Hepatitis : Type, Sign, Symptom, Cause,Transmission, Treatment Hepatitis A, B, C, D, And E

Hepatitis is the liver inflammation disease.It may occur without symptoms.

Hepatitis is divided into

I. Acute Hepatitis 

Acute Hepatitis is characterized by constitutional symptoms that are typically self-limiting.It is generally caused by viral infection.The signs of acute hepatitis also include easy bruising and bleeding, confusion, sleepiness and disorientation.

Acute Hepatitis involves three phases of an infection pattern :

1. The Initial Prodromal Phase (Preceeding Symptom) involves non-specific and flu-like.

Signs and symptoms :

• Fatigue
• Nausea
• Vomiting
• Poor appetite
• Joint pain
• Headache
• Fever
• Dark urine
• Clay-colored stools

2. Clinical Jaundice (Yellowing of the skin) and icterus (yellowing of the eyes) follow the prodrome after about one to two weeks and can last for up to four weeks.

Signs and symptoms :

• An enlarged liver
• Right upper abdominal pain
• An enlarged spleen
• A mild unintentional weight loss

3. The Recovery Phase is characterized by resolution of the clinical symptoms of hepatitis with persistent elevations in liver lab values and a persistently enlarged liver.

Cases of Hepatitis :

• Hepatitis A and hepatitis E will resolve fully after one to two months.
• Hepatitis B will resolve in three to four months.
• Hepatitis C will resolve completely.

Drug-induced hepatitis can have an allergic reaction signs such as :

• Rash
• Fever
• Inflammation of membranes lining certain organs
• Elevated a white blood cell type
• Suppression of bone marrow activity

II. Chronic Hepatitis

Chronic Hepatitis can manifest signs and symptoms specific to liver dysfunction with long-standing inflammation and damage to the organ.It presents constitutional symptoms like acute hepatitis.Chronic hepatitis interferes with hormonal function of the liver.

Signs and symptoms of Chronic hepatitis :

• Fatigue
• Nausea
• Vomiting
• Joint pain
• Poor appetite
• Jaundice
• Icterus
• Abnormal hair growth
• Acne
• Lack of menstrual period in women

III. Fulminant Hepatitis

Fulminant Hepatitis or Massive Hepatic cell death is a rare and life-threatening complication of acute hepatitis.It can occur in cases of hepatitis B, hepatitis D, and hepatitis E.

Causes of Hepatitis can be divided into some categories :

I. Infectious 

• Viral Hepatitis is caused by five viruses, such as hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E.

Hepatitis A and hepatitis E are both transmitted  by the fecal-oral-route.Hepatitis A and hepatitis E are self-limiting illnesses that do not lead to chronic hepatitis.Hepatitis B,  hepatitis C and hepatitis D are transmitted when blood or mucus membranes are exposed to infected blood and body fluids, such as semen and vaginal secretions.

Five Types of Viral Hepatitis :

1. Hepatitis A (HAV)

Hepatitis A is a liver disease caused by the Hepatitis A virus.It gets better in a few weeks without treatment.The incubation period of Hepatitis A is usually 14 until 28 days.Acetaminophen (Paracetamol) and medication against vomiting should not be given.

Signs and symptoms of Hepatitis A

• Nausea
• Vomiting
• Fatigue
• Loss of appetite
• Fever
• Abdominal pain or discomfort
• Dark urine
• Pale stool
• Jaundice (yelowing of the skin and eyes)
• Side or joint pain

Transmission of Hepatitis A

• Drinking contaminated water 
• Eating food handled by an infected person
• Being close contact with an infected person
• Having sex with person who has Hepatitis A virus
• Eating raw shellfish from water poluted with sewage

Risk factors

• HIV-positive
• Working or travelling in areas with high rates of Hepatitis A
• Hemophilia
• A man has sex with other men
• Living with person who has Hepatitis A
• Using injected or noninjected illicit drugs
• People with poor sanitary habits
• Do not have access to clean water

Diagnosis

Hepatitis A can be diagnosed by using tests.

