HEPATITIS A

Summary:

Hepatitis A (HAV) is an RNA virus and the most common cause of symptomatic acute hepatitis in the
United States. The main mode of transmission is fecal-oral, but consumption of raw shellfish and direct
contact with contaminated blood can cause infection.

HAV causes acute and relapsing hepatitis. It does not cause chronic hepatitis.

Treatment is usually supportive, and hospitalization may be needed for severe cases. Liver
transplantation is recommended in case of fulminant HAV hepatitis.

There is a safe and effective vaccine to prevent HAV infection. It is recommended for patients at high
risk of acquiring hepatitis A and for patients with chronic liver disease.

Intramuscular human immune globulin is recommended for postexposure prophylaxis.

Etiology:

People develop hepatitis A infection after contracting HAV. This virus is typically transmitted by ingesting
food or liquid contaminated with fecal matter that contains the virus. Once transmitted, the virus
spreads through the bloodstream to the liver, where it causes inflammation and swelling.

In addition to transmission from eating food or drinking water containing HAV, the virus can also be
spread by close personal contact with an infected person. HAV is contagious, and a person who has
hepatitis A can easily pass the disease to others living in the same household.

You can contract hepatitis A by:

 eating food prepared by someone with the hepatitis A virus
 eating food handled by preparers who don’t follow strict hand-washing routines before touching
food that you eat
 eating sewage-contaminated raw shellfish
 not using condoms when having sex with someone who has the hepatitis A virus
 drinking polluted water
 coming in contact with hepatitis A-infected fecal matter
 If you contract the virus, you will be contagious two weeks before symptoms even appear. The
contagious period will end about one week after symptoms appear.

Pathophysiology:

HAV is not directly cytopathic to the hepatocyte. Injury to the liver is secondary to the host's immune
response. Replication of HAV occurs exclusively within the cytoplasm of the hepatocyte. Human
leukocyte antigen (HLA)-restricted, HAV-specific CD8+ T lymphocytes and natural killer cells mediate
hepatocellular damage and destruction of infected hepatocytes. Interferon gamma appears to have a
central role in promoting the clearance of infected hepatocytes.

Risk factors:

 poor sanitation;
 lack of safe water;
 living in a household with an infected person;
 being a sexual partner of someone with acute hepatitis A infection;
 use of recreational drugs;
 sex between men;
 Travelling to areas of high endemicity without being immunized.

Signs and symptoms:

 flu-like symptoms (fever, fatigue, body aches)

 abdominal pain (especially in the right upper quadrant)
 light-colored stool
 dark urine
 loss of appetite
 unexplained weight loss
 jaundice (yellowing of skin or eyes)
 Symptoms usually appear 15 to 50 days after you contract the virus.

Intervention:

 Rest. Many people with hepatitis A infection feel tired and sick and have less energy.
 Wash your hands thoroughly after using the toilet and changing diapers. Scrub vigorously for at
least 20 seconds and rinse well. Dry your hands with a disposable towel.
 Don't prepare food for others while you're actively infected. You can easily pass the infection to
others.
 HEPATITIS B

Summary:

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For some people, hepatitis B
infection becomes chronic, meaning it lasts more than six months. Having chronic hepatitis B increases
your risk of developing liver failure, liver cancer or cirrhosis — a condition that permanently scars of the
liver.

Most adults with hepatitis B recover fully, even if their signs and symptoms are severe. Infants and
children are more likely to develop a chronic (long-lasting) hepatitis B infection.

A vaccine can prevent hepatitis B, but there's no cure if you have the condition. If you're infected, taking
certain precautions can help prevent spreading the virus to others.

Causes:

Hepatitis B infection is caused by the hepatitis B virus (HBV). The virus is passed from person to person
through blood, semen or other body fluids. It does not spread by sneezing or coughing.

Hepatitis B infection may be either short-lived (acute) or long lasting (chronic).

