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

Jaundice from Hepatitis A.

• 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
• Can cause aversion to tobacco among smokers
• ~1-2% of HAV infections in adults lead to fulminant hepatic failure
• Death from hepatic failure is rare

Differential Diagnosis

Causes of acute hepatitis

• Acetaminophen toxicity (most common cause of acute liver failure in the US)
• Viral hepatitis
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E
  • HSV
  • Epstein-Barr virus
  • Varicella zoster virus
• Toxoplasmosis
• Acute alcoholic hepatitis
• Toxins
  • Mushroom toxicity
  • Crotinarius mushrooms
    • Gyromitra mushrooms
    • Amanita mushrooms
• Ischemic hepatitis
• Autoimmune hepatitis
• Wilson's disease

Evaluation

Hepatitis A serology.

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

Management

• Supportive care
  • Antiemetics
  • Oral or IV hydration
  • Avoid hepatotoxic medications
• 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

• Acute hepatitis