Hepatitis A: Acute Symptoms and Clinical Course

Hepatitis A virus (HAV) causes acute, self-limited hepatitis; no chronic infection. Incubation 15–50 days (mean 28).

Typical Symptoms (Often Mild/Asymptomatic in Children)

• Prodrome: Fatigue, malaise, anorexia, nausea, vomiting, low-grade fever, RUQ discomfort.
• Icteric phase: Dark urine (bilirubinuria), pale stools, jaundice, pruritus, hepatomegaly, tender liver.
• Extrahepatic: Arthralgias, rash (serum sickness-like), cytopenias.

Course

• Symptoms 2–8 weeks; most recover fully.
• Relapsing hepatitis (10–15%): Recurrence at 1–3 months.
• Fulminant hepatic failure: Rare (<0.5%), higher risk with age, chronic liver disease.

Diagnosis

• Anti-HAV IgM (acute infection).
• ALT/AST markedly elevated (1000s).
• Bilirubin, INR, albumin.

Management

• Supportive: Hydration, nutrition, avoid hepatotoxins (alcohol, acetaminophen).
• Post-exposure prophylaxis: HAV vaccine ± IG within 2 weeks.
• Vaccination: 2-dose series (6–18 mo apart); routine for children, travelers, high-risk.

Reportable disease. No specific antiviral. Immunity lifelong after infection.