Hepatitis D,E - Liver Disease

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

Hepatitis E

·        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

Epstein Barr Virus

·        1% of infections present as acute viral hepatitis, with significant elevation of ALT (mild ­ALT 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 ­feeling 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:

Cytomegalovirus (CMV)

·        See Infectious diseases chapter