Hepatitis A to E

There are several different viruses which can cause abnormalities of liver function. They may be asymptomatic or present with jaundice, fatigue fever, aching joints and lethargy. These include;

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Epstein Barr and cytomegalovirus, which commonly cause flu like symptoms in young people but may also cause abnormal liver tests. Epstein Barr virus causes glandular fever. Both these infections tend to be self limiting, but may persist or recur in patients who are immunocompromised.

Hepatitis A is a viral infection transmitted by ingestion (eating or drinking) of contaminated food or liquid. Hepatitis A is an acute illness and is always self-limiting. Whilst it may last for several weeks or even months and cause significant upset and jaundice it is rarely life-threatening. Pregnant and immunocompromised individuals are particularly susceptible. There is an effective vaccine.

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Hepatitis B is usually acquired by exposure to an infected persons’ bodily fluids. This may arise in utero when transmission to foetus’s  from the infected mother can occur. Other modes of acquisition include sexual contact, exchange of blood products and needlestick injury (risk 10%). There is a vaccine used to prevent spread in high risk populations. It may cause an acute illness, which makes patients unwell and often causes jaundice (being unwell soon after acquisition confers a greater probability of clearing the virus), or chronic infection which may pose a high or low risk of liver disease or infectivity depending on the levels of viral replication that persist. There is effective treatment for chronic viral hepatitis with high viral load. In general those with low viral load, at low risk of transmitting the disease and of developing chronic liver disease and it’s complications are not offered treatment, which is available to those with higher viral loads and greater risk of ill health and infectivity. Infection with hepatitis B may be complicated the development of a rare liver tumour known as a hepatoma.

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Hepatitis C

Hepatitis C is usually acquired by exposure to blood or blood products (although blood products in the UK are now screened for the antibody to the virus). The commonest mode of acquisition is through the sharing of needles in the context of substance misuse. Acquisition through conventional sexual contact is very unusual (1;1000) though there are cases of transmission when violent sexual encounters have led to significant blood exchange at the time of the encounter. The risk of acquisition of the virus through healthcare related needlestick injury is thought to be about 2%, as compared to HIV – 0.3%. There is effective treatment.

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Hepatitis delta (D)

This is a virus which only ever occurs in the setting of co-infection with hepatitis B, since it relies on some of Hepatitis B’s proteins for reproduction.

 

Hepatitis E

Hepatitis E is a viral infection transmitted by ingestion (eating or drinking) of contaminated food or liquid. Hepatitis E is an acute illness and is always self-limiting. Whilst it may last for several weeks or even months and cause significant upset and jaundice it is rarely life-threatening. Pregnant and immunocompromised individuals are particularly susceptible. It is thought that other mammals may be a significant reservoir of infection (perhaps pigs in particular).