Transmission of Hepatits A usually precedes symptoms by 2 weeks when stool concentrations are highest. Patients are considered non-infectious 1 week after onset of jaundice.
Symptomatic patients may present with abrupt-onset fever, abdominal pain, malaise, and jaundice.
IgM anti-hepatitis A virus serology is the test of choice for diagnosis.
Common examination findings are hepatomegaly and clinical jaundice with marked elevation of serum transaminases (usually >1000 units/L).
No specific therapy is available and treatment is supportive.
Post-exposure prophylaxis may be with active or passive immunisation, depending on specific patient factors, and according to individual national guidelines.
Hepatitis A virus (HAV) is an RNA virus. It is not associated with chronic liver disease. Mode of transmission is faecal-oral; therefore, it is more prevalent in environments with improper hygiene. Most infections in adults are symptomatic, whereas 70% of infections in children younger than 6 years, who are also the key reservoir for transmission, are asymptomatic. Average incubation period is 28 days.
History and exam
Musaddiq Waheed, MD
Archbold Memorial Hospital
Assistant Clinical Professor
Florida State University School of Medicine
MW declares that he has no competing interests.
Dr Muaddiq Waheed would like to gratefully acknowledge the late Dr Fida A. Khan for his contribution to this topic.
FAK declared that he has no competing interests.
Howard J. Worman, MD
Professor of Medicine and Cell Biology
Columbia University College of Physicians and Surgeons
HJW declares that he has no competing interests.
Srikrishna Nagri, MD
SN declares that he has no competing interests.
George Y. Wu, MD, PhD
Professor of Medicine
University of Connecticut Health Center
GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.
Kittichai Promrat, MD
Division of Gastroenterology
Department of Medicine
KP declares that he has no competing interests.
Pierre Van Damme, MD, PhD
Director of Vaccine & Infectious Disease Institute
University of Antwerp
PVD has been and still is principal investigator of vaccine trials for several vaccine manufacturing companies, from which the university obtained and obtains research contracts and funds for conducting such vaccine trials.
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