Question

Discuss in depth the five types of Hepatitis in terms of etiology, symptoms, treatment and prevention.

Answer 1

Hepatitis is a condition characterized by inflammation of liver. It is commonly caused by viral infection. But it may also as a result of autoimmune disorder during which the immune system of the body attacks the liver causing inflammation. This is referred to as autoimmune hepatitis. In addition to this, hepatitis can also occur due to exposure to certain medications, vitamins, food supplements, toxins, and alcohol.

Viral hepatitis occurs due to infection by different types of viruses but have similar clinical presentations. According to the types of viruses causing infection, there are five types of hepatitis. They are classified as Hepatitis A, B, C, D, and E. The infection caused by these viruses differ in pathological and immunological features.

Hepatitis A

• It is a highly contagious infection.
• The causative organism is hepatitis A virus (HAV).
• These types of viruses are present in the stool of infected persons. Infection passes through the fecal-oral route. The infections spread when infected persons do not wash their hands properly after bowel movement and pass on the virus by touching.
• Contaminated food and water are the main mode of passing the infection.
• People are susceptible to infection by eating undercooked or uncooked fruits, vegetables, shellfish, etc.
• Symptoms of hepatitis A varies. Some people especially children are not presented with any symptoms. Common symptoms include fever, nausea, vomiting, abdominal pain, diarrhea, gray stools, and appetite loss. Apart from this, extreme fatigue leading to jaundice, rashes on skin, and joint pain may also occur.
• No specific medicines are available for treatment. Treatment include measures to relieve the symptoms by taking rest, managing nausea, avoiding alcohol intake, etc.
• Preventive measures include taking hepatitis A vaccination, educating the public regarding proper hygiene, sanitation, and importance of washing hands. Apart from this, communities must adopt proper treatment of water and sewage. People should be made aware about the importance of washing and cooking food properly. Since this type of infection is common in developing countries, people travelling to these regions must take immunization.

Hepatitis B

• It is also a highly contagious infection.
• The causative organism is hepatitis B virus (HBV).
• These types of viruses are present in the blood and body fluids of infected persons and infection passes through sexual contact, direct contact with blood or blood products (by sharing razors and needles). People tested positive for HBV are potentially infectious. Perinatal transmission is also common where infected mother may transmit the disease to her infant.
• In infants the infection remain asymptomatic and children normally have mild form of the disease. Symptoms of HBV infection include fever, nausea, vomiting, abdominal pain, loss of appetite, and extreme fatigue leading to jaundice. Eventually the infection can become vigorous leading to death.
• Mild forms of hepatitis B may cure on its own. But for chronic hepatitis, treatment include the use of antiviral medications and antibody injections that help to fight the virus and slows the activity of viruses. In many cases, when medications do not work, patient may require a liver transplant.
• Hepatitis B can be prevented by hepatitis B vaccination. This vaccination includes a series of three intramuscular injections for over six months. This vaccination gives a lifelong immunity from the disease. Other preventive measures include practicing safe sex, avoiding direct contact with blood or bodily fluid, avoiding illegal street drugs, using sterile needles, cleaning the wounds promptly, etc.

Hepatitis C

• The causative organism is hepatitis C virus (HCV).
• It is a parenterally (transmission via routes other than digestive system) transmitted infection. They are primarily transmitted by the use of injectable drugs. It is commonly found in IV drug users and hemophilia patients.
• People may remain asymptomatic even during chronic illness. Chronic cases may lead to severe damage of liver and liver cancers. Common symptoms of the disease include abdominal discomfort, nausea, and fatigue.
• Treatment includes the use of antiviral medications
• Preventive measures include universal screening of blood and blood products, using precaution and barrier measures, using sterilized equipment, educating the public, etc. No vaccination is available for Hepatitis C. Infections were noted in population born from 1945 to 1965. Hence, in such cases, screening should be done for them.

Hepatitis D

• The causative organism is hepatitis D virus (HDV).
• The virus is also called “delta” and has a defective single stranded RNA. For these viruses to multiply and infect cells, they require the helper function of HBV. Hence, these infections are found in populations where there is high rate of HBV infection.
• Drug addicts, hemophilic patients, male homosexuals have high rates of HDV infection.
• It is transmitted through contact with blood and blood products. Sexual transmission is comparatively lesser and perinatal transmission is infrequent.
• People may develop the disease as co infection with HBV or may also as super infection who are suffering from chronic HBV infection.
• Signs and symptoms are similar to hepatitis B.
• Only few treatments are available for HDV infection. But even after taking medications, the person may remain positive of HDV.
• No vaccinations are available for hepatitis D. Immunizing with HBV vaccine is useful for those who are not already infected by HBV. Hence, avoidance of exposure is the best measure of prevention.

Hepatitis E

• This type of infection is similar to hepatitis A as there is no chronic form of the disease.
• The causative organism is hepatitis E virus (HEV).
• They are transmitted through fecal oral route. Rarely, infected blood products may also transmit the disease and perinatal transmission is also found in rare cases. Contaminated water is the most common mode of transmission.
• Symptoms include stomach cramps, nausea, vomiting, loss of appetite, fever, fatigue, etc.
• No specific treatment is available for HEV infection. It is usually self-limiting. Treatment measures are taken to relive the symptoms associated with the disease.
• Preventive measure include consuming clean and boiled drinking water, avoiding ice, uncooked vegetables and fruits and shellfish. No vaccination is available for the disease. Proper waste and sewage disposal and maintain standards for water supply must be done at the community level to prevent the disease.