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Viral Hepatitis

Human Viral Hepatitis

Viral hepatitis is an inflammatory liver condition that most commonly arises from hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV). The prevalence of these viruses varies geographically.


Ground glass hepatocytes high mag cropped 2
Ground glass hepatocytes high mag cropped 2
Ground glass hepatocytes high mag cropped 2, CC BY-SA 3.0

Presentation

The clinical picture of acute viral hepatitis is variable and is dependent on the type of the virus and the individual circumstances [1]. This is often a self-limiting disease as a majority of patients will exhibit no/mild symptoms [2]. However, a few may develop a rapid onset of fulminant liver failure.

There are 4 phases of viral hepatitis. In the viral replication stage, the infection is not clinically apparent although the serology is positive. This is followed by the prodromal period, which is characterized by acute manifestations such as fatigue, malaise, fever, anorexia, nausea, emesis, abdominal pain, urticaria, and arthralgia. In the icteric phase, the patients develop jaundice, gastrointestinal disturbance, dark urine, gray-colored stools, right upper quadrant pain, and hepatomegaly. Finally, recovery of the symptoms and liver enzymes occurs in the convalescence stage.

Complications

Patients with HBV and HCV can cause chronic infection, cirrhosis, and hepatocellular carcinoma [3].

Physical exam

Assessment of the patient may yield remarkable findings such as jaundice, scleral icterus, and an enlarged and tender liver.

