Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- 43 Acute viral hepatitis
- 44 Chronic hepatitis
- 45 Biliary infection: cholecystitis and cholangitis
- 46 Pyogenic liver abscess
- 47 Infectious complications of acute pancreatitis
- 48 Esophageal infections
- 49 Gastroenteritis
- 50 Food poisoning
- 51 Antibiotic-associated diarrhea
- 52 Sexually transmitted enteric infections
- 53 Acute appendicitis
- 54 Diverticulitis
- 55 Abdominal abscess
- 56 Splenic abscess
- 57 Peritonitis
- 58 Whipple’s disease
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
44 - Chronic hepatitis
from Part VII - Clinical syndromes: gastrointestinal tract, liver, and abdomen
Published online by Cambridge University Press: 05 April 2015
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- 43 Acute viral hepatitis
- 44 Chronic hepatitis
- 45 Biliary infection: cholecystitis and cholangitis
- 46 Pyogenic liver abscess
- 47 Infectious complications of acute pancreatitis
- 48 Esophageal infections
- 49 Gastroenteritis
- 50 Food poisoning
- 51 Antibiotic-associated diarrhea
- 52 Sexually transmitted enteric infections
- 53 Acute appendicitis
- 54 Diverticulitis
- 55 Abdominal abscess
- 56 Splenic abscess
- 57 Peritonitis
- 58 Whipple’s disease
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
Summary
Chronic hepatitis is defined as necroinflammation of the liver of more than 3 to 6 months’ duration, demonstrated by persistently elevated serum aminotransferase levels and associated with characteristic histologic findings. The causes of chronic hepatitis include hepatitis B, C, and D viruses (HBV, HCV, and HDV) as well as noninfectious disorders, including nonalcoholic steatohepatitis (NASH), autoimmune hepatitis, hepatitis following medication exposure (such as isoniazid or nitrofurantoin), Wilson's disease, α1-antitrypsin deficiency, and, infrequently, celiac disease. Hepatitis A virus does not cause chronic hepatitis, but hepatitis E virus may rarely lead to chronic hepatitis in immunosuppressed persons or transplant recipients. Chronic hepatitis is characterized on the basis of etiology; grade of portal, periportal, and lobular inflammation (minimal, mild, moderate, or severe); and stage of fibrosis (none, mild, moderate, severe, cirrhosis).
In the absence of advanced cirrhosis, patients are often asymptomatic or have mild, nonspecific symptoms. Infection caused by HBV may be associated with glomerulonephritis and polyarteritis nodosa. HCV is a pathogenetic factor in mixed cryoglobulinemia and membranoproliferative glomerulonephritis and may be related to lichen planus, autoimmune thyroiditis, lymphocytic sialadenitis, idiopathic pulmonary fibrosis, sporadic porphyria cutanea tarda, and monoclonal gammopathies. HCV infection confers a 20% to 30% increased risk of non-Hodgkin's lymphoma and may induce insulin resistance (which in turn increases the risk of hepatic fibrosis); moreover, the risk of type 2 diabetes mellitus is increased in persons with chronic hepatitis C. Hepatic steatosis is a particular feature of infection with HCV genotype 3 and may also occur in patients infected with other HCV genotypes who have risk factors for fatty liver. On the other hand, chronic HCV infection is associated with a decrease in serum cholesterol and low-density lipoprotein levels.
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- Information
- Clinical Infectious Disease , pp. 296 - 307Publisher: Cambridge University PressPrint publication year: 2015