Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Aug 28 2019

Hepatitis A Virus

Images virus.jpg
  • Snapshot
    • A 28-year-old man presents to his primary care physician for fatigue, malaise, and abdominal pain. He reports his symptoms began a few days ago and have progressively worsened. His symptoms are associated with nausea, 2 episodes of emesis, and generalized pruritus. Social history is significant for recent travel to India. He is currently sexually active with multiple men and does not use condoms. Physical examination is notable for scleral icterus, generalized jaundice, and hepatomegaly. Serologic testing is remarkable for anti-HAV IgM antibodies.
  • Introduction
    • Classification
      • a Hepatovirus in the Picornaviridae family
        • single-stranded positive-sense RNA virus with an icosahedral capsid
    • Epidemiology
      • risk factors
        • sexual contact
        • working in a daycare
        • serving in the military
        • eating raw or undercooked shellfish and vegetables
    • Transmission
      • via the fecal-oral route
    • Pathogenesis
      • within the cytoplasm of a hepatocyte, the virus replicates
        • CD8+ T-cells and natural killer cells destroy the infected hepatocytes, leading to hepatocellular damage
          • when the immune response to the infected hepatocytes is severe, it can result in severe hepatitis
    • Prognosis
      • typically a self-limited illness
      • does not become a chronic condition
  • Presentation
    • Symptoms
      • nausea and vomiting
      • anorexia
      • abdominal pain
      • dark urine
      • pale stools
    • Physical exam
      • hepatomegaly
      • jaundice and scleral icterus
  • Studies
    • Serologic testing
      • anti-HAV IgM
        • active infection is present
      • anti-HAV IgG
        • a previous infection was present
        • no active disease
        • the patient is protected against infection
      • elevated aminotransferases
  • Differential
    • Hepatitis B infection
      • differentiating factors
        • presence of anti-hepatitis B antibodies in serological testing
    • Hepatitis C infection
      • differentiating factor
        • presence of anti-hepatitis C antibodies in serological testing
  • Treatment
    • Medical
      • hepatitis A virus (HAV) vaccine
        • indication
          • all children at 1 year of age
          • all children between ages 2 and 18 who live in an area with a high disease incidence
          • people who travel or work in countries with a high disease incidence
          • men who have sex with men
          • illicit drug users
          • patients with chronic liver disease
        • comments
          • used to protect against exposure to the HAV
      • immune globulin
        • indication
          • in infants < 6 months of age
          • in travelers who have a contraindication to the vaccine (e.g., allergy)
        • comments
          • this provides passive immunization against the HAV
      • hepatitis A virus vaccine and immune globulin
        • indication
          • patients with chronic liver disease
          • immunocompromised patients who are not able to mount an adequate immune response to the hepatitis A vaccine
  • Complications
    • Cholestatic hepatitis
    • Fulminant hepatitis (< 1% of cases)
1 of 0
1 of 3
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options