5 Types Of Viral Hepatitis: Symptoms, Diagnosis And Treatment

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

Hepatitis A

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

Symptoms of  Hepatitis A

  • Onset is generally acute.
  • Initially patient has moderate fever, malaise, loss of appetite and nausea and abdominal pain.
  • After initial phase patient passes dark colored urine, stools are clay colored.
  • Sclera and skin shows icterus (yellowish discoloration of sclera) which may last for 1 to 4 weeks.
  • Carrier state is unusual.

Hepatitis A Diagnosis

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

Hepatitis B

  • Causative agents- hepatitis B virus is DNA containing virus, 42nm in diameter.
  • Mode of transmission- usually indirect, through parentral route from hepatitis B virus contaminated blood transfusion.
  • Sharing of contaminated needles and shaving razors.
  • 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.
  • Vertical transmission by mother to fetus is possible.
  • Incubation period is 45 to 60 days.

Symptoms of  Hepatitis B

  • Onset is gradual
  • Mild loss of appetite
  • Nausea and vomiting are uncommon

The illness may follow any of the following courses:

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

Diagnosis: Various immunologic assays are available for specific diagnosis of hepatitis B virus (HBV) i.e. HBsAG.

Hepatitis C

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

Symptoms Of  Hepatitis C

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

Hepatitis C Diagnosis

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

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 to 8 weeks.
  • Investigations- anti HDV antibody can be demonstrated.

Hepatitis E

  • Hepatitis E virus (HEV) is an RNA virus similar to a calicivirus.
  • Incubation period is 15 to 60 days.
  • Transmission is by feco-oral route.
  • Incidence is higher in pregnant women and adults compared with children.
  • Acute illness is associated with icterus (yellow discoloration of 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.