• Blood test uses a blood sample that is sent to a laboratory to test for Hepatitis A.
• Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) is to detect the Hepatitis A virus RNA

Treatment

• Vaccination is given as a shot into the muscle in two doses 6-8 months apart for children 12 months of age or older.It should be started before 24 months of age.All children should begin getting Hepatitis A vaccine at age one.The dose is different for adult depending on the vaccine type.
• Rest
• Eat more high-calorie foods, such as drinking fruit juice or milk rather than water
• Eat snack throughout the day rather than eat full meals
• Rest the liver

2. Hepatitis B (HBV)

Hepatitis B is a liver disease caused by Hepatitis B virus.Hepatitis B infection may be either short-lived (acute) or long lasting (chronic).Acute Hepatitis B infection lasts less than six months.Chronic Hepatitis B infection lasts six months or longer.


Signs and symptoms of Hepatitis B

• Fever
• Nausea
• Vomiting
• Loss of appetite
• Weakness
• Fatigue
• Abdominal pain
• Dark urine
• Joint pain
• Yellowing of the skin and whites of the eyes (jaundice)

Transmission of Hepatitis B

• Pregnant women infected with HBV can pass the virus to their babies during childbirth.
• Needles or syringes have contaminated with infected blood.
• Needle stick injuries in health care setting.
• Sexual contact with infected partner through saliva, semen and vaginal secretion.

Risk Factors

• Multiple sex partners
• A man has sex with other men
• Sharing needles during intravenous (IV) drug use
• Infected mother to infant born
• Living with infected chronic HBV person
• Job that exposes to human blood
• Travelling to regions with high infection rates of HBV, such as Africa, Eastern Europe, and Central and Southeast Asia
• Having HIV
• Receiving kidney dialysis

Complication

• Cirrhosis (scarring of the liver)
• Liver failure
• Liver cancer
• Other conditions, including kidney disease and anemia

Diagnosis

Hepatitis B can be diagnosed by using tests as below :

• Blood Test is to determine virus in the body and whether it is acute or chronic.
• Liver Biopsy uses a small sample of the liver to determine the liver damage.

Treatment of Hepatitis B

• Vaccine

All children should get the first dose of hepatitis B vaccine at birth.Children at age of  six to eighteen months should get complete the vaccine series.Hepatitis B vaccine is recommended for all babies.Vaccine can prevent hepatitis B.Babies and young children are at much greater risk of a chronic infection if they are infected."Catch-up vaccination is recommended for children and adolescents who were never vaccinated or who did not get the entire vaccine series.

Treatment for Acute Hepatitis B infection

Acute hepatitis B infection may not need treatment because it will go away on its own.It is recommeded to take a rest, consume adequate nutritions and fluids which can fight this infection.

Treatment for Chronic Hepatitis B infection

• Antiviral medications, including Adefovir (Hepsera), Lamivudine (Epivir), Telbivudine (Tyzeka), Entecavir (Baraclude), Pegylated Interferon (Pegasys) and Tenofovir (Viread).
• Interferon Alfa-2b (Intron A) is an synthetic version of a substance produced by the body to fight infection.It is used by young people with hepatitis B who do not want to undergo long-term treatment.
• Liver transplant is surgery to remove injured liver and replace it in healthy one from another person.

3. Hepatitis C (HCV)

Hepatitis C is a contagious liver disease that ranges in severity from a mild illness.It lasts a few weeks to a serious, lifelong illness.Hepatitis C is not spread through food or water and by hugging, breastfeeding, shaking hand, sneezing, coughing and sharing eating utensils.Hepatitis C Virus can survive outside the body for up to three weeks at room temperature or on environmental surfaces.Many people infected with the Hepatitis C virus do not know that they are infected because they do not feel sick.The average time of Hepatitis C symptoms occurs about six to seven  weeks after exposure.It can range from two weeks to six months.

Hepatitis C can be divided into :

• Acute Hepatitis C Virus Infection is a short-term illness that occurs within the first six months after exposing to the hepatitis C virus.
• Chronic Hepatitis C Virus is a long-term illness that occurs when hepatitis C virus remains in the body of a person.People with chronic Hepatitis C are common to have a liver enzyme (ALT) level up and down or normal to near normal period.

Signs and symptoms of Hepatitis C

• Fever
• Nausea
• Vomiting
• Loss of appetite
• Fatigue
• Abdominal pain
• Joint pain
• Dark urine
• Clay-colored bowel movement
• Jaundice (yellowing of the skin and eyes)

Transmission of Hepatitis C

• Pregnant women infected with HBV can pass the virus to their babies during childbirth.
• Sharing needles, syringes and other equipments to inject drugs.
• Accidental needle sticks.
• Having Sexual contact with infected partner of hepatitis C virus.
• Sharing care items that may have contact with blood, such as toothbrush, razor.

