The document discusses the various causes of acute viral hepatitis, including hepatitis A, B, C, D, and E. It notes that while symptoms are generally similar between the different types and include fever, jaundice, and nausea, there are differences in transmission method, incubation period, likelihood of chronic infection, and available treatments and vaccines for each. For example, hepatitis A is transmitted through contaminated food or water and has a vaccine, while hepatitis C has a higher rate of chronic infection and was previously difficult to treat.

1. Acute viral hepatitis
A, B, C, D, E

2. Acute hepatitis- causes
 Viral- AVH
 Hepatitis A-E
 Immunosuppressed- CMV, EBV, HSV
 Other infection- Leptospirosis, Brucellosis
 Alcohol
 Drugs- H,R,Z, paracetamol etc.
 Ischemic
 Pregnancy
 SLE
 Wilson’s disease

3. Common features of AVH
 Variable incubation period, followed by
 Fever, malaise, myalgia, RUQ pain,
nausea/vomiting, loss of appetite
 Jaundice, seen in ~1/3rd
,
follows resolution of fever
 More symptomatic in young
 ALT/SGPT- markedly elevated
 FHF rare- ~1%- encephalopathy
 Clinical resolution over 2-6 weeks

4. Hepatitis A
 RNA virus of picornavirus family
 Transmission- feco-oral
 Sporadic or epidemic
 Incubation period- ~30 days
 More severe in adults
 FHF rare, no chronic state
 Rx- supportive
 Vaccine - inactivated HAV- 2 doses in 1 year

5. Hepatitis E
 RNA virus of herpeviridae family
 Transmission- water-borne
 Epidemics in developing world
 Incubation period- 3-8 weeks- avg. 5 wks.
 Severe in pregnant women
 Mostly self-limited, no chronicity
 Rx- supportive

6. Hepatitis B
 dsDNA virus, 8 genotypes- A-H
 Transmission- sexual, infected blood, vertical
 Incubation period- average 3 months
 FHF- rare, mortality ~60%
 Chronicity- 1-10%, more in infants ~90%
 Rx-
 Supportive
 HBIG- attenuates severity- 0.06 ml/kg
 Lamivudine/Entecavir in severe disease
 Vaccine- 3 doses- 0,1,6

7. HBV markers
 HBsAg- 1st
evidence of infection, persistence
indicates chronicity
 Anti-HBs- recovery, immunity
 HBcAg- not detected in blood
 IgMIgG anti-HBc over the course of
disease
 HBeAg- viral replication & infectivity
 Anti-HBe- decreased infectivity
 HBV-DNA- viral replication & infectivity

8. Hepatitis D
Only with HBV infection
Acute infection- no different
Chronic infection- more severe

9. Hepatitis C
 RNA virus of flavivirus family, 6 genotypes
 Transmission- sexual, infected blood, vertical
 Incubation period- 6-7 weeks
 Acute infection- usually asymptomatic
 Chronicity- >70%
 Dx- anti-HCV or HCV-RNA
 Rx- acute-supportive

10. Hepatitis C
 RNA virus of flavivirus family, 6 genotypes
 Transmission- sexual, infected blood, vertical
 Incubation period- 6-7 weeks
 Acute infection- usually asymptomatic
 Chronicity- >70%
 Dx- anti-HCV or HCV-RNA
 Rx- acute-supportive