Fever
  • Abstract A typhoid patient presenting with fever and jaundice is reported. Investigations revealed that the patient had both typhoid fever and acute viral hepatitis A.[ncbi.nlm.nih.gov]
  • This article is centered on the histologic patterns of injury in acute viral hepatitis, encompassing the hepatotropic viruses A, B, C, D, and E and the "icteric hemorrhagic fevers" (dengue, hantavirus, yellow fever).[ncbi.nlm.nih.gov]
  • The virus first known to cause hepatitis was the yellow fever virus, a mosquito-borne flavivirus.[en.wikipedia.org]
  • A 62-year-old man, affected by Chronic Active Hepatitis (discovered in 1993) and treated with interferon, referred to our department with increased abdominal volume, persistent abdominal pain, continuous-remittent fever and jaundice.[ncbi.nlm.nih.gov]
  • She was admitted to our hospital with fever, jaundice and abdominal pain. Hepatic and pancreatic enzymes were elevated. Her serum alanine aminotransferase (ALT) level was high.[ncbi.nlm.nih.gov]
Fatigue
  • This is followed by the prodromal period, which is characterized by acute manifestations such as fatigue, malaise, fever, anorexia, nausea, emesis, abdominal pain, urticaria, and arthralgia.[symptoma.com]
  • Symptoms of acute (newly acquired) hepatitis include: fever, fatigue, loss of appetite, nausea, vomiting, abdominal/stomach pain, dark urine, clay-colored feces, joint pain, and jaundice (yellowing of the skin or eyes).[dph.georgia.gov]
  • The most frequently reported symptom was fatigue (73.7%), and the most common complications were cholecystitis (0.4%) and fulminant hepatitis (0.4%). The median hospital stay was 9 days (range 1-373).[ncbi.nlm.nih.gov]
  • HCV or HBV carriers may exhibit the following symptoms: Fever Fatigue Decreased appetite Nausea Vomiting Abdominal pain Dark urine Grey-coloured faeces Joint pain Jaundice An in vitro laboratory diagnostic test is therefore crucial to confirm a diagnosis[roche.com]
  • Clinically, constitutional symptoms along with malaise, fatigue, and anorexia may be present.[pathwaymedicine.org]
Malaise
  • She was admitted to the hospital with a history of general malaise and nausea of 5 days duration. Her serum showed high transaminase levels and positive HBs-Ag and increased IgM HBc-Ab titers.[ncbi.nlm.nih.gov]
  • This is followed by the prodromal period, which is characterized by acute manifestations such as fatigue, malaise, fever, anorexia, nausea, emesis, abdominal pain, urticaria, and arthralgia.[symptoma.com]
  • Clinically, constitutional symptoms along with malaise, fatigue, and anorexia may be present.[pathwaymedicine.org]
  • Characteristic of viral hepatitis are anorexia, malaise, headache, pain over the liver, fever, jaundice, clay-colored stools, dark urine, nausea and vomiting, and diarrhea.[medical-dictionary.thefreedictionary.com]
  • They include A poor appetite A general feeling of illness (malaise) Nausea and vomiting Often a fever Often pain in the upper right part of the abdomen (where the liver is located) In people who smoke, a distaste for cigarettes is a typical symptom.[merckmanuals.com]
Weight Loss
  • The symptoms are similar to mild flu , and may include : Jaundice is a symptom of hepatitis. diarrhea fatigue loss of appetite mild fever muscle or joint aches nausea slight abdominal pain vomiting weight loss jaundice The acute phase is not usually dangerous[medicalnewstoday.com]
  • The symptoms are similar to mild flu, and may include : Jaundice is a symptom of hepatitis. diarrhea fatigue loss of appetite mild fever muscle or joint aches nausea slight abdominal pain vomiting weight loss jaundice The acute phase is not usually dangerous[medicalnewstoday.com]
  • They include: fatigue flu-like symptoms dark urine pale stool abdominal pain loss of appetite unexplained weight loss yellow skin and eyes, which may be signs of jaundice Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle[healthline.com]
Anemia
  • The interferons have side effects, which include anemia, depression, and other problems and while they are a recommended therapy, are much less commonly used in the United States than the oral medications.[patients.gi.org]
  • At Mayo Clinic, we reported two cases of a less severe form of hepatitis-associated aplastic anemia 79.[doi.org]
  • But there are side effects to this treatment, including severe anemia (low red blood cells) and birth defects.[webmd.com]
Nausea
  • She was admitted to the hospital with a history of general malaise and nausea of 5 days duration. Her serum showed high transaminase levels and positive HBs-Ag and increased IgM HBc-Ab titers.[ncbi.nlm.nih.gov]
  • This is followed by the prodromal period, which is characterized by acute manifestations such as fatigue, malaise, fever, anorexia, nausea, emesis, abdominal pain, urticaria, and arthralgia.[symptoma.com]
  • A nonspecific viral prodrome is followed by anorexia, nausea, and often fever or right upper quadrant pain. Jaundice often develops, typically as other symptoms begin to resolve.[msdmanuals.com]
  • Soda, juices, and hard candy may help reduce nausea. Follow your doctor’s instructions for medicines to take to relieve your symptoms. As your symptoms improve, you may gradually increase your level of activity.[hepatitiscentral.com]
