Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

Hepatitis A and E 683

Signs & Symptoms

■Spectrum of acute HAV and HEV infection: asymptomatic to FHF

(rare; 0.1%)

■Typical symptoms in acute infection: malaise, anorexia, nausea,

vomiting

■Onset of symptoms abrupt in HAV and HEV infection

■Cholestatic hepatitis may complicate HAV infection

■Relapsing or biphasic HAV infection may occur

Physical

■Liver mildly enlarged and tender

tests

Basic Tests: Blood

■Mild disease: increased AST/ALT (vary from 500 to 5000 IU); normal

or mild decreased WBC, with or without lymphocytosis

■Severe disease: increased bilirubin (usually <10 mg/dl) and INR;

decreased albumin

■Cholestatic disease: bilirubin may be >20 mg/dl; AST/ALT decline

toward normal even though bilirubin high; variable increased alka-

line phosphatase

Specific Tests

■Serology

■Acute HAV infection:

■Positive IgM anti-HAV confirms acute infection; disappears in con-

valescence

■Positive IgG anti-HAV also present; persists indefinitely

■Acute HEV infection:

■IgM anti-HEV confirms acute infection; IgG anti-HEV may also be

present; HEV RNA in stool; tests not yet licensed in U.S.

■Positive IgG anti-HEV in convalescence; IgM anti-HEV and HEV RNA

disappears

Imaging

■Ultrasound: nondiagnostic

Biopsy

■Not routinely performed; diagnosis of acute HAV and HEV infection

based on serology

■Biopsy findings: focal hepatocyte necrosis with cell dropout; Coun-

cilman bodies; diffuse mononuclear cell infiltrate