The 5 Types of Hepatitis

Common conditions, Health, Lifestyle

Hepatitis liver

The liver is a vital organ located in the upper right part of your belly under the ribs.

Functions of the liver:

  • Making bile, a yellowish-green liquid that helps with digestion
  • Producing proteins and blood-clotting factors that the body needs
  • Regulating glucose (sugar) in the blood and stores extra sugar
  • Working with the stomach and intestines to digest food
  • Storing vitamins and minerals
  • Removing toxic (poisonous) substances from the blood

“Hepatitis” means inflammation of the liver. Hepatitis is also the name of a family of viral infections that affect the liver.

There are 5 types:

  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E

The most common types of hepatitis disease are Hepatitis A, B and C. 

Causes of infection and types –

Hepatitis A: This is caused by consuming food or drinking water that is contaminated with faecal matter (human waste). As compared to other infections of hepatitis, hepatitis A usually improves without treatment.

Hepatitis B: It can be transmitted through sexual contact with an infected partner, through infected blood transfusions and dirty needles. Hepatitis B may scar the liver (cirrhosis) and lead to liver cancer.

Hepatitis C: This is the most common form of viral hepatitis. The exact cause is unknown, but it can happen through blood transfusion of infected blood and blood products, contaminated injections and through injection drug use.

Hepatitis D: Hepatitis D occurs in people with hepatitis B, increasing the severity of symptoms associated with hepatitis B.

Hepatitis E: Similar to hepatitis A, hepatitis E happens among people in countries with unhygienic living conditions where contaminated water and food consumption often leads to a spread of infection.

Which hepatitis is dangerous?

  • Types B and C have been reported more among people leading to a chronic (long-term) illness of liver disease. It is the most common cause of liver cirrhosis (liver tissue scarring) and cancer.
  • In addition, there are vaccines to prevent Hepatitis A and B. However, there is no known vaccine for Hepatitis C.

Period of illness with different types of hepatitis

Acute Hepatitis viral infection: This is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis virus. Hepatitis A and E may not cause chronic hepatitis but for some with compromised immunity and delayed treatment, it may lead to chronic infection.

Chronic Hepatitis virus infection: Hepatitis viruses B and C can progress from acute to chronic episodes of illness after about 6months. It is long-term as the virus remains in a person’s body and continues to affect liver cells for years to an extent that there can be a complete liver failure.  

Pathophysiology of Hepatitis infection

Acute infection: The course of the virus is not completely understood but once it enters into the body, it multiplies and the infection persists due to weak immune responses which fails to control the viral spread of infection. Symptoms will appear and continue.

Chronic infection is established with the progression of infection. Liver lesions appear due to the immune responses and inflammation of the liver cells. It also triggers fibrogenesis in which the cells of the liver become hard, thickened and fibrous. This leads to scarring of the liver tissue known as cirrhosis. People with cirrhosis are then at high risk of developing end stage liver disease (ESLD) with hepatocellular carcinoma (cancer of the liver cells). 

Chronic hepatitis

Fig 1: Stages of liver infection with Hepatitis C virus(HCV)

Signs and Symptoms with all types of hepatitis

  • Fever due to infection.
  • Fatigue due to loss of appetite, nausea, and vomiting. Also, lead to long-term weight loss.
  • Abdominal pain due to build-up of fluid in the stomach due to inflammation. This occurs when the damaged liver doesn’t produce enough albumin, a substance that regulates the amount of fluid in cells. This may also lead to Pale colored stools, darker urine.
  • Joint pain: Pain and stiffness are early signs of inflammation caused by the body’s autoimmune response to the hepatitis virus.
  • Jaundice: Bilirubin present in the hemoglobin of the red blood cells can build up and cause your skin and the whites of your eyes to turn yellow. 
  • Brain problems: A build-up of toxins in the brain can cause personality changes. Advanced symptoms include abnormal shaking, agitation, disorientation, and slurred speech.
  • Diabetes: Liver is unable to store excess glucose and too much sugar is present in the bloodstream which may lead to insulin resistance or type 2 diabetes.

Who may be at risk of getting Hepatitis?

  • Infants born to infected mothers can get hepatitis B
  • Travelers to regions with high risk of Hepatitis infection most commonly reported in Asia, Africa, South America and the Caribbean.
  • Sexual contact with infected persons that cause viral transmission through body fluids.   
  • Household members, healthcare professionals and caregivers of infected persons through an accidental transmission.
  • Recipients of blood transfusions who may have accidentally received an infected blood.
  • Long-term hemodialysis patients through an accidental infected needle use or blood transmission.