  • Common symptoms include: Feeling tired Discomfort or an ache over the liver Nausea Viral Hepatitis Diagnosis The diagnosis of viral hepatitis begins with blood tests for liver enzymes, such as an aspartate aminotransferase (AST) test and/or an alanine[uofmhealth.org]
Vomiting
  • Symptoms of acute (newly acquired) hepatitis include: fever, fatigue, loss of appetite, nausea, vomiting, abdominal/stomach pain, dark urine, clay-colored feces, joint pain, and jaundice (yellowing of the skin or eyes).[dph.georgia.gov]
  • Affected people may have a poor appetite, nausea, vomiting, fever, pain in the upper right part of the abdomen, and jaundice. Doctors do a physical examination and take blood samples to analyze. Vaccines can prevent hepatitis A, B, and E.[merckmanuals.com]
  • Characteristic of viral hepatitis are anorexia, malaise, headache, pain over the liver, fever, jaundice, clay-colored stools, dark urine, nausea and vomiting, and diarrhea.[medical-dictionary.thefreedictionary.com]
  • HCV or HBV carriers may exhibit the following symptoms: Fever Fatigue Decreased appetite Nausea Vomiting Abdominal pain Dark urine Grey-coloured faeces Joint pain Jaundice An in vitro laboratory diagnostic test is therefore crucial to confirm a diagnosis[roche.com]
Loss of Appetite
  • Symptoms of acute (newly acquired) hepatitis include: fever, fatigue, loss of appetite, nausea, vomiting, abdominal/stomach pain, dark urine, clay-colored feces, joint pain, and jaundice (yellowing of the skin or eyes).[dph.georgia.gov]
  • In healthy individuals, it causes an acute illness with fever, loss of appetite and jaundice lasting two to three weeks. Complete recovery is the rule, followed by life-long immunity to the virus.[ucsfhealth.org]
  • Possible symptoms may include, tiredness, abdominal pain, loss of appetite , feeling and being sick and jaundice (yellowing of the whites of the eyes and skin).[perspectum-diagnostics.com]
  • In most people, interferon-ribavirin causes flu-like symptoms with muscular aches, irritability, loss of appetite and depression. Rashes and hair loss also may occur.[ucsfhealth.org]
  • Others may have Loss of appetite Nausea and vomiting Diarrhea Dark-colored urine and pale bowel movements Stomach pain Jaundice, yellowing of skin and eyes Some forms of hepatitis are mild, and others can be serious.[medlineplus.gov]
Abdominal Pain
  • This case report, along with the review presented, describes a patient diagnosed with acute viral hepatitis, who developed a framework of intense abdominal pain and laboratorial alterations compatible with acute pancreatitis.[ncbi.nlm.nih.gov]
  • Besides features of viral hepatitis, the presence of typical abdominal pain, high serum amylase, and ultrasound or CT scan features suggested the diagnosis of acute pancreatitis.[ncbi.nlm.nih.gov]
  • A 62-year-old man, affected by Chronic Active Hepatitis (discovered in 1993) and treated with interferon, referred to our department with increased abdominal volume, persistent abdominal pain, continuous-remittent fever and jaundice.[ncbi.nlm.nih.gov]
  • She was admitted to our hospital with fever, jaundice and abdominal pain. Hepatic and pancreatic enzymes were elevated. Her serum alanine aminotransferase (ALT) level was high.[ncbi.nlm.nih.gov]
  • A CT scan of the abdomen obtained for evaluation of lower abdominal pain showed a 4- x 4- x 6.5-cm mass in the right lobe of the liver that, on biopsy, was found to be poorly differentiated HCC.[ncbi.nlm.nih.gov]
Diarrhea
  • In older cattle bovine virus diarrhea (mucosal disease) is the major cause.[medical-dictionary.thefreedictionary.com]
  • Others may have Loss of appetite Nausea and vomiting Diarrhea Dark-colored urine and pale bowel movements Stomach pain Jaundice, yellowing of skin and eyes Some forms of hepatitis are mild, and others can be serious.[medlineplus.gov]
  • The symptoms are similar to mild flu , and may include : Jaundice is a symptom of hepatitis. diarrhea fatigue loss of appetite mild fever muscle or joint aches nausea slight abdominal pain vomiting weight loss jaundice The acute phase is not usually dangerous[medicalnewstoday.com]
  • The symptoms are similar to mild flu, and may include : Jaundice is a symptom of hepatitis. diarrhea fatigue loss of appetite mild fever muscle or joint aches nausea slight abdominal pain vomiting weight loss jaundice The acute phase is not usually dangerous[medicalnewstoday.com]
  • The symptoms of acute viral hepatitis can include low-grade fever, headaches, muscle ache, tiredness, loss of appetite, nausea, vomiting, diarrhea, dark-colored urine or light-colored stools.[patients.gi.org]
Jaundice
  • Jaundice is a rare clinical presentation in typhoid fever, therefore hepatitis A should be considered in typhoid fever and jaundice because both enterically transmitted disease may simultaneously occur.[ncbi.nlm.nih.gov]
  • The serum level of interferon alpha (INF alpha) in patients with different clinical forms of acute viral hepatitis during the first 10 days, from day 11 to day 20, and after day 20 of the onset of jaundice was studied using the radioimmunoassay test of[ncbi.nlm.nih.gov]
