Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- fever
- malaise
- nausea and vomiting
- jaundice
- hepatomegaly
- right upper quadrant pain
- clay-coloured stools
Other diagnostic factors
- fatigue
- headache
- dark urine
- pruritus
- arthralgias and myalgias
- cough
- diarrhoea
- constipation
- splenomegaly
- posterior cervical lymphadenopathy
- evanescent rash
- bradycardia
Risk factors
- living in endemic region
- travel to endemic region
- close personal contact with an infected person
- men who have sex with men
- known foodborne outbreak
- illegal drug use
- homelessness
- occupational exposure
Diagnostic investigations
1st investigations to order
- serum transaminases
- serum bilirubin
- blood urea
- serum creatinine
- prothrombin time
- immunoglobulin M (IgM) anti-hepatitis A virus (HAV)
Investigations to consider
- immunoglobulin G (IgG) anti-hepatitis A virus (HAV)
- hepatitis A virus RNA detection
Treatment algorithm
unvaccinated people with recent exposure to hepatitis A (<2 weeks)
confirmed hepatitis A
Contributors
Authors
Doan Y Dao, MD
Assistant Professor of Medicine
Director, Center of Excellence for Liver Disease in Vietnam
Johns Hopkins School of Medicine
Department of Medicine
Division of GI and Hepatology
Baltimore MD
Disclosures
DYD receives grants from Roche Diagnostics International Ltd and Gilead Sciences.
Acknowledgements
Dr Doan Dao would like to gratefully acknowledge Dr Musaddiq Waheed and the late Dr Fida A. Khan, the previous contributors to this topic.
Disclosures
MW and FAK declared that they have no competing interests.
Peer reviewers
Howard J. Worman, MD
Professor of Medicine and Cell Biology
Columbia University College of Physicians and Surgeons
New York
NY
Disclosures
HJW declares that he has no competing interests.
Srikrishna Nagri, MD
Gastroenterologist
Dartmouth-Hitchcock Nashua
Nashua
NH
Disclosures
SN declares that he has no competing interests.
George Y. Wu, MD, PhD
Professor of Medicine
University of Connecticut Health Center
Farmington
CT
Disclosures
GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.
Kittichai Promrat, MD
Assistant Professor
Division of Gastroenterology
Department of Medicine
Brown University
RI
Disclosures
KP declares that he has no competing interests.
Pierre Van Damme, MD, PhD
Professor
Director of Vaccine & Infectious Disease Institute
University of Antwerp
Antwerp
Belgium
Disclosures
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.
References
Key articles
Centers for Disease Control and Prevention. Hepatitis A. [internet publication].Full text
Kemmer NM, Miskovsky EP. Hepatitis A. Infect Dis Clin North Am. 2000 Sep;14(3):605-15. Abstract
Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020 Jul 3;69(5):1-38.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Acute hepatitis B
- Hepatitis E
- Acute hepatitis C
More DifferentialsGuidelines
- Hepatitis A
- Child and adolescent immunization schedule by age: recommendations for ages 18 years or younger, United States, 2025
More Guidelines
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