Hepatitis
Hepatitis A
Definition
Hepatitis A is a highly contagious liver infection
caused by the hepatitis A virus. The hepatitis A virus
is one of several types of hepatitis viruses that cause
inflammation that affects your liver's ability to
function.
Hepatitis A was clearly recognized as an entity
separate from other types of hepatitis during World
War II, but only later did studies provide convincing
evidence of the prevalence and transmission of
hepatitis A virus (HAV).
Structure
The Hepatitis virus (HAV) is a Picornavirus; is the
causative agent of infectious hepatitis.
Non-enveloped
 contains a single-stranded RNA
 packaged in a protein shell "capsid" .
 There is only one serotype of the virus,
but multiple genotypes exist.
At the 5’ end of the RNA strand is a viral protein called
VPg.
Symptoms
Hepatitis A signs and symptoms typically don't appear until
you've had the virus for a few weeks. Signs and symptoms of
hepatitis A include:

Fatigue

Nausea and vomiting

Abdominal pain or discomfort.

Loss of appetite

Low-grade fever

Dark urine

Muscle pain

Yellowing of the skin and eyes (jaundice)

Acute liver failure
In rare cases, hepatitis A can cause acute liver failure,
which is a loss of liver function that occurs suddenly.
Causes
Hepatitis A is caused by infection .
Hepatitis A virus can be transmitted several ways, such as:
 The hepatitis virus is usually spread when a person ingests tiny
amounts of contaminated fecal matter.
 When someone with the virus handles the food
 you eat without first carefully washing his or her
 hands after using the toilet
 Drinking contaminated water
 Being in close contact with a person who's infected — even if that
person has no signs or symptoms
Risk factors
 You're at increased risk of hepatitis A if you:
 Travel or work in regions with high rates of hepatitis A
 Are HIV positive
 Use injected or noninjected illicit drugs
 Live with another person who has hepatitis A
 Children in preschools and day-care centers
Diagnosis
Although HAV is excreted in the feces towards the end
of the incubation period,
specific diagnosis is made by the detection of HAV in the
blood.
During the acute stage of the infection,
the liver enzyme alanine transferase (ALT)
is present in the blood at levels much
higher than is normal.
The enzyme comes from the liver cells that have been
damaged by the virus.
Treatments
No specific treatment exists for hepatitis A. Your body will
clear the hepatitis A virus on its own. In most cases of
hepatitis A, the liver heals completely in a month or two
with no lasting damage.
However, there are some things you can do that might help
you feel better:

Get enough calories.

Get plenty of rest.

Drink plenty of fluids.

Avoid medicines that can harm the liver

Avoid alcohol.