  • Three patients presented only jaundice and hepatomegaly; one also had liver failure. All the four patients underwent bone marrow aspiration which showed bone marrow aplasia.[ncbi.nlm.nih.gov]
  • The dilemma in which an anesthesiologist is put is whether to promise the anesthesia straightaway in the face of a demonstrable acute jaundice in pregnancy to advise a postponement of surgery until a turn for the better.[ncbi.nlm.nih.gov]
  • A 62-year-old man, affected by Chronic Active Hepatitis (discovered in 1993) and treated with interferon, referred to our department with increased abdominal volume, persistent abdominal pain, continuous-remittent fever and jaundice.[ncbi.nlm.nih.gov]
Hepatomegaly
  • Three patients presented only jaundice and hepatomegaly; one also had liver failure. All the four patients underwent bone marrow aspiration which showed bone marrow aplasia.[ncbi.nlm.nih.gov]
  • In the icteric phase, the patients develop jaundice, gastrointestinal disturbance, dark urine, gray-colored stools, right upper quadrant pain, and hepatomegaly. Finally, recovery of the symptoms and liver enzymes occurs in the convalescence stage.[symptoma.com]
  • Rare manifestations of CMV hepatitis include tender hepatomegaly, granulomatous hepatitis, anicteric or icteric cholestatic hepatitis, and acute hepatitis with massive necrosis. Figure 2. Massive hepatic necrosis due to Hsv-1.[doi.org]
Scleral Icterus
  • Physical exam Assessment of the patient may yield remarkable findings such as jaundice, scleral icterus, and an enlarged and tender liver.[symptoma.com]
  • Icteric Phase During this phase clinical signs of jaundice and scleral icterus will appear and some right upper quadrant tenderness may develop due to enlargement of the liver.[pathwaymedicine.org]
Hepatosplenomegaly
  • Hepatosplenomegaly and laboratory evidence of mild to moderate hepatic dysfunction are the predominant features, with increased aminotransferases and alkaline phosphatase in 88% and 64% of cases, respectively, but lower than commonly encountered in active[doi.org]
Arthralgia
  • This is followed by the prodromal period, which is characterized by acute manifestations such as fatigue, malaise, fever, anorexia, nausea, emesis, abdominal pain, urticaria, and arthralgia.[symptoma.com]
  • Shed HBsAg can form immune complexes that can then deposit in multiple tissues causing certain glomerular pathologies , skin rash, and arthralgia. Gross Appearance The liver may be enlarged and slightly reddened.[pathwaymedicine.org]
  • HCV RNA can be demonstrated in the tumor as well as in surrounding liver tissue although HCV RNA cannot be integrated in the hepatocytic DNA. 3--Essential cryoglobulinemia -which produce purpura, arthralgia and weakness.[meddean.luc.edu]
Urticaria
  • This is followed by the prodromal period, which is characterized by acute manifestations such as fatigue, malaise, fever, anorexia, nausea, emesis, abdominal pain, urticaria, and arthralgia.[symptoma.com]
  • Skin signs of acute viral hepatitis Acute urticaria is commonly observed in patients with viral infections, including HAV, HBV and HCV.[dermnetnz.org]
  • Occasionally, especially with hepatitis B, infected people develop joint pains and itchy red hives on the skin (wheals or urticaria).[merckmanuals.com]
Dark Urine
  • In the icteric phase, the patients develop jaundice, gastrointestinal disturbance, dark urine, gray-colored stools, right upper quadrant pain, and hepatomegaly. Finally, recovery of the symptoms and liver enzymes occurs in the convalescence stage.[symptoma.com]
  • Symptoms of acute (newly acquired) hepatitis include: fever, fatigue, loss of appetite, nausea, vomiting, abdominal/stomach pain, dark urine, clay-colored feces, joint pain, and jaundice (yellowing of the skin or eyes).[dph.georgia.gov]
  • HCV or HBV carriers may exhibit the following symptoms: Fever Fatigue Decreased appetite Nausea Vomiting Abdominal pain Dark urine Grey-coloured faeces Joint pain Jaundice An in vitro laboratory diagnostic test is therefore crucial to confirm a diagnosis[roche.com]
  • The most common symptoms of hepatitis include: Dark urine (hepatitis A, B, C) Stomach pain (hepatitis B, C) Yellow skin or eye whites, called jaundice (hepatitis A, B, C) Pale or clay-colored stool (hepatitis A, C) Low-grade fever (hepatitis A, B, C)[my.clevelandclinic.org]
Headache
  • She complained of blurred vision and headache mainly while reading. She had a 35-year history of hepatitis B and liver cirrhosis.[ncbi.nlm.nih.gov]
  • Characteristic of viral hepatitis are anorexia, malaise, headache, pain over the liver, fever, jaundice, clay-colored stools, dark urine, nausea and vomiting, and diarrhea.[medical-dictionary.thefreedictionary.com]
  • The symptoms of acute viral hepatitis can include low-grade fever, headaches, muscle ache, tiredness, loss of appetite, nausea, vomiting, diarrhea, dark-colored urine or light-colored stools.[patients.gi.org]
  • Urticaria associated with fever , headache and painful joints is known as serum sickness-like reaction , and affects 20% to 30% of patients with acute hepatitis B.[dermnetnz.org]
  • Urticaria associated with fever, headache and painful joints is known as serum sickness-like reaction and affects 20% to 30% of patients with acute hepatitis B.[dermnetnz.org]

