Hepatitis

Hepatitis

Definition of Hepatitis

 

Hepatitis (plural hepatitides) is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The condition can be self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis.

Hepatitis may occur with limited or no symptoms, but often leads to jaundice, anorexia (poor appetite) and malaise. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide, but hepatitis can also be caused by toxic substances (notably alcohol, certain medications, some industrial organic solvents and plants), other infections and autoimmune diseases.

Cause of Hepatitis A

 

Acute

• Viral hepatitis (15 families)
  • Adenoviridae: Adenoviruses
  • Arenaviruses: Guanarito virus, Junín virus, Lassa fever virus, Lujo virus, Machupo virus and Sabiá virus
    
  • Bunyaviruses: Crimean-Congo hemorrhagic fever virus, Dobrava virus, Hantaan virus, Puumala virus, Rift Valley fever virus, Seoul virus and SFTS virus
    
  • Coronaviridae: Severe acute respiratory syndrome virus
    
  • Erythrovirus: Parvovirus B19
    
  • Flaviviruses: Akhurma virus, Dengue, Hepatitis C, Kyasanur Forest disease virus, Omsk hemorrhagic fever virus, Yellow fever
  • Filoviruses: Ebola virus and Marburg virus
    
  • Hepadnaviridae: Hepatitis B
  • Hepeviridae: Hepatitis E
  • Herpesviruses: Cytomegalovirus, Epstein Barr virus, Varicella zoster virus, Human herpesvirus 6, Human herpesvirus 7 and Human herpesvirus 8
    
  • Orthomyxoviruses: Influenza
    
  • Parvoviridae: Parvovirus B19
    
  • Picornaviruses: Echovirus, Hepatitis A
  • Reovirus: Colorado tick fever virus, Reovirus 3
    
  • Unassigned family: Hepatitis D

• Bacterial
  • Anaplasma
    
  • Babesia
    
  • Bartonella
    
  • Chlamydia trachomatis
    
  • Coxiella burnetii
    
  • Ehrlichia
    
  • Leptospira
  • Listeria
    
  • Mycobacterium tuberculosis
    
  • Nocardia
    
  • Novosphingobium aromaticivorans
    
  • Orientia tsutsugamushi
    
  • Rickettsia
    
  • Rhodococcus
    
  • Salmonella
    
  • Streptococcus pyogenes
    
  • Treponema pallidum
    
  • Yersinia
    

• Protozoal
  • Entamoeba histolytica
    
  • Cryptosporidium
    
  • Isospora
    
  • Leishmania
    
  • Plasmodium
    
  • Toxoplasma

• Parasitic
  • Ascaris lumbricoides
    
  • Ancylostoma
    
  • Baylisascaris
    
  • Capillaria hepatica
  • Clonorchis sinensis
  • Dicrocoelium dendriticum
  • Echinococcus
  • Fasciola hepatica
    
  • Fasciolopsis buski
    
  • Metorchis
    
  • Necator
  • Opisthorchis
    
  • Paragonimus
    
  • Strongyloides stercoralis
    
  • Schistosoma
    
  • Toxocara
    

• Fungal
  • Aspergillus
    
  • Candida
  • Cryptococcus
    
  • Histoplasma
    
  • Microsporidium
    
• Algal
  • Prototheca
    

• Non infectious
  • Alcohol
    
  • Auto immune conditions: systemic lupus erythematosus
    
  • Drugs: Paracetamol, amoxycillin, antituberculosis medicines, minocycline and many others (see longer list below).
  • Ischemic hepatitis (circulatory insufficiency)
  • Metabolic diseases: Wilson’s disease
    
  • Pregnancy
  • Toxins: Amanita toxin in mushrooms, carbon tetrachloride, asafetida

Chronic

• Alcohol
  
• Autoimmune
  • Autoimmune hepatitis
• Drugs
  • Isoniazid
  • Ketoconazole
  • Methyldopa
  • Nitrofurantoin
• InheritedNon-alcoholic steatohepatitis
  • Wilson’s disease
    
  • Alpha 1-antitrypsin deficiency
• Viral hepatitis: (Hepatitis A does not cause chronic hepatitis)
  • Hepatitis B with or without hepatitis D
  • Hepatitis C
  • Hepatitis E
    

Signs and Symptoms of Hepatitis

 

Acute

Initial features are of nonspecific flu-like symptoms, common to almost all acute viral infections and may include malaise, muscle and joint aches, fever, nausea or vomiting, diarrhea, and headache. More specific symptoms, which can be present in acute hepatitis from any cause, are: profound loss of appetite, aversion to smoking among smokers, dark urine, yellowing of the eyes and skin (i.e., jaundice) and abdominal discomfort. Physical findings are usually minimal, apart from jaundice in a third and tender hepatomegaly (swelling of the liver) in about 10%. Some exhibit lymphadenopathy (enlarged lymph nodes, in 5%) or splenomegaly (enlargement of the spleen, in 5%).