Exercise regularly.
Prevention
 Consider the hepatitis A vaccine
 Practice good hygiene
including washing your hands often —
is one of the best ways to protect against hepatitis A.
 Follow safety precautions when traveling
 peeling and washing all your fresh fruits and vegetables
yourself and by avoiding raw or undercooked meat and
fish.
 Drink bottled water and. If bottled water isn't available,
boil tap water before drinking it.
Hepatitis B
Definition
Hepatitis B is a serious disease caused by a virus that
attacks the liver and can cause both acute and chronic disease. The virus,
which is called hepatitis B virus (HBV), can cause lifelong infection,
cirrhosis (scarring) of the liver, liver cancer, liver failure, and death .
Hepatitis B is a potentially life-threatening liver infection caused by the
hepatitis B virus. It is a major global health problem and the most serious type
of viral hepatitis. It can cause chronic liver disease and puts people at high risk
of death from cirrhosis of the liver and liver cancer.
Worldwide, an estimated two billion people have been infected with the
hepatitis B virus (HBV), and more than 350 million have chronic (long-term)
liver infections.
Structure
HBV is a 42nm, double-shelled
deoxyribonucleic acid (DNA) virus of the
class Hepadnaviridae.
The outer surface membrane contains hepatitis
B surface antigen (HBsAg), which also
circulates in blood as 22-nm spherical and
tubular particles
The inner core of the virus contains hepatitis B core antigen (HBcAg),
hepatitis B e antigen (HBeAg), a single molecule of partially doublestranded DNA, and DNA-dependent DNA polymerase.
Symptoms
Hepatitis B virus can cause an acute illness with symptoms that
last several weeks, including yellowing of the skin and eyes
(jaundice), dark urine, extreme fatigue, nausea, vomiting and
abdominal pain. People can take several months to a year to
recover from the symptoms. HBV can also cause a chronic liver
infection that can later develop into cirrhosis of the liver or liver
cancer.
Diagnosis
Infection with hepatitis B is suspected when the medical
history and the physical examination reveal risk factors for the
infection or symptoms and signs that are suggestive of
hepatitis B. Abnormalities in the liver tests (blood tests) also
can raise suspicion; however, abnormal liver tests can result
from many conditions that affect the liver. The diagnosis of
hepatitis B can be made only with specific hepatitis B virus
blood tests. These tests are known as hepatitis 'markers' or
'serology.'
Transmission
Hepatitis B virus is transmitted between people by contact with the
blood or other body fluids (i.e. semen and vaginal fluid) of an
infected person. Modes of transmission are the same for the human
immunodeficiency virus (HIV), but HBV is 50 to 100 times more
infectious Unlike HIV, HBV can survive outside the body for at
least 7 days. During that time, the virus can still cause infection if it
enters the body of a person who is not infected.
HBV is not spread by contaminated food or water, and cannot be
spread casually in the workplace
Treatment
There is no specific treatment for acute hepatitis B. Care is
aimed at maintaining comfort and adequate nutritional
balance, including replacement of fluids that are lost from
vomiting and diarrhoea.
Chronic hepatitis B can be treated with drugs,
including interferon and anti-viral agents,
which can help some patients. Treatment can
cost thousands of dollars per year and is not
available to most patients in developing
countries
Prevention
All infants should receive the hepatitis B vaccine: this is the mainstay of hepatitis
B prevention.
The vaccine can be given as either three or four separate doses, as part of existing
routine immunization schedules. In areas where mother-to-infant spread of HBV
is common, the first dose of vaccine should be given as soon as possible after
birth (i.e. within 24 hours).
The complete vaccine series induces protective antibody levels in more than 95%
of infants, children and young adults. After age 40, protection following the
primary vaccination series drops below 90%. At 60 years old, protective antibody
levels are achieved in only 65 to 75% of those vaccinated. Protection lasts at least
20 years and should be lifelong. All children and adolescents younger than 18 years
old and not previously vaccinated should receive the vaccine.
Hepatitis C
Definition
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV).
Hepatitis C is a contagious liver disease that results from infection
with hepatitis C virus (HCV). It can range in severity from a mild
illness lasting a few weeks to a serious, lifelong illness. HCV is
usually spread when blood from a person infected with HCV enters
the body of someone who is not infected. HCV is among the most
common viruses that infect the liver
•About 130–170 million people are chronically infected with
hepatitis C virus, and more than 350 000 people die from hepatitis
C-related liver diseases each year.
Structure
Hepatitis C virus (HCV) is a
hepacivirus of the family Flaviviridae,
according to the Viral Hepatitis
Prevention Board (VHPB). It is an
RNA virus with an envelope. Proteins
on its surface help an HCV virus
particle (called a virion) to bind to and
infect host cells; once it is brought
within a host cell, it replicates (creates
more copies of itself).
Symptoms
Following initial infection, approximately 80% of people do not
exhibit any symptoms. Those people who are acutely symptomatic
may exhibit fever, fatigue, decreased appetite, nausea, vomiting,
abdominal pain, dark urine, grey-coloured faeces, joint pain, and
jaundice (yellowing of skin and the whites of the eyes). When a
chronically-infected person develops symptoms, it may indicate
advanced liver disease.
Statistically, 60–70% of chronically-infected persons develop
chronic liver disease, 5-20% develop cirrhosis, and 1–5% die from
cirrhosis or liver cancer.
Diagnosis
Diagnosis of acute infection is often missed because the infected
person has no symtoms. Common methods of antibody
detection cannot differentiate between acute and chronic
infection. The presence of antibodies against HCV (anti-HCV)
indicates that a person is or has been infected. HCV
recombinant immunoblot assay (RIBA) and HCV RNA testing
are used to confirm the diagnosis of HCV infection.
Diagnosis of chronic infection diagnosis is made when antiHCV is present for more than 6 months. Similar to acute
infections, diagnosis should be confirmed with an additional
test. Specialized tests are often used to evaluate patients for liver
disease including cirrhosis and liver cancer.
Transmission
The virus is most commonly transmitted through exposure to
infectious blood such as through: receipt of contaminated blood
transfusions, blood products, and organ transplants; injections given
