Hepatitis D history and symptoms: Difference between revisions

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{{Hepatitis D}}
{{Hepatitis D}}
{{CMG}}; {{AE}} {{VK}}; {{JS}} {{JM}}
{{CMG}}; {{AE}} {{JS}} {{JM}}


==Overview==
==Overview==
Hepatitis D can only occur in patients who are simultaneously ([[coinfection]]) or previously ([[superinfection]]) [[infected]] with [[HBV]]. Common symptoms of hepatitis D include: [[fever]]; [[Jaundice|yellowish discoloration of the eyes and skin]]; [[fatigue]]; [[abdominal pain]]; [[loss of appetite]]; [[nausea]]; [[vomiting]]; and dark urine. [[Coinfection]] is associated with a more severe form of the disease, often leading to [[fulminant hepatitis]]. In [[superinfection]], [[symptoms]] may be unspecific initially, and the majority of these cases progress into chronicity.<ref name="pmid23242761">{{cite journal| author=Heidrich B, Manns MP, Wedemeyer H| title=Treatment options for hepatitis delta virus infection. | journal=Curr Infect Dis Rep | year= 2013 | volume= 15 | issue= 1 | pages= 31-8 | pmid=23242761 | doi=10.1007/s11908-012-0307-z | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23242761  }} </ref><ref name=CDC>{{cite web | title = Hepatitis D | url = http://www.cdc.gov/hepatitis/D/index.htm }}</ref>


== History==
==History==
When hepatitis D infection occurs concurrently with [[hepatitis B]] infection, the incubation period of between 6 weeks and 6 months is the same for both. When viral hepatitis D infection occurs as a superinfection in someone already infected with hepatitis B, who remains [[HBsAg]] positive, the incubation period is thought to be between 2 and 10 weeks, on the basis of experimental infections in chimpanzees. Hepatitis D is most contagious just before the onset of symptoms but may remain infectious indefinitely in the HBsAg-positive person.<ref>Center for Substance Abuse Treatment. Screening for Infectious Diseases Among Substance Abusers. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1993. (Treatment Improvement Protocol (TIP) Series, No. 6.) Chapter 15 - Viral Hepatitis D.</ref> Symptoms of hepatitis D are similar to those of hepatitis B. The onset of symptoms is usually abrupt, and jaundice usually develops after the symptoms have disappeared.
Part of the initial evaluation for HDV infection includes a thorough patient history focusing on potential modes and timing of infection. Aspects covered in the patient's history include:<ref name="pmid19399815">{{cite journal| author=Rotman Y, Brown TA, Hoofnagle JH| title=Evaluation of the patient with hepatitis B. | journal=Hepatology | year= 2009 | volume= 49 | issue= 5 Suppl | pages= S22-7 | pmid=19399815 | doi=10.1002/hep.22976 | pmc=PMC2881483 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19399815  }} </ref>
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*Exposure to blood and/or blood products
With HBV and HDV co-infection, the fate of HDV is determined by the host response to HBV, which in more than 95% of adults results in viral clearance. Acute co-infection can be more severe than acute mono-infection with HBV, thereby resulting in acute liver failure; however, disease expression is wide-ranging. By contrast, HDV superinfection of an individual with chronic HBV results in chronic HDV infection in most people. In the remainder, replication of HDV stops, and the natural history of the disease is that of the underlying HBV; however, the residual liver disease might be advanced. Important evidence from an Italian cohort showed that 10% of patients with anti-HDV antibodies cleared HBsAg after a mean follow-up of 4 years, compared with 2·8% of those with HBV mono-infection.89 The mechanism for increased rate of HBsAg loss after clearance of HDV RNA is unknown, but an enhanced immune response against HBV and HDV seems plausible. Figure 3 shows the typical evolution of serological and virological markers in co-infected patients versus superinfected patients.
*[[Intravenous drug use|Injection drug use]]([[IDU]])
*Sexual exposure
*Occupational exposure
*Recent history of invasive procedures performed in non-hospital health care settings, including [[hemodialysis]] centers and long-term care facilities<ref name="pmid19124818">{{cite journal| author=Thompson ND, Perz JF, Moorman AC, Holmberg SD| title=Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. | journal=Ann Intern Med | year= 2009 | volume= 150 | issue= 1 | pages= 33-9 | pmid=19124818 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19124818  }} </ref>
===Chronic HDV===
In chronic [[HDV]], history taking includes obtaining information regarding factors associated with the progression of [[liver disease]].<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>  The following aspects should be covered:<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref><ref name="pmid19399815">{{cite journal| author=Rotman Y, Brown TA, Hoofnagle JH| title=Evaluation of the patient with hepatitis B. | journal=Hepatology | year= 2009 | volume= 49 | issue= 5 Suppl | pages= S22-7 | pmid=19399815 | doi=10.1002/hep.22976 | pmc=PMC2881483 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19399815  }} </ref>
*Risk factors for [[coinfection]] with [[HDV]], [[HCV]], and [[HIV]]
*Family history of [[liver disease]] and [[HCC]]
*Medication history
*Smoking status
*Alcohol consumption
*[[Drug abuse]]
*Sexual activity
*[[Antiretroviral]] drug regimen if coinfected with [[HIV]](to assess potential for treatment resistance)


