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Hepatitis A

Type A hepatitis is an acute, generally self - limited necroinflammatory liver disease, is one frequent
cause of foodborne infection, which can cause mild to severe illness. The incubation period is usually
14 - 28 days. Most patient recover fully from infection with lifelong immunity; it does not cause chronic
liver disease and the presentation as fulminant hepatitis accounts for 0.5 % of the worldwide mortality
due to hepatitis.
To describe a case of acute liver failure due to type A hepatitis.
Female of 32 years old, with no significant past medical history, who presented at Emergency
Department for complain of jaundice, abdominal pain in right hypochondrium. She referred general
discomfort, loss of appetite, and diarrheic stools. On arrival, blood chemistry showed mixed pattern
alteration, total bilirubin 4.9 mg / dL, direct bilirubin 3.8 mg / dL, indirect bilirubin 1.1 mg / dL, AST 913
U / L, ALT 982 U / L, GGT 230 U / L, DHL 2142 U / L, and FA 175 U / L. During hospitalization, she
presented fever, encephalopathy and coluria. Physical examination was significant for somnolence,
mild scleral icterus and right upper quadrant abdominal tenderness. Study protocol was initiated to rule
out Weil syndrome and other viral etiology hepatitis. Ultrasound of the liver and bile duct reported
hepatomegaly and splenomegaly; type B and C hepatitis panel, TORCH panel and Elisa for HIV
reported as negatives. Diagnosis of type A hepatitis was confirmed upon report of positive IgM and IgG
> 81mUl / ml for type A hepatitis virus.
The course of type A hepatitis is typically more severe in adults than in children. Adult infections will be
characterized by diarrhea and hyperbilirrubinemia peaking 7 to 10 days after the onset of jaundice. In
the context of the epidemiological paradox, liver failure from type A hepatitis is rare, and is estimated
to occur in less than 5 % of cases. The treatment is supportive.
World Health Organization. (2020). Hepatitis A. October 8, 2020. World Health Organization. Sitio web:
Lemon, S. Ott, J. Damm, P. Shouval, D. Type A viral hepatitis: A summary and update on the molecular
virology, epidemiology, pathogenesis and prevention. (2018). Journal of hepatology. 68: 167-184.
Abutaleb, A. Kottilil, S. Hepatitis A: epidemiology, natural history, unusual clinical manifestations and
Desai, A. Kim, A. Management of Hepatitis A in 2020-2021. (2020). Journal of American Medical
Association. 1: E1-E2. doi:10.1001/jama.2020.4017.
Randazzo, W. Sánchez, G. Hepatitis A infections from food. (2020). Journal of applied microbiology.
1:1-13. doi: 10.1111/jam14727.
Razavi, H. Global epidemiology of viral hepatitis. (2020). Gastroenterology Clinics of North America 49:
Arshad, M. Murphy, N. Bangash, M. Acute liver failure. (2020). Clinical Medicine. Royal college of
physicians. 20 (5): 505–508. doi: 10.7861/clinmed.2020-0612.
Type A Hepatitis Highlights
1.4 million cases per year globally
Infections can be sporadic or epidemic
Fecal - oral
Person to person contact
IgM antibodies to HAV
Classical presentation
Children: Asymptomatic
Adults: Jaundice, RUQ pain, hyperbilirubinemia, anorexia.
Unusual presentation
Relapsing hepatitis
Prolonged cholestasis
Acute liver failure
HAV vaccine
Postexposure prophylaxis HAV vaccine
HAV immune globulin