with contaminated syringes, needle-stick injuries in health-care
settings; injection drug use; being born to an HCV-infected mother. It
is less commonly transmitted through sex with an infected person and
sharing of personal items contaminated with infectious blood.
Hepatitis C is not spread through breastmilk, food or water or by
casual contact such as hugging, kissing and sharing food or drinks
with an infected person.
Treatment
Treatment outcomes depend on many factors,
including whether a patient is being treated for acute
or chronic disease. Acute HCV infection is
uncommonly diagnosed, because it often manifests
with nonspecific flulike symptoms. Available
evidence suggests that interferon-based therapy
given early in the course of infection decreases the
risk of progression to chronic disease. 5 Health care
workers, for example, who are accidentally exposed
to HCV-infected blood via a needle stick injury,
should be followed carefully for evidence of
ongoing infection and, if unable to clear the
infection spontaneously, be treated early.
Prevention
•Primary prevention
No vaccine exists to prevent HCV infection, unlike those for hepatitis A and B virus. The
risk of infection can be reduced by avoiding:
•unnecessary and unsafe injections
•unsafe blood products
•unsafe sharps waste collection and disposal
•use of illicit drugs and sharing of injection equipment
•unprotected sex with HCV-infected persons
•sharing of sharp personal items that may be contaminated with infected blood
•tattoos, piercings and acupuncture performed with contaminated equipment.
•Secondary and tertiary prevention
If a person is infected with HCV, they should:
•receive education and counselling on options for care and treatement
•be immunized with hepatitis A and B vaccine, to prevent co-infection from these hepatitis
viruses, to protect their liver
•get early and appropriate medical management including antiviral therapy if appropriate
and get regular monitoring for early diagnosis of liver disease.
Hepatitis D
History
 In 1977, Dr. Mario Rizzetto and associates discovered in Italy, in
patients affected by Hepatitis B a new antigen different than
surface, core and e systems that they called "delta antigen". This
antigen was detected by immunofluorescence in the nuclei of
liver cells in patients infected with hepatitis B and looked similar
to hepatitis B core antigen. , tenaciously postulated by Dr.
Rizzetto, was confirmed some years later by experimentally
infecting chimpanzees and obtaining a new viral particle which
was given the name of Hepatitis D Virus (HDV).
Structure Hepatitis D or Delta
Hepatitis D is called Delta virus, is characterized
by the inability to reproduce, reproduction and
lonely, and needs the presence of another liver
virus for reproduction, it is often with hepatitis C
(b) Hepatitis B
o should be possible Additional virus infection (d)
when any patient with hepatitis C virus (b)
chronic
o concurrent infection co-infection: When a
patient is infected with the virus (d) and virus (b)
at the same time
o superinfection super-infection.: When a patient
is infected with the virus (d) and the patient
infected with hepatitis C (b) previously
Symptoms:
* jaundice (yellowing of the skin and eyes)
* shift to color the urine dark tea color
* turning to the light color stool
* symptoms as symptoms (influenza), loss of appetite, general
weakness and fatigue, nausea and vomiting
* fever, headache or pain in the joints
* skin rash or itching
Modes of transmission
*the transfer of blood or blood products
* sexual intercourse with an infected
* Drug abuse by injection common
* dialysis
*o Acupuncture, tattooing, ear or nose piercing,
circumcision, non-sterile instruments
* Working in the field when it is under to deal with
blood or other
*body fluids
Diagnosis:
Diagnosis is made by testing to detect the presence of
antibodies to the virus (d)
Treatment:
o Do not no cure for the condition
o uses the drug interferon alpha
interferon-alpha for the treatment of
patients with hepatitis (b) and (d)
Methods of prevention:
To date there is no vaccination against this virus, but
since it required the presence of the virus (b) to be
infected with HIV (d) Valttaam against the virus, (b)
provides protection against viruses, albeit indirectly, for
the virus (d). Patients infected with HIV (b)
understanding vulnerable to HIV infection (d), and
therefore must take the protective measures necessary to
avoid injury
Hepatitis E
Viral hepatitis is liver inflammation caused by a virus
Hepatitis E is most often seen in young-to-middle-aged
adults (15 years to 40 years old). Major waterborne
epidemics of hepatitis E have occurred in Asia and North
and East Africa. To date, no U.S. outbreaks have been
reported
Causes :
The disease occurs through infection with the
hepatitis E virus, which commonly happens
through "fecal-oral transmission." This type of
transmission can occur when a person eats or
drinks something that has been contaminated
with the stool of someone infected with the
hepatitis E virus. It can also result from placing a
utensil or other infected object into the mouth.
transmission:
Transmitted by contaminated water
Person-to-person transmission is uncommon.
There is no evidence for sexual transmission
or for transmission by transfusion
When a person becomes infected with the
hepatitis E virus, it begins to multiply
within the liver. Fourteen to 60 days later, a
person may develop hepatitis E symptoms.
This period between transmission of the
virus and the start of symptoms is called the
"hepatitis E incubation period
Symptoms
 Excessive tiredness
 A lack of appetite
 Nausea
 Diarrhea
 A low-grade fever
 Muscle pain
 Joint pain
 A sore throat
 Dark urine
 Pale-colored stool
 Stomach pain (or abdominal pain) on the right side .

 Jaundice (yellowing of the skin or the whites of the eyes)
Diagnosing
When diagnosing hepatitis E, your healthcare provider will
begin by asking questions about your medical history,
including questions about:
Symptoms
Current medical conditions
Current medications
Family history of medical conditions
Any recent travel
Alcohol and/or drug use
Sexual history
Tests Used for Diagnosing Hepatitis E
Since cases of hepatitis E are not clinically distinguishable
from other types of acute viral hepatitis, diagnosis is made
by blood tests which detect elevated antibody levels of
specific antibodies to hepatitis E in the body
Treatment :
Hepatitis E is a viral disease, antibiotics are of no value in the
treatment of the infection.
No available therapy is capable of altering the course of acute
infection
Specific Hepatitis E Treatment Suggestions:
Get enough calories
Get plenty of rest
Drink plenty of fluids
Avoid medicines that can harm the liver
Avoid alcohol
Exercise regularly
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