What is it?

There are 5 types of viruses that causeviral hepatitis: HAV, HBV, HCV, HDV, HEV. They all damage the liver tissue. However, the viruses differ in the characteristics of the virus and at the clinical level- while all liver viruses can lead to an acute occurrence which can be asymptomatic, symptomatic or cause full blown hepatitis, only some of the viruses can cause a chronic occurrence, cirrhosis of the liver and even Hepatocelullar carncinoma. In viral hepatitis, three main signs were observed:
Increase in liver enzymes - ALT, AST, ALKP, GGT - These enzymes are found in the liver cells and therefore massive destruction of liver cells is manifested in an increase in the level of enzymes in the blood.
Increase in bilirubin ⇑ expressed in jaundice - bilirubin is a breakdown product of Heme from red blood cells that is metabolized in the liver and excreted into bile. When there is destruction of liver cells the level of bilirubin in the blood rises.
Impaired liver function - The liver is responsible for, among other things, the production of albumin and coagulation factors. Once there is inflammation in the liver, functions dependent on the production of these substances are impaired - an prolongation of the INR is seen as well as a decrease in the level of albumin in the blood. In severe cases, cirrhosis may also be seen on its marks.
Hepatitis A
HAV causes an acute illness that usually is self-limited within weeks.
Many times the occurrence is asymptomatic (especially in children), and in any case there is no chronic disease as a result of HAV.
The virus is common in African, Southeast Asian and South American countries - where hygiene is low.
Infection with the virus is done by passing viruses from the feces through the mouth towards the digestive tract.
Hepatitis B
The virus is common in Africa, Southeast Asia and South America. The main transmission and age of infection at a particular location depend on the percentage of carriers in the population: In places where the percentage of carriers is high, the main route of transmission is between mother and baby (and accordingly, the main age of infection is near birth), in places where the percentage of carriers is medium or low most of the infection is through blood and sex and age of infection ranges from childhood to adulthood. The course of HBV infection: The disease can progress from acute to chronic disease and even cirrhosis of the liver and liver cancer. Progression from the acute to chronic stage depends on age - over 90% of children will develop chronic disease following acute illness, while less than 5% of adults will develop chronic illness following acute illness. Chronic illness increases the risk of cirrhosis and cancer, liver transplantation or death.
Hepatitis D-
It is not possible to be infected only with HDV and the person must be previously or simultaneously infected with HBV in order that the virus will exist in our bodies. 5% of those infected with HBV are also infected with HDV. Ways of transmission are the same as HBV and, here too, prevention is of high importancy.
Hepatitis C-
Risk factors for HCV today are IV drug users, unprotected sex, and non-sterile needles. In the past blood transfusions were a major risk factor but today they are scanned for HCV.
Hepatitis E-
Transmitted through contaminated food and contaminated water (in endemic places like India). In the vast majority of cases causes acute onset. It should be noted that pregnant women in the third trimester develop life-threatening disease with 15-25% mortality.

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Signs & symptoms

The most common symptoms of infection with the various viruses are flu-like symptoms - fatigue, muscle aches, headache, fever. Loss of appetite, nausea, vomiting, diarrhea, abdominal pain and jaundice.
hepatitis A - The clinical manifestation of HAV ranges from asymptomatic infection, especially in children and infants, to severe symptomatic disease, as they age. The chance of full blown hepatitis that can also lead to the need for a liver transplant increases as the infection occurs at an older age.
Hepatitis B - HBV incubation time is 1-4 months. Sometimes there is a prodrome that includes low fever and joint pain. 70% of cases are asymptomatic. The clinical manifestation of a chronic infection - is either asymptomatic, or without specific complaints (complaint of fatigue for example), to symptoms and signs of chronic liver disease.
Hepatitis C-
The acute phase of HCV is usually asymptomatic or has non-specific symptoms. The main problem is around the chronic infection - 75% of those acutely infected develop a chronic disease (and 25% will recover completely). Among those who develop chronic disease - within 20 years 10-20% will develop liver cirrhosis and among these patients 1-4% will develop cancer or liver failure. It is important to remember that the HCV symptoms are not limited to the liver only. There may be problems in a variety of systems: joint problems, eye problems, kidney problems (nephrotic syndrome, glomerulonephritis), rashes, Non Hodgkin's B cell lymphoma, cryoglobulinemia and more. Treatment for HCV also affects the extrahepatic symptoms.
Hepatitis E-
The incubation period between infection and the onset of the disease lasts several weeks. The symptoms are similar to the symptoms of other viral infections in the liver, and include a prodormal stage manifested by fever-like illness, chills, abdominal pain, loss of appetite, nausea, vomiting, pale stools, dark urine, diarrhea, joint pain and macular rash. After a few days, jaundice and itching also appear. With the onset of jaundice, the prodormal signs disappear.
The duration of the disease is between 4-1 weeks, and it is usually self-limited.