Workup

The workup consists of the assessment of the clinical presentation, history and risk factors, physical examination, and the pertinent tests.

Laboratory tests

Patients suspected to have viral hepatitis should undergo serology studies to determine the presence of antibodies to the virus. Interpretation of serology markers takes into account differentiation between acute and chronic infection as well as what constitutes an immune status. Also, the clinician must consider the window period for the specific viral subtypes.

Hepatitis A

An acute infection with HAV is associated with immunoglobulin M (IgM) anti-HAV antibodies [4], which persists for a few months whereas immunoglobulin G (IgG) antibodies reflect a history of infection.

Hepatitis B

Diagnosis of hepatitis B is based on numerous markers. An acute infection is represented by the detection of HBsAg, anti-HBc (total- IgM and IgG antibodies), IgM anti-HBc, and negative anti-HBs [5].

Chronic hepatitis B infection is characterized by the presence of HBsAg that has persisted for more than 6 months [4], positive anti-HBc (total), and negative IgM anti-HBc and anti-HBs [5]. Also, HBV DNA levels are increased [6]. Additionally, alanine transaminase (ALT) and aspartate transaminase (AST) levels are consistently or intermittently elevated [6].

Patients who are immune due to past exposure exhibit negative HBsAg but positive anti-HBc and anti-HBs while those who have received vaccination for hepatitis B demonstrate negative HBsAg and anti-HBc with a positive anti-HBs [5].

Also, HBeAg is present when viral replication is taking place while anti-HBe is detectable when HBeAg subsides.

Hepatitis C

In addition to serology, HCV RNA testing and liver biopsy also helpful for diagnosis of hepatitis C. A reactive HCV antibody test does not determine whether the infection is acute or chronic [7] [8], hence further evaluation with HCV RNA testing is warranted. If the latter is detected, then the infection is currently active [9] [10]. Moreover, liver enzymes should be obtained.

Hepatitis D

This disease is diagnosed with the detection of IgM anti-HDV and IgG anti-HDV.

Hepatitis E

HEV infection is diagnosed by IgM anti-HEV and IgG anti-HEV. Moreover, blood and stool samples may be positive for HEV RNA.

