Hepatitis B history and symptoms: Difference between revisions

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{{Hepatitis B}}
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==Overview==
==Overview==


50% of adult patients and the majority of infants and children with acute HBV do not present with symptoms.  Symptoms may initially be non-specific.<ref name="Pnkbk">Center for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hepatitis B 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html#features</ref> Proper and thorough history taking is important in both acute and chronic HBV infections in order to determine modes of infection transmission as well as to assess risk factors for the progression of HBV-related liver disease.<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><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>
50% of adult patients and the majority of infants and children with acute HBV do not present with symptoms.  Symptoms may initially be non-specific.<ref name="CDC">Center for Disease Control and Prevention. Hepatitis B Epidemiology and Prevention of Vaccine-Preventable Diseases 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html</ref>   Proper and thorough history-taking is important in both acute and chronic HBV infections in order to determine modes of infection transmission, as well as to assess [[risk factors]] for the progression of HBV-related [[liver disease]].<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><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>


==History==
==History==
Part of the initial evaluation for HBV 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>
Part of the initial evaluation for HBV 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>
*Exposure to blood and/or blood products
*Exposure to blood and/or blood products
*[[Intravenous drug use|Injection drug use]]([[IDU]])
*[[Intravenous drug use|Injection drug use]] ([[IDU]])
*Sexual exposure
*Sexual exposure
*Occupational exposure
*Occupational exposure
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*[[Drug abuse]]
*[[Drug abuse]]
*Sexual activity
*Sexual activity
*History of previous HBV treatment(to assess potential for treatment resistance)
*History of previous HBV treatment (to assess potential for treatment resistance)
*[[Antiretroviral]] drug regimen if coinfected with [[HIV]](to assess potential for treatment resistance)
*[[Antiretroviral]] drug regimen if coinfected with [[HIV]] (to assess potential for treatment resistance)
 
===Patients from Areas of High Endemicity===
===Patients from Areas of High Endemicity===
History taking among immigrants from regions with a high prevalence of HBV should include questions regarding family history of acute and/or [[chronic liver disease]], rituals in which shared and [[non-sterile]] instruments were used such as scarification and piercing, and traditional medical procedures.<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>
History-taking among immigrants from regions with a high prevalence of HBV should include questions regarding family history of acute and/or [[chronic liver disease]], rituals in which shared and non-sterile instruments were used (e.g., scarification, piercing), and traditional medical procedures.<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>


==Symptoms==
==Symptoms==


Approximately 50% of adults with acute [[HBV]] infections are [[asymptomatic]]. However, clinical symptoms occur more often in adults than in infants or children, who usually have an asymptomatic acute course.<ref name="CDC">Center for Disease Control and Prevention. Hepatitis B Epidemiology and Prevention of Vaccine-Preventable Diseases 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html</ref>
Approximately 50% of adults with acute [[HBV]] infections are [[asymptomatic]]. However, clinical symptoms occur more often in adults than in infants or children, who usually have an asymptomatic, acute course.<ref name="CDC">Center for Disease Control and Prevention. Hepatitis B Epidemiology and Prevention of Vaccine-Preventable Diseases 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html</ref>
   
   
Symptoms can include:<ref name="CDC">Center for Disease Control and Prevention. Hepatitis B Epidemiology and Prevention of Vaccine-Preventable Diseases 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html</ref>  
Symptoms can include:<ref name="CDC">Center for Disease Control and Prevention. Hepatitis B Epidemiology and Prevention of Vaccine-Preventable Diseases 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html</ref>  
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{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 22:04, 29 July 2020

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

Overview

50% of adult patients and the majority of infants and children with acute HBV do not present with symptoms. Symptoms may initially be non-specific.[1] Proper and thorough history-taking is important in both acute and chronic HBV infections in order to determine modes of infection transmission, as well as to assess risk factors for the progression of HBV-related liver disease.[2][3]

History

Part of the initial evaluation for HBV infection includes a thorough patient history focusing on potential modes and timing of infection. Aspects covered in the patient's history include:[2]

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

Chronic HBV

In chronic HBV, history taking includes obtaining information regarding factors associated with the progression of HBV-related liver disease.[3] The following aspects should be covered:[3][2]

  • 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
  • History of previous HBV treatment (to assess potential for treatment resistance)
  • Antiretroviral drug regimen if coinfected with HIV (to assess potential for treatment resistance)

Patients from Areas of High Endemicity

History-taking among immigrants from regions with a high prevalence of HBV should include questions regarding family history of acute and/or chronic liver disease, rituals in which shared and non-sterile instruments were used (e.g., scarification, piercing), and traditional medical procedures.[2]

Symptoms

Approximately 50% of adults with acute HBV infections are asymptomatic. However, clinical symptoms occur more often in adults than in infants or children, who usually have an asymptomatic, acute course.[1]

Symptoms can include:[1]

References

  1. 1.0 1.1 1.2 Center for Disease Control and Prevention. Hepatitis B Epidemiology and Prevention of Vaccine-Preventable Diseases 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html
  2. 2.0 2.1 2.2 2.3 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.
  3. 3.0 3.1 3.2 Lok AS, McMahon BJ (2009). "Chronic hepatitis B: update 2009". Hepatology. 50 (3): 661–2. doi:10.1002/hep.23190. PMID 19714720.
  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.


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