Hepatitis B: Difference between revisions
 
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==Background==
==Background==
[[File:Prevalence-of-hepatitis-b-surface-antigen.png|thumb|Baseline prevalence of Hepatitis B exposure.]]
*Blood-borne DNA virus
*Incubation period: 1-3 months
*Virus can cause acute, chronic, or asymptomatic infection


==Clinical Features==
==Clinical Features==
[[File:Jaundice08.jpg|thumb|Jaundice of the skin]]
[[File:Jaundice.jpg|thumb|Pediatric jaundice with icterus of sclera.]]
*[[Nausea/vomiting]]
*[[RUQ pain]]
*[[Jaundice]]
*[[Fever]]


==Differential Diagnosis==
==Differential Diagnosis==
{{Acute hepatitis causes}}
{{STD DDX}}


==Diagnosis==
==Evaluation==
*[[LFTs]]
**AST, ALT > 1000s
**Elevated bilirubin
**Elevated alk phophatase
*Elevated INR
*CBC, BMP
*Assess for alternative etiologies of symptoms as appropriate (see: [[jaundice]], [[RUQ pain]], [[nausea/vomiting]])
{{Acute hepatitis panel}}
 
===Evaluating Hepatitis B Serology Results===
[[File:Hepatitis B serology.jpg|thumb|Hepatitis B serology findings.]]
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Clinical Scenario'''
| align="center" style="background:#f0f0f0;"|'''HBsAg'''
| align="center" style="background:#f0f0f0;"|'''anti-HBc'''
| align="center" style="background:#f0f0f0;"|'''anti-HBs'''
|-
| Susceptible to infection||negative||negative||negative
|-
| Immune due to natural infection||negative||positive||positive
|-
| Immune due to Hep B infection||negative||negative||positive
|-
| Acutely infected||positive||anti-HBc- positive;        IgM anti-HBc- positive||negative
|-
| Chronically infected||positive||anti-HBc- positive;      IgM anti-HBc- negative||negative
|}


==Management==
==Management==
===Post Exposure Prophylaxis===
*Supportive care for acute disease
 
{{Hepatitis B post exposure prophylaxis}}
{{Hepatitis B post exposure prophylaxis}}
==Disposition==
==Disposition==
*Consider admission for:
*INR >2, Bilirubin >30, hypoglycemia
*Any GI bleeding
*Intractable pain, inability to tolerate PO
*Significant comorbidity/immunocompromised or age >50 years


==See Also==
==See Also==
*[[Viral hepatitis]]
*[[Acute hepatitis]]
*[[Jaundice]]


==External Links==
==External Links==
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==References==
==References==
<references/>
<references/>
[[Category:ID]][[Category:GI]]

Latest revision as of 20:31, 28 February 2024

Background

Baseline prevalence of Hepatitis B exposure.
  • Blood-borne DNA virus
  • Incubation period: 1-3 months
  • Virus can cause acute, chronic, or asymptomatic infection

Clinical Features

Jaundice of the skin
Pediatric jaundice with icterus of sclera.

Differential Diagnosis

Causes of acute hepatitis

Sexually transmitted diseases

Evaluation

  • LFTs
    • AST, ALT > 1000s
    • Elevated bilirubin
    • Elevated alk phophatase
  • Elevated INR
  • CBC, BMP
  • Assess for alternative etiologies of symptoms as appropriate (see: jaundice, RUQ pain, nausea/vomiting)

Interpreting Acute Hepatitis Panel Results

Anti-hepatitis A, IgM Hepatitis B surface antigen Anti-hepatitis B core, IgM Anti-hepatitis C Interpretation
Positive Negative Negative Negative Acute hepatitis A
Negative Positive Positive Negative Acute hepatitis B
Negative Positive Negative Negative Chronic hepatitis B infection
Negative Negative Positive Negative Acute hepatitis B; quantity of hepatitis B surface antigen is too low to detect
Negative Negative Negative Positive Acute or chronic hepatitis C; additional tests are required to make the determination

Evaluating Hepatitis B Serology Results

Hepatitis B serology findings.
Clinical Scenario HBsAg anti-HBc anti-HBs
Susceptible to infection negative negative negative
Immune due to natural infection negative positive positive
Immune due to Hep B infection negative negative positive
Acutely infected positive anti-HBc- positive; IgM anti-HBc- positive negative
Chronically infected positive anti-HBc- positive; IgM anti-HBc- negative negative

Management

  • Supportive care for acute disease

Hepatitis B Post-Exposure Prophylaxis

Treatment is generally initiated after coordination with occupational health and infectious disease service and based the the exposed patient's vaccination history[2]

Unvaccinated

  • If the source is HBsAg(+) then give HBIG x1 and initiate HBV vaccine in two separate sites
  • If source is HGsAG(-) then start the HBV vaccine series
  • If source blood is unavailable and high risk then give HBIG x1 initiate the HBV series
    • If source blood is low risk and unavailable then begin HBV series

Previously vaccinated non responder (one series)

Non responder status is defined as anti-has <10mIU/mL

  • If the source is HBsAg(+) then give HBIG x 1 and begin revaccination series
    • Can also opt to perform second HBIG administration in one month
  • If source is HBsAg(-) then no treatment is needed
  • If source blood is unavailable and high risk then treat as if HBsAg(+)

Previously vaccinated non responder (two series)

Non responder status is defined as anti-has <10mIU/mL

  • If the source is HBsAg(+) then give HBIG x2 and no HBV series
  • If source is HGsAG(-) then no treatment is needed
  • If source blood is unavailable then initiate the HBV series

Treatment Dosing

No contraindications for pregnancy or breast feeding

  • HBIG 0.06 mL/kg IM
    • Give in opposite arm from hepatitis B vaccine if patient also receiving vaccine
  • Vaccination series: HBV vaccine options:
    • Engerix-B 20mcg IM
    • Recombivax HB 10mcg IM

Disposition

  • Consider admission for:
  • INR >2, Bilirubin >30, hypoglycemia
  • Any GI bleeding
  • Intractable pain, inability to tolerate PO
  • Significant comorbidity/immunocompromised or age >50 years

See Also

External Links

References

  1. ↑ Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec 17; 137(12): 947-54.
  2. ↑ Postexposure prophylaxis to prevent hepatitis b virus infection. CDC MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm?s_cid=rr5516a3_e
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