History and exam

Key diagnostic factors

common

fever

Often abrupt-onset and before the patient has jaundice.

malaise

Often abrupt-onset and before the patient has jaundice.

nausea and vomiting

Often abrupt-onset and before the patient has jaundice.

jaundice

Occurs in about 70% to 80% of symptomatic adult patients.[41] Typically peaks 2 weeks after infection. Jaundice is uncommon in young children.[1]​[8]​[Figure caption and citation for the preceding image starts]: Hepatitis A infection manifested here as jaundice of the conjunctivae and facial skinCDC/ Dr. Thomas F. Sellers/Emory University; used with permission [Citation ends].com.bmj.content.model.Caption@7f009238

hepatomegaly

Occurs in about 70% to 80% of symptomatic patients.[41] Often occurs with right upper quadrant pain.

right upper quadrant pain

Often occurs with tender hepatomegaly.

clay-colored stools

Stools are acholic, giving rise to a clay color.[1]​

Other diagnostic factors

common

fatigue

Often abrupt-onset and before the patient has jaundice.

headache

Often abrupt-onset and before the patient has jaundice.

dark urine

A feature of the icteric phase.

pruritus

A feature of the icteric phase.

uncommon

arthralgias and myalgias

Extrahepatic features may be evident.

cough

Extrahepatic features may be evident.

diarrhea

May be a feature of the preicteric phase.

constipation

May be a feature of the preicteric phase.

splenomegaly

Possible physical sign on abdominal examination.

posterior cervical lymphadenopathy

May be detected on examination.

evanescent rash

Nonspecific feature.

bradycardia

May be detected on examination.[44]​

Risk factors

strong

living in endemic region

In developing countries with poor sanitation >90% of children are infected before 10 years of age.[14]

travel to endemic region

Unvaccinated people from developed countries who travel to areas of high or intermediate hepatitis A endemicity have a significant risk for acquiring hepatitis A.[1]​[25] ​

Risk is highest for people who live in or visit rural areas, frequently eat and drink in places with poor sanitation, or trek in backcountry areas.[25] 

close personal contact with an infected person

Risk factor for infection.[1]​[17]​​ Hepatitis A virus infection risk is increased in household contacts of international adoptees.[25]

men who have sex with men

Risk factor for infection.[1]​[17]​​​ Outbreaks of hepatitis A in men who have sex with men have been reported frequently in the US and Europe.[25]

known foodborne outbreak

Foods associated with outbreaks are typically eaten raw, and include fruits, vegetables, and shellfish.[25] The disease may also be acquired by direct contact with contaminated water or ice (including shellfish harvested from sewage-contaminated water), from contaminated frozen foods, or from foods contaminated by infected food handlers.[26][27]​​

illegal drug use

The number of cases of hepatitis A virus infection associated with injection drug use in the US has increased rapidly since 2015. Injection drug use is the most commonly reported risk factor in the US.[1]​[17]​​

homelessness

The number of cases of hepatitis A virus infection associated with homelessness in the US has increased rapidly since 2015.[1]​[17]​​

weak

occupational exposure

People who work in research laboratories handling hepatitis A-infected material, and people who work with nonhuman primates, are at risk of occupational infection.[1] Healthcare workers and workers exposed to sewage are not at significantly increased risk.[25]

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