Hepatitis

The inaugural international hepatitis C awareness day, coordinated by various European and Middle Eastern patient groups, took place on October 1, 2004, However many patient groups continued to mark ‘hepatitis day’ on disparate dates. However many patient continued to mark ‘hepatitis day’ on disparate dates. For this reason in 2008, the World Hepatitis Alliance in collaboration with patient groups declared may 19 the first global world hepatitis day. Following the adoption ofa resolution during the 63^rd world health assembly in May 2010, World hepatitis day was given global endorsement as the primary focus for national and international awareness-raising efforts and the date was changed to July 28 (in honour of Nobel Laureate Baruch Samuel Blumberg, discoverer of the hepatitis B virus, who celebrates his birthday on that date). The resolution resolves that “28 July shall be designated as world hepatitis day in order to provide an opportunity for education, and to stimulates the strengthening of preventive and control measures of this disease in member states”

Viral hepatitis affects 400 million people globally, every year 6-10 million people are newly infected. An estimated 90 % people with hepatitis do not know they have hepatitis. And over 90% of people with hepatitis C can be completely cured within 3-6 months. These are the some facts released by WHO. This year we will going to celebrate the “WORLD HEPATITIS DAY” on the 28^th July 2016 as the slogan of “KNOW HEPATITIS-ACT NOW”. Viral hepatitis infection is widely spread affecting 400million people worldwide-over 10 times the number of people infected with HIV. Globally, about 1.4 million people die each year from hepatitis. It is estimated that only 5% of people with chronic hepatitis know their infection, and less than 1% have access to treatment. WHO has set a goal to eliminate viral hepatitis as a major public health threat by 2030, Target between 6 and 10 million infections are reduced to less than 1 million by 2030.

Hepatitis implies injury to the liver parenchyma characterized by the presence of inflammatory cells in the tissue of the organ. Or hepatitis is an inflammation of the liver. The condition can be self-limiting or can be progress to fibrosis (scaring), cirrhosis or liver cancer. Viral hepatitis is a common cause of jaundice and must be considered in anyone presenting with hepatitis liver blood tests (high transaminases).  All these viruses cause illnesses with similar clinical and pathological features and which are frequently Anicteric or even asymptomatic. They differ in their tendency to cause acute and chronic infections. They are 5 main hepatitis viruses, referred as types A, B, C, D and E. these five types are greatest concern because of the burden of illness and death they cause and  the potential for outbreaks and epidemic spread. In particular types B & C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.

        Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

Facts on Hepatitis

Here are some facts about hepatitis

ü  The five main types of hepatitis are caused by virus they are HAV, HBV, HCV, HDV and HEV.

ü  Hepatitis A is caused by consuming contaminated food or water.

ü  Hepatitis B is sexually transmitted disease.

ü  Globally around 250 million people are affected by hepatitis C and 300 million people are estimated to be hepatitis B carriers. More than 240 million people die every year due to complication of hepatitis B.

ü   Hepatitis C virus is bloodborne virus and the most common modes of infection are through unsafe injection practices, inadequate sterilization of medical equipment, and the transfusion of unscreened blood and blood products.

ü  Globally, between “130-150” million people globally have chronic hepatitis c infection.

ü  Approximately 700000 people die each year from hepatitis-C related liver disease

ü  There is currently no vaccine for hepatitis C; however research in this are going on.

ü  Hepatitis D infection occur only simultaneously or as super-infection with hepatitis B virus.

ü  Approximately 15 million people across world are chronically coinfected with hepatitis B virus and hepatitis D virus.

ü  Hepatitis D virus infection are prevented by hepatitis B immunization.

ü  Every year, there are an estimated 20 million people are infected with hepatitis E virus. Leading to an estimated 3.3 million symptomatic cases on hepatitis E worldwide.

ü  Hepatitis B is sexually transmitted disease.

