Hepatitis A laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
[[Hepatitis A]] cannot be differentiated from other types of [[viral hepatitis]] on the basis of clinical or [[epidemiologic]] features alone. Laboratory tests are required for its [[diagnosis]]. Serologic tests in hepatitis A virus (HAV) infection reveal elevated [[IgM]] anti-[[HAV]] in the acute phase (gold standard) in addition to an elevated [[IgG]] anti-[[HAV]] that remains elevated for the person's lifetime. Additional laboratory findings include the detection and sequencing of [[HAV]] [[RNA]], an elevated direct [[bilirubin]], and elevated [[liver enzymes]]. [[Liver biopsy]] has a minimal role in the [[diagnosis]] of HAV infection and it is only used when the [[diagnosis]] is unclear or when relapse is suspected. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
===Serologic Tests=== | ===Serologic Tests=== | ||
[[Serologic]] testing to detect [[immunoglobulin M]] ([[IgM]]) antibody to the capsid proteins of [[HAV]] (IgM anti-HAV) is required to confirm the [[diagnosis]] of acute [[HAV infection]]. | [[Serologic]] testing to detect [[immunoglobulin M]] ([[IgM]]) antibody to the capsid proteins of [[HAV]] (IgM anti-HAV) is required to confirm the [[diagnosis]] of acute [[HAV infection]]. | ||
* [[Immunoglobulin M]] ([[IgM]]) anti-[[HAV]]:<ref>Bower WA, Nainan OV, Margolis HS. Duration of viremia in naturally-acquired hepatitis A viral infections. [Abstract 103] In: Abstracts of the Infectious Diseases Society of America 35th Annual Meeting. Alexandria, VA: Infectious Diseases Society of America, 1997.</ref><ref name="pmid3759243">{{cite journal |author=Liaw YF, Yang CY, Chu CM, Huang MJ |title=Appearance and persistence of hepatitis A IgM antibody in acute clinical hepatitis A observed in an outbreak |journal=[[Infection]] |volume=14 |issue=4 |pages=156–8 |year=1986 |pmid=3759243 |doi= |url= |accessdate=2012-02-28}}</ref> | * [[Immunoglobulin M]] ([[IgM]]) anti-[[HAV]]:<ref>Bower WA, Nainan OV, Margolis HS. Duration of viremia in naturally-acquired hepatitis A viral infections. [Abstract 103] In: Abstracts of the Infectious Diseases Society of America 35th Annual Meeting. Alexandria, VA: Infectious Diseases Society of America, 1997.</ref><ref name="pmid3759243">{{cite journal |author=Liaw YF, Yang CY, Chu CM, Huang MJ |title=Appearance and persistence of hepatitis A IgM antibody in acute clinical hepatitis A observed in an outbreak |journal=[[Infection]] |volume=14 |issue=4 |pages=156–8 |year=1986 |pmid=3759243 |doi= |url= |accessdate=2012-02-28}}</ref> | ||
:* | :* Is the gold standard for the detection of acute illness. | ||
:* | :* Becomes detectable 5-10 days before the onset of [[symptoms]] and can persist for up to 6 months after [[infection]] | ||
:* Does not always indicate acute infection in [[asymptomatic]] adults. [[IgM]] anti-[[HAV]] can be present in the following cases: | |||
::* Previous [[HAV infection]] with prolonged presence of IgM anti-HAV | |||
::* [[False-positive]] result | |||
::* [[Asymptomatic]] [[infection]] (more common in children) | |||
* [[Immunoglobulin G]] ([[IgG]]) anti-[[HAV]]:<ref name="pmid7876654">{{cite journal |author=Stapleton JT |title=Host immune response to hepatitis A virus |journal=[[The Journal of Infectious Diseases]] |volume=171 Suppl 1 |issue= |pages=S9–14 |year=1995 |month=March |pmid=7876654 |doi= |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=7876654 |accessdate=2012-02-28}}</ref> | * [[Immunoglobulin G]] ([[IgG]]) anti-[[HAV]]:<ref name="pmid7876654">{{cite journal |author=Stapleton JT |title=Host immune response to hepatitis A virus |journal=[[The Journal of Infectious Diseases]] |volume=171 Suppl 1 |issue= |pages=S9–14 |year=1995 |month=March |pmid=7876654 |doi= |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=7876654 |accessdate=2012-02-28}}</ref> | ||
:* Appears early in the course of [[infection]] | :* Appears early in the course of [[infection]] | ||
:* Remains detectable for the person's lifetime | :* Remains detectable for the person's lifetime, conferring protection against reinfection | ||
:* Confers lifelong protection against the disease | :* Confers lifelong protection against the disease | ||
Two [[serologic]] tests are licensed for the detection of antibodies to [[HAV]]: | Two [[serologic]] tests are licensed for the detection of [[antibodies]] to [[HAV]]: | ||
* [[IgM]] anti-[[HAV]] | * [[IgM]] anti-[[HAV]] | ||
* Total anti-[[HAV]] ([[IgM]] and [[IgG]] anti-[[HAV]]) | * Total anti-[[HAV]] ([[IgM]] and [[IgG]] anti-[[HAV]]) | ||
