Hepatitis

Dr. Faozat Aragbaye
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Hepatitis refers to an inflammatory condition of the liver. The condition can be self limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g., alcohol, certain drugs), and    autoimmune diseases can also cause hepatitis.

  Five types of viral hepatitis

Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E.

CAUSES

Hepatitis A is always an acute, short term disease, while hepatitis B, C, and D are most likely to become ongoing and chronic. Hepatitis E is usually acute but can be particularly dangerous in pregnant women.

Hepatitis A- caused by an infection with hepatitis A virus (HAV). This type of hepatitis is most commonly transmitted by consuming food or water contaminated by faeces from person infected with hepatitis A.

Hepatitis B- transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV).

Hepatitis C- comes from hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact.

Hepatitis D (delta hepatitis)- a serious liver disease caused by hepatitis D virus (HDV),  HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can’t multiply without the presence of hepatitis B.

Hepatitis E- a waterborne disease caused by hepatitis E virus (HEV). Hepatitis E is manly found in areas with poor sanitation and typically results from ingesting faecal matter that contaminates the water supply.

Causes of non-infectious hepatitis

Excessive alcohol consumption can cause liver damage and inflammation.

Other toxic causes of hepatitis include overuse or overdose of medications and exposure to poisons.

Autoimmune system response- in some cases, the immune system mistakes the liver as a harmful object and begins to attack it. It causes ongoing inflammation that can range from mild to severe, often hindering liver function.

SYMPTOMS

Many people with hepatitis experience either mild or no symptoms. When symptoms appear, they can do so from 15 to 180 days after infection, this applies to all types of hepatitis. B and C may not have symptoms at the beginning of the disease.

Signs and symptoms of acute hepatitis appear quickly. They include:

• fatigue
• diarrhoea
• mild fever
• muscle joint pain
• nausea
• vomiting
• slight abdominal pain
• Loss of appetite
• weight loss
• Yellowness of skin and eyes(jaundice)

The acute phase is not usually dangerous, but in certain people it can result in acute liver failure and death. It may also progress to a chronic infection. This is most likely with HBV or HCV.

 As the disease progresses, chronic hepatitis can lead to progressive liver failure, resulting in jaundice, swelling of the lower extremities, confusion, and blood in faeces and vomit.

DIAGNOSIS

As the symptoms of the different types of hepatitis are similar, the type and severity of hepatitis may only be diagnosed through laboratory tests.

The diagnosis of hepatitis includes:

• Physical examination
• Blood tests
• Nucleic acid tests
• Liver biopsy
• Paracentesis
• Elastography
• Surrogate markers

TREATMENT

Some types and cases of hepatitis can heal without intervention, but sometimes it can progress to scarring of the liver or cirrhosis.

Hepatitis A

There is no specific treatment for HAV. The doctor will advise the patient to abstain from alcohol and drugs during recovery. Most patients with hepatitis A will recover without intervention.

Hepatitis B

Hepatitis B patient needs to rest and abstain completely from alcohol. He would also be placed on antiviral agent called interferon or other antiviral suppressive therapies.

Hepatitis C

Hepatitis C patient will be placed on antiviral agent without ribavirin. Some directed antivirals and combination therapies are now available to treat the hepatitis C virus based on its subtype.

PREVENTION

Hepatitis can be dangerous and difficult to treat, so people are advised to take precautions against possible infection.

Hepatitis A

Mostly spread through infected food and water. The following precautions should be taken:

• Wash your hands with soap after using the toilet
• Only drink commercially bottled water or boiled water if unsure of the local sanitation
• Only eat peelable fruits if in a location with unreliable sanitation
• Only eat raw vegetables if you are sure they have been cleaned or disinfected thoroughly
• Get a vaccine for HAV before travelling to places where hepatitis may be endemic.

Hepatitis B

To minimize risk of transmission:

• Practice safe sex
• Only used clean needles
• Know your sexual partner status if you are a carrier
• Do not share toothbrushes, razors, or manicure instruments
• Only allow well- sterilized equipment for tattoo, skin piercing etc
• Have the HBV vaccination either at risk or not.

Hepatitis C

To prevent transmission:

• Do not share needle
• Only allow well-sterilized equipment for skin piercing
• Consume alcohol in moderation
• Do not inject illegal drugs

Hepatitis A and C are curable, but hepatitis B is only preventable by vaccine. A cure is still under development.

OUTLOOK

Hepatitis A- will normally resolve in 2 months without leaving any long –term effects.  Persons with HAV will usually be immune to hepatitis A for the rest of their life

Hepatitis B: Most adults infected with HBV virus recover within 90days and achieve lifelong immunity. However 90% of infants, 20% of older children and 5% of adults will develop a chronic infection and develop severe health problems, such as liver cirrhosis and cancer

Hepatitis C- This becomes a lifelong infection in 70 to 85% of people living with the virus. Hepatitis C is fatal in between 1 and 5% of people. The infection can now be cured, and 15 to 25% of peoplewith HCV clear the infection without treatment.