Symptomatology and Outcome
In a self-limiting acute case resulting from coinfection, the
symptoms can include fatigue, lethargy, abdominal pain, anorexia and nausea,
lasting usually 3 to 7 days, followed by an icteric period of jaundice
characterized by persistent fatigue and nausea, clay-colored stool and dark
urine, and high serum bilirubin. This results in the characteristic yellow tinge
of the skin and eyes. The symptoms usually resolve themselves, although fatigue
may persist for a significant period after clinical symptoms have disappeared.
Chronic disease can result in 5% of patients and fulminant hepatitis in 1%. The
majority of patients recover, however.
The acute symptoms are similar to those in coinfection, but the
illness is more severe and comes on more quickly. Fulminant liver failure can
result in 5% of cases and the disease proceeds to chronic infection in 80-90%.
These patients are likely (60-70%) to develop cirrhosis more rapidly and have an
increased chance of acquiring HCC. The symptoms of chronic hepatitis are less
severe than the acute disease and bilirubin, albumin, and prothrombin levels may
be normal. Alanine aminotransferase and aspartate aminotransferase (ALT and
AST), enzymes of the liver that are released into the blood during liver damage
and are thus indicative of ongoing hepatitis, may be elevated. HBsAg levels may
be undetectable since HB markers are usually suppressed by HDV. Cases that
progress to cirrhosis often result in death. Fulminant hepatitis is ten times
more common in HDV than in other viral hepatitis agents. The symptoms include
encephalopathy, personality changes, abnormal behavior, concentration problems,
and sleep disorders. The mortality rate can be as high as 80%. HCC rates are the
same as in HBV infection.