Hepatitis B differential diagnosis: Difference between revisions

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*It may be asymptomatic or at the far end of the spectrum, may present with acute [[liver failure]] with [[jaundice]], elevated [[prothrombin time|PT]], and [[aminotransferase]] values >1000 U/L
*It may be asymptomatic or at the far end of the spectrum, may present with acute [[liver failure]] with [[jaundice]], elevated [[prothrombin time|PT]], and [[aminotransferase]] values >1000 U/L
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Hepatitis B must be differentiated from other causes of rash and arthritis<ref name="pmid3101626">{{cite journal| author=Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK| title=The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis. | journal=Arch Intern Med | year= 1987 | volume= 147 | issue= 2 | pages= 281-3 | pmid=3101626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3101626  }} </ref><ref name="pmid16297736">{{cite journal| author=Rice PA| title=Gonococcal arthritis (disseminated gonococcal infection). | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 853-61 | pmid=16297736 | doi=10.1016/j.idc.2005.07.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297736  }} </ref><ref name="pmid22353959">{{cite journal| author=Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG| title=Disseminated gonococcal infection in women. | journal=Obstet Gynecol | year= 2012 | volume= 119 | issue= 3 | pages= 597-602 | pmid=22353959 | doi=10.1097/AOG.0b013e318244eda9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22353959  }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Nongonococcal [[septic arthritis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with an acute onset of joint swelling and pain (usually monoarticular)
*Culture of joint fluid reveals organisms
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute rheumatic fever]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with polyarthritis and rash (rare presentation) in young adults. Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis.
*Poststreptococcal arthritis have a rapid response to [[salicylate]]s or other [[antiinflammatory drugs]].
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Syphilis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with acute secondary syphilis usually presents with generalized, pustular lesions at the palms and soles with [[lymphadenopathy|generalized lymphadenopathy]]
*Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL) and Fluorescent treponemal antibody absorption (FTA-ABS) tests confirm the presence of the causative agent.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Reactive arthritis]] (Reiter syndrome)'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Musculoskeletal manifestation include [[arthritis]], [[tenosynovitis]], [[dactylitis]], and low back pain.
*Extraarticular manifestation include [[conjunctivitis]], [[urethritis]], and genital and oral lesions.
*Reactive arthritis is a clinical diagnosis based upon the pattern of findings and there is no definitive diagnostic test
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Hepatitis B virus|Hepatitis B virus (HBV) infection]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with fever, chills, polyarthritis, [[tenosynovitis]], and [[urticarial|urticarial rash]]
*Synovial fluid analysis usually shows noninflammatory fluid
*Elevated [[aminotransaminases|serum aminotransaminases]] and evidence of acute HBV infection on serologic testing confirm the presence of the HBV.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Herpes simplex virus|Herpes simplex virus (HSV)]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Genital and extragenital lesions can mimic the skin lesions that occur in disseminated gonococcal infection
*Viral culture,  [[polymerase chain reaction|polymerase chain reaction (PCR)]], and direct fluorescence antibody confirm the presence of the causative agent.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[HIV infection]] '''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Present with generalized rash with mucus membrane involvement, fever, chills, and [[arthralgia]]. Joint effusions are uncommon
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Gout|Gout and other crystal-induced arthritis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with acute monoarthritis with fever and chills
*Synovial fluid analysis confirm the diagnosis.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lyme disease]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Present with erythema chronicum migrans rash and [[monoarthritis]] as a later presentation.
*Clinical characteristics of the rash and and serologic testing confirm the diagnosis.
|}
|}


Revision as of 02:08, 24 September 2017

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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], Sara Mehrsefat, M.D. [3]

Overview

Hepatitis B must be differentiated from other diseases that cause fever, nausea, vomiting, jaundice, hepatomegaly, icteric sclera, elevated ALT, and elevated AST, such as other types of viral hepatitis, alcoholic hepatitis, and autoimmune hepatitis.[1][2][3][4]

Differentiating Hepatitis B from other Diseases

The table below summarizes the findings that differentiate hepatitis B from other conditions that cause fever, nausea, vomiting, jaundice, hepatomegaly, and icteric sclera.[1][2][3][4][5][6][7][8]

Disease Findings
Viral Hepatitis A
  • Abrupt onset of prodromal symptoms
  • Detectable serum immunoglobulin M (IgM) anti-HAV antibodies
  • Hepatitis, caused by the hepatitis A virus, produces a self-limited disease
Viral Hepatitis C
Viral Hepatitis D
Viral Hepatitis E
Alcoholic Hepatitis
Autoimmune Hepatitis

