Clinical features

  • Asymptomatic
  • Classic form: fever, fatigue, malaise, abdominal discomfort (right upper quadrant), nausea, diarrhoea, anorexia, followed by jaundice, dark urine and more or less clay coloured stool
  • Fulminant form: acute liver failure due to massive liver necrosis, often fatal. It is more common in HepB patients with secondary infection with D virus and pregnant women who get hepatitis E in their third trimester

Differential diagnosis

  • Other causes of hepatitis, e.g. drugs, herbs, tumours, and autoimmune diseases
  • Gastroenteritis, relapsing fever
  • Pancreatitis
  • Malaria, leptospirosis, yellow fever
  • Haemorhagic fevers, e.g. Marburg and Ebola


  • Complete blood count
  • Slide or RDT for malaria parasites
  • Liver function tests
  • Viral antigens and antibodies: Hepatitis B, Hepatitis C, and HIV serology


Classic form

  • Supportive management
  • Rest and hydration
  • Diet: high in carbohydrates and vitamins and vegetable proteins. Avoid animal proteins e.g.
  • Avoid any drug – they may aggravate symptoms Refer if patient has features of liver failure or
    decompensated liver disease
  • Avoid drugs generally but especially sedatives and hepatotoxic drugs
  • Ensure effective infection control measures e.g. institute barrier nursing, personal hygiene
  • Patient isolation is not necessary unless there is high suspicion of viral haemorrhagic fevers


  • Hygiene and sanitation
  • Immunization against hepatitis B (all children, health workers, household contacts of people with chronic
    hepatitis B, sex workers and other populations at risk)
  • Safe transfusion practices
  • Infection control in health facilities
  • Screening of pregnant women
  • Safe sexual practices (condom use)