Acute viral hepatitis is more likely to be asymptomatic in younger people. Symptomatic individuals may present after convalescent stage of 7 to 10 days, with the total illness lasting 2 to 6 weeks.

A small proportion of people with acute hepatitis progress to acute liver failure, in which the liver is unable to clear harmful substances from the circulation (leading to confusion and coma due to hepatic encephalopathy) and produce blood proteins (leading to peripheral oedema and bleeding). This may become life-threatening and occasionally requires a liver transplant.

Chronic

Chronic hepatitis often leads to nonspecific symptoms such as malaise, tiredness and weakness, and often leads to no symptoms at all. It is commonly identified on blood tests performed either for screening or to evaluate nonspecific symptoms. The occurrence of jaundice indicates advanced liver damage. On physical examination there may be enlargement of the liver.

Extensive damage to and scarring of liver (i.e. cirrhosis) leads to weight loss, easy bruising and bleeding tendencies, peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the peritoneal cavity). Eventually, cirrhosis may lead to various complications: esophageal varices (enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction).

Acne, abnormal menstruation, lung scarring, inflammation of the thyroid gland and kidneys may be present in women with autoimmune hepatitis.

Risk Factors for Hepatitis

 

Depending on the type of hepatitis virus, there are different ways that people can acquire hepatitis. The main ways that people contract hepatitis are:

• Hepatitis A. Through contaminated food and water
• Hepatitis B. Through sexual contact
• Hepatitis C. Through contact with infected blood, usually by sharing drug injection needles and syringes

People at high risk for hepatitis A infection include:

• International travelers
• Day care employees and children
• People living in a household with someone who has hepatitis A
• People are HIV positive
• Men who have sex with men
• Users of illegal drugs

The CDC recommends routine testing for chronic hepatitis B virus (HBV) infection for the following high risk groups:

• Persons born in regions with high rates of hepatitis B infection
• People travel or work in regions with high rates of hepatitis A
• People who use injected drugs or who share needles
• Men who have sex with men
• People receiving chemotherapy or immunosuppressive therapy for certain medical conditions including cancer, organ transplantation, or rheumatologic or gastoenterologic disorders
• Donors of blood, organs, or semen
• Hemodialysis patients
• All pregnant women and infants born to mothers infected with HBV
• People who have sex with an infected person or who live in a household with an infected person
• Health care workers and others exposed to blood products and needlestick devices.
• People are HIV positive

People at high risk for hepatitis C include:

• Current and former drug injection users (this group is most at risk)
• People who received a blood transfusion, blood product, or organ before 1992 when procedures were implemented to screen blood for hepatitis C
• People who received a blood clotting product prior to 1987, when screening procedures were implemented
• Hemodialysis patients
• People who have had tattooing or body piercing performed with non-sterile instruments
• Healthcare workers who may be exposed to needlesticks
• People infected with HIV
• Babies born to mothers infected with hepatitis C

 

Diagnosis of Hepatitis

 

Diagnosis can be made using various biochemical markers of hepatitis in conjunction with an assessment of the patient’s medical history and a physical examination.

Blood tests are used to detect the presence of hepatitis A in your body. A sample of blood is taken, usually from a vein in your arm, and sent to a laboratory for testing. Your doctor may also discuss your signs and symptoms as part of making a diagnosis.

Prevention from Hepatitis

 

• Wash your hands after going to the bathroom and before fixing food or eating.
• Use latex condoms, which may lower the risk of transmission.
• Avoid tap water when traveling to certain countries or regions. 
• Hepatitis is preventable by vaccination. Be vaccinated in time.
• Don’t share drug needles and personal items—such as toothbrushes, razors and nail clippers—with an infected person.
• Ethanol, mostly in alcoholic beverages, is a significant cause of hepatitis. Avoid alcohol consumption.

Treatment of Hepatitis

 

Bed rest, abstaining from alcohol, and taking medication to help relieve symptoms. Most people who have hepatitis A and E get well on their own after a few weeks.

Hepatitis B is treated with drugs, such as lamivudine and adefovir dipivoxil. Hepatitis C is treated with a combination of peginterferon and ribovarin.

Liver transplant of hepatitis B or C, or D-caused liver failure.