnant
wo m en infected with hep atitis E d uring their third trim ester (2 0 % m o rtality ).
– Chronic hepatitis
H ep atitis B , C and ∆ m ay lead to cirrho sis o r hep ato m a.
Main profiles observed in different clinical scenarios during HBV infection
A gH Basanntitbi-oHdBiess anti-H Bc anti-H BcA gH Banetibaondti-iHes B e H B V Interp retatio n
antibo d ies IgM D N A
+ (– ) (– ) + (+ ) (– ) (+ ) A cute hep atitis
+/– – + – – +/– – A cute hep atitis,
reco very p hase
– +/– + –– – –P o st-infectio us
im m unity (cured)
+ – + +/– + – +C(wilhdrovinruics)hep atitis
–+ – – – – – P o st-vaccinatio n
im m unity
The tests in p arentheses are no t useful fo r d iagno sis.
198
Viral hepatitis
– S everal viral infectio ns o f the liver are gro up ed und er the head ing o f viral hep atitis:
hep atitis A , B , C , ∆ (d elta) and E .
– The d ifferent hep atitis viruses are p resent thro ugho ut the wo rld , but their p revalence
varies by co untry . H ep atitis A and B are co m m o n in d evelo p ing co untries wh ere
nearly the entire p o p ulatio n is infected d uring child ho o d o r ad o lescence.
– The clinical characteristics o f all five d iseases are sim ilar eno ugh to m ak e d ifferential
d iagno sis d ifficult; h o w ever, th ere are ep id em io lo gical, im m uno lo gical and
p atho lo gical d ifferences. P atients with hep atitis B , C and ∆ m ay later d evelo p chro nic
liver d isease o r even hep ato cellular carcino m a.
– The m ain ch aracteristics o f each ty p e o f viral hep atitis are sum m ariz ed in a table o n
the next p age.
Clinical features
– Asymptomatic forms
M ild o r anicteric fo rm s are the m o st co m m o n, irresp ective o f the causal virus. The
risk o f d evelo p ing later co m p licatio ns fro m hep atitis B , C and ∆ are the sam e as fo r
sy m p to m atic p atients.
– Classic forms
I nsid io us o r sud d en o nset with sy m p to m s o f vary ing intensity : fever, fatigue, nausea,
gastro intestinal d isturbance, fo llo wed by jaund ice, d ark co lo ured urine and m o re o r
less clay -co lo ured sto o l.
– Fulminant forms
H ep ato cellular failure with severe, o ften fatal, cy to ly sis. This fo rm is m o st frequent in
h ep atitis B p atients w ith seco nd ary infectio n w ith th e ∆ virus, and in p regnant
wo m en infected with hep atitis E d uring their third trim ester (2 0 % m o rtality ).
– Chronic hepatitis
H ep atitis B , C and ∆ m ay lead to cirrho sis o r hep ato m a.
Main profiles observed in different clinical scenarios during HBV infection
A gH Basanntitbi-oHdBiess anti-H Bc anti-H BcA gH Banetibaondti-iHes B e H B V Interp retatio n
antibo d ies IgM D N A
+ (– ) (– ) + (+ ) (– ) (+ ) A cute hep atitis
+/– – + – – +/– – A cute hep atitis,
reco very p hase
– +/– + –– – –P o st-infectio us
im m unity (cured)
+ – + +/– + – +C(wilhdrovinruics)hep atitis
–+ – – – – – P o st-vaccinatio n
im m unity
The tests in p arentheses are no t useful fo r d iagno sis.
198
