Hepatitis D virus infection
HDV is transmitted most commonly through blood or blood products, although transmission can also occur by sexual contact and much less commonly through vertical transmission. Higher prevalence rates occur in the Mediterranean regions, central / western Africa, northern Asia, Vietnam, and Amazonian areas. Implementation of HBV vaccination programs in most high- and middle-income countries has reduced the global incidence of HDV infection as well, especially among younger patients. In Europe, rates have been increasing due to immigration from endemic areas.
Clinically, HDV infection may present asymptomatically, with symptoms of acute hepatitis, or with worsening of previously asymptomatic HBV infections. Signs and symptoms of HDV infection are nonspecific to this virus and include jaundice, pruritus, anorexia, fatigue, abdominal distention and ascites, and encephalopathy. Patients may also complain of dark-colored urine or pale stools.
Physical examination may reveal lowered blood pressure, yellow skin discoloration, spider angiomata, abdominal distention and ascites, hepatosplenomegaly, palmar erythema, Muehrcke nails, and Terry nails.
Immunocompromised patient considerations: A substantially more aggressive progression of HDV may be associated with triple infection with HIV and HBV, and screening for HDV is recommended for HIV-positive / HBV-positive patients.
B17.8 – Other specified acute viral hepatitis
707341005 – Viral hepatitis type D
Differential Diagnosis & Pitfalls
- Other viral hepatitis (hepatitis A, hepatitis B, hepatitis C, hepatitis E)
- Epstein-Barr virus infection
- Coxsackie virus
- Alcoholic hepatitis
- Nonalcoholic fatty liver disease
- Fatty liver of pregnancy
- Autoimmune disorders affecting the liver (see, eg, autoimmune hepatitis, primary biliary cholangitis)
- Herpes simplex virus (HSV) infection (see disseminated HSV)
- Rotor's syndrome
- Dubin-Johnson syndrome
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Cryptosporidium infection
- Intrahepatic or extrahepatic malignancy (see liver cancer)
- Pancreatitis (acute, chronic)