1. STDs
2. Hep B
3. Symptoms

Hepatitis B Symptoms Singapore | Shim Clinic

Hepatitis B may be asymptomatic, but it may also be symptomatic.

CLINICAL FEATURES

Incubation period. 40-160 days

Symptoms

• Virtually all infants and children have asymptomatic acute infection
• Asymptomatic infection is also found in 10-50% of adults in the acute phase and is especially likely in those with HIV coinfection
• Chronic carriers are usually asymptomatic but may have fatigue or loss of appetite
• The prodromal and icteric phases are very similar to hepatitis A, but may be more severe and prolonged

Signs

• As for Hepatitis A in the acute phase
• If chronic infection occurs there are often no physical signs. After many years of infection, depending on the severity and duration, there may be signs of chronic liver disease

Complications

• Fulminant hepatitis occurs in <1% of symptomatic cases but carries a worse prognosis than that caused by hepatitis A
• Chronic infection (>6 months) occurs in 5-10% of symptomatic cases but the rate is higher in immunocompromised patients with HIV infection, chronic renal failure or those receiving immunosuppressive drugs. Immunosuppressive treatment can also reactivate hepatitis B. Almost all (>90%) of infants born to infectious (HBeAg +ve) mothers will become chronic carriers unless immunised
• There are 4 phases of chronic carriage:
  1. Immune Tolerant (HBe Ag +ve, normal ALT levels, little or no necroinflammation on liver biopsy)
  2. Immune Active, HBe Ag +ve phase (HBe Ag +ve, raised ALT, progressive necroinflammation and fibrosis)
  3. Inactive hepatitis B carrier (HBsAg+ve, HBeAg -ve, low levels of HBV DNA and normal ALT)
  4. HBeAg –ve chronic active hepatitis (Precore, Corepromotor mutations, HBeAg –ve, detectable HBV DNA, progressive inflammation and fibrosis). Types 2 and 4 may progress to cirrhosis and liver cancer, with type 4 generally progressing fastest
• Concurrent hepatitis C infection can lead to fulminant hepatitis, more aggressive chronic hepatitis and increased risk of liver cancer. Concurrent HIV infection increases the risk of progression to cirrhosis and death. Hepatitis A coinfection can be severe acutely, but may lead to the reduction of longterm HBV replication
• Concurrent Delta virus infection, or delta virus superinfection may lead to progressive fibrosis, cirrhosis and endstage liver disease
• Mortality is <1% for acute cases. Between 10 – 50 % of chronic carriers will develop cirrhosis leading to premature death in approximately 50%. Ten percent or more of cirrhotic patients will progress to liver cancer
• There is an increased rate of miscarriage/premature labour in acute infection. There is a risk of vertical transmission

References

• Hepatitis B symptoms @ Wikipedia