HEPATITIS; CRISIS OF PEOPLE

CLINICAL MANIFESTATIONS;
various types of hepatitis  and their incubation period and clinical presentations were given in below table

Type

Clinical presentation

HAV

[2-4weeks]

symptoms include mild to severe it includes dark coloured urine and jaundice, loss of appetite, abdominal pain, diarrhoea, fever malaise.

HBV

Hepatocellular carcinoma,  Liver cirrhosis,    Fatigability,    Anorexia,  Nausea  Myalgia, Vomiting

Patient with fulminant and sub fulminant hepatitis shows following

Mental confusion, coma, ascites, hepatic encephalopathy. Characteristic complications and symptoms from decompensated liver disease are related to portal HTN and synthetic dysfunction. in these including physical and mental changes like Hepatic encephalopathy, Ascites ,Variceal bleeding, Ankle oedema and  Paraesthesia’s

 

HCV

Palma erythema

Well-wishing of the eyes

Liver cirrhosis

Mucosa associated lymphoid tissue tumours (MALT) ((Trépo,2014;Vinod k Dhawan). The patients who are suffered with chronic HDV will developed the acute liver disease

HDV

[3-7 weeks]

 

Pre-icteric phase -Nausea &anorexia ,Lethargy, fatigue

Icteric phase- Fatigue &nausea persist

 risks for fulminant hepatitis it is characterised by encephalopathy &deep jaundice.

Hepatocarcinomatous.

Symptoms-Fatigue ,Dark urine, Joint pain and Abdominal pain (Phusa,2005).

HEV

asymptomatic in acute and sub-acute liver failure, but in symptomatic causes

Jaundice, Fever, Joint pain ,muscle and abdominal pain (Kamar,2016).

DIAGNOSIS;
Hepatitis A virus (HAV) is diagnosed by the detection of HAV-IGM antibodies in the blood and other additional tests include “reverse transcriptase- polymerase chain reaction [PT-PCR] to detect hepatitis A virus RNA (Pallavi,2017).  Patient with acute hepatitis showing/following Low grade fever, jaundice, spider nevi with chronic disease including hepatomegaly, splenomegaly, vasculitis
The laboratory studies include
* Aspirate aminotransferase levels
* Alkaline phosphatase level
* Aluminium levels
* Serologic tests
* Total and direct and indirect bilirubin levels in serum (Nikolas2001).

HCV infection was diagnosed by the following
* HCV antibody enzyme immune assay   recombinant immunoblots assay
* Quantitative HCV RNA polymerase chain reaction (Thad Wilkins,2010).
* To detect   HDV antigens present in the blood
* To   check the liver damage present or absent
* Other tests include liver function tests (www.altiusdirectory.com). Diagnosis is done by two types direct and in direct. In indirect method to detect virus or virus particles or nucleic acid in blood and stool samples by the method of immune electron microscopy RT-Pyrin direct method to detect anti-HEV.LAMP(loop mediated isothermal implication) (Ahmed,2015). Advances in hepatitis E-1 virology pathogenesis and diagnosis (Rakesh Aggarwal ,2011).

SCREENING
The persons who are having HCV 15-20%experincess the spatulous recovery and remaining 75-80% of people are progressed   to chronic HCV. There are two types of screening in which one is selective and another one is universal screenings(Shobha,2014).

TRANSMISSION;
* HAV is transmitted by the focal oral route
* In families, the infected persons prepared the food for others in an unhygienic condition like improper washing/cleaning of the hands
* Homosexual transmission
* Water out breaks
* Sewage contamination
* The close physical contact with infected person.
It is mainly remitted through faecal oral route, By the contamination of water and water supplies (Kumar,2013), Hepatitis E virus is also spreads from HEV infected animals, By the blood transfusion but, it is occurred rarely (James,2010).

RISK OF HEPATITIS
*Parenteral drug administrations
*People who have multiple sex partners more than two or multiple
*Infected persons to spread with close in the house holds (Elgouhari,2008).

TREATMENT
HAV has there is no particular treatment but it involves supportive care.
To monitoring the fluid balance and prevent the complications like dehydration and exhaustion. The supportive care includes that replenishing nutrition. (Kathleen1998).
Drug therapy
When the patient has low level or decreased level serum aminotransferase activity, bilirubin content would be treated with corticosteroids. if corticosteroids are failed in chronic HBV then we go HB immunoglobulin (HBIG)and interferon alpha Drugs chart

1. Interferon alpha -2a 3MUTIW/IM SC -12
2. Interferon alpha 1 9Ug TIW SC -6MONTHS
In chronic HBV alpha 2b 10million UTIW -4 months.
In acute HCV infection, if patient have symptoms of fatigue and elevated levels of ALT in that condition to give Alpha-interferon, in chronic HCV infection Ribavirin TID according to the patient weight (generally 1000mg is given if the weight less than 75 if more than 75 1200mg), INF-ALPHA 2b 3 million units for a week.

Glucocorticoids are the infective treatment in HDV By the experimental trails INF alpha
High doses of INF alpha (9 million units three times a week) for 12 months 58% beneficiary Drugs

Lamivudine, adefovir, enterovirus if it is failure then go liver transplantations (Sultanik,2016).. There is no particular treatment for HEV or anti-viral therapies’ is treated with supportive therapy. To avoid the drugs which can cause liver toxicity. It should be adequate rest, nutrition and fluids (cdc.gov/)


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