Hepatitis B must be differentiated from other causes of rash and arthritis[9][10][11]

Disease Findings
Nongonococcal septic arthritis
  • Presents with an acute onset of joint swelling and pain (usually monoarticular)
  • Culture of joint fluid reveals organisms
Acute rheumatic fever
  • Presents with polyarthritis and rash (rare presentation) in young adults. Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis.
  • Poststreptococcal arthritis have a rapid response to salicylates or other antiinflammatory drugs.
Syphilis
  • Presents with acute secondary syphilis usually presents with generalized, pustular lesions at the palms and soles with generalized lymphadenopathy
  • Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL) and Fluorescent treponemal antibody absorption (FTA-ABS) tests confirm the presence of the causative agent.
Reactive arthritis (Reiter syndrome)
  • Musculoskeletal manifestation include arthritis, tenosynovitis, dactylitis, and low back pain.
  • Extraarticular manifestation include conjunctivitis, urethritis, and genital and oral lesions.
  • Reactive arthritis is a clinical diagnosis based upon the pattern of findings and there is no definitive diagnostic test
Hepatitis B virus (HBV) infection
  • Presents with fever, chills, polyarthritis, tenosynovitis, and urticarial rash
  • Synovial fluid analysis usually shows noninflammatory fluid
  • Elevated serum aminotransaminases and evidence of acute HBV infection on serologic testing confirm the presence of the HBV.
Herpes simplex virus (HSV)
  • Genital and extragenital lesions can mimic the skin lesions that occur in disseminated gonococcal infection
  • Viral culture, polymerase chain reaction (PCR), and direct fluorescence antibody confirm the presence of the causative agent.
HIV infection
  • Present with generalized rash with mucus membrane involvement, fever, chills, and arthralgia. Joint effusions are uncommon
Gout and other crystal-induced arthritis
  • Presents with acute monoarthritis with fever and chills
  • Synovial fluid analysis confirm the diagnosis.
Lyme disease
  • Present with erythema chronicum migrans rash and monoarthritis as a later presentation.
  • Clinical characteristics of the rash and and serologic testing confirm the diagnosis.

References

  1. ↑ 1.0 1.1 Centers for Disease Control and Prevention. Viral Hepatitis http://www.cdc.gov/hepatitis/ Accessed on October 4th, 2016
  2. ↑ 2.0 2.1 Cohen JA, Kaplan MM (1979). "The SGOT/SGPT ratio--an indicator of alcoholic liver disease". Dig Dis Sci. 24 (11): 835–8. PMID 520102.
  3. ↑ 3.0 3.1 Williams AL, Hoofnagle JH (1988). "Ratio of serum aspartate to alanine aminotransferase in chronic hepatitis. Relationship to cirrhosis". Gastroenterology. 95 (3): 734–9. PMID 3135226.
  4. ↑ 4.0 4.1 Krawitt EL (2006). "Autoimmune hepatitis". N Engl J Med. 354 (1): 54–66. doi:10.1056/NEJMra050408. PMID 16394302.
  5. ↑ Centers for Disease Control and Prevention. Viral Hepatitis http://www.cdc.gov/hepatitis/ Accessed on October 4th, 2016
  6. ↑ World Health Organization, Guidelines for the screening care and treatment of persons with hepatitis C infection. (2015). http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1&ua=1 Accessed on October 5th, 2016
  7. ↑ Centers for Disease Control and Prevention. MMWR. Prevention of Hepatitis A Through Active or Passive Immunization Recommendations of the Advisory Committee on Immunization Practices (ACIP) (2006). http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5507a1.htmAccessed on October 5th, 2016
  8. ↑ Buti M, Esteban R, Jardi R, Rodriguez-Frias F, Casacuberta J, Esteban JI; et al. (1989). "Chronic delta hepatitis: detection of hepatitis delta virus antigen in serum by immunoblot and correlation with other markers of delta viral replication". Hepatology. 10 (6): 907–10. PMID 2583685.
  9. ↑ Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK (1987). "The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis". Arch Intern Med. 147 (2): 281–3. PMID 3101626.
  10. ↑ Rice PA (2005). "Gonococcal arthritis (disseminated gonococcal infection)". Infect Dis Clin North Am. 19 (4): 853–61. doi:10.1016/j.idc.2005.07.003. PMID 16297736.
  11. ↑ Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG (2012). "Disseminated gonococcal infection in women". Obstet Gynecol. 119 (3): 597–602. doi:10.1097/AOG.0b013e318244eda9. PMID 22353959.

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