Is Fever Common in Viral Hepatitis A?
Yes, fever is a common symptom in acute hepatitis A, particularly in adults and older children, occurring as part of the initial prodromal illness that precedes jaundice by several days. 1
Clinical Presentation by Age
The likelihood of experiencing fever and other symptoms in hepatitis A is strongly age-dependent:
- Children under 6 years: More than 90% of infections are asymptomatic, and when symptoms do occur, they typically lack both fever and jaundice 1
- Older children and adults: Infection is typically symptomatic with fever occurring commonly, and jaundice develops in >70% of patients 2, 1
Timing and Characteristics of Fever
Fever appears during the prodromal phase, which lasts 1-7 days and precedes the onset of jaundice. 1 This initial presentation includes:
- Fever (often elevated body temperature persisting for days) 3
- Malaise and fatigue 1, 4
- Anorexia and nausea 2, 1
- Abdominal discomfort 2
The fever typically occurs during the period of peak infectivity, which is the 2-week window before jaundice onset or liver enzyme elevation. 1
Clinical Course
After the febrile prodromal period, patients typically develop:
- Dark urine (bilirubinuria) - often the first symptom prompting medical attention 1
- Jaundice - appearing within days of dark urine onset 1
- Clay-colored stools 1
The average incubation period before symptoms begin is 28 days (range: 15-50 days). 2, 1
Important Clinical Pitfalls
Do not exclude hepatitis A based solely on the absence of fever, as the clinical presentation varies significantly by age and individual immune response. 2 The disease cannot be differentiated from other viral hepatitides based on clinical features alone—serologic testing for IgM anti-HAV is required for definitive diagnosis. 1, 4
In atypical cases, fever may be prolonged or associated with extrahepatic manifestations including arthralgias, skin rash, or cholestatic features with pruritus and diarrhea. 5, 6