Viral Hepatitis - Types, Causes, Risk Factors, Symptoms, Diagnosis and Treatment

What Is Viral Hepatitis?

The term hepatitis refers to inflammation of the liver. When the cause of this liver inflammation remains to be a viral infection, it is known as viral hepatitis. In viral hepatitis, the liver becomes swollen and painful as a response to the infection. Liver damage also occurs. Five viruses are known to cause viral hepatitis, and this condition is contagious, meaning it spreads from one person to another. The viruses that cause this infection are known as hepatic viruses. As of now, only five to seven viruses causing hepatitis have been identified, but there are several unidentified viruses causing hepatitis, which will sooner or later be discovered.

What Are the Types of Viral Hepatitis?

Based on the duration of symptoms, two types of viral hepatitis exist,

• Acute Hepatitis - In the acute form of the disease, the infection and symptoms remain for a short period, after which the virus goes away due to the body’s ability to fight off the infection. They can also be asymptomatic, and there are rare instances wherein the condition can progress to severe forms of the disease, such as liver failure. When symptoms are present, they can resemble that of flu and appear between two weeks to six months after exposure. Symptoms of acute viral hepatitis include fatigue, fever, abdominal pain, dark-colored urine, pale stools, anorexia, nausea, vomiting, jaundice, and flu-like symptoms.

• Chronic Hepatitis - The chronic form of the disease develops after an acute infection fails to resolve. Viral hepatitis is said to be chronic when the hepatic virus antigen and high titers of viral DNA (deoxyribonucleic acid) or RNA (ribonucleic acid) persist in the serum for more than six months. While treatment may or may not be needed for acute hepatitis, chronic hepatitis necessarily requires treatment to prevent complications like liver cancer, cirrhosis (scarring of the liver), etc. It can take a decade for such complications to develop; however, they cause life-threatening events. Most chronic hepatitis patients remain asymptomatic, when present, symptoms are non-specific, mild, and include indigestion and fatigue.

Based on the types of hepatic viruses causing the disease, five types of viral hepatitis exist. They are,

Hepatitis A -

• Hepatitis A is said to occur in countries with compromised community sanitation. It is spread through ingestion of food and water contaminated by an infected person’s feces (feco-oral route). Hepatitis A easily gets transmitted through intimate kissing and poor hand sanitation.

• It causes only acute infection and does not progress to chronic hepatitis.

• Children aged six years and below usually are asymptomatic.

• The infection resolves in affected individuals within weeks or months of infection exposure.

• Vaccines are available against hepatitis A.

Hepatitis B -

Though hepatitis B infection is usually acute, it can become chronic too. The ways through which hepatitis B spreads are;

• Unprotected sexual intercourse.

• Sharing needles, razors, and toothbrushes with infected blood on them.

• Tattooing.

• Body piercing.

• Breastfeeding (from infected mother to the baby).

• Accidental skin prick in healthcare workers.

Thankfully vaccines are available to protect and prevent oneself from contracting the infection.

Hepatitis C -

The ways through which hepatitis A spreads are,

• Blood transfusion.

• Needle-stick injuries.

• Sharing needles (among drug abusers).

• From the infected mother to the baby.

• Hemodialysis.

• Sexual intercourse (rare).

Around 85 % of the hepatitis C-infected individuals develop chronic viral hepatitis over time. And most people living with hepatitis remain unaware of their infection and unwittingly transmit hepatitis to others. No vaccines are available to date for hepatitis C.

Hepatitis D -

• The hepatitis D virus cannot survive and cause disease on its own. It requires an accompanied infection of the hepatitis B virus. This hepatitis B virus produces a protein (called envelope protein) that is utilized by the hepatitis D virus to infect our liver cells.

• Hepatitis D is spread similar to hepatitis B.

• The combination of hepatitis B and D in the same person makes it difficult to treat the disease.

• A person with hepatitis B may either acquire hepatitis D concurrently or later. Such people are at an increased risk of cirrhosis than those with hepatitis B alone.

Hepatitis E -

• Hepatitis E is common in the Asian continent.

• It spreads through contaminated water.

• The disease process is similar to that of hepatitis A.

What Symptoms Does Viral Hepatitis Cause?

People with viral hepatitis experience similar symptoms regardless of the type of hepatic virus causing it. Most times, viral hepatitis does not cause any symptoms or causes mild symptoms. When present, they include,

• Nausea.

