Hepatitis A
Diagnosis
Probable if symptoms as above and has an epidemiological link to a confirmed hepatitis A case OR has IgM antibody to the hepatitis A virus
Possible if acute illness, discrete onset of symptoms AND jaundice or elevated serum aminotransferase levels.
Confirmed if Meets the clinical case definition and has IgM and IgG antibodies to hepatitis A, OR Has hepatitis A RNA (HAV RNA) detected regardless of clinical features, OR Is asymptomatic with no recent history of immunisation, but has anti HAV IgM in oral fluid or serum, and has an epidemiological link to a confirmed hepatitis A case.
CLINICAL FEATURES
Icteric phase (from 1 up to 12 weeks)- jaundice, pale stools, dark urine, pruritis, fatigue, anorexia, nausea and vomiting. Exam may show hepatomegaly, splenomegaly, lymphadenopathy, hepatic tenderness.
Prodromal phase - Flu like symptoms, GI symptoms, nil obvious on exam.
Convalescent phase (up to 6m) - malaise, anorexia, muscle weakness, hepatic tenderness.
INVESTIGATIONS
DIFFERENTIAL DIAGNOSIS
Hepatic serology
Obtain blood sampling for hepatitis A virus immunoglobulin M (HAV-IgM) and hepatitis A virus immunoglobulin G (HAV-IgG)
IF +ve HAV-IgM and +ve HAV-IgG - acute Hep A likely
High HAV IgG and moderate HAV IgM suggests recent infections
+ve IgM and -ve IgG suggests false positive
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-ve HAV IgM and +ve HAV IgG suggests past Hep A infection or immunity.
LFTs - Raised ALT, AST and bilirubin levels
Raised Prothrombin time may suggest severe hepatitis or liver failure.
Alcohol hepatitis or drug induced liver disease.
HIV
Other causes of viral hepatitis inc Hep B,C, D and E, Cytomegalovirus, Epstein Barr virus.
Auto-immune hepatitis, bacterial causes, Granulomatous disorders, Wilsons disease.
MANAGEMENT
Contact
Managing patients
Prevention
Lifestyle, travel and occupational advice
Vaccination of high risk patients
Lifestyle advice - including STI screen, hygiene, pregnancy advice
Follow up - blood tests (4-12 weeks), referral if worsening symptoms or bloods not improving.
Symptom relief - anti-emetics, analgesia and anti- histamine