Acute viral hepatitisA, B, C, D, E

Acute hepatitis- causesViral- AVHHepatitis A-EImmunosuppressed- CMV, EBV, HSVOther infection- Leptospirosis, BrucellosisAlcoholDrugs- H,R,Z, paracetamol etc.IschemicPregnancySLEWilsons disease

Common features of AVHVariable incubation period, followed byFever, malaise, myalgia, RUQ pain, nausea/vomiting, loss of appetiteJaundice, seen in ~1/3rd, follows resolution of feverMore symptomatic in youngALT/SGPT- markedly elevatedFHF rare- ~1%- encephalopathyClinical resolution over 2-6 weeks

Hepatitis ARNA virus of picornavirus familyTransmission- feco-oralSporadic or epidemicIncubation period- ~30 daysMore severe in adultsFHF rare, no chronic stateRx- supportiveVaccine - inactivated HAV- 2 doses in 1 year

Hepatitis ERNA virus of herpeviridae familyTransmission- water-borneEpidemics in developing worldIncubation period- 3-8 weeks- avg. 5 wks.Severe in pregnant womenMostly self-limited, no chronicityRx- supportive

Hepatitis BdsDNA virus, 8 genotypes- A-HTransmission- sexual, infected blood, verticalIncubation period- average 3 monthsFHF- rare, mortality ~60%Chronicity- 1-10%, more in infants ~90%Rx- SupportiveHBIG- attenuates severity- 0.06 ml/kg Lamivudine/Entecavir in severe diseaseVaccine- 3 doses- 0,1,6

HBV markersHBsAg- 1st evidence of infection, persistence indicates chronicityAnti-HBs- recovery, immunityHBcAg- not detected in bloodIgMIgG anti-HBc over the course of diseaseHBeAg- viral replication & infectivityAnti-HBe- decreased infectivityHBV-DNA- viral replication & infectivity

Hepatitis DOnly with HBV infectionAcute infection- no differentChronic infection- more severe

Hepatitis CRNA virus of flavivirus family, 6 genotypesTransmission- sexual, infected blood, verticalIncubation period- 6-7 weeksAcute infection- usually asymptomaticChronicity- >70%Dx- anti-HCV or HCV-RNARx- acute-supportive