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Hepatitis A virus infection
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Hepatitis A virus infection

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Contributors: Yoshihiko Murata MD, PhD, William Bonnez MD, Mukesh Patel MD, James H. Willig MD, MSPH
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Synopsis

Hepatitis A is an illness that is caused by a picornavirus and leads to acute hepatitis. Transmission of hepatitis A occurs by fecal-oral route, person-to-person household or sexual contact, or consumption of contaminated foods or liquids. In the United States, large outbreaks and epidemics occur approximately every 10 years with stable baseline prevalence between epidemics. Among cases of hepatitis A reported to the Centers for Disease Control and Prevention (CDC), risk factors include international travel, intravenous or non-intravenous illegal drug use, and household or sexual contact with persons with hepatitis A.

The typical incubation time is 28 days (range: 15-50 days). In young children (<5 years), the vast majority of infections are asymptomatic, whereas in older children and adults, icteric infections are almost as common as anicteric forms. Symptomatic patients infected with hepatitis A experience a constellation of symptoms, including fever, fatigue, anorexia, abdominal pain, nausea, vomiting, pruritus (due to hyperbilirubinemia), and/or jaundice (typically preceded by onset of dark-colored urine). Physical examination often reveals hepatosplenomegaly. Laboratory findings typically include elevated transaminases and bilirubin. Rare extrahepatic manifestations of hepatitis A include arthralgias, hemolytic or aplastic anemia, acalculous cholecystitis, myocarditis, toxic epidermal necrolysis, glomerulonephritis, and cutaneous vasculitis.

Hepatitis A is usually a self-limited disease that does not lead to chronic infection or chronic liver disease. However, 10%-15% of patients can experience transient relapses of symptoms within 6 months following the initial hepatitis A episode. Fulminant hepatitis A, with a case fatality rate of approximately 0.5%, can lead to acute liver failure and may require emergent liver transplantation.

Pediatric Patient Considerations:
The majority of pediatric hepatitis A infections are asymptomatic or clinically unrecognized. Hepatitis A causes symptomatic illness in only 30% of adolescents and children compared with 70% of adults.

Immunocompromised Patient Considerations:
Patients with underlying chronic liver disease, including chronic hepatitis B or C, are at increased risk of morbidity and mortality due to acute hepatitis A.

Among pregnant women, there is no evidence to suggest that acute hepatitis A is associated with an increased case fatality rate.

Codes

ICD10CM:
B15.9 – Hepatitis A without hepatic coma

SNOMEDCT:
40468003 – Viral hepatitis, type A

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Last Updated: 10/25/2016
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Hepatitis A virus infection
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Hepatitis A virus infection (Prodromal Phase) : Dark urine, Diarrhea, Fatigue, Fever, Nausea/vomiting, Alkaline phosphatase elevated, ALT elevated, AST elevated, Anorexia, RUQ pain
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