Hepatocellular Carcinoma
  • Abstract Chronic infection with hepatitis viruses represents the major causative factor for end-stage liver diseases, including liver cirrhosis and primary liver cancer (hepatocellular carcinoma, HCC).[ncbi.nlm.nih.gov]
  • KEYWORDS: chronic viral hepatitis; hepatitis B; hepatitis C; hepatocarcinogenesis; hepatocellular carcinoma; virus-induced cancer[ncbi.nlm.nih.gov]
  • This inflammation can be acute and self-limited, chronic (leading to cirrhosis and an increased risk for hepatocellular carcinoma), or fulminant (requiring lifesaving liver transplantation).[ncbi.nlm.nih.gov]
  • Because the dreaded complications of chronic HBV and HCV--cirrhosis with liver failure and hepatocellular carcinoma--can be seen in childhood, routine follow-up with a pediatric gastroenterologist or hepatologist is recommended.[ncbi.nlm.nih.gov]
  • Here, we briefly review the structural diversity of glycans in viral hepatitis -related hepatocellular carcinoma, discuss their roles in regulating the initiation and development of liver cancer, and introduce potential clinical applications.[ncbi.nlm.nih.gov]
Liver Biopsy
  • Background/Aims: The invasiveness of a liver biopsy and its inconsistent results have prompted efforts to develop noninvasive tools to evaluate the severity of chronic hepatitis.[ncbi.nlm.nih.gov]
  • Before RTE, all patients underwent a US-guided percutaneous liver biopsy (right lobe).[ncbi.nlm.nih.gov]
  • In two of the four patients a liver biopsy revealed patchy necrosis with inflammatory mononuclear cell infiltrate.[ncbi.nlm.nih.gov]
  • This report describes unusual foci of hepatocellular hemosiderosis ("iron-rich foci" or IRF) in liver biopsy specimens from three patients with chronic hepatitis with or without cirrhosis (two hepatitis C-related, one hepatitis B-related).[ncbi.nlm.nih.gov]
  • Percutaneous liver biopsies were performed. Liver specimens were examined by light and electron microscopy, and immunohistochemistry.[ncbi.nlm.nih.gov]

Treatment
  • Epidemiological features, screening strategies and indications for treatment and monitoring have been explored and commented.[ncbi.nlm.nih.gov]
  • treatment in those with known HCV infection; reinfection with HCV; and migration of HCV-infected populations.[ncbi.nlm.nih.gov]
  • The laboratory diagnosis of viral hepatitis is important in order to plan immediate patient management, determine treatment choices and provide patient education in order to limit transmission of infections to others.[ncbi.nlm.nih.gov]
  • However, as the experience of treatment increases, new challenges have emerged for the maximum optimization and success of therapy.[ncbi.nlm.nih.gov]
  • Despite severe thyrotoxicosis, combined IFN-alpha and ribavirin therapy was continued and radioiodine treatment was considered for Graves' disease.[ncbi.nlm.nih.gov]

Prognosis
  • The three major viruses that affect the liver , hepatitis A, B, and C (HAV, HBV, HCV) differ according to mode of transmission, pathology, and prognosis.[healthcommunities.com]
  • These differences impact eligibility for potentially-curative therapy and prognosis.[bmcgastroenterol.biomedcentral.com]
  • Roberts, Prognosis of 18 H7N9 Avian Influenza Patients in Shanghai, PLoS ONE, 9, 4, (e88728), (2014).[doi.org]
  • To learn more about the route of transmission and prognosis for each virus, visit the CDC’s Division of Viral Hepatitis.[drugabuse.gov]
  • Acute parvovirus B19 infection associated with fulminant hepatitis of favourable prognosis in young children. Lancet 1998; 352: 1739-41. [ Links ] 78. Brown K. Parvoviruses. Fifth ed. Vol. 2 Philadelphia: Churchill Livingstone; 2000.[doi.org]

