Viral Hepatitis Symptoms, Treatments | Chronic Hepatitis Diagnosis

Viral Hepatitis Types

Based on viral, immunologic and epidemiologic consideration, five types of viral hepatitis are recognized (i.e. hepatitis A, B, C, D and E).

I.  Hepatitis A

1. Causative agent: Hepatitis A virus is an RNA virus, 27nm in diameter and is classified as a picornavirus.
2. Mode of infection- it is through feco-oral route, contaminated food and water; through fingers and feeding utensils.
3. Incubation period- 15-30days. Average of 25-30days.

Symptoms of  Hepatitis A

1. Onset is generally acute.
2. Prodromal phase- patient has moderate fever, malaise, loss of appetite and nausea.
3. After prodromal phase patient passes dark colored urine, stools are clay colored.
4. Sclera and skin shows icterus (yellowish discoloration of sclera) which may last for 1-4wks.
5. Carrier state is unusual.

Chronic Hepatitis A Diagnosis

1. Serological tests for diagnosis of hepatitis A are available (anti HAV and IgM anti HAV).
2. IgM anti­-HAV indicates recent infection.
3. ALT SGPT is high. ALT Levels are high in first week of illness.
4. Transminase levels remain elevated for 1-3wks.
5. Prophylaxis: Pooled immunoglobulin is given intramuscular which protects personal contacts and household members.

II.  Hepatitis B

1. Causative agents- hepatitis B virus is DNA containing virus, 42nm in diameter.
2. Mode of transmission- usually indirect, through parentral route from hepatitis B virus contaminated blood transfusion.
3. Sharing of contaminated needles and shaving razors.
4. As virus is found in other biological fluids such as blood, urine, breast milk etc. it may be transmitted via transcutaneous route through abrasions in skin.
5. Vertical transmission by mother to fetus is possible.
6. Incubation period is 45-60days.

Symptoms of  Hepatitis B

1. Onset is gradual.
2. Mild loss of appetite.
3. Nausea and vomiting are uncommon.

The illness may follow any of the following courses:

1. Asymptomatic infection with minimal liver damage.
2. Acute hepatitis.
3. Leading to chronic carrier state.
4. Chronic hepatitis may evolve into chronic persistent or chronic active hepatitis.

Chronic Hepatitis B Diagnosis

1. Various immunologic assays are available for specific diagnosis of hepatitis B virus (HBV) i.e. HBsAG.
2. Prophylaxis- active immunization is achieved by administering hepatitis B vaccine.
3. Plasma derived and DNA recombinant vaccines both are useful.

III.  Hepatitis C

1. Causative agents- hepatitis C virus is a single stranded RNA virus belonging to flavivirus family.
2. Modes of transmission- more than 80% of cases of post transfusion hepatitis in some series were attributed to hepatitis C.
3. Mainly transmitted through blood and blood products but may also be transmitted sexually.
4. Peri-natal transmission may also occur.
5. Incubation period varies from 2-24wks.

Symptoms of  Hepatitis C

1. Onset is gradual and presents with jaundice.
2. Malaise appears mild compared to hepatitis B and may even be asymptomatic.
3. 50% of patients may develop chronic liver disease such as cirrhosis or even hepatocellular cancer.

Chronic Hepatitis C Diagnosis

1. Serological test for anti-HCV (hepatitis C virus) are now available.
2. There may be cyclic elevation of transaminase level.

Prophylaxis-

1. Screening of all blood products such as crypto-precipitate for HCV is strongly recommended.
2. Pooled immunoglobulin do not confer passive immunity.

IV.          Hepatitis D

• Causative agents- hepatitis delta virus is a 35-37nm defective RNA fragment and delta protein antigen.
• It cannot cause disease alone, but requires hepatitis B as a helper virus which is coated on it.
• Infection with HDV (hepatitis D virus) in persons already infected with HBV may get fulminant illness.
• Chronic asymptomatic carriers of HBV are at risk of developing delta hepatitis and subsequent chronic liver disease and cirrhosis.
• Mode of transmission is by blood transfusion or products or through mucous membrane inoculation.
• Incubation period is 2-8wks.
• Investigations- anti HDV antibody can be demonstrated.

V.   Hepatitis E

• Hepatitis E virus (HEV) is an RNA virus similar to a calicivirus.
• Incubation period is 15-60days.
• Transmission is by feco-oral route.
• Incidence is higher in pregnant women and adults compared with children.
• Acute illness is associated with icterus (yellowish coloration if sclera), loss of appetite, fever and malaise.
• Serological tests for detecting HEV antibody are possible.
• Passive immuno-prophylaxis is not effective.

Treatment for Viral Hepatitis

• No specific therapy.
• Rest in bed is recommended till transaminase levels are high.
• Good nutritious diet rich in carbohydrate and protein should be given.
• Fats should be restricted.
• If chronic active hepatitis has already set in, corticosteroid may be used to suppress immune mechanisms.
• Chronic persistent hepatitis is however a benign condition and does not require any specific treatment.

Related Topics
• Hepatitis D Symptoms, Transmission: Hepatitis Delta Virus Prevention
• Hepatitis A Transmission: Symptoms, Diagnosis And Treatment
• Chronic Uvetis Treatments: Symptoms And Diagnosis Of Chronic Uvetis
• Hepatitis In Children: Symptoms, Causes And Prevention Of Hepatitis
• Hepatitis E Symptoms And Transmission: Treatment For HEV Infection