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95: Hepatitis

INTRODUCTION

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 (HBV) and hepatitis C (HCV) virus.

The differential diagnosis of 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], herpes simplex, rubella, varicella, toxoplasmosis, Listeria monocytogenes, syphilis, and tuberculosis, as well as bacterial sepsis, which can cause nonspecific hepatic dysfunction). Table 95–1 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 95–1.HEPATITIS TESTING
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Table 95–1.HEPATITIS TESTING
Specific Test Description
HAV Etiologic agent of “infectious” hepatitis
Anti-HAV Detectable at onset of symptoms; lifetime persistence
Anti-HAV-IgM Indicates recent infection with HAV; positive up to 4–6 months postinfection
Anti-HAV-IgG Signifies previous HAV infection; confers immunity
HBV Etiologic agent of “serum” hepatitis
HBsAg Detectable in serum; earliest indicator of acute infection or indicative of chronic infection if present >6 months
Anti-HBs Indicates past infection with and immunity to HBV, passive antibody from HBIG, or immune response from HBV vaccine
HBeAg Correlates with HBV replication; high-titer HBV in serum signifies high infectivity; persistence for 6–8 weeks suggests a chronic carrier state
Anti-HBe Presence in carrier of HBsAg suggests a lower titer of HBV and lower risk of transmitting HBV
HBcAg No commercial test available; found only in liver tissue
Anti-HBc Identify people with acute, resolved, or chronic HBV infection (not present after immunization); high titer indicates active HBV infection; low titer presents in chronic infection
Anti-HBc-IgM Recent infection with HBV positive for 4–6 months after infection; detectable in “window” period after surface antigen disappears
Anti-HBc-IgG Appears later and may persist for years if viral replication continues
HCV Etiologic agent of hepatitis C
Anti-HCV Serologic determinant of hepatitis C infection

anti-HAV, antibody to HAV (IgM and IgG subclasses); anti-HAV-IgG, IgG class antibody to HAV; anti-HAV-IgM, IgM class antibody to HAV; anti-HBc, antibody to HBcAg; anti-HBc-IgG, IgG class antibody to HBcAg; anti-HBc-IgM, IGM class antibody to HBcAg; anti-HBe, antibody to HBeAg; anti-HBs, antibody to HBsAg; anti-HCV, antibody to hepatitis C; HBeAg, hepatitis B e antigen; HBcAg, hepatitis B core antigen; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; HCV, hepatitis C virus; IgM and IgG, immunoglobulins M and G.

HEPATITIS A

I. DEFINITION

Hepatitis A (infectious hepatitis) is caused by a nonenveloped 27-nM RNA virus that is a member of the Picornaviridae family (HAV). It is transmitted by the fecal-oral route. ...

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