Viral hepatitis refers to infections caused by viruses that affect the liver. Viral hepatitis includes five distinct diseases caused by five different viruses. The different viruses are called by a letter name:

• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis D
• Hepatitis E

What is Hepatitis A?

Hepatitis A accounts for 20 percent to 25 percent of hepatitis cases in developed countries. Hepatitis A is usually transmitted through the fecal-oral route, meaning a person somehow ingests contaminated feces from an infected person. If an infected person did not wash his or her hands properly after using the bathroom, the disease may spread from the person’s hands. The incubation period is two to six weeks, during which the infected individual is contagious.

Another cause of hepatitis A is eating shellfish harvested from contaminated water. Developing countries experience hepatitis A epidemics caused by drinking water contaminated with raw sewage.

The prognosis for hepatitis A patients is excellent with self-limiting course, and recovery is complete. About 85 percent of people with hepatitis A recover within three months, and almost all recover within six months. The disease does not become chronic, and there are no long-term health implications.

What is Hepatitis E?

Hepatitis E, also called enteric hepatitis (enteric means related to the intestines), is similar to hepatitis A, and more prevalent in Asia and Africa. It is also transmitted through the fecal-oral route. It is generally not fatal, though it is more serious in women during pregnancy and can cause fetal complications. Most patients with hepatitis E recover completely.

Hepatitis A and E Symptoms

Hepatitis A and hepatitis E present with similar symptoms. The diseases may develop without any signs or symptoms, or symptoms may be nonspecific. If you experience any of the symptoms below for more than two weeks, make an appointment with a gastroenterologist.

There are three phases of hepatitis A and E, and symptoms may differ depending on the stage. Early in the disease, called the prodromal phase, symptoms may include:

• Fever
• Joint pain or arthritis
• Rash
• Edema (swelling)

Symptoms of the next phase, the preicteric phase , include:

• Fatigue
• Myalgia (muscle pain)
• Anorexia
• Nausea and/or vomiting
• Fever
• Cough
• Abdominal pain and/or diarrhea
• Dark urine and light stool color

During the icteric phase :

• Jaundice (yellowing of the skin and whites of the eyes) develops
• Anorexia, nausea and vomiting may worsen
• Irritated skin lesions may develop
• Other symptoms may subside

Hepatitis A and E Diagnosis

The diagnosis phase of hepatitis A and E includes:

• History and physical examination
• Blood tests

History and Physical Examination

A diagnosis begins with comprehensive physical exam, during which you describe your symptoms and medical history. Perhaps more than other diseases, the diagnosis of hepatitis A and E is largely dependent on medical history. Your doctor will pay close attention to your particular risk factors and physical exam.

You will be asked about:

• Recent travels
• Exposure to water or shellfish that may have been contaminated by sewage
• Sexual activity
• Intravenous drug use
• Medications

Blood Tests

Hepatitis A: A blood test will reveal certain antibodies in your blood, called anti-HAV IgM. These antibodies indicate whether you were infected with hepatitis A. The peak levels occur early in the infection and persist for about four to six months.

Hepatitis E: Your doctor can diagnose hepatitis E by testing your blood and/or stool for certain antibodies, or by detection of the virus.

Labs will also look for:

• The presence (or elevated levels of) certain enzymes in your blood
• High levels of bilirubin
• Low white blood cell count