Hepatovirus: Infectious Hepatitis or Hepatitis A: Transmission, Incubation, Symptoms, Diagnosis, Prognosis, Prevention

Hepatovirus is subtype of Picornavirus. The Hepatovirus causes liver infection known as hepatitis A. Hepatovirus in most cases causes initial symptoms of upper gastrointestinal and respiratory tract infection. Later the virus spreads through blood to liver and causes liver infection known as Hepatovirus hepatitis. Hepatitis is an infectious inflammatory disease of liver. It is important to know about Hepatovirus and infectious hepatitis or hepatitis A.

There are various subtypes of picornavirus, which cause infections in humans. Out of these types, Hepatovirus causes infectious hepatitis or hepatitis A. Let us understand the mode of transmission, incubation period, symptoms, diagnosis and prevention of hepatitis A.

The type A, infectious hepatitis is caused by Hepatovirus. Hepatitis A is a highly contagious infection. The source of virus is an infected individual. Hepatovirus is observed to be active in human blood and human is considered as a natural reservoir.

The Hepatovirus is resistant to drying, detergent and solvent like ether and chloroform. Hepatovirus causing infectious hepatitis or Hepatitis A can be inactivated by chlorine treatment of water and formalin UV radiation of other solutions or solid objects.

The mode of transmission of Hepatovirus infection is as follows-

The active Hepatoviruses are passed through the stool of hepatitis A infected individual. Individuals infected by Hepatovirus may forget or ignore to clean the hands after passing stool. The particles of feces, which carry the infective virus are then smeared on surrounding objects and furniture. A healthy individual may touch the contaminated objects or furniture and transmit the viruses to oral cavity when the hand touches the food.

The sharing of contaminated needle used by Hepatovirus infected patient can cause transmission of infectious hepatitis or hepatitis A to the healthy individual.

Infectious hepatitis or hepatitis A infection is also transmitted when an individual infected with Hepatovirus donates blood, which is later transfused to healthy individual.

The public places are often shared for cleaning, toilet and bath. Such places do get contaminated by individuals suffering with infectious hepatitis. Use of such contaminated public places causes rapid spread of Hepatovirus infection to healthy individual. In several Asian and African countries, the toilets are not clean effectively resulting in spreading of infected feces.

Hepatitis A infection spreads rapidly to others when people live in overcrowded areas.

Incubation period is the time period since a person gets exposed to the virus and the presentation of symptoms. The incubation period of hepatitis A Hepatovirus infection is 5 to 15 days in individual exposed to Hepatovirus. The initial symptoms are often observed in 5 to 50 days.

The exposure to Hepatovirus causes initial upper respiratory tract infection as well as gastrointestinal system. Infection later spreads through the blood to liver resulting in symptoms and signs of hepatitis. The Hepatovirus attacks and spread in hepatocytes and Kupffer cells of liver, which results in rapid multiplication of viruses.

Symptoms of infectious hepatitis or hepatitis A appear similar to flu like symptoms during the initial phase of the disease. The Hepatovirus infection is often treated like flu for first 1 to 2 weeks. The commonest early symptoms of infectious hepatitis include fatigue, fever, running nose, cough and throat pain.

The symptoms of infectious hepatitis or hepatitis A related to gastrointestinal system include appetite loss, nausea, vomiting and diarrhea. Other signs and symptoms include jaundice, abdominal pain, weakness, fatigue and enlarged liver.

Hepatovirus infection can be diagnosed with the help of clinical examination, history of symptoms and clinical investigations. Some of the investigations useful in making a diagnosis of infectious hepatitis or hepatitis A include:

• Alanine Transaminase (ALT) test – Increased
• Aspartate Aminotransferase (AST) test- Increases
• Alkaline Phosphatase (ALP) test- Increased
• Albumin test- normal
• Bilirubin test- Increased

• IgG antibodies- IgG antibodies concentration increases following Hepatovirus infection of liver. Increase of IgG level in serum is observed in 4 to 6 weeks, suggesting immunity for future infection and possible past infection.
• IgM antibodies- The Hepatitis A IgM antibodies are increased immediately following infection. The increased of IgM is diagnostic for Hepatovirus liver infection.
• HBV Surface Antibody- Suggests individual tested positive was exposed for infection.

These blood tests are useful and aid in the diagnosis and monitoring of hepatitis A or infectious hepatitis.

The ultrasound scanning shows enlarged liver, thick gall bladder wall and enlarged lymph node.

Computerized tomography (CT) scan- CT scan is performed to evaluate liver size and radiological appearance.

• Liver size is increased and known as hepatomegaly.
• The increased gall bladder wall thickness is observed in patients with acute hepatitis.
• Enlarged lymph nodes are observed around liver.

Liver needle biopsy is done in most cases of hepatitis, if found appropriate. The findings are often diagnostic in other types of hepatitis, commonly Hepatitis B and C. The findings observed under microscopy in viral Hepatitis A are focal necrosis, Kupffer cell proliferation, presence of acidophil bodies and signs of portal hypertrophy. In addition, cholestasis and piecemeal necrosis are observed in few cases.

The Hepatovirus hepatitis A if ignored can cause fatal outcome in 4 of 1000 cases in all age groups. The mortality rate is higher in elderly and published data suggests 17.5 per 1000 patients.

Treatment of hepatovirus infection or infectious hepatitis may be given based on the severity of symptoms. It is important to control vomiting and diarrhea and prevent dehydration. Most patient recover to normal function in 6 to 8 weeks. The disease may recur in few cases after 6 months.

Some of the important ways that help in prevention of Hepatovirus caused infectious hepatitis or hepatitis A include:

• Avoid Contact- The spread of Hepatovirus infection can be prevented by avoiding contact with an infected person.
• Frequent Hand Wash- If infected person is a relative or a roommate, frequent hand wash is recommended. Hand wash is recommended following use of public space, toilets, or when travelling in groups, in plane, train or bus.
• Cooked Food- Vegetables, fruits, poultry and meat are handled by several individuals prior to purchase at market. The possibilities of spread of disease from infected individual to a healthy person is rare if these foods are consumed after treatment with heat. It is best to properly wash all food items and cook them properly before eating.
• Vaccination- Vaccination prevents liver infection in susceptible individual as well as eliminates recurrence of infectious type A hepatitis. The vaccination prevents occurrence of infection for 20 years and often repeated every 20 years. The treatment of infection hepatitis A, B, C, D and E is more or less remains same.

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