Hepatitis BOf the various viruses causing hepatitis (A, B, C, delta and E) hepatitis B is particularly important due to its high infectivity and its ability to cause chronic hepatitis, cirrhosis (scarring of liver) and even cancer. The hepatitis B virus is a DNA virus (viruses can be either DNA viruses or RNA viruses and they are unique as no other living organism exists without both DNA and RNA). Mode of transmission: The disease can be transmitted from a mother to a baby through the placenta. Later in life the disease can be acquired through transfusion of blood products, by the use of contaminated needles, accidental pricks from contaminated needles, or sexual intercourse. The disease is more common in drug addicts who share needles. Clinical features: The disease has an incubation period of 21-135 days. In the initial stage the symptoms are nonspecific. There may be slight fever abdominal pain and vomiting. Fever may be absent is some children. The color of urine changes to dark yellow and the stools may become pale. The liver is enlarged. Some children may develop rashes or joint pain. Laboratory tests: Liver function tests will be abnormal. Live enzymes are elevated is blood and the bilirubin level is also raised (bilirubin is the yellow pigment responsible for jaundice). Erythrocyte sedimentation rate (ESR) is elevated.
During the acute stage diagnosis can be confirmed by identifying the specific antigen of the virus called surface antigen-Hepatitis B surface antigen (HBs Ag) and the antibody to another antigen called core antigen-Hepatitis B core antigen (HBc Ag). The antibody belongs to IgM group. Persistence of HBs Ag for more than eight weeks usually heralds chronic hepatitis. Management: During the acute stage treatment is mainly supportive with bed rest and low fat diet. If vomiting is severe hospitalization and intravenous fluid administration may be required. Drugs which can cause liver damage like paracetamol should be avoided. No specific medication is recommended during the acute stage. Patients with chronic hepatitis may be treated with either alpha-interferon or lamivudine. Alpha-interferon has to be given as subcutaneous injection three times a week for about six months. It slows the replication of the virus and boosts the body’s immune system. The treatment is quite expensive. The drug can cause side effects such as flu like symptoms. Lamivudine is an anti-viral drug which can be administered orally. The drug has to be given daily for a period of at least one year. Side effects are uncommon. Herbal remedies have been tried in the treatment of liver diseases including hepatitis B. However more studies are required to confirm their usefulness. Prognosis: Most of the people recover completely and do not become carriers. Clinical improvement occurs in about two to three weeks and HBsAg disappears. But about ten percent of patients develop chronic liver disease in the form of chronic hepatitis. Some of these patients progress to cirrhosis. There is higher incidence of liver cancer among patients of hepatitis B compared to general population. Useful links
Page last reviewed on 8th November 2009
|
