Liver & intrahepatic bile ducts
Viral hepatitis
Chronic viral hepatitis
Authors: Rifat Mannan, M.D., Songyang Yuan, M.D., Ph.D.
Topic Completed: 1 December 2015
Minor changes: 8 October 2021
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PubMed Search: Chronic viral hepatitis[TI] liver[TI] full text[sb]
Table of Contents
Definition / general | Essential features | Epidemiology | Etiology | Clinical features | Microscopic (histologic) images | Differential diagnosis | Additional referencesCite this page: Mannan A.A.S.R. Chronic viral hepatitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/liverchronicviralhep.html. Accessed December 3rd, 2021.
Definition / general
- Chronic viral hepatitis is a major global health problem, affecting more than 600 million people worldwide
Essential features
- Chronic viral hepatitis is defined as persistence of viral antigen or RNA in the serum for more than 6 months after the onset of acute infection
- In infected individuals, viruses induce a chronic inflammatory process
- Longstanding repetition of the inflammation and healing process may lead to liver fibrosis, cirrhosis and eventually hepatocellular carcinoma
Epidemiology
- Hepatitis B virus (HBV)
- Small DNA virus consists of a central core composed of DNA and hepatitis B core antigen (HBcAg) and a shell of hepatitis B surface antigen (HBsAg)
- 240 million people are chronically infected with HBV worldwide
- Chronic HBV infection is endemic in Southeast Asia, China and sub-Saharan Africa
- HBV usually causes an acute hepatitis but chronic hepatitis develops in 10% of patients
- 15 - 40% of infected patients may develop serious liver disease, resulting in 1.2 million deaths per year
- Hepatitis C virus (HCV)
- HCV is a positive sense, single stranded 9600 kb RNA virus
- HCV affects more than 170 million people worldwide
- Central and East Asia, North Africa and the Middle East have the highest prevalence
- 80 - 85% of patients with acute hepatitis C cannot clear the virus and progress to chronic infection
- Percentage of transition to chronic infection is higher for patients coinfected with HIV and is lower for women and children
- 20 - 30% of patients develop cirrhosis in two decades, accounting for 500,000 deaths per year
- Hepatitis D virus (HDV)
- Defective RNA virus which requires the obligatory help of HBV for transmission and packaging
- HDV infection is higher in areas where HBV is endemic
- HDV superinfection in an HBV carrier usually results in chronic HDV infection, occurring in over 90% of cases
- Compared with chronic HBV infection, chronic HBV / HDV coinfection is associated with a higher risk of cirrhosis, occurring in 70% of cases
- In about 15% of patients, cirrhosis develops within 1 to 2 years from the onset of acute HDV infection
Etiology
- Three viruses are known to cause chronic hepatitis:
- Hepatitis B virus (HBV)
- Hepatitis C virus (HCV)
- Hepatitis D virus (HDV)
- Other viruses are uncommon to cause chronic hepatitis
Clinical features
- Clinical manifestations vary widely, reflecting the interaction between viral pathogens and patient antiviral immune responses
- Some patients remain asymptomatic for many years, while others may rapidly progress to cirrhosis and finally hepatocellular carcinoma
- Characteristic symptoms include malaise, anorexia, fatigue, low grade fever and right upper quadrant abdominal pain
- Jaundice is often absent
- Aminotransferase levels may be within the reference range or may reach 300 U/L
- Extrahepatic manifestations can occur in multiple organs including kidneys, eyes, joints, skin
- HBV infection may cause skin rash, arthritis, arthralgia, glomerulonephritis, polyarteritis nodosa
- HCV infection has been associated with cryoglobulinemia, glomerulonephritis, idiopathic thrombocytopenic purpura, Sjögren syndrome
Microscopic (histologic) images
Images hosted on other servers:
Portal inflammation in chronic hepatitis
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Fibrosis and cirrhosis
Differential diagnosis
- Chronic viral hepatitis should be differentiated from other diseases presenting similar pictures
Additional references