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Sensitive tests for [[immunoglobulin M]] ([[IgM]]) and [[immunoglobulin G]] ([[IgG]]) anti-HAV in saliva have been developed but are not licensed in the United States. | Sensitive tests for [[immunoglobulin M]] ([[IgM]]) and [[immunoglobulin G]] ([[IgG]]) anti-HAV in saliva have been developed but are not licensed in the United States. | ||
[[ | ===Electron Microscopy=== | ||
* [[HAV]] [[RNA]] can be detected in the [[blood]] and [[stools]] of the majority of persons during the acute phase of [[infection]] by using [[nucleic acid]] amplification methods. | |||
* [[Nucleic acid]] sequencing has been used to determine the relatedness of [[HAV]] isolates for [[epidemiologic]] investigations. However, only a limited number of research laboratories have the capacity to use these methods, which makes them not commonly used in the [[diagnosis]] of [[HAV infection]].<ref name="pmid10029643">{{cite journal |author=Hutin YJ, Pool V, Cramer EH, Nainan OV, Weth J, Williams IT, Goldstein ST, Gensheimer KF, Bell BP, Shapiro CN, Alter MJ, Margolis HS |title=A multistate, foodborne outbreak of hepatitis A. National Hepatitis A Investigation Team |journal=[[The New England Journal of Medicine]] |volume=340 |issue=8 |pages=595–602 |year=1999 |month=February |pmid=10029643 |doi=10.1056/NEJM199902253400802 |url=http://dx.doi.org/10.1056/NEJM199902253400802 |accessdate=2012-02-28}}</ref> | |||
===Liver Function Tests=== | ===Liver Function Tests=== | ||
Liver enzymes such as [[aminotransferase]] and [[alkaline phosphatase]] | [[Liver enzymes]] such as [[aminotransferase]] and [[alkaline phosphatase]], along with direct [[bilirubin]] are commonly elevated among patients with [[Hepatitis A]]:<ref name="pmid7876641">{{cite journal |author=Tong MJ, el-Farra NS, Grew MI |title=Clinical manifestations of hepatitis A: recent experience in a community teaching hospital |journal=[[The Journal of Infectious Diseases]] |volume=171 Suppl 1 |issue= |pages=S15–8 |year=1995 |month=March |pmid=7876641 |doi= |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=7876641 |accessdate=2012-03-08}}</ref> | ||
* The serum levels of [[alanine aminotransferase]] ([[ALT]]) are usually higher than [[aspartate aminotransferase]] ([[AST]]) | |||
* [[Bilirubin]] levels tends to increase after the elevation of serum [[aminotransferase]] | |||
===Other Laboratory Findings=== | ===Other Laboratory Findings=== | ||
*[[Acute phase reactant]]s, such as [[CRP]] and [[erythrocyte sedimentation rate]] ([[ESR]]), are commonly elevated in hepatitis A. | |||
Shown below is an image depicting the course of change of the serum concentration of serum [[IgG]], [[IgM]] and [[ALT]] following [[hepatitis A virus]] infection. | |||
===Liver Biopsy=== | ===Liver Biopsy=== | ||
The role of a liver biopsy is minimal in the diagnosis of hepatitis A. It may be used in cases involving chronic relapsing hepatitis A or when the diagnosis is unclear. | The role of a [[liver biopsy]] is minimal in the [[diagnosis]] of [[hepatitis A]]. It may be used in cases involving chronic relapsing [[hepatitis A]] or when the [[diagnosis]] is unclear. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Foodborne illnesses]] | [[Category:Foodborne illnesses]] | ||
[[Category: | [[Category:Hepatitis|A]] | ||
[[Category:Picornaviruses]] | [[Category:Picornaviruses]] | ||
[[Category:Viral diseases]] | [[Category:Viral diseases]] | ||
[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
[[Category:Disease]] | |||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category: | [[Category:Hepatology]] | ||
[[Category:Gastroenterology]] | |||
Latest revision as of 22:04, 29 July 2020
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Hepatitis A |
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Hepatitis A laboratory findings On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Hepatitis A cannot be differentiated from other types of viral hepatitis on the basis of clinical or epidemiologic features alone. Laboratory tests are required for its diagnosis. Serologic tests in hepatitis A virus (HAV) infection reveal elevated IgM anti-HAV in the acute phase (gold standard) in addition to an elevated IgG anti-HAV that remains elevated for the person's lifetime. Additional laboratory findings include the detection and sequencing of HAV RNA, an elevated direct bilirubin, and elevated liver enzymes. Liver biopsy has a minimal role in the diagnosis of HAV infection and it is only used when the diagnosis is unclear or when relapse is suspected.
