Inapparent or subclinical infections and infection without jaundice are common with all the different hepatitis viruses, particularly in children under the age of 6 years. The clinical picture ranges from an asymptomatic infection to a mild anicteric illness, to acute disease with jaundice, to severe prolonged jaundice, to fulminant hepatitis.
Differences between the clinical syndromes of acute hepatitis A, acute hepatitis B and other types of viral hepatitis become apparent on analysis of large numbers of well-documented cases, but these differences are not reliable for the diagnosis of individual patients with jaundice.
The following description of the acute illness applies to all types of viral hepatitis. Prodromal nonspecific symptoms, such as fever, chills, headache, fatigue, malaise and aches and pains, are followed a few days later by anorexia, nausea, vomiting and right upper quadrant abdominal pain, followed by the passage of dark urine and clay-coloured stools. Jaundice of the sclera and the skin develop. With the appearance of jaundice, there is usually a rapid subjective improvement of symptoms. The jaundice usually deepens for a few days and persists for 1-2 weeks. The faeces then darken and the jaundice diminishes over a period of about 2 weeks. Convalescence may be prolonged.
In areas of high prevalence, most children are infected with hepatitis A early in life and such infections are generally asymptomatic. Infections acquired later in life are of increasing clinical severity. Less than 10% of cases of acute hepatitis A in children up to the age of 6 are icteric, but this increases to 40-50% in the 6-14 age group and to 70-80% in adults. Of 115 551 cases of hepatitis A in the USA between 1983 and 1987, only 9% of the cases, but more than 70% of the fatalities, were in those aged over 49.
Hepatitis A does not persist in the liver, chronic infec tion does not occur and there is no evidence of progression to chronic liver disease.
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