Hepatitis A natural history, complications and prognosis: Difference between revisions
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The likelihood of having [[symptoms]] with [[HAV infection]] increases with age. Fewer than 10% of infections among children aged 0-4 years result in [[jaundice]]; this percentage increases to 30%-40% among children aged 5-9 years, 60%-80% among youths aged 10-17 years, and 80%-90% among adults aged ≥18 years<ref name="pmid11986444">{{cite journal |author=Armstrong GL, Bell BP |title=Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization |journal=[[Pediatrics]] |volume=109 |issue=5 |pages=839–45 |year=2002 |month=May |pmid=11986444 |doi= |url=http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=11986444 |accessdate=2012-02-28}}</ref>. | The likelihood of having [[symptoms]] with [[HAV infection]] increases with age. Fewer than 10% of infections among children aged 0-4 years result in [[jaundice]]; this percentage increases to 30%-40% among children aged 5-9 years, 60%-80% among youths aged 10-17 years, and 80%-90% among adults aged ≥18 years<ref name="pmid11986444">{{cite journal |author=Armstrong GL, Bell BP |title=Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization |journal=[[Pediatrics]] |volume=109 |issue=5 |pages=839–45 |year=2002 |month=May |pmid=11986444 |doi= |url=http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=11986444 |accessdate=2012-02-28}}</ref>. | ||
When signs and [[symptoms]] occur, typically they last less 2 months, although 10%-15% of [[symptomatic]] persons have prolonged or relapsing disease lasting up to 6 months<ref name="pmid1312659">{{cite journal |author=Glikson M, Galun E, Oren R, Tur-Kaspa R, Shouval D |title=Relapsing hepatitis A. Review of 14 cases and literature survey |journal=[[Medicine]] |volume=71 |issue=1 |pages=14–23 |year=1992 |month=January |pmid=1312659 |doi= |url= |accessdate=2012-02-28}}</ref>. | When signs and [[symptoms]] occur, typically they last less 2 months, although 10%-15% of [[symptomatic]] persons have prolonged or relapsing disease lasting up to 6 months.<ref name="pmid1312659">{{cite journal |author=Glikson M, Galun E, Oren R, Tur-Kaspa R, Shouval D |title=Relapsing hepatitis A. Review of 14 cases and literature survey |journal=[[Medicine]] |volume=71 |issue=1 |pages=14–23 |year=1992 |month=January |pmid=1312659 |doi= |url= |accessdate=2012-02-28}}</ref> | ||
When [[symptoms]] occur, [[HAV infection]] is usually acute and self-limited. The rare cases of fulminant [[hepatitis]] are more common among patients with previous [[liver disease]], such as [[chronic hepatitis C]].<ref name="pmid9445408">{{cite journal| author=Vento S, Garofano T, Renzini C, Cainelli F, Casali F, Ghironzi G et al.| title=Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. | journal=N Engl J Med | year= 1998 | volume= 338 | issue= 5 | pages= 286-90 | pmid=9445408 | doi=10.1056/NEJM199801293380503 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9445408 }} </ref> | |||
==Complications== | ==Complications== | ||
Revision as of 17:17, 28 July 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [3]
Overview
Hepatitis A, caused by infection with HAV, has an incubation period of approximately 28 days (range: 15--50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease (CLD). However, 10%--15% of patients experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and most children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection.[1]
Natural History
Hepatitis A is caused by the hepatitis A virus (HAV). The virus is primarily spread through fecal-oral transmission, commonly after ingesting food or water that is contaminated with the virus. The infected patients have a peak infectivity during the 2 week period before onset of jaundice or elevation of liver enzymes. This is the period when the concentration of virus in stools is highest.[2]
The likelihood of having symptoms with HAV infection increases with age. Fewer than 10% of infections among children aged 0-4 years result in jaundice; this percentage increases to 30%-40% among children aged 5-9 years, 60%-80% among youths aged 10-17 years, and 80%-90% among adults aged ≥18 years[3].
When signs and symptoms occur, typically they last less 2 months, although 10%-15% of symptomatic persons have prolonged or relapsing disease lasting up to 6 months.[4]
When symptoms occur, HAV infection is usually acute and self-limited. The rare cases of fulminant hepatitis are more common among patients with previous liver disease, such as chronic hepatitis C.[5]
Complications
There are usually no complications. One in a thousand cases becomes fulminant hepatitis, which can be life threatening.
Prognosis
- The United States Centers for Disease Control and Prevention (CDC) in 1991 reported a low mortality rate of 4 deaths per 1000 cases for the general population but a higher rate of 17.5 per 1000 in those aged 50 and over.
- Young children who are infected with hepatitis A typically have a milder form of the disease, usually lasting from 1-3 weeks, whereas adults tend to experience a much more severe form of the disease.
- Adults are often confined to bed and minimal activity for about 4 weeks and have to stop their work for one to three months or longer.
- Many adults take up to 36 months and occasionally longer to recover entirely.
- Symptoms that may be experienced after the first month or two are low immunity, with an increased risk of catching minor infections
- Many people experience a slow but sure improvement, over this later period.
- They are generally able to function normally, still needing more sleep and reduced athletic activity.
- It is common for recovering patients to experience occasional "off" days, during which they need to rest more.
- Hepatitis A can be sexually transmitted, especially during oral-anal contact, but not after the patient has recovered.
- Approximately 15% of people diagnosed with hepatitis A may experience one or more symptomatic relapse(s) for up to 24 months after contracting this disease.
References
- ↑ Sexually Transmitted Diseases Treatment Guidelines, 2010. Centers for Disease Control and Prevention. Recommendations and Reports December 17, 2010 / 59(RR12);1-110 [1]
- ↑ Tassopoulos NC, Papaevangelou GJ, Ticehurst JR, Purcell RH (1986). "Fecal excretion of Greek strains of hepatitis A virus in patients with hepatitis A and in experimentally infected chimpanzees". The Journal of Infectious Diseases. 154 (2): 231–7. PMID 3014009. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ Armstrong GL, Bell BP (2002). "Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization". Pediatrics. 109 (5): 839–45. PMID 11986444. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ Glikson M, Galun E, Oren R, Tur-Kaspa R, Shouval D (1992). "Relapsing hepatitis A. Review of 14 cases and literature survey". Medicine. 71 (1): 14–23. PMID 1312659. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Vento S, Garofano T, Renzini C, Cainelli F, Casali F, Ghironzi G; et al. (1998). "Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C." N Engl J Med. 338 (5): 286–90. doi:10.1056/NEJM199801293380503. PMID 9445408.