Risk factors

• Multiple sex partners
• Mother infected with hepatitis C virus to infant born
• Current injection drug users
• Past injection drug users
• Recipients of donated blood, blood products and organs
• Hemodialysis patients
• HIV-infected person
• Having tattoos or body piercings

Diagnosis

Hepatitis C can be diagnosed by using some tests or procedure as follow :

• Blood Test is to measure liver function and liver enzyme (protein produced by the liver) level.
• Screening Test is  to show whether someone has developed antibodies to the Hepatitis C virus.
• A Liver Biopsy is a test to take a small piece of liver to look for liver damage.
• Liver Transplant is a surgical procedure to remove a diseased liver and replace it with a healthy liver from a donor.

Treatment of Hepatitis C

Treatment for Acute Hepatitis C can be done without treatment because it will clear on its own.

Treatment for Chronic Hepatitis C

• Medications

The Food and Drug Administration (FDA) approved some drugs for chronic Hepatitis C :

• Ribavirin (CoPegus)
• Daclatasvir (Daklinza)
• Sofosbuvir, Velpatasvir (Epclusa)
• Ledipasvir (Harvoni)
• Telaprevir (Incivek)
• Interferon Alphacon-1 (Infergen)
• Interfeton Alpha-2b (Intron A)
• Simeprevir (Olysio)
• Boceprevir (Victrelis)
• Pegylated Interferon (Pegasys)
• Pegylated Interferon alpha-2b (Pegintron)
• Interferon Alpha-2a (Roferon)
• Boceprevir (Victrelis)
• Elbasvir (Zepatier)
• Ombitasvir, Paritaprevir and Ritonavir (Technivie)

4. Hepatitis D (HDV)

Hepatitis D or Delta Virus is an infection that causes the inflammation of liver.Hepatitis D is uncureable.It is common in the South America, Russia, West Africa, Pacific Islands, Central Asia and Mediterranean.The Hepatitis D virus requires that a person first be infected with Hepatitis B virus.Hepatitis D is divided into acute and chronic.Acute Hepatitis D may go away on its own.Chronic Hepatitis D infection lasts for six months or longer.The outcome of Hepatitis D depends on whether HDV is contracted as a co-infection or a superinfection.Co-infection happens when both HDV and HBV are contracted simultaneously.Co-infection of HDV and HBV is acute and self-limiting infections.

Signs and symptoms of Hepatitis D

• Vomiting
• Fatigue
• Loss of appetite
• Dark urine
• Abdominal pain
• Joint pain
• Jaundice (yellowing the skin and eyes)

Transmission of Hepatitis D

• Urine
• Blood
• Semen
• Vaginal fluids
• Pregnant women infected with hepatitis D to their babies during childbirth

Risk factors

• Having Hepatitis B
• Receiving blood transfusion frequently
• A man has sex with other men

Diagnosis

Hepatitis D can be diagnosed by using serologic test that is a blood test to look for antibodies in the blood.The diagnosis of delta hepatitis should be considered if positive Hepatitis B Virus is present.

• Blood Test is to evaluate liver by measuring protein levels, liver enzymes and bilirubin in the blood.
• Radioimmunoassay (RIA) is to detec total anti HDV antibodies.
• Enzyme Immunoassay (EIA) is to detect the presence of a substance, usually an antingen, in a liquid sample or wet sample.
• Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) is to monitor ongoing HDV infection.

Treatment

There are unknown treatment for acute and chronic Hepatitis D.There is no vaccine for Hepatitis D.
Interferon Alpha is only temporary to inhibit viral activity.


5. Hepatitis E (HEV)

Hepatitis E or hep E is a liver disease that is caused by Hepatitis E Virus.Most people with hepatitis E recover completely.Hepatitis E virus infection results in a self-limited, acute illness.Developed Countries are common to get HEV because they have inadequate water supply and  environmental sanitation.The symptoms of Hepatitis E occur about fifteen to sixty days after exposure.

There are four genotypes of HEV :

• Genotype 1 locates in Africa and Asia

The transmision route is spread by water-borne fecal-oral person to person.

