WHAT IS HEPATITIS

July 28 is World Hepatitis day. This year’s theme is “Find the missing millions” which refers to the millions of people probably living with some form of hepatitis without knowing it. Some estimates suggest around 300 million individuals may be in this group, which is why raising awareness about this disease is still necessary [1].

Hepatitis is an inflammatory disease of the liver which can progress to fibrosis, cirrhosis and even liver cancer. Although most research and cases are associated to viral hepatitis, non-viral hepatitis also exist and will be explored in this article [2].

Viral hepatitis

There are 5 subtypes of viral hepatitis (A, B, C, D and E). All of these viruses have the potential to spread and cause massive infection with various degrees of ease.

In particular hepatitis B and C have been a cause of concern for the healthcare system because they are the main agents responsible for chronic viral hepatitis which often leads to cirrhosis and cancer. Chronic rather than acute infections are mostly responsible for the most severe health consequences. People with acute infections might not even develop any noticeable symptoms [2].

Hepatitis A virus: Is present in fecal matter from infected people and the virus infects others by being ingested with contaminated food or water, which is very common in areas with sanitation problems, also, some practices allow person to person infection. This infection is often acute, and most people recover with almost no negative consequences, however, some individuals are more vulnerable to experience worse outcomes. A vaccine is available [4].

Symptoms include: Fatigue, nausea and vomiting, abdominal pain, clay-colored feces, loss of appetite, mild fever, dark urine, joint pain and jaundice [9].

Hepatitis B virus: This virus can spread via contact with body fluids from infected individuals. 25% of those who develop chronic hepatitis B are likely to die, however, not all people experience the chronic disease, in fact, age is a strong predictor for this occurrence with younger patients being more vulnerable. A vaccine is available [5].

Symptoms include: Abdominal pain, dark urine, joint pain, loss of appetite, nausea and vomiting, weakness and fatigue and jaundice [10].

Hepatitis C virus: This virus is transmitted mostly by contact with blood or blood products from infected individuals. Hepatitis C can develop into a chronic disease in around 70% of cases but the development of the disease into cirrhosis can take up to 30 years [6]. While no vaccine is available, there are treatments available.

Symptoms include: bleeding easily, bruising easily, fatigue, poor appetite, jaundice, dark urine, itchy skin, fluid buildup in your abdomen, leg swelling, weight loss, confusion, hepatic encephalopathy, spiderlike blood vessels on your skin [11].

Hepatitis D virus: This is sometimes called a “defective” virus. It can only infect individuals already infected with the hepatitis B virus which causes a more severe infection associated to some degree of immunosuppression. Its spread is difficult, limited mostly to cases where the infected patient has an extremely high viral load during the chronic phase of the disease [7].

Hepatitis E virus: This virus is rare in developed countries but is capable of causing epidemics and can lead to death specially for pregnant women and older adults, however, it often only leads to an acute infection. The main method is through the spread of  contaminated food and water. A vaccine against this virus does exist but is not widely available [8].

Symptoms include feeling tired, nausea and vomiting, poor appetite, pain over the liver, dark urine, light-color color stool, jaundice [12].

Non-viral hepatitis

Hepatitis is not only caused by viruses; several mechanisms can cause severe liver damage leading to the same final effects of viral hepatitis. These include autoimmune diseases, hepatotoxic drugs and alcohol abuse [13].

Symptoms include jaundice, abdominal pain, nausea and vomiting, dark-colored urine, itching and rash, fatigue, loss of appetite [13].

Treatment

Severe cases of viral hepatitis in the population are treated with antiviral medication or prevented with proper vaccination. For autoimmune hepatitis, a combination of corticosteroids and other immunosuppressors is highly recommended [14].

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References:

• [1] World hepatitis day: Time to #FindTheMissingMillions. (n.d.). Retrieved from https://www.worldhepatitisday.org/
• [2] What is hepatitis? (n.d.). Retrieved from https://www.who.int/news-room/q-a-detail/what-is-hepatitis
• [3] Cuthbert, J. A. (2001). Hepatitis A: old and new. Clinical microbiology reviews, 14(1), 38-58.
• [4] Lai, C. L., Ratziu, V., Yuen, M. F., & Poynard, T. (2003). Viral hepatitis B. The Lancet, 362(9401), 2089-2094.
• [5] Poynard, T., Yuen, M. F., Ratzin, V., & Lai, C. L. (2003). Viral hepatitis C. The Lancet, 362(9401), 2095-2100.
• [6] Rizzetto, M. (2009). Hepatitis D: thirty years after. Journal of hepatology, 50(5), 1043-1050.
• [7] Hoofnagle, J. H., Nelson, K. E., & Purcell, R. H. (2012). Hepatitis E. New England Journal of Medicine, 367(13), 1237–1244. doi:10.1056/nejmra1204512
• [8] Hepatitis a - Symptoms and causes. (2019, March 6). Retrieved from https://www.mayoclinic.org/diseases-conditions/hepatitis-a/symptoms-causes/syc-20367007
• [9] Hepatitis B - Symptoms and causes. (2017, October 27). Retrieved from https://www.mayoclinic.org/diseases-conditions/hepatitis-b/symptoms-causes/syc-20366802
• [10] Hepatitis C - Symptoms and causes. (2020, March 20). Retrieved from https://www.mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278
• [11] Hepatitis D. (2017, May 1). Retrieved from https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-d#symptoms
• [12] Autoimmune hepatitis (non-viral hepatitis) symptoms, diagnosis, treatment and prevention. (n.d.). Retrieved from https://www.aurorahealthcare.org/services/gastroenterology-colorectal-surgery/non-viral-hepatitis#Overview
• [13] Kahn, A. (n.d.). Hepatitis: Types, symptoms, and treatment. Retrieved from https://www.healthline.com/health/hepatitis#treatment

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