Hepatitis D
·
Defective virus that can only
replicate in the presence of HBV infection (requires HBsAg as a viral coat)
·
Common in Middle East, Pacific
Islands
·
Clinical:
o Acute D on Acute B: in IV drug users.
Often severe/fulminating
o Chronic D on Chronic B: endemic in many parts of the world. Perinatal transmission
·
Complications: Chronic hepatitis more common in HBV carriers
who are also infected with HDV
·
HBV vaccination also protects
against HDV
·
Faecally transmitted:
contaminated food and water
·
Epidemic in India, China, Russia,
parts of Africa
·
Higher mortality than HAV, up to
20% in pregnant women
·
Test for IgM-specific antibody
·
1% of infections present as acute
viral hepatitis, with significant elevation of ALT (mild ÂALT in
most cases)
·
DNA virus
·
One of Herpes Group
· Spread by respiratory secretions (e.g. sneeze, kiss)
· Pre-schoolers an important reservoir: usually just a non-specific URT infection. In later life (e.g. adolescent) get it more acutely plus hepatitis. 1 – 5% present as hepatitis
· Associated with Burkett‟s lymphoma & nasopharyngeal carcinoma
Clinical
·
Highly variable course. Often asymptomatic if < 5 years
·
Sore throat (often exudative)
·
Fever
· Lymph nodes up
·
Tender liver (liver involvement ® ¯appetite
and Âfeeling unwell), maybe big spleen
·
Rash in 10%
·
Doesn‟t resolve (especially after
antibiotics)
·
Will be tired for weeks/months
·
Incubation 30 – 50 days
·
Association with symptoms:
·
See Infectious diseases chapter
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