Acute viral hepatitis is a frequent cause of liver disease and is generally caused by hepatitis A, B, or C in the United States. Hepatitis D occurs as a coinfection in patients with hepatitis B and is rare in this country. Hepatitis E has been limited to travelers to foreign countries.
|
Feature |
A |
B |
C |
D |
E |
|
Family |
Picorna |
Hepadeno |
Flavi |
Satellite |
Calci |
|
Genome |
RNA |
DNA |
RNA |
RNA |
RNA |
|
Incubation Days |
15-50 |
45-160 |
30-150 |
21-90 |
14-65 |
|
Onset |
Abrupt |
Insidious |
Insidious |
Insidious |
Abrupt |
|
Oral/fecal |
Yes |
No |
No |
No |
Yes |
|
Parenteral |
Rare |
Usual |
Usual |
Usual |
No |
|
Other vectors |
Food/water |
Sexual |
Sexual |
Sexual? |
Water |
|
Carriers |
No |
Yes |
Yes |
Yes |
No |
|
Chronicity |
Rare |
25% |
75% |
10-15% |
No? |
|
Mortality % |
0.6 |
1.4 |
1 -2 |
30 |
1-2 |
The following panels and individual tests are recommended for diagnosis and monitoring of viral hepatitis.
|
Clinical Situation |
Recommended Tests |
|
Acute Hepatitis Screen |
Anti-HAV IgM, anti-HBc IgM, HBsAg, anti-HCV |
|
Hepatitis B Infectivity |
HBsAg, HBeAg, Anti-HBe |
|
Hepatitis B Carrier State |
HBsAg, HBeAg, Total Anti-HBc |
|
Hepatitis B Immunity |
Anti-HBs & Total Anti-HBc |
|
Post Hepatitis B Vaccination Immunity |
Anti-HBs |
|
Hepatitis A Immunity |
Anti-HAV, Total |
|
Hepatitis C Diagnosis |
Anti-HCV ELISA & Confirmatory PCR |
|
Hepatitis C Monitoring |
HCV Quantitative PCR |
Approximately 5-10% of community acquired hepatitis is thought attributable to non A-E types, caused by the flavi-like viruses GBV-A, GBV-B, and GBV-C. The recently reported hepatitis G is caused by one strain of GBV-C. While the natural history of these infections is not fully known, they appear to be transmitted parenterally and cause a spectrum of disease from asymptomatic infection through severe liver disease. Currently, no commercial assays are available for serological diagnosis.
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