Hepatitis B: Difference between revisions
Ostermayer (talk | contribs) (Prepared the page for translation) |
Ostermayer (talk | contribs) (Prepared the page for translation) |
||
| Line 1: | Line 1: | ||
<languages/> | <languages/> | ||
<translate> | <translate> | ||
==Background== | ==Background== | ||
| Line 8: | Line 9: | ||
*Incubation period: 1-3 months | *Incubation period: 1-3 months | ||
*Virus can cause acute, chronic, or asymptomatic infection | *Virus can cause acute, chronic, or asymptomatic infection | ||
| Line 18: | Line 20: | ||
*[[Special:MyLanguage/Jaundice|Jaundice]] | *[[Special:MyLanguage/Jaundice|Jaundice]] | ||
*[[Special:MyLanguage/Fever|Fever]] | *[[Special:MyLanguage/Fever|Fever]] | ||
| Line 28: | Line 31: | ||
{{STD DDX}} | {{STD DDX}} | ||
<translate> | <translate> | ||
| Line 42: | Line 46: | ||
{{Acute hepatitis panel}} | {{Acute hepatitis panel}} | ||
<translate> | <translate> | ||
| Line 63: | Line 68: | ||
| Chronically infected||positive||anti-HBc- positive; IgM anti-HBc- negative||negative | | Chronically infected||positive||anti-HBc- positive; IgM anti-HBc- negative||negative | ||
|} | |} | ||
| Line 72: | Line 78: | ||
{{Hepatitis B post exposure prophylaxis}} | {{Hepatitis B post exposure prophylaxis}} | ||
<translate> | <translate> | ||
| Line 81: | Line 88: | ||
*Intractable pain, inability to tolerate PO | *Intractable pain, inability to tolerate PO | ||
*Significant comorbidity/immunocompromised or age >50 years | *Significant comorbidity/immunocompromised or age >50 years | ||
| Line 88: | Line 96: | ||
*[[Special:MyLanguage/Acute hepatitis|Acute hepatitis]] | *[[Special:MyLanguage/Acute hepatitis|Acute hepatitis]] | ||
*[[Special:MyLanguage/Jaundice|Jaundice]] | *[[Special:MyLanguage/Jaundice|Jaundice]] | ||
| Line 93: | Line 102: | ||
*[[Special:MyLanguage/Antibiotics (By_Diagnosis)|Antibiotics (By_Diagnosis)]] | *[[Special:MyLanguage/Antibiotics (By_Diagnosis)|Antibiotics (By_Diagnosis)]] | ||
| Line 100: | Line 110: | ||
[[Category:ID]][[Category:GI]] | [[Category:ID]][[Category:GI]] | ||
</translate> | </translate> | ||
Latest revision as of 23:00, 4 January 2026
Background
- Blood-borne DNA virus
- Incubation period: 1-3 months
- Virus can cause acute, chronic, or asymptomatic infection
Clinical Features
Differential Diagnosis
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[1])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
Sexually transmitted diseases
- Chancroid
- Chlamydia trachomatis
- Granuloma inguinale
- Hepatitis B
- Herpes Simplex Virus-2
- HIV
- Human papillomavirus
- Lymphogranuloma venereum
- Neisseria gonorrhoeae
- Trichomonas
- Syphilis
Evaluation
- LFTs
- AST, ALT > 1000s
- Elevated bilirubin
- Elevated alk phophatase
- Elevated INR
- CBC, BMP
- Assess for alternative etiologies of symptoms as appropriate (see: jaundice, RUQ pain, nausea/vomiting)
Interpreting Acute Hepatitis Panel Results
| 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 |
Evaluating Hepatitis B Serology Results
| Clinical Scenario | HBsAg | anti-HBc | anti-HBs |
| Susceptible to infection | negative | negative | negative |
| Immune due to natural infection | negative | positive | positive |
| Immune due to Hep B infection | negative | negative | positive |
| Acutely infected | positive | anti-HBc- positive; IgM anti-HBc- positive | negative |
| Chronically infected | positive | anti-HBc- positive; IgM anti-HBc- negative | negative |
Management
- Supportive care for acute disease
Hepatitis B Post-Exposure Prophylaxis
Treatment is generally initiated after coordination with occupational health and infectious disease service and based the the exposed patient's vaccination history[2]
Unvaccinated
- If the source is HBsAg(+) then give HBIG x1 and initiate HBV vaccine in two separate sites
- If source is HGsAG(-) then start the HBV vaccine series
- If source blood is unavailable and high risk then give HBIG x1 initiate the HBV series
- If source blood is low risk and unavailable then begin HBV series
Previously vaccinated non responder (one series)
Non responder status is defined as anti-has <10mIU/mL
- If the source is HBsAg(+) then give HBIG x 1 and begin revaccination series
- Can also opt to perform second HBIG administration in one month
- If source is HBsAg(-) then no treatment is needed
- If source blood is unavailable and high risk then treat as if HBsAg(+)
Previously vaccinated non responder (two series)
Non responder status is defined as anti-has <10mIU/mL
- If the source is HBsAg(+) then give HBIG x2 and no HBV series
- If source is HGsAG(-) then no treatment is needed
- If source blood is unavailable then initiate the HBV series
Treatment Dosing
No contraindications for pregnancy or breast feeding
- HBIG 0.06 mL/kg IM
- Give in opposite arm from hepatitis B vaccine if patient also receiving vaccine
- Vaccination series: HBV vaccine options:
- Engerix-B 20mcg IM
- Recombivax HB 10mcg IM
Disposition
- Consider admission for:
- INR >2, Bilirubin >30, hypoglycemia
- Any GI bleeding
- Intractable pain, inability to tolerate PO
- Significant comorbidity/immunocompromised or age >50 years
See Also
External Links
References
- ↑ 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.
- ↑ Postexposure prophylaxis to prevent hepatitis b virus infection. CDC MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm?s_cid=rr5516a3_e