This site is intended for healthcare professionals

Sign in
Go to /sign-in page

You can view 5 more pages before signing in

Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Hepatitis B virus infection has a wide-ranging incubation period - from 45-180 days, with an average of 60-90 days (1)

Acute infection is clinically recognised in only a small proportion of cases

  • less that 10% of children and 30-50% of adults show icteric disease
  • in patients with clinical illness, the onset is usually insidious with a prodrome of non-specific symptoms such as fever, joint pain, urticarial or maculopapular rashes, malaise, and non-specific gastrointestinal symptoms such as nausea, often progressing to jaundice.
  • the acute episode may be similar to that seen in HAV or HAC but more severe. Jaundice rarely persists for more than 4 weeks and usually, is not severe.
  • in many patients, the disease is subclinical. Non-jaundiced patients are more likely to develop chronic disease than icteric ones.

A fulminant course may indicate superimposed infection in a symptomless HBV carrier with a new agent such as HDV or HAV. Manifestations include fatigue, jaundice, encephalopathy and ascites. Urgent and immediate referral is indicated in following patients:

  • worsening symptoms/signs of liver failure (e.g., encephalopathy)
  • laboratory tests indicating deteriorating liver function or liver failure
    • elevated or rising INR
    • elevated or rising bilirubin
    • low or falling platelet count (1)

Recovery and lifelong immunity for acute infection is seen in majority (95%) of immunocompetent adults. The reminder of patients will develop chronic infection

  • a flare of chronic HBV may present like acute HBV, and should be included in the differential diagnosis (1)

Circulating immune complexes containing HBsAg may produce extra-hepatic complications such as:

  • glomerulonephritis - especially in children
  • polyarteritis - usually affecting the medium and small arteries
  • peripheral neuropathy
  • polymyalgia rheumatica

Reference:

  1. Public Health Agency of Canada. Primary care management of hepatitis B – Quick reference 2013
  2. NICE (February 2006). Adefovir dipivoxil and peginterferon alfa-2a for the treatment of chronic hepatitis B

Create an account to add page annotations

Create a free account

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.