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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.
Section 3. Summaries of Infectious Diseases
Hepatitis B
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: People with hepatitis B virus (HBV) infection may present with a variety of signs and symptoms, including subacute illness with nonspecific symptoms (eg, anorexia, nausea, or malaise), clinical hepatitis with jaundice, and fulminant fatal hepatitis. Asymptomatic seroconversion is common, and the likelihood of developing symptoms of hepatitis is age dependent. Anicteric or asymptomatic infection is most common in young children. Extrahepatic manifestations, such as arthralgias, arthritis, macular rashes, thrombocytopenia, or papular acrodermatitis (Gianotti-Crosti syndrome), can occur early in the course of the illness and may precede jaundice. Acute hepatitis B cannot be distinguished from other forms of acute viral hepatitis on the basis of clinical signs and symptoms or nonspecific laboratory findings. Chronic HBV infection is defined as the presence of hepatitis B surface antigen (HBsAg) in serum for at least 6 months or by the presence of HBsAg in a person who tests negative for antibody of the immunoglobulin (Ig) M subclass to hepatitis B core antigen (anti-HBc).
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Age at the time of acute infection is the primary determinant of the risk of progressing to chronic infection. More than 90% of infants infected perinatally will develop chronic HBV infection. Between 25% and 50% of children infected between 1 and 5 years of age become chronically infected, whereas only 6% to 10% of acutely infected older children and adults develop chronic HBV infections. Patients who develop acute HBV infection while immunosuppressed or with an underlying chronic illness have an increased risk of developing chronic infection. Up to 25% of infants and older children who acquire chronic HBV infection will eventually develop HBV-related hepatocellular carcinoma or cirrhosis.
The clinical outcome of untreated chronic HBV
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