Symptomatology and Outcome


In a self-limiting acute case resulting from coinfection, the symptoms can include fatigue, lethargy, abdominal pain, anorexia and nausea, lasting usually 3 to 7 days, followed by an icteric period of jaundice characterized by persistent fatigue and nausea, clay-colored stool and dark urine, and high serum bilirubin. This results in the characteristic yellow tinge of the skin and eyes. The symptoms usually resolve themselves, although fatigue may persist for a significant period after clinical symptoms have disappeared. Chronic disease can result in 5% of patients and fulminant hepatitis in 1%. The majority of patients recover, however.

The acute symptoms are similar to those in coinfection, but the illness is more severe and comes on more quickly. Fulminant liver failure can result in 5% of cases and the disease proceeds to chronic infection in 80-90%. These patients are likely (60-70%) to develop cirrhosis more rapidly and have an increased chance of acquiring HCC. The symptoms of chronic hepatitis are less severe than the acute disease and bilirubin, albumin, and prothrombin levels may be normal. Alanine aminotransferase and aspartate aminotransferase (ALT and AST), enzymes of the liver that are released into the blood during liver damage and are thus indicative of ongoing hepatitis, may be elevated. HBsAg levels may be undetectable since HB markers are usually suppressed by HDV. Cases that progress to cirrhosis often result in death. Fulminant hepatitis is ten times more common in HDV than in other viral hepatitis agents. The symptoms include encephalopathy, personality changes, abnormal behavior, concentration problems, and sleep disorders. The mortality rate can be as high as 80%. HCC rates are the same as in HBV infection.
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