Epidemiology

• 50% acquired during travels abroad

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Etiology

• Contaminated water and food (e.g., raw shellfish)

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Pathophysiology

• HAV is not cytopathic in itself; research suggests that liver damage is caused by cellular immunity (especially CD8+ T cells).

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Clinical features

Tip

• Unlike hepatitis B or C, HAV infection is a self-limiting disease that is not associated with an asymptomatic viral carrier state and does not progress to chronic hepatitis, cirrhosis, or hepatocellular carcinoma.
• HAV only has acute phase, HCV only has chronic phase

In children age < 6, HAV infection is most often (>80%) silent or subclinical . Clinical disease is typically more severe (70% of symptomatic patients with jaundice) in adults (some of whom develop an aversion to smoking, for unclear reasons)

• Incubation period: 2–6 weeks
• Phases of acute viral hepatitis
  • Prodromal phase: 1–2 weeks
    • Right upper quadrant pain, tender hepatomegaly
    • Fever, malaise
    • Anorexia, nausea, vomiting
  • Icteric phase: ∼ 2 weeks
    • Jaundice
    • Dark urine and pale stools
    • Pruritus
  • Resolution of symptoms

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Diagnostics

• Liver biopsy: not routinely indicated
  • Periportal inflammation (mononuclear cell infiltration)
  • Hepatocyte swelling
  • Ballooning degeneration
  • Bridging necrosis
  • Councilman bodies (apoptotic hepatocytes)

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Treatment

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