Cause of viral hepatitis

Common

ü  Hepatitis A

ü  Hepatitis B ± Hepatitis D

ü  Hepatitis C

ü  Hepatitis E

Less common

ü  Cytomegalovirus

ü   Epstein–Barr virus

Rare

ü  Herpes simplex

ü  Yellow fever

Clinical features and presentation

Most of the case of viral hepatitis are presented with the non-specific prodromal illness characterized by headache, myalgia, arthralgia, nausea and anorexia usually precedes the development of jaundice by a few days to two weeks. Vomiting and diarrhoea may follows and abdominal discomfort may common other symptoms and sign are

ü  Cervical lymphadenopathy

ü  Dark urine

ü  Hepatomegaly with or without splenomegaly

Symptoms are only lasts for 3-6 weeks.

Classic presentation acute viral hepatitis

o   Phase 1 - Viral replication; Patients are asymptomatic during this phase.

o   Phase 2 – Prodromal

o   Phase 3 - Icteric phase

o   Phase 4 - Convalescent phase; symptoms and icterus resolve. Liver enzymes return to normal.

1. Prodromal phase:

ü  Patients experience anorexia, nausea, vomiting, alterations in taste, arthralgias, malaise, fatigue, urticaria, and pruritus. Some develop an aversion to cigarette smoke.

ü  When seen by a health care provider during this phase, patients are often diagnosed as having gastroenteritis or a viral syndrome.

2. Icteric Phase

ü  Jaundice, Patients may note dark urine, followed by pale-colored stools.

ü  In addition to the predominant gastrointestinal symptoms and malaise, patients become icteric and may develop right upper quadrant pain with hepatomegaly.

Clinical Evaluation Chronic Hepatitis viral hepatitis

-          Occurs after acute Hepatitis in >80% of people with HCV

-          Some are asymptomatic, or have mild symptoms; others may only present with late complications (cirrhosis/HCC)

-          Categorized based on grade of inflammation, stage of fibrosis, and etiology of disease

Common symptoms of sever hepatitis are Jaundice (yellowing of the skin & the whites of the eyes), Muscle Aches, Headaches, Joint Pain (due to circulating immune-complexes), Fever, Diminished Appetite, Nausea Vomiting, Diarrhea, Abdominal Pain, Dark “tea-colored” urine, Pale “clay-colored” stools, Edema (large amount of fluid collect in the abdomen beneath the skin), Bleeding easily (decrease in levels of coagulation factors made by liver)

Diagnosis

Diagnosis of viral hepatitis was done by the two different approaches they are as follow.

Using the patient's medical history

-          drug and medication use

-          alcohol consumption

-          family history

-          exposure to toxins

-          past surgeries

-          past travels

-          sexual history

Invasive diagnostic approach

-          palpate the liver area to look for signs of swelling or tenderness

-          perform laboratory tests(LFT, ALT, AST, SGPT, SGOT, Bilirubin )

-          order a liver biopsy

Management

Viral hepatitis B can prevented by vaccination. Most individuals do not need hospital care. Drugs such as sedatives and narcotics, which are metabolised in the liver, should be avoided. No specific dietary modifications are needed. Alcohol should be avoided during the acute illness. Elective surgery should be avoided in cases of acute viral hepatitis, as there is a risk of post-operative liver failure. Liver transplantation is very rarely indicated for acute viral hepatitis complicated by liver failure, but is commonly performed for complications of cirrhosis resulting from chronic hepatitis B and C infection.

Complication

ü  Acute liver failure

ü  Cholestatic hepatitis

ü  (hepatitis A)

ü  Aplastic anaemia

ü  Chronic liver disease and

ü  cirrhosis (hepatitis B and C)

ü  Relapsing hepatitis

References

1.      Park textbook of preventive and social medicine 22^nd edition, Bhanot publication, India.

2.      Davidson’s principal and practise of medicine 21^st edition, Elsevier Publication, US.

3.      www.who.int/hepatitis

4.      www.wikipedia.org/hepatitis

See also