Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ Key Features ++ Essentials of Diagnosis ++ Often asymptomatic Prodrome of anorexia, nausea, vomiting, malaise, aversion to smoking Fever, enlarged and tender liver, jaundice Markedly elevated aminotransferases early in the course Liver biopsy shows hepatocellular necrosis and mononuclear infiltrate Source of infection is unknown in many ++ General Considerations ++ The hepatitis C virus (HCV) is a single-stranded RNA virus (hepacivirus) with properties similar to those of flavivirus Seven major genotypes of HCV have been identified Coinfection is found in at least 30% of persons infected with HIV HIV leads to more rapid progression of chronic hepatitis C to cirrhosis Anti-HCV is not protective; in patients with acute or chronic hepatitis, its presence in serum generally signifies that HCV is the cause ++ Demographics ++ In the past, HCV caused over 90% of cases of posttransfusion hepatitis, yet only 4% of cases of hepatitis C were attributable to blood transfusions Over 50% of cases are transmitted by injection drug use Body piercing, tattoos, and hemodialysis may be risk factors The risk of sexual and maternal-neonatal transmission is low and may be greatest in those with high circulating levels of HCV RNA Multiple sexual partners may increase the risk of HCV infection Transmission via breast-feeding has not been documented Hospital-acquired transmission may occur between patients on a liver unit or via Multidose vials of saline Reuse of disposable syringes Contamination of shared saline, radiopharmaceutical, and sclerosant vials ++ Clinical Findings ++ Symptoms and Signs ++ The incubation period averages 6–7 weeks Clinical illness Often mild Usually asymptomatic Characterized by waxing and waning aminotransferase elevations and a high rate (> 80%) of chronic hepatitis In patients with the CC genotype, Spontaneous clearance of HCV following acute infection is more common (64%) Jaundice is more likely to develop during the course of acute hepatitis C ++ Differential Diagnosis ++ Hepatitis A, B, D, E virus Hepatitis G virus (HGV) rarely, if ever, causes frank hepatitis TT virus (TTV) Found in up to 7.5% of blood donors Readily transmitted by blood transfusions However, an association between this virus and liver disease has not been established A related virus known as SEN-V has been found in 2% of US blood donors Is transmitted by transfusion May account for some cases of transfusion-associated non-ABCDE hepatitis Cytomegalovirus, Epstein-Barr virus, and herpes simplex virus, particularly in immunocompromised hosts ++ Diagnosis ++ Laboratory Tests ++ Antibodies to HCV (Figure 16-3) The immunoassay has moderate sensitivity (false-negatives) for the diagnosis early in the course and in healthy blood donors and has low specificity (false-positives) in persons with elevated γ-globulin levels In these situations, a diagnosis of hepatitis C may be confirmed by use of an assay for HCV RNA Occasional persons are found to have anti-HCV in serum without ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessMedicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessMedicine Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options