PATHOGENS

• Viral pathogens that may induce hepatitis (other than traditional hepatitis virus HAV, HBV, HCV, HDV and HEV) as part of their disease spectra and are encountered in the U.S. include (only partial listing):
  • Herpes viruses (herpes simplex viruses 1, 2)
  • Varicella-zoster virus
  • Epstein-Barr virus (LFT abnormalities or elevated bilirubin part of infectious mononucleosis, especially in middle-aged adults acquiring primary infection)
  • Cytomegalovirus (often milder mononucleosis-like presentations than primary EBV)
  • Human herpes virus 6)
  • Enteroviruses (coxsackieviruses and echoviruses)
  • Adenovirus
    • 2022 outbreak worldwide in children, adenovirus virus 41 is the leading hypothesis[20]
  • Influenza
  • Parvovirus B19
  • Human immunodeficiency virus (HIV): during acute infection
  • Coronavirus (SARS)
  • Influenza (usually mild)
  • Reovirus (Colorado tick fever virus, reovirus 3)
  • Kls-V (virus described in 2011 in patients with elevated ALT, unclear if causal)
• Other less common pathogens that induce hepatitis include:
  • Flaviviruses (dengue and Yellow fever viruses)
  • Arenaviruses (Junin, Machupo, and Lassa fever viruses)
  • Phleboviruses (Rift Valley fever virus)
  • Filoviruses (Marburg and Ebola viruses)
  • Paramyxoviruses (measles virus)
  • Togaviruses (rubella virus).
• Not substantial human pathogens:
  • GB viruses or GB virus C (some classify as GBV-A, GBV-C and GBV-D): transmitted via transfusion, intravenous drug use, hemodialysis, sexual contact, and from mother to fetus. Not believed to be a clinically significant pathogen as it does not replicate in the liver.
  • Hepatitis F virus: was the designation for a purported enterically transmitted agent during 1994, but subsequent studies did not confirm its existence.
  • TT virus (Torque teno virus, TTV, member of family Circoviridae, genus Anellovirus): some limited evidence points to oncological potential.