Hepatitis A

Overview of Hepatitis A

Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), the HBV-associated delta agent or hepatitis D virus (HDV), and hepatitis E virus (HEV). All these human hepatitis viruses are RNA viruses, except for hepatitis B, which is a DNA virus but replicates like a retrovirus.

Although these agents can be distinguished by their molecular and antigenic properties, all types of viral hepatitis produce clinically similar illnesses. These range from asymptomatic and inapparent to fulminant and fatal acute infections common to all types, on the one hand, and from subclinical persistent infections to rapidly progressive chronic liver disease with cirrhosis and even hepatocellular carcinoma, common to the bloodborne types (HBV, HCV, also HDV), on the other. [2]

Acute viral hepatitis may be asymptomatic, marked only by an increase in aminotransferase levels, or symptomatic with or without jaundice or sub fulminant or fulminant depending on the causative agent.

Though the natural history of acute hepatitis can vary according to the etiological agent, it can be divided as follows depending on clinical features and laboratory findings:

1. Prodromal period

• Bilirubinuria appears earlier than a rise in serum bilirubin.
• Serological viral markers help in arriving at a diagnosis.
• Urobilinogen and total bilirubin rise occur before clinical jaundice.
• Liver enzymes AST and ALT are > 500 units
• Leucopaenia may be observed with onset of fever.

2. Acute icteric stage

• Bilirubin rises, plateaus and then gradually decreases.
• Serum AST and ALT rise and fall rapidly and reach normal range in 2 to 5 weeks.
• ESR is raised initially and falls during convalescence

3. Defervescent stage

• Diuresis occurs at onset of convalescence.
• Bilirubinuria disappears, serum bilirubin is still increased.
• Urine urobilinogen increases.
• bilirubin becomes normal after 3 to 6 weeks [1]

Causes of Hepatitis A

• Antibodies to HAV (anti-HAV) can be detected during acute illness when serum aminotransferase activity is elevated and fecal HAV shedding is still occurring.
• This early antibody response is predominantly of the IgM class and persists for several (~3) months, rarely for 6–12 months. During convalescence, however, anti-HAV of the IgG class becomes the predominant antibody.
• Therefore, the diagnosis of hepatitis A is made during acute illness by demonstrating anti HAV of the IgM class. After acute illness, anti-HAV of the IgG class remains detectable indefinitely, and patients with serum anti-HAV are immune to reinfection.
• Neutralizing antibody activity parallels the appearance of anti-HAV, and the IgG anti-HAV present in immune globulin accounts for the protection it affords against HAV infection.
• Liver injury is immune mediated by natural killer cells, virus-specific CD8+ cytotoxic T lymphocytes and nonspecific cells recruited at the site of inflammation.[2]

Transmission of Hepatitis A

The main route of transmission is faeco-oral, occasionally, HAV is transmitted by blood products or through illicit use of injectable drugs [1]

Classification of Hepatitis A

1. Hepatitis A
2. Hepatitis B
3. Hepatitis C
4. Hepatitis D
5. Hepatitis E

Sign & Symptoms of Hepatitis A

Acute viral hepatitis occurs after an incubation period that varies according to the responsible agent Incubation period 2–6 weeks, related to the infecting dose.

Prodromal symptoms consist of i.e.

• Malaise
• Loss of appetite
• Nausea, Vomiting
• Fever also Headache
• Dark urine
• Pale stool
• Fatigue, Malaise
• Arthralgias
• Photophobia
• Pharyngitis, cold, cough
• Anorexia

Age is the most important determinant of the severity of hepatitis A as also presence of chronic liver disease [1]

