Acute Hepatitis A

Authors: Emily Darby, MD David H. Spach, MD

Last updated: November 14, 2012

A 37-year-old previously healthy woman presents with a chief complaint of dark urine. She has had flu-like symptoms over the last week, including fever, headache, decreased appetite, and mild nausea. Review of systems is otherwise negative. She denies any intravenous drug use, receipt of blood transfusions, or recent travel. She is a graduate student in astronomy, is married, and has a 4-year-old son and 9-month-old daughter who are in daycare. Physical examination reveals a temperature of 100.5°F, mild hepatomegaly, and faint scleral icterus. Laboratory studies show a white blood cell count of 10,200/µL, hematocrit 38%, platelet count 205,000/µL, normal chemistry panel, aspartate aminotransferase (AST) 1,130 units/L, alanine aminotransferase (ALT) 1,480 units/L, total bilirubin of 3.7 mg/dL, and INR 1.0. Additional laboratory tests are performed and she is diagnosed with acute hepatitis A virus (HAV) infection.

Which of the following statements is TRUE regarding acute HAV infection in this patient?

A Because serologic testing for hepatitis A antibody is likely to be negative this early in the illness, a stool or serum PCR test for HAV would best confirm a diagnosis of acute HAV infection.
B Her children are a highly unlikely source of her exposure to HAV since they have not shown any signs of jaundice.
C It is probable that her exposure to HAV occurred within the last 30 to 50 days.
D The degree of the elevation in her hepatic aminotransferase levels suggests she is at risk for chronic hepatitis A infection.