Hepatitis

What happens when the virus strikes!

As the types go, viral hepatitis caused by HAV , HEV AND HCV result in acute disease with symptoms like nausea, abdominal pain , fatigue, malaise andjaundice. Hbv and hdv also lead to chronic infection where in an infected individual develops cirrhosis and hepatocellular carcinoma (Hcc0. Moreover, chronic hepatitis carriers remain infectious and can transmit the disease for several years. HDV and hev on the other hand are not hepatotropic viruses, but are extrahepatic based on the virus’s manifestations in the body. This gives us a vast array of aspects to study and acquire knowledge about hepatitis, as each type exhibits varied causes, mode of transmission, symptoms and the body’s immune response, imposing a big reason to worry for our explosive population.

Diagnosis

Anti HCV antibodies are screened using ELISAS. Presence of HCV RNA is checked by nested RT PCR and quantification of HCV viral load (for disease staging and response to antiviral therapy) is done using quantitative real time PCR based assay. There is no marker to distinguish between acute and chronic HCV (and also HBV)infections.

But infection beyond 6 months is categorised to chronic HCV (and chronic HBV), and thus regular liver biochemical tests checking for the levels of AST(aspartate aminotransferase), ALT(alanine aminotransferase),total bilirubin, alkaline phosphatase and albumin evaluate the precise causeof liver disease. Abdominal ultrasound, cross-sectional imaging is undergone for screening of hepatocellular carcinoma. Alsopatients of chronic threat undergo physical examination toevaluate liver diseaselike spider angiomata, palmar erythema, splenomegaly, jaundiceor caput medusa.

Patients with cirrhosis need timely evaluation of ALT levels, and in case of disease severity, liver biopsy assessment is essential. also, in scenaios of mixed etiologies like HCV infection with HBV infection ,metabolic syndrome, alcoholism or autoimmunity,a histological test is considered.

Note:- (Patients diagnosed withHCV shouldbe tested for HIV and HBV due to the common nodes of transmission.)

Diagnosis

HDV infections are diagnosed by detecting anti-HDV by EIA or RIA, but anti-HDV that first appears during the infection is variable and tends to stay for a short time after overcoming acute hepatitis D, leaving no evidence of previous infection. Also , IGM anti-HDV does not distinguish acute and chronic HDV infection. To diagnose acute simultaneous HBV HDV coinfection, anti-HDV with IgM anti-HBC is detected. In case of HDV super infection where in patients suffer from chronic hepatitis B,presence of anti-HDV along with HBsAg and IgG anti_HBc are detected. HDV antigen in liver and HDV RNA in serum and liver can be detected during HDV replication but are seldom used.

Diagnosis

Anti-HEV lgM and Anti-HEV lgG are detected by ELISA. However, very early actue cases may notdetect lgM antibodies and thus, HEV RNA by nested RT PCR is more of an option. Apart from the antibody levels, elevated serum concentration levels of bilirubin, ALT and AST are detected within 1 to 6 weeks after the onset of illness are taken into consideration for detection.

Vaccination

When a virus enters human body (the host), it is bound to create ripples of immune response -body ‘s reaction to the foreign unknown material. This brought the need to administer an antigenic material (a vaccine) to stimulate an individual’s immune system to develop adaptive immdnity to the pathogen. In1950s Dr .Baruch blumbeng was travelling the world studing genetic variations from human blood samples, until he stumbled upon yellow jaundice and discoverd an antigen that detected presence of hepatitis B in blood samples in 1963.” Popularised with the name Australia antigen, discovery of hepatitis B antigen was a breakthrough study for inventing hepatitis B vaccine. 1969 was the year when Dr. Blumberg and Dr. lriving Millman invented the virus which addressed the necessity for prevention of chronic hepatitis infection due to HBV , which affects approximately 80% of people to develop liver cancer.Early vaccines were preparred by haversting HbsAg From the plasma of people with chronic infection, While more recent ones are obtanied by expressing Plasmids, containing the corressponding gene in Yeast or mammalian cells HBV vaccinations are either monovalent composed of hightly purified preparation of HbsAg or companation or A or B antigens in a formulation suitable for pediatric or adult. Though vaccination has brought a positive impact on curbing the virus spread among the population with less adverse effects, this does not rule out the possibility of neurological conditions like Gullain-Barre syndrome, multiple, sclerosisetc., affecting individuals.

Diagnosis

HDV infections are diagnosed by detecting anti-HDV by EIA or RIA, but anti-HDV that first appears during the infection is variable and tends to stay for a short time after overcoming acute hepatitis D, leaving no evidence of previous infection. Also , IGM anti-HDV does not distinguish acute and chronic HDV infection. To diagnose acute simultaneous HBV HDV coinfection, anti-HDV with IgM anti-HBC is detected. In case of HDV super infection where in patients suffer from chronic hepatitis B,presence of anti-HDV along with HBsAg and IgG anti_HBc are detected. HDV antigen in liver and HDV RNA in serum and liver can be detected during HDV replication but are seldom used.



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