5 Types Of Viral Hepatitis: Symptoms, Diagnosis And Treatment

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.
  
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• 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.
  
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• 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.