Hepatitis is inflammation of the liver; usually from a viral infection, but sometimes from toxic agents.
Hepatitis A, an RNA enterovirus, spread by contact with fecal matter or blood, most often through ingestion of contaminated food. Rarely fatal, it cannot be treated except by bed rest for 1Ð4 weeks, during which time no alcohol should be consumed. It may recur after 3 months. Hepatitis B is shed through blood, semen, vaginal secretions, and saliva approximately 4Ð6 weeks after symptoms develop; the virus may take up to 6 months to incubate, and people may also become asymptomatic carriers.
Hepatitis B may heal slowly, and is a leading cause of chronic liver disease and cirrhosis. Effective vaccines exist, but it is the fastest spreading form of the disease in the U.S., with some 300,000 cases reported annually. Rates were up 80% from 1981Ð1986 among IV drug users and up 38% during the same period among heterosexuals; among homosexuals, previously a high-risk group, rates held stable.
Hepatitis C, infecting about 150,000 Americans annually, remains in the blood for years and accounts for a large percentage of cirrhosis, liver failure, and liver cancer cases. Its main mode of transmission is through blood transfusion, and possibly sexual intercourse.
Types D and E are less frequently seen in the U.S.
Causes of viral hepatitis includes: Multiple viruses; simultaneous infection with more than one virus possible.
HAV and HEV transmitted enterically; parenteral route rare ¥ Maximum infectivity 2 weeks prior to jaundice
HBV transmitted sexually via blood or perinatally; also enterically. Co-infection with HDV markedly increases severity of HBV
HCV transmitted through blood or its products. In 30%, mode of transmission unknown.
HDV identified only with HBV infection
RISK FACTORS for viral hepatitis include: Health care workers/other occupational risks; Hemodialysis patients; Recipients of blood and/or blood products; Intravenous drug users; Sexually active homosexual males; Household exposure; Adopted children from areas of high exposure; Positive needlestick; High risk sexual behavior; May be endemic in institutions
Marked elevation of AST/ALT (particularly ALT, 400 to several thousand U/L)
Mild to moderate elevation of alkaline phosphatase
Bilirubin from normal to markedly elevated; with elevation, conjugated and unconjugated fractions usually increased
For more severe hepatitis, measure prothrombin and partial thromboplastin times, serum albumin, electrolytes and glucose, CBC and platelets
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