• Generally, incubation periods for hepatitis A range from 15–45 days (mean, 4 weeks), for hepatitis B and D from 30–180 days (mean, 8–12 weeks), for hepatitis C from 15–160 days (mean, 7 weeks), and for hepatitis E from 14–60 days (mean, 5–6 weeks).
• Additionally, The prodromal symptoms of acute viral hepatitis are systemic and quite variable.
• Constitutional symptoms of anorexia, nausea also vomiting, fatigue, malaise, arthralgias, myalgias, headache, photophobia, pharyngitis, cough, and coryza may precede the onset of jaundice by 1–2 weeks. The nausea, vomiting, and anorexia are frequently associated with alterations in olfaction and taste.
• Besides this, A low-grade fever between 38° and 39°C (100°–102°F) is more often present in hepatitis A and E than in hepatitis B or C, except when hepatitis B is heralded by a serum sickness–like syndrome; rarely, a fever of 39.5°–40°C (103°–104°F) may accompany the constitutional symptoms.
• All in all, Dark urine and clay-colored stools may be noticed by the patient from 1–5 days before the onset of clinical jaundice.[2]

Diagnosis of Hepatitis A

• Raised serum bilirubin
• Serum AST also ALT levels remain high
• Alkaline phosphatase level is only mildly elevated, though if it remains persistently high, it suggests hepatitis-associated cholestasis
• Hepatitis A specific IgM antibody can be detected at the onset of symptoms and at the first rise in serum ALT.
• IgG anti HAV becomes positive at onset of illness and is detectable for many years.
• Nucleic acid-based tests like PCR performed on stool. [1]

Treatment of Hepatitis A

• Unlike other types of viral hepatitis, hepatitis A rarely causes long-term liver damage and doesn’t become a long-term (chronic) illness.
• There isn’t a specific treatment for hepatitis A, and most people will recover fully within one to two months.
• Usually, symptoms are managed at home
• Plenty of rest
• Painkillers and medication to help with itchiness, nausea or vomiting.

Occasionally hepatitis A can last longer and, in rare cases, it can be life-threatening if it causes the liver to stop working properly (liver failure).[2]

Prophylaxis of Hepatitis A

Hepatitis A Vaccine: –

Dose primary course of 2 doses (1 mL each) one month apart. Booster Dose—One dose of 6–12 months after first dose for active immunization which provides long-lasting immunity.

Apart from individuals at high risk, hepatitis A vaccination is recommended in patients with chronic hepatitis C. Post-exposure Prophylaxis For intimate contacts (household, sexual, institutional) of persons with hepatitis A.

Dose: Immunoglobulin 0.02 mL/kg is recommended as early after exposure as possible; it may be effective even when administered as late as 2 weeks after exposure [1]

Diet & Regimen of Hepatitis A

• Stimulating the liver can stress the liver and stimulants such as colas, chocolate, coffee, and tea are restricted.
• Fruit juices also, because they contain high levels of concentrated sugar which stress the digestive process and the pancreas, while feeding the virus. [3]
• Stimulating the liver can stress the liver and stimulants such as colas, chocolate, coffee, and tea are restricted.
• Fruit juices also, because they contain high levels of concentrated sugar which stress the digestive process and the pancreas, while feeding the virus. [3]

Frequently Asked Questions

What is Hepatitis A?

Acute viral hepatitis is a systemic infection affecting the liver predominantly caused by five well-characterized hepatotropic viruses, which are designated hepatitis A, B, C, D and E.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Hepatitis A?

• Arsenicum album
• Bryonia
• Calcarea carbonica
• Cinchona officinalis
• Chelidonium manjus
• Hepar sulphuris
• Mercuris
• Digitalis
• Lachesis
• Natrum sulphuricum

What causes Hepatitis A?

Hepatitis A virus [HAV]

What are the symptoms of Hepatitis A?

• Malaise
• Loss of appetite
• Nausea, Vomiting
• Fever & Headache
• Dark urine
• Pale stool
• Fatigue, Malaise
• Arthralgias
• Photophobia
• Pharyngitis, cold, cough
• Anorexia

How to prevent Hepatitis A?

Hepatitis A Vaccine (Dose primary course of 2 doses one month apart. Booster Dose—One dose of 6–12 months after first dose for active immunization which provides long-lasting immunity.)