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Hepatitis - Symptoms

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of hepatitis.

Symptoms:

Symptoms of Hepatitis A

Symptoms are usually mild, especially in children, and generally appear between 2 - 6 weeks after exposure to the virus. Adult patients are more likely to have fever, jaundice, nausea, fatigue, and itching that can last up to several months. Stools may appear chalky grey and urine will appear darkened.

Symptoms of Hepatitis B

Acute Hepatitis B. Many people with acute hepatitis B have few or no symptoms. If symptoms appear, they tend to occur 6 weeks to 6 months (most commonly 3 months) after exposure and be mild and flu-like. Symptoms may include mild fever, nausea, vomiting, loss of appetite, fatigue, or muscle or joint aches. Some patients develop dark urine and jaundice (yellowish tinge to skin).

Symptoms of acute hepatitis B can last from a few weeks to 6 months. Even if people infected with hepatitis B have no symptoms, they can still spread the virus.

Chronic Hepatitis B. While some people with chronic hepatitis B have symptoms similar to those of the acute form, many people can have the chronic form for decades and show no symptoms. Liver damage may eventually be detected when blood tests for liver function are performed (see Diagnosis section). [For more information, see In-Depth Report #75: Cirrhosis.]

Symptoms of Hepatitis C

Most patients with hepatitis C do not experience symptoms. Chronic hepatitis C can be present for 10 - 30 years, and cirrhosis or liver failure can sometimes develop before patients experience any clear symptom. Signs of liver damage may first be detected when blood tests for liver function are performed.

If initial symptoms do occur, they tend to be very mild and resemble the flu with fatigue, nausea, loss of appetite, fever, headaches, and abdominal pain. People who have symptoms usually tend to experience them about 6 - 7 weeks after exposure to the virus. Some people may not experience symptoms for up to 6 months after exposure. People who have hepatitis C can still pass the virus on to others even if they do not have symptoms.

Resources

www.cdc.gov/hepatitis -- Centers for Disease Control and Prevention
www.aasld.org -- American Association for the Study of Liver Diseases
www.hepfi.org -- Hepatitis Foundation International
www.hepb.org -- Hepatitis B Foundation
www.liverfoundation.org -- American Liver Foundation
www2.niddk.nih.gov -- National Institute of Diabetes and Digestive and Kidney Diseases
www.immunize.org -- Immunization Action Coalition
www.hivandhepatitis.com -- Hepatitis and HIV
www.unos.org -- United Network for Organ Sharing

References

Advisory Committee on Immunization Practices (ACIP) Centers for Disease Controland Prevention (CDC). Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2007 Oct 19;56(41):1080-4.

American Academy of Pediatrics Committee on Infectious Diseases. Hepatitis A vaccine recommendations. Pediatrics. 2007 Jul;120(1):189-99.

Dienstag JL. Hepatitis B virus infection. N Engl J Med. 2008 Oct 2;359(14):1486-500.

Jou JH, Muir AJ. In the clinic. Hepatitis C. Ann Intern Med. 2008 Jun 3;148(11):ITC6-1-ITC6-16.

Lai CL, Gane E, Liaw YF, Hsu CW, Thongsawat S, Wang Y, et al. Telbivudine versus lamivudine in patients with chronic hepatitis B. N Engl J Med. 2007 Dec 20;357(25):2576-88.

Lok ASF and McMahon BJ. American Association for the Study of Liver Diseases Practice Guidelines: Chronic Hepatitis B. Hepatology. 2007;2:507 -539.

Maheshwari A, Ray S, Thuluvath PJ. Acute hepatitis C. Lancet. 2008 Jul 26;372(9635):321-32.

Mukherjee S, Sorrell MF. Controversies in liver transplantation for hepatitis C. Gastroenterology. 2008 May;134(6):1777-88.

National Institutes of Health. Consensus Development Conference Statement: Management of Hepatitis B. October 20 -22, 2008.

Pungpapong S, Kim WR, Poterucha JJ. Natural history of hepatitis B virus infection: an update for clinicians. Mayo Clin Proc. 2007 Aug;82(8):967-75.

Rambaldi A, Jacobs BP, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003620.

Scott JD, Gretch DR. Molecular diagnostics of hepatitis C virus infection: a systematic review. JAMA. 2007 Feb 21;297(7):724-32.

Victor JC, Monto AS, Surdina TY, Suleimenova SZ, Vaughan G, Nainan OV, et al. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med. 2007 Oct 25;357(17):1685-94. Epub 2007 Oct 18.

Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep. 2008 Sep 19;57(RR-8):1-20

Reviewed last on: 12/5/2008
Harvey Simon, MD, Editor-in-Chief, In-Depth Reports; Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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