Viral Hepatitis means inflammation of the liver. The liver may get inflamed due to various causes like excessive use of alcohol, infectious causes, and viral infection of the liver. In this article, we will discuss about Viral Hepatitis, which constitutes for more than half of hepatitis cases. We will also discuss about the various causes, symptoms, and treatments for Viral Hepatitis.

Viral Hepatitis

The three basic forms of viral hepatitis that we will be discussing in this article are:

  • Hepatitis A
  • Hepatitis B
  • Hepatitis C

How Is Viral Hepatitis Defined?

  • Inflammatory Disease- The medical term Viral Hepatitis suggests inflammatory disease of the liver caused by viral infection.
  • Self-Limiting Disease- An acute infection as a result of the Hepatitis virus may result in pathological conditions, which may range from self-limited symptomatic disease to liver failure.
  • Hepatitis Virus A, B and C- Liver inflammation is identified as Hepatitis A, B and C, caused by hepatitis virus A, B and C respectively.
  • Clinical Presentation- Individuals with acute forms of Hepatitis A or B are generally symptomatic but individuals with Hepatitis C can be both symptomatic as well as asymptomatic.
  • Diagnostic Findings- Some of the general symptoms of Viral Hepatitis are fatigue, anorexia, nausea with vomiting, extremely elevated aminotransferase values along with hyper-bilirubinemia (increased blood bilirubin).
  • Liver Failure- Extremely severe cases of Viral Hepatitis may advance to complete liver failure.

Causes Of Viral Hepatitis

Causes Of Viral Hepatitis Are As Follows-

  • Hepatitis Virus-
    • Hepatitis A
    • Hepatitis B
    • Hepatitis C
    • Hepatitis D
    • Hepatitis E
  • Cytomegalovirus
  • Epstein Barr Virus
  • Herpes Simplex

About Hepatitis A Virus1

  • Transmission Of Hepatitis A Virus -
    • The virus is also known as Picornavirus.
    • The oral route transmits the virus.
    • The contaminated water is the main source.
    • Virus is discharged in feces.
    • Contamination of water or food when comes in contact with fecal discharge causes transmission of the diseases and endemic spread.
    • It is a very rare that this virus is transmitted by transfusion.
    • This infection is mainly caused by ingestion of contaminated food or water.
  • Antibodies-
    • Antibodies are formed following infection and protect against future viral infection.
  • Common Geographic Area Of Infection For Hepatitis A Virus -
    • Infection caused by Hepatitis A virus is mainly prevalent in the countries of the Middle East, Africa, Asia, and South America.
  • Infectious and Symptomatic Period Of Hepatitis A Virus –
    • Lasts for 4 to 6 weeks.
    • Acute form of infection- lasts for 2 week to 6 week.
    • Chronic form is not observed.
    • The infection is self limiting.1
  • Relapse of Hepatitis A Virus -
    • Observed in 15 to 20% of the patients. Most of the relapse occurs within first one year.
  • Prevention Of Hepatitis A Virus-
    • Improvement in the standards of sanitation has helped to reduce the infection in epidemic countries. In recent years, the infection caused by this virus has gone down considerably.

About Hepatitis B Virus

  • Transmission of Hepatitis B Virus:
    • Perinatal Transmission- Hepatitis B virus is transmitted perinatally. The infection generally appears to occur in intrapartum period.
    • Sexual Transmission2: Hepatitis B virus can be easily transmitted through sexual contact. This mode of transmission of the Hepatitis B virus accounts for at least 50% of infections related to Hepatitis B in the United States.
    • Parenteral Transmission: Individuals with hemophilia and those undergoing dialysis or those individuals who have had an organ transplant are more prone to develop hepatitis B infection. Intravenous drug use is also one major risk factor for development of infection related to Hepatitis B in the United States.
  • Antibodies
    • Antibodies often does not prevent relapse of hepatitis B infection.
    • Antibodies are often inadequate and do not cause total disinfection of viruses.
    • Hepatitis B vaccine prevents hepatitis B infection and relapse.
  • Common Geographic Area OF Hepatitis B Virus -
    • South east area
  • Infectious and Symptomatic Period of Hepatitis B Virus -
    • 3 to 6 months.
    • Hepatitis B virus can stay inactive in liver for life of a patient and may cause immune complex disease.
  • Relapse of Hepatitis B Virus -
    • Relapse may occur because of low antibodies.
    • Infection causes close to 1 million fatalities per year.
    • Relapse may result in cirrhosis and hepatocellular carcinoma.
  • Prevention of Hepatitis B Virus -
    • Avoid sexual contact with infected patient
    • Avoid contaminated needle.
    • Make sure not to drink tap water in endemic or epidemic area.

About Hepatitis C Virus

Individuals with hemophilia are more prone to have Hepatitis C infection.