• Vomiting.

• Fatigue.

• Fever.

• Appetite loss.

• Abdominal pain.

• Pale stools.

• Dark urine.

• Jaundice.

• Malaise.

• Itching.

• Muscle and joint pain.

When chronic hepatitis sets in, the following symptoms can occur;

• Swelling of the extremities.

• Confusion.

• Hives.

• Blood in vomit.

• Bloody stools.

• Jaundice.

What Is the Incubation Period of Viral Hepatitis?

The incubation period is the time between initial exposure to the virus (or any microorganism) and the development of symptoms or onset of illness. The incubation period of the different types of viral hepatitis are tabulated below:

Who Is at Risk for Viral Hepatitis?

• Healthcare workers.

• People with multiple sex partners.

• Newborn baby of an infected mother.

• Workers handling sewage and water treatment.

• Drug abusers (who take intravenous drugs).

• People receiving components of blood for bleeding disorders through blood transfusion.

• People with HIV or AIDS (human immunodeficiency virus or acquired immunodeficiency syndrome).

• People living in a community with compromised water and food sanitation.

• People receiving long-term kidney dialysis.

How Is the Diagnosis of Viral Hepatitis Made?

In acute hepatitis patients, diagnosis is promptly made based on their presenting symptoms, as mentioned earlier. In the case of chronic hepatitis patients, diagnosis becomes tricky due to the absence of symptoms or the presence of mild non-specific symptoms. The following investigations are suggested for establishing a diagnosis.

Blood Tests -

• Liver Enzymes: Increased levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) can be found in the blood sample in patients with viral hepatitis. Apart from hepatic virus-induced liver disease, there are other causes like alcohol, medications, bacterial infection, etc., which can also cause a spike.

• Viral Antibodies: To confirm that hepatitis is caused due to a virus, viral antibodies test is beneficial. Antibodies to hepatic viruses are identified in the blood of the infected individual.

• Viral Proteins Test: This test is beneficial to identify the presence of the virus in chronic viral hepatitis patients wherein the virus’ genetic material and protein are detected in the blood.

What Complications Does Viral Hepatitis Cause?

Viral hepatitis in its acute form does not cause any serious complications. But when the infection resides for a long time, more than six months (as in the case of hepatitis B and C), it becomes chronic, which can later worsen to cause complications such as,

• Liver cirrhosis.

• Liver cancer.

• Liver failure.

How Can Viral Hepatitis Be Treated?

Acute Viral Hepatitis -

• For this condition, only conservative treatment is suggested. Treatment is aimed to improve the symptoms.

• Intravenous fluids will be needed to correct dehydration.

• Medications that get metabolized in the liver are mostly avoided (like Acetaminophen).

• Avoiding alcohol and smoking is necessary.

• Adequate rest is needed.

• It is also essential to consume nutritional foods.

Chronic Viral Hepatitis -

There is no cure for hepatitis A. Other types of chronic hepatitis are treated with antiviral medications and interferons.

• The medications for hepatitis B are,

• Entecavir (Baraclude).

• Tenofovir (Viread).

• Hepatitis C medications include,

• Simeprevir (Olysio).

• Daclatasvir (Daklinza).

• Sofosbuvir (Solvadi).

• Simeprevir+Sofosbuvir.

• Hepatitis D is treated with interferons and medicines for hepatitis B.

• Hepatitis E is treated with Peginterferon alfa-2a and Ribavirin.

How Can Viral Hepatitis Be Prevented?

1. Avoid sharing needles for intravenous drug injections.

2. Avoid sharing razors, toothbrushes, and infected person’s items.

3. Make sure the needle is changed before getting tattoos.

4. Drink bottled water if you are traveling.

5. Use physical contraceptives like condoms during sex.

6. More importantly, get vaccinated for hepatitis A and B. Vaccines for hepatitis A and B are available. Hepatitis B vaccine can also protect against hepatitis D. But hepatitis C does not have a vaccine till date.

What Vaccines Are Approved for Viral Hepatitis?

The United States Food and Drug Administration (FDA) has approved the following vaccines;

Conclusion:

All people with an increased risk of hepatitis are advised to get hepatitis vaccines. Most people recover from acute hepatitis with supportive care. Those with chronic hepatitis need to take medications with a doctor's prescription for a period of six months and should get their liver condition assessed regularly to prevent complications.