Viral hepatitis is the cause of most cases of acute
hepatitis. Types include
Hepatitis A,
Hepatitis B,
Hepatitis C,
Hepatitis B with D,
Hepatitis E,
Hepatitis F virus (existence unknown), and
Hepatitis G or GBV-C.
In addition to the hepatitis viruses, other viruses can also cause hepatitis, including cytomegalovirus, Epstein-Barr virus, yellow fever, etc.
Hepatitis A
Hepatitis A or
infectious jaundice is caused by a
picornavirus transmitted by the
fecal-oral route, often associated with
ingestion of
contaminated food or with
anal/oral sex. It causes an acute form of hepatitis and does not have a chronic stage. The patient's
immune system makes
antibodies against hepatitis A that confer
immunity against future infection. People with
hepatitis A are advised to
rest, stay
hydrated and avoid
alcohol. A
vaccine is available that will prevent
infection from hepatitis A for up to 10 years. Hepatitis A can be spread through
personal contact, consumption of
raw sea food or drinking
contaminated water. This occurs primarily in
third world countries. Strict
personal hygiene and the avoidance of raw and unpeeled
foods can help prevent an
infection. Infected people excrete the hepatitis A virus with their
feces two weeks before and one week after the appearance of
jaundice. The time between the
infection and the start of the
illness averages 28 days (ranging from 15 to 50 days), and most recover fully within 2 months, although approximately 15% of
sufferers may experience continuous or
relapsing symptoms from six months to a year following initial
diagnosis.
Hepatitis B
Hepatitis B is caused by a
hepadnavirus, which can cause both acute and chronic hepatitis. Chronic hepatitis develops in the 15% of patients who are unable to eliminate the virus after an initial infection. Identified methods of transmission include
blood (
blood transfusion, now rare),
tattoos (both amateur and professionally done),
sexually (through
sexual intercourse or through contact with
blood or
bodily fluids), or via mother to child by
breast feeding (minimal evidence of
transplacental crossing). However, in about half of cases the source of infection cannot be determined.
Blood contact can occur by sharing
syringes in
intravenous drug use,
shaving accessories such as
razor blades, or touching
wounds on infected persons.
Needle-exchange programmes have been created in many countries as a form of
prevention.
Patients with chronic hepatitis B have antibodies against hepatitis B, but these antibodies are not enough to clear the infection that establishes itself in the DNA of the affected liver cells. The continued production of virus combined with antibodies is a likely cause of the immune complex disease seen in these patients. A vaccine is available that will prevent infection from hepatitis B for life. Hepatitis B infections result in 500,000 to 1,200,000 deaths per year worldwide due to the complications of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Hepatitis B is endemic in a number of (mainly South-East Asian) countries, making cirrhosis and hepatocellular carcinoma big killers. There are six FDA-approved treatment options available for persons with a chronic hepatitis B infection: alpha-interferon, pegylated interferon adefovir, entecavir, telbivudine and lamivudine. About 65% of persons on treatment achieve a sustained response.
Hepatitis C
Hepatitis C (originally "non-A non-B hepatitis") is caused by a
virus with an
RNA genome that is a member of the
Flaviviridae family. It can be transmitted through contact with
blood (including through
sexual contact if the two parties'
blood is mixed) and can also cross the
placenta. Hepatitis C may lead to a chronic form of hepatitis, culminating in
cirrhosis. It can remain
asymptomatic for 10-20 years. Patients with hepatitis C are susceptible to severe hepatitis if they contract either hepatitis A or B, so all hepatitis C patients should be
immunized against hepatitis A and hepatitis B if they are not already
immune, and avoid
alcohol. The
virus can cause
cirrhosis of the
liver.
HCV viral levels can be reduced to undetectable levels by a combination of
interferon and the
antiviral drug ribavirin. The
genotype of the
virus determines the rate of response to this
treatment regimen.
Genotype 1 is more resistant to
interferon therapy than other
HCV genotypes.
Hepatitis C is the most common bloodborne infection in the United States.
Hepatitis D
Hepatitis D is caused by hepatitis delta agent, which is similar to a viroid as it can only propogate in the presence of the Hepatitis B virus.
Hepatitis E
Hepatitis E produces symptoms similar to
hepatitis A, although it can take a fulminant course in some patients, particularly
pregnant women; it is more prevalent in the
Indian subcontinent.
Hepatitis F virus
Hepatitis F virus is a hypothetical
virus linked to hepatitis. Several
hepatitis F virus candidates emerged in the 1990s; none of these reports have been substantiated.
Hepatitis G, now called GB virus C
Another potential viral cause of hepatitis, initially identified as
hepatitis G virus, is probably spread by blood and sexual contact. There is very little evidence that this virus causes hepatitis, as it does not appear to replicate primarily in the liver. It is now classified as
GB virus C.
References