Unlike hepatitis A, hepatitis B can turn into a chronic infection with both nonprogressive and progressive forms. Progressive chronic liver disease can cause cirrhosis and is also an important precursor for the development of hepatocellular carcinoma.
In the United States, acute HBV infections typically affect adults and the majority of individuals have mild or no symptoms. Some experience nonspecific constitutional symptoms such as fever, anorexia, RUQ pain, or jaundice and is usually self limited. Less than 10 percent of affected adults go on to become chronic HBV carriers.
In areas with high prevalence of HBV, perinatal transmission is common. When infants are affected via perinatal transmission, the rate of becoming a chronic carrier is significantly increased, with approximately 90% of newborns with HBV becoming chronic carriers.
Cirrhosis is characterized by the replacement of liver tissue by fibrosis, scar tissue, and regenerative nodules resulting in loss of liver function. HBV infection can cause progressive chronic hepatitis leading to cirrhosis.
HBV induced chronic liver disease is an important precursor for the development of hepatocellular carcinoma of the liver.
Membranous glomerulonephritis is the second most common cause of nephrotic syndrome in adults characterized by the presence of subepithelial immune complex deposition along the glomerular basement membranes causing a spike and dome appearance. HBV infection is commonly associated as a secondary cause of membranous glomerulonephritis.
Polyarteritis nodosa is an immune complex mediated transmural vasculitis that typically affects small to medium sized vessels. This vasculitis commonly affects renal and mesenteric vessels while classically sparing the pulmonary arteries. This disease has a strong association with hepatitis B infection.
A serum sickness like syndrome is an occasional extrahepatic manifestation of hepatitis B infection. Serum sickness like reactions refer to symptoms that resemble serum sickness but in which immune complexes cannot be found. Serum sickness is characterized by immune complex deposition in the skin, joints, and organs that can cause fever, lymphadenopathy, arthralgias, cutaneous eruptions, GI disease, and proteinuria.
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