Hepatitis A Virus: Essential Knowledge and a Novel Identify-Isolate-Inform Tool for Frontline Healthcare Providers

Kristi L. Koenig, MD; Siri Shastry, MD; Michael J. Burns, MD


Western J Emerg Med. 2017;18(6):1000-1007. 

In This Article

Clinical Presentation

HAV infection often presents with a prodromal period characterized by nausea, vomiting, anorexia, fever, malaise and abdominal pain. After a few days to weeks, patients may develop dark urine and pale, clay-colored stools as well as jaundice and pruritus. In some infected persons, there is no prodromal phase or it is so mild that the infected person does not present for medical care until jaundice develops. Approximately 70% of infected adults will exhibit initial symptoms; jaundice occurs in 40–70% of cases.[13] During the prodromal phase, infected persons are highly contagious as there is viremia, and large quantities of infectious virus are shed in the stool. On physical examination, patients commonly present with fever, jaundice, scleral icterus and hepatomegaly.[14,15] Less commonly, patients may demonstrate extrahepatic signs and symptoms of the disease, including splenomegaly, rash and arthralgias. In very rare cases, hematologic abnormalities (e.g. aplastic anemia, red cell aplasia and thrombocytopenia), neurologic abnormalities (e.g. optic neuritis and transverse myelitis), rheumatologic findings (e.g. leukocytoclastic vasculitis, glomerulonephritis, cryoglobulinemia) as well as toxic epidermal necrolysis and myocarditis can occur.[16–21]