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Hepatitis D occurs only as a co-infection with hepatitis B virus and usually makes the hepatitis B infection more severe. The earliest symptoms are nausea, loss of appetite, joint pains, and tiredness. There may be fever (not marked) and an enlarged liver may cause discomfort or actual pain in the right upper part of the abdomen. Later, jaundice (a yellowing of the skin and whites of the eyes that occurs when the liver is no longer able to eliminate certain pigmented substances) may develop. People with both HBV and HDV are more likely to have sudden, severe symptoms, called fulminant hepatitis. Those who are infected with both HBV and HDV are at greater risk for developing serious complications associated with chronic liver disease. People infected with HBV and HDV may become chronically infected and may be contagious from time to time for the rest of their lives.

When a person becomes infected with the hepatitis D virus (HDV), the virus begins to multiply within the liver. Fourteen days to 180 days later, a person may develop hepatitis D symptoms.

However, not everyone infected with the hepatitis D virus will actually have symptoms. Also, some of the people who do develop symptoms will have only very mild symptoms. You can look and feel perfectly healthy, yet still be infected with the disease and infect others.

The list of signs and symptoms mentioned in various sources for Hepatitis D includes the 11 symptoms listed below:

1.Yellow skin
2.Yellow eyes
3.Jaundice
4.Diarrhea
5.Abdominal pain
6.Loss of appetite
7.Vomiting
8.Nausea
9.Fatigue
10.Fever
11.Flu-like symptoms

Jaundice (yellowing of the skin or the whites of the eyes) usually occurs several days after early symptoms of hepatitis D first appear. However, it may occur up to two weeks after symptoms begin. At this point, early symptoms tend to improve; but other new symptoms, such as abdominal pain (or stomach pain) on the right side, may appear.

One serious complication that can occur during this acute hepatitis D infection is fulminant hepatitis a serious condition that results in liver failure. Up to 5 percent of people who get infected with the hepatitis B virus at the same time as the hepatitis D virus will develop fulminant hepatitis. Up to 20 percent of people with chronic hepatitis B will develop fulminant hepatitis with an acute hepatitis D infection.

The coinfection’s symptoms split into two phases: the preicteric phase which contains signs like: fatigue, lethargy, anorexia, nausea, headache for 3-7 days and the icteric phase which presents signs like: jaundice, fatigue and nausea – clay-colored stools and dark urine. Unfortunately, the disease is often asymptomatic.

In suprainfection, the symptoms are more severe and includes: jaundice, coagulopathy, confusion, difficulty concentrating, changes in personality, disturbances in sleep.

As the other forms of hepatitis, the infection with hepatitis D virus can cause symptoms as: fever, loss of appetite, diarrhea, jaundice, nausea and vomiting, pain in the right upper part of the abdomen.