The Clinical Features of Acute Viral Hepatitis

Abstract

Acute viral hepatitis attributable to infection by the hepatitis A virus (HAV), the hepatitis B virus (HBV), the hepatitis D (delta) virus, and any of the three or more non-A, non-B hepatitis viruses is associated with a broad spectrum of clinical features. This spectrum largely reflects the severity of illness and varies enormously from inapparent asymptomatic infection at one extreme, through symptomatic anicteric and icteric hepatitis, to confluent hepatic necrosis and fatal fulminant hepatitis at the other. It would be misleading to suggest that all clinical features are associated with disease severity; a set of extrahepatic syndromes, which appear to have no direct relationship to the severity of illness, is also encountered during the course of a variable proportion of viral hepatitis cases. These are either manifestations of extrahepatic tissue damage directly induced by the agents of viral hepatitis (an example of which may be the association of aplastic anemia with non-A, non-B viral hepatitis¹) or immunologically mediated tissue injury. The serum sickness-like syndrome seen in hepatitis B is the classic example of the latter. It should be emphasized that while certain clinical features suggest infection with a specific type of viral hepatitis, absolute differentiation of etiologic agents in individual cases cannot be undertaken on this basis alone.