Chapter 5 : Viral Hepatitis

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This chapter discusses the typical clinical and pathological features of viral hepatitis as well as the suggested initial evaluation of a patient presenting with suspected viral hepatitis. Five different human hepatitis viruses have been recognized and characterized in detail. The five established agents are hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV), all RNA viruses, except for HBV, a DNA virus. Two observations established that epidemics of jaundice were caused by a filterable infectious agent, i.e., a virus. First, outbreaks of hepatitis in military personnel immunized with yellow fever vaccine were shown to have resulted from contamination of the vaccine by an agent in the serum used to supplement viral culture media. Second, viral hepatitis was transmissible to volunteers with filtered inocula. The clinical features and course of uncomplicated acute viral hepatitis are similar among the several types of viral hepatitis. Fatigue, malaise, and anorexia are common symptoms and can accompany all types of chronic viral hepatitis. In uncomplicated acute viral hepatitis, the reticulin framework is typically preserved. Acute viral hepatitis may also result from infections other than HAV to HEV. HCV RNA testing may be useful if chronic viral hepatitis is suspected but other serologic markers (including anti-HCV) are negative, particularly in immunocompromised individuals or those on chronic hemodialysis.

Citation: Tai A, Dienstag J. 2009. Viral Hepatitis, p 59-80. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch5

Key Concept Ranking

Viral Liver Diseases
Viral Hepatitis
Hepatitis B
Positive-Sense Single-Stranded RNA Viruses
Hepatitis C
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Image of FIGURE 1

Round, eosinophilic Councilman bodies (arrow) signifying apoptosis of hepatocytes. (Courtesy of G. Y. Lauwers.)

Citation: Tai A, Dienstag J. 2009. Viral Hepatitis, p 59-80. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch5
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Image of FIGURE 2

Bridging necrosis (also known as interface hepatitis or piecemeal necrosis). An inflammatory infiltrate is visible within the portal tracts, spilling out into the hepatic lobule and resulting in piecemeal necrosis or interface hepatitis (white arrow). The hepatic lobule contains fat (black arrow) within hepatocytes, a common finding in viral hepatitis. (Courtesy of G. Y. Lauwers.)

Citation: Tai A, Dienstag J. 2009. Viral Hepatitis, p 59-80. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch5
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Image of FIGURE 3

Cirrhosis resulting from chronic hepatitis C. The portal tracts contain numerous chronic inflammatory cells, which occasionally disrupt the limiting plate and spill out into the hepatocyte lobules (interface hepatitis). The lobules are separated from one another by fibrous septa to create nodules. (Courtesy of G. Y. Lauwers.)

Citation: Tai A, Dienstag J. 2009. Viral Hepatitis, p 59-80. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch5
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Image of FIGURE 4

Diagnostic approach to a patient with acute viral hepatitis.

Citation: Tai A, Dienstag J. 2009. Viral Hepatitis, p 59-80. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch5
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Image of FIGURE 5

Diagnostic approach to a patient with chronic viral hepatitis.

Citation: Tai A, Dienstag J. 2009. Viral Hepatitis, p 59-80. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch5
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Clinical and epidemiological features of viral hepatitis

Citation: Tai A, Dienstag J. 2009. Viral Hepatitis, p 59-80. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch5
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Common serologic patterns and their interpretations

Citation: Tai A, Dienstag J. 2009. Viral Hepatitis, p 59-80. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch5

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