Diagnosis

Diagnosis of the disease is done by blood tests for serology.
Hepatitis A- viruses in the feces appear about a week after infection, even before the onset of symptoms. There is a concern that a patient will infect people in close contact during the asymptomatic period because no special precautions will be taken.
IgM antibodies begin to rise after 4 weeks from the moment of infection, and reach a peak at week 6 from the moment of infection - over time the level of these antibodies decreases.
IgG antibodies begin to appear at week 5 from the moment of infection and increase over time. These antibodies are stored in the serum for a long time and indicate infection with the virus or a previous vaccination.
Hepatitis B
Negative HBsAg and Anti-Core IgM indicate that there is no active infection - acute or chronic. Positive HBsAg positive indicates that there is immune protection (from vaccine or past infection) and anti-core IgG positive indicates past infection, as no core proteins are used in favor of the vaccine.
Negative HBsAg and Anti-Core IgM indicate that there is no active infection - acute or chronic. Positive Anti HBsAg indicates that there is immune protection (from vaccination or past infection). The lack of anti-core IgG indicates that the protection was created as a result of a vaccine.
Positive HBsAg indicates active infection while the positive Anti-Core IgM allows us to determine that the infection is acute.
Positive HBsAg indicates an active infection while the positive Anti-Core IgG allows us to determine that the infection is chronic. -

Hepatitis D-
The initial diagnosis will indicate the presence of envelope proteins HBs along with a sharp increase in IgM antibody levels against the delta proteins of HDV in the blood. After a certain period of time it will also be possible to detect viral RNA by performing RT-PCR.

Hepatitis C-
Diagnosis of carrier HCV is made using a simple blood test for the antibody (anti-HCV). If this test is positive, the amount of virus in the blood should be checked using a PCR (viral load) test, as well as the type of virus (genotype).

Hepatitis E-
In serology the virus can be detected in the feces quite early in the disease. An acute condition of the disease will be identified using IgM antibodies to the virus and PCR to the RNA of HEV in the blood / feces (more reliable). Serology and PCR should be taken for HEV even in cases where the patient has not traveled to an endemic site of the disease.

Treatment

Hepatitis A - HAV treatment is only supportive treatment, there is no specific cure for the virus.
If the infection causes a serious illness,a liver transplant is considered but it is very uncommon.
The focus regarding HAV is on prevention. The vaccine is an inactivated vaccine that is given by injection into a muscle in two doses -at the age 12 through 23 months and a econd dose: at least 6 months after the first dose. In some places in the US the disease has almost been eradicated following the vaccine .
Hepatitis B-
Antiviral drugs such as Adefovir, Entacavir, tenofovir, telbivudine help treating HBV. The drug should be taken throughout life. The best therapeutic strategy is prevention by administering a recombinant vaccine, given at one day of age, one month of age and six months of age.
Hepatitis D -
The treatment of the disease is by a drug called interferon, but it eliminates HDV in the minority of cases, there are high relapse rates and severe side effects
Hepatitis C-
In recent years, there has been a breakthrough in the treatment of hepatitis C and today the treatment, which includes 2 or more drugs separately or as one combined pill, leads to a cure in about 95% of cases. The treatment is given for about 12 weeks, the side effects are relatively mild but it is very expensive.
Hepatitis E-
HEV treatment is only supportive care. Prevention is important by maintaining proper hygiene.

☝️ This is not a substitute for professional medical advice. Please consult with your physician before making any medical decision.

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