Hepatitis D

[Phloston]

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Does anyone know the most common outcome of HepD infection?

HepA+B, most commonly = subclinical disease followed by complete recovery.

HepC, most commonly = chronic, asymptomatic hepatitis

Wikipedia says that HepD has the highest mortality rate (20%) when associated with infection, but what about the other 80%? Is it asymptomatic chronic hepatitis or complete resolution, etc.?

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Edit: found what I was looking for:

Semin Liver Dis. 2012 Aug;32(3):228-36. Epub 2012 Aug 29.
Clinical features of hepatitis d.
Farci P, Niro GA.
Source
Hepatic Pathogenesis Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.

Abstract
Hepatitis D is caused by infection with hepatitis D virus (HDV), a defective RNA virus that requires the obligatory helper function of hepatitis B virus (HBV) for its in vivo transmission. Thus, HDV is acquired only by coinfection with HBV or by superinfection of an HBV carrier. The clinical outcome of hepatitis D differs according to the modality of infection. Whereas coinfection evolves to chronicity in only 2% of the cases, superinfection results in chronic infection in over 90% of the cases. HDV is a highly pathogenic virus that causes acute, often fulminant hepatitis, as well as a rapidly progressive form of chronic viral hepatitis, leading to cirrhosis in 70 to 80% of the cases. The clinical picture of HDV disease is evolving as a consequence of a significant change in the epidemiology of HDV infection, which has led to a significant decline in incidence in Western countries, mainly as a result of universal HBV vaccination programs. However, in the face of a declining prevalence in areas of old endemicity like Europe, immigration poses a threat of HDV resurgence. The interaction of HDV with other hepatitis viruses or human immunodeficiency virus is complex and may lead to different patterns in terms of virologic expression and immunologic responses. Multiple viral infections are associated with rapid progression of liver fibrosis and eventually with the development of hepatocellular carcinoma. Hepatitis D is not a vanishing disease, and continuous efforts should be made to improve its prevention and treatment.

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.


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I just C+P this into Wikipedia (and cited it of course). Yay for me.


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Then, for the sake of it, I went further into PubMed and looked up HepE epidemiology, and apparently there are two main types:

Type I (epidemic): In developing countries, the icteric rate is HIGH and mortality is greatest in PREGNANT WOMEN.

Type-II (autochthonous): Developing AND DEVELOPED countries, the icteric rate is LOW, MEN are most commonly affected, and mortality is greatest in OLDER ADULTS.

I find that interesting, because that means the most common HepE infections in the USA are asymptomatic and in males, and if a death occurs, it's not necessarily in a pregnant woman. We'd instead have to worry about pregnant women more so just if they travel.

HepE source: http://www.nejm.org.ezproxy.library.uq.edu.au/doi/full/10.1056/NEJMra1204512

 

[alternatego]

I'll let you know that info is not going to be very useful for your Step 1, but its still pretty cool you took the time to dig it out

 

[smartparts]

Hep D is a tentative pathogen in the 'deltavirus' category. It relies on the replication machinery of Hep B to infect people. It is an icosahedral, enveloped, circular, single-stranded negative sense RNA virus. Its genome functions as a ribozyme and superinfection increases the chances of fulminant hepatitis/liver failure in Hep B cases. It's treated with interferon alpha and prevented by Hep B vaccination.

Source: Microcards (3rd), Clinical Microbio Made Ridiculously Simple (5th)

 

[Phloston]

Hep D is a tentative pathogen in the 'deltavirus' category. It relies on the replication machinery of Hep B to infect people. It is an icosahedral, enveloped, circular, single-stranded negative sense RNA virus. Its genome functions as a ribozyme and superinfection increases the chances of fulminant hepatitis/liver failure in Hep B cases. It's treated with interferon alpha and prevented by Hep B vaccination.

Source: Microcards (3rd), Clinical Microbio Made Ridiculously Simple (5th)

When I went through the 2nd edition, I noticed the Microcards said delta virus is icosahedral. FA says helical. I wasn't sure as to whether the third edition would say any different.

 

[Morsetlis]

It uses the HBV capsid which is icosahedral (and in fact you detect it with sHBsAg and delta antigen). It is in Baltimore Class V, which are all helical except for Arenaviridae and Deltaviridae.

Coinfection leads to a fizzling out effect. Subsequent superinfection of HBV with HDV leads to fulminant hepatitis and cirrhosis / death.

 

[OveractiveBrain]

Does anyone know the most common outcome of HepD infection?

Hep A is only Acute

Hep B can be Both acute and chronic. If good immunesystem, it is acute, and your liver explodes. If no good immune system (neonates), then it is chronic, and you see little symptoms until cirrhosis.

Hep C is Chronic only

Hep D Doesn't matter. But if you must know, it is either a superinfection on top of Hep B, and, if acute, causes fulminant hepatitis.... OR it is chronic, and accelerates the chronic disease. The thing you have to know about Hep D is that it needs Hep B to infect.

Hep E is Everywhere Else. Think pregnant females in africa. We don't see it in the US and you won't see it on the USMLE.

Take a look at this video for more info regarding the viruses./