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Key Features

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Essentials of Diagnosis
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  • Gastrointestinal upset, anorexia, vomiting, diarrhea

  • Jaundice, tender hepatomegaly, abnormal liver function tests

  • Serologic evidence of hepatitis B disease: HBsAg, HBeAg, anti-HBc IgM

  • History of parenteral, sexual, or household exposure or maternal HBsAg carriage

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General Considerations
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  • Incubation period is 45–160 days

  • Acquired either perinatally from a carrier mother or later in life from exposure to contaminated blood through shared needles, needle sticks, skin piercing, tattoos, or sexual transmission

  • Transmission via blood products is rare

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Clinical Findings

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Symptoms and Signs
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  • Most infants and young children are asymptomatic, especially if the infection is acquired vertically

  • Slight fever

  • Malaise

  • Mild gastrointestinal upset

  • Visible jaundice is usually the first significant finding and is accompanied by darkening of the urine and pale or clay-colored stools

  • Hepatomegaly is frequently present

  • Rare presentations

    • Immune complex–mediated rash

    • Arthritis or glomerulonephritis

    • Nephrotic syndrome

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Differential Diagnosis
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  • Viral hepatitis (hepatitis A virus, hepatitis C virus)

  • Autoimmune hepatitis

  • Wilson disease

  • Hemochromatosis

  • Nonalcoholic fatty liver disease (NAFLD)

  • α1-Antitrypsin deficiency

  • Drug-induced hepatitis

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Diagnosis

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Laboratory Findings
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  • Presence of HBsAg and anti-HBc IgM confirms diagnosis

  • Recovery from acute infection is accompanied by HBsAg clearance and appearance of anti-HBs and anti-HBc IgG

  • Individuals who are immune by vaccination are positive for anti-HBs but negative for anti-HBc IgG

  • Presence of HBsAg for at least 6 months indicates chronic infection

  • Vertical transmission to newborns is documented by positive HBsAg

  • LFT results are similar to those for hepatitis A

  • Renal involvement may be suspected on the basis of urinary findings suggesting glomerulonephritis or nephrotic syndrome

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Diagnostic Procedure
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  • Liver biopsy is most useful in chronic infection to determine the degree of fibrosis and inflammation

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Treatment

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Medical
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  • Supportive measures are used during the active symptomatic stage of acute infection

  • Corticosteroids are contraindicated

  • No other treatment is needed for acute HBV infection

  • Nucleos(t)ide therapy may be helpful when acute infection is complicated by acute liver failure

  • For patients with chronic hepatitis B in whom the immunoactive phase persists for more than 6 months or those who are HBeAg-negative,

    • α-Interferon (5–6 million units/m2 of body surface area injected subcutaneously three times a week for 4–6 months)

      • Inhibits viral replication in 30–40% of patients

      • Normalizes the ALT level

      • Leads to the disappearance of HBeAg and the appearance of anti-HBe

      • Side effects are common

      • Younger children may respond better than older children

    • Orally administered nucleoside analog therapy

      • Lamivudine (3 mg/kg/d up to 100 mg/d) and entecavir (0.15–0.5 mg daily depending on age and weight) for children > 2 years old

      • Adefovir (10 mg/d) or tenofovir (300 mg/d) for children > 12 years old

      • Entecavir (0.5 mg once daily) or telbivudine (600 mg once daily) for children ...

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