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CLA: HEPATITIS

HEPATITIS

The word “hepatitis” literally means inflammation of the liver (hepar means liver and -itis means inflammation of). Just like when other parts of our bodies become inflamed, the liver becomes swollen and tender. Many things can cause inflammation of the liver, but we usually reserve the term “hepatitis” for those causes that are viral. Of the viral hepatitis group, we can identify the specific viral cause in about 75%. The symptoms of viral hepatitis are general and vary greatly, so they don’t help too much in identifying the specific viral cause. The most common symptoms are: loss of appetite, fever, bodily aches, feeling tired, nausea and/or vomiting, food doesn’t taste right, yellow skin and/or eyes, brownish or dark urine and lighter, looser stool than usual. The time from becoming infected by the virus until the symptoms begin does vary somewhat between viruses and is helpful to know. Following are the most common types of viral hepatitis:

HEPATITIS A

This form of hepatitis is the most common form of viral hepatitis in the US and is even more common elsewhere in the world. It is typically mild, but occasionally progresses to cirrhosis (scarring of the liver) or worse and is spread by water and food through inadequate hand washing after using the toilet, poor sanitation in general and personal contact. It is particularly common in daycare centers. It is not usually spread by casual household contact. Prevention relies on proper sanitary habits. Medications (immunoglobulins and vaccine) are available for treatment. The laboratory looks for antibodies in the blood that are specific for hepatitis A.

HEPATITIS B

This form of hepatitis is common, blood-borne, sexually transmitted and also is spread by sharing certain inanimate objects (e.g., needles). The symptoms of hepatitis B are commonly more severe than hepatitis A, start a bit later from the time of infection, and last longer.

Newborn babies of mothers who carry the hepatitis B virus are at great risk of developing hepatitis B. If left unvaccinated after 24 hrs. from birth, approximately 50% of these newborns will develop chronic (life-long) hepatitis. Medication for new hepatitis patients consists of immunoglobulin specific for hepatitis B. A vaccine is also available which confers life-long immunity, as does being infected by the virus. Approximately 10% of persons who contract hepatitis B will continue to have symptoms and laboratory tests that indicate chronic hepatitis. Of these, 15-25 % will continue on with more aggressive forms of hepatitis B and some will die from liver failure. The most common laboratory tests used to identify the presence of the virus are (1), to test for fragments of the viruses surface (HepBsAg) and (2), to identify the antibodies that are formed in response to its surface (HepBsAb). Also, the laboratory commonly looks for antibodies to the central material or core of the virus (HepBcAb). Prevention centers on avoiding sexual spread and intravenous drug use.

HEPATITIS C

This form of hepatitis was identified in 1989 and is transmitted by sharing needles from intravenous drug use and from blood transfusions. Prior to its identification, there was no blood test specifically for it and most patients who developed post-transfusion hepatitis had what we now call hepatitis C. This virus produces a mild, long-term hepatitis and can be treated by immunoglobulin and a drug called alpha interferon. Unfortunately, approximately 20 % of people with hepatitis C will develop cirrhosis (scarring of the liver) and a few percent will develop cancer of the liver. The good news is that the incidence of hepatitis C is decreasing in the US. Blood transfusions are now checked for its presence. Prevention centers on avoiding intravenous drug use (sharing of needles) and screening all blood transfusion units for hepatitis C.

HEPATITIS D

This virus does cause hepatitis but it is peculiar in that it will only live and damage liver cells if the hepatitis B virus is also present. It is acquired the same ways that hepatitis B is acquired, but may be acquired at a separate time after hepatitis B is present. If a person has both the hepatitis B and D viruses, he/she has a 50% chance of developing cirrhosis (scarring of the liver). The treatment available is the same as for hepatitis B. If hepatitis B is “cured” (meaning no more hepatitis viruses anywhere in the body), the hepatitis D viruses will not survive.

HEPATITIS E

This virus does produce hepatitis but it is mentioned here only for completeness. Travelers acquire it from contaminated drinking water in other countries.

If any of the above testing is positive for any reason other than having been previously vaccinated, you should discuss the results with a physician.

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