![]() ![]() The CBC may show mild leukocytosis and thrombocytopenia may be present in severe cases. Patients with acute viral hepatitis may have leukopenia, relative lymphocytosis, and immune-mediated symptoms (rash, hives, arthralgias, and fever) in the preicteric phase. ![]() In acute viral hepatitis, constitutional symptoms (nausea, fatigue, arthralgias, myalgias, headache, pharyngitis, cough, rhinitis, cervical adenopathy) may precede jaundice by 1-2 weeks. About 0.14 % of hospitalized patients develop fulminant hepatitis with bleeding diathesis (GI bleeding) and coma. Symptoms occurring in less than 30% of patients include headache, myalgia, arthralgia, diarrhea, and constipation. Other common symptoms are loss of appetite, dark urine, and light-colored stools. Confusion and severe vomiting may be seen in cases of fulminant hepatitis. Several cases have been reported of arthritis, vasculitis, and cryoglobulinemia. OTHER FINDINGS: Complications include pancreatitis, renal failure, encephalitis, Guillain-Barre syndrome, hemolysis, anemia, cholecystitis, thrombocytopenic purpura, and pancytopenia. Virus is excreted in the stool from 14-21 days before the onset of jaundice to 8 days after the onset of jaundice. Transmission by transfusion has been reported. Men who have sex with men are at increased risk. Case-fatality is less than 1% in most populations, but can reach 1.8% in older adults. Humans are the primary reservoirs, rarely primates. Risky foods include raw oysters, clams, other shellfish, and contaminated, raw fruits and vegetables. Children with subclinical infections are sources of infection for others. ![]() About 10% of infected people have a prolonged or relapsing illness lasting 6-9 months. About 70% of infected children <6 years are asymptomatic. 2/3 of patients recover completely within 2 months. Jaundice occurs in about 7% of children 5 years old and younger, in about 37% of children aged 5-9, and in more than 70% among adolescents and adults. In acute viral hepatitis, aminotransferase levels are generally >10 times the upper limit of normal. Usually, symptoms are self-limited within about 3 weeks, and ALT returns to normal in about 7 weeks. Fulminant hepatitis occurs in only 0.1% of cases. Recovery usually occurs within 6-12 months. Chronic infections do not occur, but 15% of cases may be prolonged or relapsing, lasting as long as a year. Many cases are mild and without jaundice. ![]()
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