Etiology
  • CONCLUSION: Adie's tonic pupil is benign neuro-ophthalmological disorder of unknown etiology. Most patients commonly present no symptoms and anisocoria is noticed accidentally.[ncbi.nlm.nih.gov]
  • Etiology remains controversial. We report association of this entity in a male child with viral hepatitis A.[ncbi.nlm.nih.gov]
  • This article outlines laboratory investigations that may be routinely ordered to assist in determining the etiology of viral hepatitis and summarises some preventive and treatment strategies that may be adopted.[ncbi.nlm.nih.gov]
  • The main epidemiological and etiological features of such association are also reported.[ncbi.nlm.nih.gov]
  • Recently, these viruses have been reported to have an etiologic role in the development of intrahepatic cholangiocarcinoma (ICC).[ncbi.nlm.nih.gov]

Epidemiology

Sex distribution
Age distribution

Pathophysiology
  • Further work is needed to confirm this association and to investigate pathophysiologic pathways, potentially advancing etiologic understanding of PD more broadly. 2017 American Academy of Neurology.[ncbi.nlm.nih.gov]
  • Further work is needed to confirm this association and to investigate pathophysiologic pathways, potentially advancing etiologic understanding of PD more broadly.[n.neurology.org]
  • Despite histologic similarities in end-organ damage and eventual carcinomas, adequate scientific rationale supports a proposed hypothesis that distinct pathophysiologic mechanisms may be responsible for hepatocarcinogenesis due to either HBV or HCV.[bmcgastroenterol.biomedcentral.com]

Prevention
  • , risk assessment for blood product and organ transplants recipients, prevention strategies for severe and chronic VHE, and laboratory test algorithms.[ncbi.nlm.nih.gov]
  • There also have been scores of recorded cases of viral hepatitis caused by herpes simplex virus.The most common types of hepatitis can be prevented or treated. Hepatitis A and hepatitis B can be prevented by vaccination.[en.wikipedia.org]
  • This secondary analysis of data reported in the 2013 Global Policy Report on the Prevention and Control of Viral Hepatitis in WHO Member States used logistic regression to examine associations between four survey questions and four socioeconomic factors[ncbi.nlm.nih.gov]
  • Testing and diagnosis is the gateway for access to both treatment and prevention services, but there remains a large burden of undiagnosed infection globally.[ncbi.nlm.nih.gov]
  • Progression of hepatitis B virus-related liver diseases can be prevented by long-term viral suppression with effective drugs.[ncbi.nlm.nih.gov]

References

Article

  1. McIntyre N. Clinical presentation of acute viral hepatitis. Br Med Bull. 1990; 46(2):533-47.
  2. Ryder SD, Beckingham IJ. Acute hepatitis. BMJ . 2001; 322(7279):151-153.
  3. Wasley A, Grytdal S, Gallagher K. Surveillance for acute viral hepatitis--United States, 2006. MMWR Surveill Summ. 2008; 57(2):1-24.
  4. Krajden M, McNabb G, Petric M. The laboratory diagnosis of hepatitis B virus. Can J Infect Dis Med Microbiol. 2005; 16(2):65-72.
  5. Interpretation of Hepatitis B Serologic Test Results. Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/hbv/pdfs/serologicchartv8.pdf. Accessed November 4, 2016.
  6. Lin KW, Kirchner DO. Am Fam Physician. 2004; 69(1):75-82.
  7. Yuki N, Hayashi N, Ohkawa K, et al. The significance of immunoglobulin M antibody response to hepatitis C virus core protein in patients with chronic hepatitis C. Hepatology. 1995; 22(2):402–406.
  8. Irshad M, Mankotia DS, Irshad K. An insight into the diagnosis and pathogenesis of hepatitis C virus infection. WJG. 2013; 19(44):7896-7909.
  9. Centers for Disease Control and Prevention. Testing for HCV infection: An update of guidance for clinicians and laboratorians. MMWR. 2013; 62(18):362-5.
  10. Klimashevskaya S, Obriadina A, Ulanova T, et al. Distinguishing Acute from Chronic and Resolved Hepatitis C Virus (HCV) Infections by Measurement of Anti-HCV Immunoglobulin G Avidity Index . J Clin Microbiol. 2007; 45(10):3400-3403.

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Last updated: 2019-07-11 21:54