• Genotype 2 locates in Mexico and West Africa

The transmision route is spread by water-borne fecal-oral.

• Genotype 3 locates in Developed Countries

The transmision route is spread by food-borne.

• Genotype 4 locates in China, Taiwan and Japan

The transmision route is spread by food-borne.

Signs and symptoms of Hepatitis E

• Fever
• Loss of appetite
• Nausea
• Vomiting
• Fatigue
• Abdominal pain
• Joint pain
• Dark urine
• Clay-colored stool
• Jaundice (yellowing of the skin and eyes)
• Itching
• Tingling, numbness and weaknes in the arms and legs

Transmission

• Faecal-oral route due to faecal contamination of drinking water
• Ingestion of raw or uncooked shellfish
• Uncooked meat or organ from infected animals

Diagnosis

• Blood Test is to measure liver function and liver enzyme (protein produced by the liver) level.It looks for antibodies (protein substances) produced by immune system of the body to fight the virus.The blood test for antibodies should distinguish infection from Hepatitis A or B.
• Polymerase Chain Reaction (PCR) Test is used to reproduce selected section of DNA or RNA for analysis.

Risk Factors

• Poor sanitation
• Lack of safe water
• Travelling to regions of high endemicity without being immunized

Treatment of Hepatitis E

• Get adequate rest
• Get enough nutrients
• Drink plenty of fluids
• Hospitalization is for severe cases or pregnant woman.
• Ribavirin Therapy is used for severe acute Hepatitis E in 21 days.

There is no specific treatment for Hepatitis E infection.It runs a limited course.

• Parasitic Hepatitis is caused by parasites, such as Protozoans, Trypanosoma cruzi, Leishmania species and Malaria-causing Plasmodium.

• Bacterial Hepatitis is caused by bacteria.

Bacterial infection of the liver results in pyogenic abscesses, acute hepatitis, or chronic liver disease.

Pyogenic abscesses is caused by enteric bacteria, such as Escherichia coli and Klebsiella pneumoniae.

Acute hepatitis is caused by  Neisseria gonorrhoeae, Neisseria meningitidis, Borrelia burgdorferi, Bartonella henselae, Brucella species, Salmonella species and Campylobacter species.

Chronic hepatitis is infected by mycobacteria species, including Tropheryma whipplei, Treponema pallidum, Coxiella burnetii and rickettsia species.

II. Metabolic

• Alcoholic Hepatitis is caused by the exessive alcohol consumption.Development of alcoholic hepatitis is associated with long term of alcohol intake in excess of 80 grams of alcohol a day in men and 40 grams of alcohol a day in women.

Alcoholic hepatitis can vary from asymptomatic hepatomegaly (enlarged liver) to symptoms of acute hepatitis or chronic hepatitis to liver failure.

• Toxic and drug-induced Hepatitis is caused by chemical agents, including industrial toxins, medications and herbal and dietary supplements.

Toxins and drugs can cause liver injury through a variety of mechanisms, such as direct cell damage, disruption of cell metabolism and causing structural changes.

Drugs, such as :

Acetaminophen (aka Tylenol or paracetamol) exhibits predictable dose-dependent liver damage.

Isoniazid causes idiosyncratic and unpredictable reactions that vary among individuals.

III. Ischemic hepatitis (Shock liver) is resulted by injury to liver cells due to insufficient blood or oxygen.It rarely causes liver damage permanently.Blood testing of people with ischemic hepatitis will show very high transaminase Enzymes levels (AST and ALT).

IV. Genetic
Genetic causes of hepatitis include alpha-1-antitrypsin deficiency, hemochromatosis and Wilson disease.

Diagnosis of Hepatitis

• Physical Exam is to check the overall health.
• A Liver Biopsy is a test to take a small piece of liver to look for liver damage.
• Liver Function Test uses Alanine Transaminase (ALT) and Aspartate Amino transferase (AST), Albumin and Bilirubin tests.ALT and AST tests measure enzymes that the liver releases in response to damage or disease.
• Blood Test is to detect the presence of hepatitis virus antibodies and antingen in the blood.It will indicate the cause of hepatitis virus 
• Ultrasound is to reveal fluid in the abdomen, an enlarged liver or the damage of liver
• Viral Antibody Test is to determine the presence of a specific  type of hepatitis virus