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  • A 35-year-old man presents to the emergency department for nausea, malaise, fatigue, and abdominal pain. He says that his abdominal pain is in the right upper quadrant and is not associated with meals. Medical history is significant for HIV infection. He intravenously injects himself with heroin and reports to sharing needles. Physical examination is notable for right upper quadrant tenderness and scleral icterus. Laboratory testing is remarkable for a marked transaminitis. Serology demonstrates the presence of HBsAg and HDAg.
  • Classification
    • an RNA hepevirus 
  • Microbiology
    • transmission
      • fecal-oral
    • properties
      • contains a helical nucleocapsid
        • uses hepatitis B virus envelope (HBsAg) in order to cause infection
  • Epidemiology
    • risk factors
      • hepatitis B co-infection
  • Associated conditions
    • co-infection with hepatitis B
      • causes an acute hepatitis
        • antibodies against HBsAg are protective
    • superinfection
      • causes acute hepatitis in a patient with chronic hepatitis B infection
  • Symptoms
    • anorexia
    • nausea
    • right upper quadrant pain
  • Physical exam
    • jaundice and scleral icterus
  • Serologic studies
    • HBsAg
      • needed to make the diagnosis since hepatitis D virus (HDV) requires hepatitis B virus envelope
    • HDAg
      • seen in acute infection
    • anti-HDV
      • seen in chronic infection
    • IgM anti-HBc
      • suggests co-infection of hepatitis B and D viruses
  • Hepatitis A infection
    • differentiating factor
      • presence of anti-hepatitis A antibodies in serological testing
  • Hepatitis B infection
    • differentiating factor
      • presence of anti-hepatitis B antibodies in serological testing
  • Hepatitis C infection
    • differentiating factor
      • presence of anti-hepatitis C antibodies in serological testing
  • Medical
    • pegylated interferon α (IFNα)
      • indication
        • seen in patients with elevated HDV RNA levels and active hepatitis
        • note, there is no treatment for acute HDV infection
  • Acute fulminant hepatic failure
  • Cirrhosis
  • Hepatocellular carcinoma
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