Laboratory Findings
Serologic Tests
Serologic testing to detect immunoglobulin M (IgM) antibody to the capsid proteins of HAV (IgM anti-HAV) is required to confirm the diagnosis of acute HAV infection.
- Immunoglobulin M (IgM) anti-HAV:[1][2]
- Is the gold standard for the detection of acute illness.
- Becomes detectable 5-10 days before the onset of symptoms and can persist for up to 6 months after infection
- Does not always indicate acute infection in asymptomatic adults. IgM anti-HAV can be present in the following cases:
- Previous HAV infection with prolonged presence of IgM anti-HAV
- False-positive result
- Asymptomatic infection (more common in children)
- Immunoglobulin G (IgG) anti-HAV:[3]
- Appears early in the course of infection
- Remains detectable for the person's lifetime, conferring protection against reinfection
- Confers lifelong protection against the disease
Two serologic tests are licensed for the detection of antibodies to HAV:
In the majority of patients, IgM anti-HAV declines to undetectable levels less than 6 months after infection. However, persons who test positive for IgM anti-HAV, more than 1 year after infection have been reported, as have likely false-positive tests in persons without evidence of recent HAV infection.
Total anti-HAV testing is used in epidemiologic studies to measure the prevalence of previous infection or by clinicians to determine whether a person with an indication for pre-exposure prophylaxis is already immune.
Sensitive tests for immunoglobulin M (IgM) and immunoglobulin G (IgG) anti-HAV in saliva have been developed but are not licensed in the United States.
Electron Microscopy
- HAV RNA can be detected in the blood and stools of the majority of persons during the acute phase of infection by using nucleic acid amplification methods.
- Nucleic acid sequencing has been used to determine the relatedness of HAV isolates for epidemiologic investigations. However, only a limited number of research laboratories have the capacity to use these methods, which makes them not commonly used in the diagnosis of HAV infection.[4]
Liver Function Tests
Liver enzymes such as aminotransferase and alkaline phosphatase, along with direct bilirubin are commonly elevated among patients with Hepatitis A:[5]
- The serum levels of alanine aminotransferase (ALT) are usually higher than aspartate aminotransferase (AST)
- Bilirubin levels tends to increase after the elevation of serum aminotransferase
Other Laboratory Findings
- Acute phase reactants, such as CRP and erythrocyte sedimentation rate (ESR), are commonly elevated in hepatitis A.
Shown below is an image depicting the course of change of the serum concentration of serum IgG, IgM and ALT following hepatitis A virus infection.
Liver Biopsy
The role of a liver biopsy is minimal in the diagnosis of hepatitis A. It may be used in cases involving chronic relapsing hepatitis A or when the diagnosis is unclear.
References
- ↑ Bower WA, Nainan OV, Margolis HS. Duration of viremia in naturally-acquired hepatitis A viral infections. [Abstract 103] In: Abstracts of the Infectious Diseases Society of America 35th Annual Meeting. Alexandria, VA: Infectious Diseases Society of America, 1997.
- ↑ Liaw YF, Yang CY, Chu CM, Huang MJ (1986). "Appearance and persistence of hepatitis A IgM antibody in acute clinical hepatitis A observed in an outbreak". Infection. 14 (4): 156–8. PMID 3759243.
|access-date=requires|url=(help) - ↑ Stapleton JT (1995). "Host immune response to hepatitis A virus". The Journal of Infectious Diseases. 171 Suppl 1: S9–14. PMID 7876654. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ Hutin YJ, Pool V, Cramer EH, Nainan OV, Weth J, Williams IT, Goldstein ST, Gensheimer KF, Bell BP, Shapiro CN, Alter MJ, Margolis HS (1999). "A multistate, foodborne outbreak of hepatitis A. National Hepatitis A Investigation Team". The New England Journal of Medicine. 340 (8): 595–602. doi:10.1056/NEJM199902253400802. PMID 10029643. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ Tong MJ, el-Farra NS, Grew MI (1995). "Clinical manifestations of hepatitis A: recent experience in a community teaching hospital". The Journal of Infectious Diseases. 171 Suppl 1: S15–8. PMID 7876641. Retrieved 2012-03-08. Unknown parameter
|month=ignored (help)