-->
[[Symptoms]] of hepatitis D are similar to those of [[hepatitis B]]. Simultaneous infection with [[HBV]] and [[HDV]] ([[coinfection]]) often courses with a severe acute form of the disease, usually with ab abrupt onset of [[symptoms]].<ref name="pmid23242761">{{cite journal| author=Heidrich B, Manns MP, Wedemeyer H| title=Treatment options for hepatitis delta virus infection. | journal=Curr Infect Dis Rep | year= 2013 | volume= 15 | issue= 1 | pages= 31-8 | pmid=23242761 | doi=10.1007/s11908-012-0307-z | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23242761  }} </ref>


==Symptoms==
==Symptoms==
 
Simultaneous infection with [[HDV]] and [[HBV]] ([[coinfection]]) is associated with a more severe form of the disease, often leading to fulminant hepatitis. In the case of [[infection]] with [[HDV]], in a previously [[HBsAg]] positive patient ([[superinfection]]), [[symptoms]] may be unspecific initially. In this last case, the disease often tends to chronicity. Common symptoms of both forms of the disease include:<ref name="pmid23242761">{{cite journal| author=Heidrich B, Manns MP, Wedemeyer H| title=Treatment options for hepatitis delta virus infection. | journal=Curr Infect Dis Rep | year= 2013 | volume= 15 | issue= 1 | pages= 31-8 | pmid=23242761 | doi=10.1007/s11908-012-0307-z | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23242761  }} </ref><ref name=CDC>{{cite web | title = Hepatiits D | url = http://www.cdc.gov/hepatitis/D/index.htm }}</ref>
* [[Jaundice]]  
* [[Fever]]
* [[Jaundice|Yellowish discoloration of the eyes and skin]]  
* [[Fatigue]]  
* [[Fatigue]]  
* [[Abdominal Pain]]  
* [[Abdominal pain]]  
* [[Loss of appetite]]  
* [[Loss of appetite]]  
* [[Nausea]], [[Vomiting]]  
* [[Nausea]]
* [[Joint pain]]  
* [[Vomiting]]  
* Dark (tea colored) urine [http://www.cdc.gov/ncidod/diseases/hepatitis/d/fact.htm]
* [[Joint pain]]
* [[Muscle pain]]
* Dark (tea colored) urine
* [[Acholic stools|Clay-colored stools]]
* [[Skin rash]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}
[[Category:Hepatitis|D]]
[[Category:Hepatitis|D]]
[[Category:Viruses]]
[[Category:Viruses]]
[[category:Disease]]
[[Category:Disease]]
[[Category:Emergency mdicine]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
{{WH}}
[[Category:Hepatology]]
{{WS}}
[[Category:Gastroenterology]]

Latest revision as of 22:06, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Jolanta Marszalek, M.D. [3]

Overview

Hepatitis D can only occur in patients who are simultaneously (coinfection) or previously (superinfection) infected with HBV. Common symptoms of hepatitis D include: fever; yellowish discoloration of the eyes and skin; fatigue; abdominal pain; loss of appetite; nausea; vomiting; and dark urine. Coinfection is associated with a more severe form of the disease, often leading to fulminant hepatitis. In superinfection, symptoms may be unspecific initially, and the majority of these cases progress into chronicity.[1][2]

History

Part of the initial evaluation for HDV infection includes a thorough patient history focusing on potential modes and timing of infection. Aspects covered in the patient's history include:[3]

  • Exposure to blood and/or blood products
  • Injection drug use(IDU)
  • Sexual exposure
  • Occupational exposure
  • Recent history of invasive procedures performed in non-hospital health care settings, including hemodialysis centers and long-term care facilities[4]

Chronic HDV

In chronic HDV, history taking includes obtaining information regarding factors associated with the progression of liver disease.[5] The following aspects should be covered:[5][3]

Symptoms of hepatitis D are similar to those of hepatitis B. Simultaneous infection with HBV and HDV (coinfection) often courses with a severe acute form of the disease, usually with ab abrupt onset of symptoms.[1]

Symptoms

Simultaneous infection with HDV and HBV (coinfection) is associated with a more severe form of the disease, often leading to fulminant hepatitis. In the case of infection with HDV, in a previously HBsAg positive patient (superinfection), symptoms may be unspecific initially. In this last case, the disease often tends to chronicity. Common symptoms of both forms of the disease include:[1][2]

References

  1. ↑ 1.0 1.1 1.2 Heidrich B, Manns MP, Wedemeyer H (2013). "Treatment options for hepatitis delta virus infection". Curr Infect Dis Rep. 15 (1): 31–8. doi:10.1007/s11908-012-0307-z. PMID 23242761.
  2. ↑ 2.0 2.1 "Hepatitis D".
  3. ↑ 3.0 3.1 Rotman Y, Brown TA, Hoofnagle JH (2009). "Evaluation of the patient with hepatitis B." Hepatology. 49 (5 Suppl): S22–7. doi:10.1002/hep.22976. PMC 2881483. PMID 19399815.
  4. ↑ Thompson ND, Perz JF, Moorman AC, Holmberg SD (2009). "Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008". Ann Intern Med. 150 (1): 33–9. PMID 19124818.
  5. ↑ 5.0 5.1 Lok AS, McMahon BJ (2009). "Chronic hepatitis B: update 2009". Hepatology. 50 (3): 661–2. doi:10.1002/hep.23190. PMID 19714720.

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