Hepatitis may be produced by many infectious and noninfectious agents. Typically, viral hepatitis refers to several clinically similar diseases that differ in cause and epidemiology. These include hepatitis A, B, C, D (delta), E, and G. Chronic, lifelong infection has only been documented with hepatitis B virus (HBV) and hepatitis C (HCV) virus.
The differential diagnosis of a newborn liver disease includes idiopathic neonatal hepatitis (giant cell), biliary atresia, metabolic disorders, antitrypsin deficiency, cystic fibrosis, iron storage disease, and other infectious agents that cause hepatocellular injury (eg, cytomegalovirus [CMV], rubella, varicella, toxoplasmosis, Listeria, syphilis, and tuberculosis, as well as bacterial sepsis, which can cause nonspecific hepatic dysfunction). Table 87–1 outlines various hepatitis panel tests useful in the management of this disease. Isolation precautions for all infectious diseases, including maternal and neonatal precautions, breast-feeding, and visiting issues, can be found in Appendix F.
Table 87–1. HEPATITIS TESTING
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Table 87–1. HEPATITIS TESTING
Etiologic agent of "infectious" hepatitis
Detectable at onset of symptoms; lifetime persistence
Indicates recent infection with HAV; positive up to 4–6 months postinfection
Signifies previous HAV infection; confers immunity
Etiologic agent of "serum" hepatitis
Detectable in serum; earliest indicator of acute infection or indicative of chronic infection if present >6 months
Indicates past infection with and immunity to HBV, passive antibody from HBIG, or immune response from HBV vaccine
Correlates with HBV replication; high-titer HBV in serum signifies high infectivity; persistence for 6–8 weeks suggests a chronic carrier state
Presence in carrier of HBsAg suggests a lower titer of HBV and resolution of infection
No commercial test available; found only in liver tissue
High titer indicates active HBV infection; low titer presents in chronic infection
Recent infection with HBV positive for 4–6 months after infection; detectable in "window" period after surface antigen disappears
Appears later and may persist for years if viral replication continues
Etiologic agent of hepatitis C
Serologic determinant of hepatitis C infection
I. Definition. Hepatitis A virus (HAV;infectious hepatitis) is caused by a RNA virus transmitted by the fecal-oral route. A high concentration of virus is found in stools of infected persons, especially during the late incubation and early symptomatic phases. Children, especially neonates, may excrete HAV for a more prolonged period than has been noted ...
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