  • Transmission of Hepatitis C Virus -
    • This virus is known as Flaviviridae and is transmitted to fetus via placenta. The virus is also known to cause infection by use of contaminated needle as seen in IV drug abuse2 and hospital practice in under developed world.
  • Antibodies-
    • Antibodies are formed following infection and protect future Hepatitis C viral infection.
    • Patient is susceptible to develop hepatitis A or B infection.
    • Hepatitis C Antibodies do not protect infection caused by Hepatitis A or B virus.
    • Patient is immunized against Hepatitis A and B to prevent A or B hepatitis.
  • Common Geographic Area Of Infection of of Hepatitis C Virus -
    • Infection caused by this virus is observed in almost all the countries in the world.
  • Infectious and Symptomatic Period of of Hepatitis C Virus –
    • 28 days
  • Relapse of of Hepatitis C Virus -
    • Relapse is uncommon
  • Prevention of of Hepatitis C Virus
    • Do not share needle or
    • Avoid needle, which is re-sterilized.

Symptoms Of Viral Hepatitis

Asymptomatic Viral Hepatitis-

  • Hepatitis C and A may not show any specific or non-specific symptoms.
  • The presenting symptom of Infectious Hepatitis is different in different individuals
  • Some people may be completely asymptomatic on presentation whereas some people may present with acute liver failure.

Symptomatic Viral Hepatitis-

  • Non-Specific Symptoms of Viral Hepatitis-
    • Fatigue
    • Loss of weight
    • Loss of appetite
  • Specific Symptoms of Viral Hepatitis-
    • Flu-Like symptoms
      • Fever
      • Body ache
      • Sleepiness
    • Abdominal Pain- on right upper abdomen
    • Symptoms of Jaundice-
      • Urine- dark color
      • Stool- pale color
      • Yellow eyes (conjunctiva)

Phases of Clinical Manifestations of Viral Hepatitis

  • Phase I:
    • Viral Replication- Phase I is also known as the Viral Replication Phase.
    • Asymptomatic- In this phase, individuals are usually asymptomatic.
    • Positive Lab Test- Positive laboratory findings in these individuals are indicative of hepatitis.
  • Phase II:
    • Prodromal Phase- This phase is also called as the prodromal phase.
    • Symptoms-
      • Anorexia
      • Nausea with vomiting
      • Taste alterations
      • Pain is felt over right upper abdomen and under the ribs.
      • Joint and muscle pain
    • Lab Test- Positive for viral hepatitis
  • Phase III:
    • Icteric Phase- This phase is also called as the Icteric Phase.
    • Enlarged Liver- The liver is enlarged (larger in size) and often palpable during abdominal examinations.
    • Cholestasis-Medical condition results in reduction in bile flow. Symptoms of cholestasis are as follows-
      • Jaundice
      • Dark urine
      • Pale stool
      • Itching
  • Phase IV:
    • Convalescent Phase-
      • The phase is a recovery phase.
      • Most of the symptoms are resolved and patient is in recovery phase.
      • Lab results are normal.

Diagnosis of Viral Hepatitis

Blood Examination-

  • Viral Hepatitis Antibody Panel Test
    • Hepatitis A Antibody: IgM increases after 2 to 3 weeks of infection and remains high up to 6 months.
    • Hepatitis B Antibody IgM- The antibody level is detected after 2 weeks and remains for several yeas or life of a patient resulting in Chronic Hepatitis B disease.
    • Hepatitis B Surface Ag- The surface protein detected over surface of virus during acute and chronic phase.
    • Hepatitis C Antibody- The test is specific to detect antibodies following hepatitis C infection.
  • Liver Function Test-
    • AST (aspartate transaminase) enzyme- elevated
    • ALT (alanine transaminase) enzyme- elevated
    • Serum Bilirubin- elevated

Treatment of Viral Hepatitis

Conservative Treatment for Viral Hepatitis-

  • Bed rest
  • Normal hydration
  • Prevent malnourishment

Antiviral Medications for Viral Hepatitis -

  • Hepatitis B-
    • Peginterferon3
    • Lamivudine
    • Adefovir Dipivoxil.
  • Hepatitis C4
    • Peginterferon and
    • Ribovarin.

Liver Failure-

  • Treatment of hepatic encephalopathy
  • Liver transplant

References:

1. Acute hepatitis A virus infection: a review of prognostic factors from 25 years experience in a tertiary referral center.

Kyrlagkitsis I1, Cramp ME, Smith H, Portmann B, O'Grady J.

Hepatogastroenterology. 2002 Mar-Apr;49(44):524-8.

2. Epidemiology, clinical data, and treatment of viral hepatitis in a large cohort of intravenous drug users.

Gigi E1, Sinakos E, Sykja A, Androulakis G, Tanis C, Stayridou V, Tsirogianni E, Zouridakis K, Bellou AL, Orfanou E, Raptopoulou-Gigi M.

J Addict Med. 2013 Jan-Feb;7(1):52-7. doi: 10.1097/ADM.0b013e318279756f.

3. Diagnosis and personalized management of hepatitis B including significance of genotypes.

Wong VW1, Sung JJ.

Curr Opin Infect Dis. 2012 Oct;25(5):570-7.

4. Hepatitis B and C.

Duddempudi AT1, Bernstein DE.

Clin Geriatr Med. 2014 Feb;30(1):149-67.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: August 5, 2014

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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