What is viral hepatitis?

Viral hepatitis is inflammation of liver cells, caused by a viral infection, commonly hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E viruses. Hepatitis A is the commonest form of acute viral hepatitis worldwide. Hepatitis A and E spreads through contaminated food and water. Hepatitis B, C and D spreads through infected blood transfusions, unprotected sexual intercourse and intravenous drug abuse. Hepatitis B and C can also be transmitted from an infected pregnant lady to her child. Hepatitis A and E generally present with acute illness and resolve with symptomatic treatment. They may uncommonly cause acute liver failure (ALF). On the other hand, hepatitis B, C and D may present as asymptomatic infection, acute hepatitis, ALF, chronic hepatitis, liver cirrhosis or liver cancers (hepatocellular carcinoma). 

 

Clinical features and diagnosis

Acute viral hepatitis 

Acute viral hepatitis (seen with hepatitis A and E) may be asymptomatic or may present with a prodrome and symptoms like fever, body ache, malaise and jaundice. The blood reports generally show deranged liver function tests. Abdominal ultrasound is generally normal in these cases. 

 

Chronic viral hepatitis

Hepatitis B or hepatitis C infection, if not cleared in 6 months, have high risk of progressing to chronic infection. Such patients may have flares of chronic hepatitis with clinical features similar to acute viral hepatitis. If left untreated, such patients may develop liver cirrhosis and liver cancers (hepatocellular carcinoma). 

              

Figure 1. Progression of untreated acute Hepatitis B infection

Figure 2. Progression of untreated acute Hepatitis C infection

The blood reports may show deranged liver function tests. Abdominal imaging in form of ultrasound, CT scan or MRI may show normal liver or chronic liver disease in form of liver cirrhosis and associated sequelae. 

 

Treatment 

Hepatitis A and E, in most cases, require symptomatic treatment. These infections generally clear away in 1 month to 6 months with supportive treatment. Hepatitis B, C and D require treatment in form of specific antiviral drugs. If not treated early, they may progress to chronic infection and associated liver complications. The treatment is decided on the basis of blood investigations and imaging. 

 

Prevention

Avoiding contaminated food and water is a basic measure to prevent contraction of hepatitis A and E. Avoiding unprotected sexual intercourse and intravenous drug abuse are important in prevention of hepatitis B, C and D. Transmission of hepatitis infection from pregnant lady to newborn child can be prevented by universal prenatal screening for hepatitis viral infections and by appropriate treatment at correct time during the pregnancy and at the time of delivery of the child. Vaccines against hepatitis A and B are available worldwide. Hepatitis B vaccination is included in the immunization schedule in most countries.

 

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