Hepatitis A, a viral infection commonly seen in children, is generally mild. However, with improved hygiene standards, adults are increasingly contracting it. This article explores the clinical outcomes and complications of acute viral hepatitis A (AVH-A) in adult patients, providing insights relevant to medical diagnosis and patient management.
AVH-A in the Adult Population: A Detailed Look
A retrospective study was conducted, analyzing data from patients diagnosed with AVH-A between 2017 and 2022. The study focused on adult patients (over 18 years) presenting with symptoms and lab results indicative of acute hepatitis. Exclusion criteria were put in place to ensure focus on AVH-A, removing cases with hepatitis B and C co-infections, negative hepatitis A and E serology, metabolic liver diseases, Wilson’s disease, pre-existing chronic liver disease, drug-induced liver injury, and incomplete data. Figure 1 illustrates the patient selection process. Diagnosis of AVH-A was confirmed through clinical evaluation, laboratory findings, and positive serological tests for IgM anti-HAV. The study’s retrospective nature and anonymized data allowed for ethical clearance exemption.
Hepatic Complications: Recognizing Severe AVH-A
The study meticulously documented hepatic complications, which are critical aspects of Avh Medical Diagnosis and management. These included:
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Acute Liver Failure: Defined by the onset of hepatic encephalopathy and/or coagulopathy (INR > 1.5) within 4 weeks of jaundice onset in individuals without pre-existing liver conditions. This is a severe, though rare, outcome of AVH-A.
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Prolonged Cholestasis: Characterized by persistent jaundice lasting over 3 months in confirmed AVH-A cases, indicating a prolonged recovery phase and requiring careful monitoring.
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Relapsing Hepatitis: A recurrence of hepatitis symptoms within six months of the initial AVH-A diagnosis, after excluding other causes like drug-induced injury or autoimmune conditions. Differential medical diagnosis is crucial here.
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Autoimmune Hepatitis: Development of autoimmune hepatitis following AVH-A. Diagnosis was based on autoimmune hepatitis scoring and liver histology, showing specific features like lymphoplasmacytic infiltration.
Extra-hepatic Complications: Expanding the Spectrum of AVH-A
Beyond liver-related issues, the study also identified extra-hepatic complications associated with AVH-A. These are less common but important to recognize for comprehensive avh medical diagnosis:
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Guillian- Barre syndrome: A rare neurological complication observed in one patient, presenting as progressive muscle weakness. Diagnosis involved cerebrospinal fluid analysis and nerve conduction studies.
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Acute Pancreatitis: Mild cases of acute pancreatitis were seen in two patients, characterized by epigastric pain, elevated amylase/lipase, and pancreatic edema on imaging.
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Glomerulonephritis: One patient developed glomerulonephritis, specifically IgA nephropathy, presenting with anasarca and nephrotic range proteinuria. Renal biopsy confirmed the diagnosis.
Study Results: Prevalence and Outcomes of AVH-A
Out of 623 patients initially screened, 104 adult patients were diagnosed with AVH-A, representing 25% of adult viral hepatitis cases in the study. The median age was 28 years, with a male predominance (67.3%). The majority (81.7%) experienced uneventful recovery. However, 19 patients developed hepatic and/or extra-hepatic complications.
Among hepatic complications, prolonged cholestasis was most frequent (8.65%), followed by acute liver failure, relapsing hepatitis, and autoimmune hepatitis (all at 1.9%). Patients with prolonged cholestasis responded well to cholestyramine and ursodeoxycholic acid. Autoimmune hepatitis cases improved with steroid therapy. Relapsing hepatitis resolved with symptomatic treatment.
Extra-hepatic complications were infrequent (Guillian- Barre syndrome, pancreatitis, and glomerulonephritis each under 2%). Patients with pancreatitis recovered with conservative management. The Guillain-Barré syndrome patient recovered after ventilation and intravenous immunoglobulin. The glomerulonephritis patient is currently undergoing treatment for proteinuria and showing improvement.
Patients with complications were predominantly male (84.2%) with a median age of 26 years. Age and sex were not statistically significant risk factors for developing complications. A small subset had co-infection with hepatitis A and E but did not develop acute liver failure. Two patients with pre-existing alcohol-related liver disease developed AVH-A induced acute-on-chronic liver failure and were referred for advanced care.
The study acknowledges limitations due to its retrospective, single-center design and lack of direct comparison with AVH-E patients.
Conclusion: Key Takeaways for AVH Medical Diagnosis
This study underscores that AVH-A constitutes a significant proportion of adult viral hepatitis cases. While most adults with AVH-A recover without complications, a subset can develop hepatic and extra-hepatic manifestations. Prolonged cholestasis is the most common hepatic complication. Extra-hepatic complications, though rare, require recognition. Effective avh medical diagnosis in adults must consider the possibility of these complications to ensure appropriate management and improve patient outcomes.
