Hepatitis B is the Type of Hepatitis Where Jaundice Typically Appears After Prodromal Symptoms Begin to Subside
In hepatitis B infection, jaundice typically appears after the prodromal symptoms begin to subside, making option B the correct answer. 1
Clinical Course of Different Types of Viral Hepatitis
Hepatitis A
In hepatitis A infection, jaundice typically appears within a few days of the onset of prodromal symptoms, which include anorexia, malaise, fever, nausea, and vomiting. The jaundice appears while these symptoms are still present, not after they subside. According to evidence, "within a few days of the onset of bilirubinuria, feces become clay colored, and sclera, skin, and mucous membranes become jaundiced" 1. The prodromal illness typically lasts 1-7 days before jaundice appears.
Hepatitis B
In hepatitis B infection, there is a characteristic pattern where prodromal symptoms (fatigue, anorexia, nausea, right upper quadrant pain) begin to improve or subside as jaundice develops. This sequential pattern of symptoms subsiding as jaundice appears is a distinguishing clinical feature of hepatitis B infection.
Hepatitis C
Hepatitis C typically presents differently, with most infections (70-80%) being asymptomatic in the acute phase 1. When symptoms do occur, they develop within 2-12 weeks of infection, but the relationship between prodromal symptoms and jaundice is not characterized by the same pattern as in hepatitis B. Only about 20% of acute hepatitis C infections are accompanied by jaundice 1.
Hepatitis E
In hepatitis E infection (particularly genotypes 3 and 4 common in developed countries), clinical manifestations are typically silent in the majority of patients, with less than 5% developing symptoms of acute hepatitis with jaundice 1. The timing relationship between prodromal symptoms and jaundice is not specifically characterized by prodromal symptoms subsiding as jaundice appears.
Important Clinical Considerations
- The timing of jaundice relative to prodromal symptoms is an important diagnostic clue in differentiating types of viral hepatitis
- In hepatitis A, jaundice typically appears while prodromal symptoms are still present
- In hepatitis B, jaundice typically appears as prodromal symptoms begin to subside
- Most cases of hepatitis C are asymptomatic in the acute phase, with only 20% developing jaundice
- The interval between onset of jaundice and development of encephalopathy has major prognostic implications in cases of fulminant hepatic failure 1
Pitfalls to Avoid
- Do not assume all viral hepatitis infections follow the same clinical course - the timing of jaundice relative to prodromal symptoms varies between different types
- Do not rely solely on the presence or absence of jaundice for diagnosis, as many cases of viral hepatitis (particularly hepatitis C) can be anicteric
- Remember that children infected with hepatitis A are often asymptomatic, with more than 90% of infections in children younger than 6 years being asymptomatic 1
- Laboratory confirmation is essential for definitive diagnosis of the specific type of viral hepatitis 1
The classic pattern of jaundice appearing as prodromal symptoms begin to subside is characteristic of hepatitis B infection, making it the correct answer to this question.