Hepatitis B history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Jolanta Marszalek, M.D. [2]
Overview
50% of adult patients and the majority of infants and children with acute HBV do not present with symptoms. When present, symptoms may initially be non-specific.[1] Proper and thorough history taking is important in both acute and chronic HBV infections in order to determine modes of infection transmission as well as to assess risk factors for the progression of HBV-related liver disease.[2][3]
History
Part of the initial evaluation for HBV infection includes a thorough patient history focusing on potential modes and timing of infection. Aspects covered in the patient's history include:[2]
- Exposure to blood and/or blood products
- Injection drug use(IDU)
- Sexual exposure
- Occupational exposure
- Family history of HBV
- Recent history of invasive procedures performed in non-hospital health care settings, including hemodialysis centers and long-term care facilities[4]
Chronic HBV
In chronic HBV, history taking includes obtaining information regarding factors associated with the progression of HBV-related liver disease.[3] The following aspects should be covered:[3][2]
- Risk factors for coinfection with HDV, HCV, and HIV
- Family history of liver disease and HCC
- Medication history
- Smoking status
- Alcohol consumption
- Drug abuse
- Sexual activity
- History of previous HBV treatment(to assess potential for treatment resistance)
- Antiretroviral drug regimen if coinfected with HIV(to assess potential for treatment resistance)
Patients from Areas of High Endemicity
History taking among immigrants from regions with a high prevalence of HBV should include questions regarding family history of acute and/or chronic liver disease, rituals in which shared and non-sterile instruments were used such as scarification and piercing, and traditional medical procedures.[2]
Symptoms
Approximately 50% of adults with acute HBV infections are asymptomatic. However, clinical symptoms occur more often in adults than in infants or children, who usually have an asymptomatic acute course.[5]
Symptoms can include:
- Fever
- Fatigue
- Nausea
- Vomiting
- Loss of appetite
- Abdominal pain
- Dark urine
- Clay-colored bowel movements
- Joint pain
- Yellowish discoloration of the eyes and skin
- Skin rash
- Muscle pain
References
- ↑ Center for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hepatitis B 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html#features
- ↑ 2.0 2.1 2.2 2.3 Rotman Y, Brown TA, Hoofnagle JH (2009). "Evaluation of the patient with hepatitis B." Hepatology. 49 (5 Suppl): S22–7. doi:10.1002/hep.22976. PMC 2881483. PMID 19399815.
- ↑ 3.0 3.1 3.2 Lok AS, McMahon BJ (2009). "Chronic hepatitis B: update 2009". Hepatology. 50 (3): 661–2. doi:10.1002/hep.23190. PMID 19714720.
- ↑ Thompson ND, Perz JF, Moorman AC, Holmberg SD (2009). "Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008". Ann Intern Med. 150 (1): 33–9. PMID 19124818.
- ↑ Center for Disease Control and Prevention. Hepatitis B Epidemiology and Prevention of Vaccine-Preventable Diseases 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html