 Acute hepatitis B infection lasts less than six months. Your immune system likely can clear acute
hepatitis B from your body, and you should recover completely within a few months. Most
people who get hepatitis B as adults have an acute infection, but it can lead to chronic infection.
 Chronic hepatitis B infection lasts six months or longer. It lingers because your immune system
can't fight off the infection. Chronic hepatitis B infection may last a lifetime, possibly leading to
serious illnesses such as cirrhosis and liver cancer

Pathophysiology:

Hepatitis B life cycle

The life cycle of HBV is complex but, essentially, it acts as a stealth virus by evading the immune system
(Chisari et al, 2010).

During the first stage of infection, the HBV virion (virus particle) attaches to a liver cell (hepatocyte) then
penetrates the hepatocyte’s cytoplasm (Locarnini et al, 2010). The HBV virion is uncoated (Fig 1), which
means that nucleocapsids can move into the hepatocyte’s nucleus and convert the DNA to covalently
closed circular DNA (cccDNA) - a double-stranded DNA structure (Valsamakis, 2007). The cccDNA is very
stable and can stay in the host nucleus for many months in chronic disease (Jeulin et al, 2013). The virus
makes copies of itself in a process that lacks “proof reading ability”, which allows the virus to mutate
(Horvat, 2011). The newly formed HBV virions are released into the bloodstream, from where they
invade other hepatocytes and repeat the replication process.

It is thought that HBV causes inflammation and progressive fibrosis in the infected liver by triggering the
immune system to attack the hepatocytes (Nebbia et al, 2012).

Risk factors:

 Hepatitis B spreads through contact with blood, semen or other body fluids from an infected
person. Your risk of hepatitis B infection increases if you:
 Have unprotected sex with multiple sex partners or with someone who's infected with HBV
 Share needles during IV drug use
 Are a man who has sex with other men
 Live with someone who has a chronic HBV infection
 Are an infant born to an infected mother
 Have a job that exposes you to human blood
 Travel to regions with high infection rates of HBV, such as Asia, the Pacific Islands, Africa and
Eastern Europe

Signs and Symptoms:

Hepatitis B range from mild to severe. They usually appear about one to four months after you've been
infected, although you could see them as early as two weeks post-infection. Some people, usually young
children, may not have any symptoms.

Hepatitis B signs and symptoms may include:

 Abdominal pain
 Dark urine
 Fever
 Joint pain
 Loss of appetite
 Nausea and vomiting
 Weakness and fatigue
 Yellowing of your skin and the whites of your eyes (jaundice)

Intervention:
Treatment for acute hepatitis B infection

If your doctor determines your hepatitis B infection is acute — meaning it is short-lived and will go away
on its own — you may not need treatment. Instead, your doctor might recommend rest, proper
nutrition and plenty of fluids while your body fights the infection. In severe cases, antiviral drugs or a
hospital stay is needed to prevent complications.

Treatment for chronic hepatitis B infection

Most people diagnosed with chronic hepatitis B infection need treatment for the rest of their lives.
Treatment helps reduce the risk of liver disease and prevents you from passing the infection to others.
Treatment for chronic hepatitis B may include:

 Antiviral medications. Several antiviral medications — including entecavir (Baraclude), tenofovir

(Viread), lamivudine (Epivir), adefovir (Hepsera) and telbivudine (Tyzeka) — can help fight the
virus and slow its ability to damage your liver. These drugs are taken by mouth. Talk to your
doctor about which medication might be right for you.
 Interferon injections. Interferon alfa-2b (Intron A) is a man-made version of a substance
produced by the body to fight infection. It's used mainly for young people with hepatitis B who
wish to avoid long-term treatment or women who might want to get pregnant within a few
years, after completing a finite course of therapy. Interferon should not be used during
pregnancy. Side effects may include nausea, vomiting, difficulty breathing and depression.
 Liver transplant. If your liver has been severely damaged, a liver transplant may be an option.
During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy
liver. Most transplanted livers come from deceased donors, though a small number come from
living donors who donate a portion of their livers.