Hepatitis A

Hepatitis A (formerly known as infectioushepatitis) is an acuteinfectious disease of the liver caused by the hepatitis A virus (HAV).

Transmission

• It is usually spread by eating or drinking food or water contaminated with infected feces.
• It may also be spread through close contact with an infectious person.

Signs and symptoms

• Symptoms typically appear 2 to 6 weeks (the incubation period) after the initial infection.
• 90% of children do not have symptoms.

 Symptoms usually last less than 2 months, although some people can be ill for as long as 6 months.

• Fatigue
• Fever
• Abdominal discomfort
• Nausea
• Loss of appetite
• Joint pains
• Urticaria
• Jaundice, a yellowing of the skin or whites of the eyes due to hyperbilirubinemia
• Diarrhea
• Clay-coloured feces 

Diagnosis

• Serum IgG, IgM
• Alanine transferas enzyme(ALT)- liver enzyme. It is present in blood at higher levels than normal.
• Blood for HAV: Hepatitis A virus is present in the blood (viremia) and feces of infected people up to two weeks before clinical illness develops.

Treatment

• There is no specific treatment for hepatitis A.
• Sufferers are advised to rest, avoid fatty foods and alcohol (these may be poorly tolerated)
• Eat a well-balanced diet, and stay hydrated.

Hepatitis B

• Hepatitis B is an infectious hepatitis caused by the hepatitis B virus (HBV).

 Transmission

The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to another via blood or fluids contaminated with blood.

• Direct contract with blood may occur through the use of dirty needles during illicit drug use, accidental needle sticks experienced by healthcare workers, or contact with blood through other means.
• Semen, which contain small amounts of blood, and saliva that is contaminated with blood also carry the virus.
• The virus may be transmitted when these fluids come in contact with broken skin or a mucous membrane (in the mouth, genital organs, or rectum) of an uninfected person.
• Another important route of transmission is from an infected mother to a newborn child, which occurs during or shortly after birth.

People who are at an increased risk of being infected

• Men or women who have multiple sex partners, especially if they don’t use a condom
• Men who have sex with men
• Men or women who have sex with a person infected with hepatitis B virus
• People with other sexually transmitted diseases
• People who inject drugs with shared needles
• People who receive transfusions of blood or blood products
• People who undergo dialysis for kidney disease
• Institutionalized mentally handicapped people and their attendants, caregivers, and family members
• Health care workers who are stuck with needles or other sharp instruments contaminated with infected blood
• Infants born to infected mothers

Signs and Symptoms

• Loss of appetite
• Feeling tired (fatigue)
• Nausea and vomiting
• Itching all over the body
• Pain over the location of the liver (on the right side of the abdomen, under the lower rib cage)
• Jaundice (a condition in which the skin and the whites of the eyes turn yellow in color)
• Dark urine (the color of cola or tea)
• Pale-colored stools (grayish or clay colored)

Symptoms of liver damage may include the following:

• Fluid retention causing swelling of the belly (ascites) and sometimes the legs
• Weight gain due to ascites
• Persistent jaundice
• Loss of appetite, weight loss, wasting
• Vomiting with blood in the vomit
• Bleeding from the nose, mouth, or rectum; or blood in the stool
• Hepatic encephalopathy (excessive sleepiness, mental confusion, and in advanced stages, development of coma)

 Diagnosis

• Hepatitis B antigen (anti-HBc).
• Viral DNA (viral load)
• Liver function tests
• Blood for electrolytes if patient has been vomiting a lot.

• CT scan or ultrasound: To detect the extent of liver damage and may also detect cancer of the liver caused by chronic hepatitis B.
• Liver biopsy: May be done to detect the extent of liver damage or to evaluate how well a treatment is working.
• Other tests may be ordered to rule out other medical conditions.

Treatment

Acute hepatitis B usually resolves on its own and does not require medical treatment.

Medical Treatment

• If the infected person is dehydrated from vomiting or diarrhea, IV fluids are prescribed to help patient feel better.
• Medications may also be used to control other symptoms.
• People with mild symptoms can be cared for at home.
• Pegylated interferon alfa. It slows the replication of the virus and boosts the body’s immune system to fight the infection.Treatment is given for 48 weeks by injection or orally.
• Nucleoside/nucleotide analogues (NAs) e.g. Adefovir , Entecavir, lamivudine, Heptovir, Heptodin, Telbivudine and tenofovir. 

Hepatitis B Prevention

• Hepatitis b vaccine
• If you are sexually active, practice safe sex.
• Correct use of latex condoms can help prevent transmission of HBV, but even when used correctly, condoms are not 100% effective at preventing transmission.
• Men who have sex with men sh’d be vaccinated against both hepatitis A and hepatitis B.
• If you inject drugs, don’t share needles or other equipment.
• Don’t share anything (including grooming products) that might have blood on it, such as a razor, toothbrush, fingernail clippers, etc.
• Health care workers should follow standard precautions and handle needles and sharps safely.

Hepatitis C

It belongs to the class of viruses called Flavviruses.

Route of transmission

• Parenteral route
• Close body contact through body fluids.
• Intravenous drug abuse.
• Sexual contact
• Mother to child transmission
• Traditional administration of medicines/practices that involves cutting of skin.

Clinical features

• Mostly asymptomatic
• Symptoms are generally mild and vague.
• Decreased appetite
• Fatigue
• Nausea
• Muscle or joint pains
• Weight lossand rarely does acute liver failure

Chronic infection

• About 80% of those exposed to the virus develop a chronic infection. (This is defined as the presence of detectable viral replication for at least six months).
• Chronic infection after several years may cause cirrhosis or liver cancer.

Dignosis

• Hepatitis Cantibodyenzyme immunoassay or ELISA,
• HCV RNApolymerase chain reaction (PCR) (viral load).
• Biopsy, to determine the degree of liver damage

Treatment 

• Combination of interferon alpha andribavirin for a period of 24 or 48 weeks.
• Sofosbuvir with ribavirin and interferon.
• Surgery-liver transplantion 

Prevention

• No vaccine available at the moment.
• Control from infections
• Proper disposal of hospital waste
• Reducing parenteral injections.

Hepatitis D (HDV)

Hepatitis D, is a disease caused by a small circular enveloped RNA virus.

Transmission

• The routes of transmission of hepatitis D are similar to those for hepatitis B.
• Infection is largely restricted to persons at high risk of hepatitis B infection, particularly injecting drug users and persons receiving clotting factor concentrates.

Treatment and prevention

• The vaccine for hepatitis B protects against hepatitis D virus because of the latter’s dependence on the presence of hepatitis B virus for it to replicate.
• Interfron alpha can be used in reducing the severity of the infection. 

Hepatitis E

Hepatitis E is a viral hepatitis caused by infection with a virus called hepatitis E virus (HEV).

Transmission

• It is spread mainly by the fecal-oral route due to fecal contamination of water supplies or food.
• Person-to-person transmission is uncommon.

Signs and symptoms

• The incubation period of hepatitis E varies from 3 to 8 weeks.
• Jaundice
• Fatigue
• Nausea.
• Anorexia
• Abdominal pain.

Diagnosis

• Viral RNA becomes detectable in stool and blood serum during incubation period.
• Serum IgM and IgG antibodies against HEV.

Prevention

1.  Improving sanitation is the most important measure in prevention of hepatitis E.
2. Vaccination

Treatment

• There is no specific treatment for acute hepatis E infection.
• Ribavarin or a combination of ribavirin and peginterferon.
• Supportive treatment.