Hepatitis D: Difference between revisions
ClaireLewis (talk | contribs) (Created page with "==Background== *Enveloped RNA virus *Infection ''only'' occurs in patients with concurrent hepatitis infection (acute, chronic or carrier state), as virus requires presenc...") |
ClaireLewis (talk | contribs) No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Enveloped RNA virus | *Enveloped RNA virus | ||
*Infection ''only'' occurs in patients with concurrent [[hepatitis]] infection (acute, chronic or carrier state), as virus requires presence of HBV for replication | *Infection ''only'' occurs in patients with concurrent [[hepatitis]] infection (acute, chronic or carrier state), as virus requires presence of [[HBV]] for replication | ||
*Rare in developed countries, transmission similar to HBV (blood-borne) | *Rare in developed countries, transmission similar to HBV (blood-borne) | ||
*HDV-HBV co-infection considered most severe variant of chronic viral hepatitis due to rapid progression to liver failure and HCC<ref>WHO Fact Sheet https://www.who.int/news-room/fact-sheets/detail/hepatitis-d</ref> | *HDV-HBV co-infection considered most severe variant of chronic viral hepatitis due to rapid progression to liver failure and HCC<ref>WHO Fact Sheet https://www.who.int/news-room/fact-sheets/detail/hepatitis-d</ref> | ||
| Line 7: | Line 7: | ||
==Clinical Features== | ==Clinical Features== | ||
*[[Acute hepatitis]], ranging from mild to fulminant hepatitis with [[acute liver failure]] | *[[Acute hepatitis]], ranging from mild to fulminant hepatitis with [[acute liver failure]] | ||
**Nausea/Vomiting | **[[Nausea/Vomiting]] | ||
**[[RUQ pain]] | **[[RUQ pain]] | ||
***Enlarged, tender liver | ***[[hepatomegaly|Enlarged]], tender liver | ||
**[[Fever]] | **[[Fever]] | ||
**[[Jaundice]], bilirubinuria | **[[Jaundice]], bilirubinuria | ||
*Chronic superinfection (HDV+HBV) | *Chronic superinfection (HDV+HBV) | ||
**Accelerates progression of chronic HBV to cirrhosis | **Accelerates progression of chronic HBV to [[cirrhosis]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 27: | Line 27: | ||
**Elevated alk phosphatase | **Elevated alk phosphatase | ||
*INR | *INR | ||
**Coagulopathy | **[[liver disease induced coagulopathy|Coagulopathy]] | ||
*Consider acetaminophen level | *Consider acetaminophen level | ||
*Acute hepatitis panel | *Acute hepatitis panel | ||
| Line 78: | Line 78: | ||
==Management== | ==Management== | ||
*Acute management is supportive | *Acute management is supportive | ||
*Consider liver transplant consultation if approaching liver failure | *Consider liver transplant consultation if approaching [[liver failure]] | ||
*Outpatient treatment with [[Interferon-α]] | *Outpatient treatment with [[Interferon-α]] | ||
Latest revision as of 21:07, 29 September 2019
Background
- Enveloped RNA virus
- Infection only occurs in patients with concurrent hepatitis infection (acute, chronic or carrier state), as virus requires presence of HBV for replication
- Rare in developed countries, transmission similar to HBV (blood-borne)
- HDV-HBV co-infection considered most severe variant of chronic viral hepatitis due to rapid progression to liver failure and HCC[1]
Clinical Features
- Acute hepatitis, ranging from mild to fulminant hepatitis with acute liver failure
- Nausea/Vomiting
- RUQ pain
- Enlarged, tender liver
- Fever
- Jaundice, bilirubinuria
- Chronic superinfection (HDV+HBV)
- Accelerates progression of chronic HBV to cirrhosis
Differential Diagnosis
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[2])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
Evaluation
- High anti-HDV IgG/IgM titers plus confirmation with serum HDV RNA definitively diagnose, however not widely available[3]
Acute Hepatitis Evaluation
- LFTs
- AST, ALT > 1000s
- Elevated bilirubin
- Elevated alk phosphatase
- INR
- Consider acetaminophen level
- Acute hepatitis panel
- Hep A Ab IgM
- Hep B cAb IgM
- Hep B sAg
- Hep B sAb
- Hep C Ab
| 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
- Acute management is supportive
- Consider liver transplant consultation if approaching liver failure
- Outpatient treatment with Interferon-α
Disposition
- Consider admission for:
- Bilirubin > 20
- PT 50% above normal, INR >2
- Hypoglycemia
- Hypoalbuminemia
- Any GI bleeding
- Uncontrolled nausea/vomiting, pain
- Significant comorbidity, immunocompromised, elderly
See Also
External Links
References
- ↑ WHO Fact Sheet https://www.who.int/news-room/fact-sheets/detail/hepatitis-d
- ↑ Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec 17; 137(12): 947-54.
- ↑ WHO Fact Sheet https://www.who.int/news-room/fact-sheets/detail/hepatitis-d