Diagnosis of hepatitis

Blood tests for the antibodies can be helpful in diagnosing both acute and chronic hepatitis. Physical examination of the symptoms along with diagnostic studies such as ultrasound scan of the liver or a liver biopsy is also done to determine the severity of liver damage.

Prevention and Treatment of Hepatitis

Immunization :

  • Hepatitis A immunization of children (1-18 years of age) consists of 2-3 doses of the vaccine. Adults need a booster dose every 6-12 months following the initial dose of vaccine. The vaccine is thought to be effective for 15–20 years or more.
  • Hepatitis B vaccines provide protection against hepatitis B for 15 years and possibly much longer. All newborns and individuals up to 18 years of age and adult should be vaccinated. Three injections over a 6 to 12-month period are provided for full protection.

Safety Measures to Prevent Hepatitis

  • Hygiene: Wash your hands after going to the bathroom and before cooking or eating.
  • Protective sex: This may lower the risk of transmission. It’s always wise to know the history of your sexual partners, especially if they have an infection, you may run the risk of contracting the disease.
  • Drinking clean water: Avoid tap water when traveling to certain countries or regions.
  • Careful handling of drug needles and use of disposable drug needles only.
  • Avoid sharing personal items such as toothbrushes, razors and nail clippers.

Once diagnosed with hepatitis, the treatment will depend on the type and stage of infection. Most adults recover completely from acute hepatitis A and B within six months period. Mild relapses may occur over time during the recovery of the disease. 

Early detection and treatment show excellent recovery from both hepatitis B and C. Further research development continues to provide a vaccine for hepatitis C.


What is Middle East Respiratory Syndrome (MERS)

Common conditions

Passengers wearing masks to prevent contracting Middle East Respiratory Syndrome (MERS) walk past a thermal imaging camera (unseen) at Incheon International Airport in Incheon, South Korea, June 2, 2015. REUTERS/Kim Hong-Ji

What is MERS?

The Middle East respiratory syndrome is a viral life-threatening infection caused by the coronavirus (MERS-CoV).

Signs and Symptoms of MERS

Although uncommon, these symptoms may be present:

  • Fever
  • Cough
  • Breathlessness

More serious symptoms:

  • Chills
  • Diahorrea
  • Nausea/vomiting
  • Coughing out blood

Complications of MERS

  • Pneumonia
  • Kidney failure
  • worsening of pre – existing diseases like diabetes, cancer, heart problems etc.

Source of MERS-CoV 

The exact source is unknown. However, camels and bats are suspected to be the main host of origin for these viruses. Camels are reported to be able to carry these viruses but it cannot be explained how many of the humans got infected without having any direct contact with camels. Bats can also carry and they often feed on fruit that’s harvested by people, so that is another possible route.

What does the virus do to the human body?

One of the most important cells of the human immune system is the macrophages. These macrophages help to eliminate any infections.

MERS-CoV can establish a productive infection in the macrophages. This induces a release of pro-inflammatory cytokines leading to:

  • Severe inflammation
  • Tissue damage

These manifest clinically as severe pneumonia and respiratory failure. The cells of the lungs are infected the most by MERS-CoV.

Severe acute respiratory syndrome (SARS) and MERS

Both SARS and MERS are relatives and have come from the Coronaviruses. They are a large family of viruses that can cause a range of illnesses in humans, from the common cold to the Severe Acute Respiratory illnesses (SARS). Viruses in this family also cause a number of animal diseases. Compared to SARS, MERS-CoV appears to be more severe and have been reported to be the cause of death to more people (40% versus 10%), more quickly and especially more severe in those with pre-existing medical conditions.

MERS is a global threat

Since the discovery of MERS in 2012, it is considered a pandemic threat to the Gulf region. However, MERS-CoV has now reached about 23 countries affecting thousands of people. 

Although MERS have been reported in US, UK, France, Germany and other countries, strict measures have been taken to stop the spread and since then there has been a decline in the numbers infected.

2015 updates on the Countries with travel-associated MERS cases: Algeria, Austria, China, Egypt, France, Germany, Greece, Italy, Malaysia, Netherlands, Philippines, Republic of Korea, Tunisia, Turkey, United Kingdom (UK), and United States of America (USA) 

However, people in South Korea are still facing the problems of MERS and about 2,300-plus people are quarantined and 1,800 schools closed in South Korea due to the fast spreading of this virus.  

Possible reasons why South Korea has more MERS cases

  • As per reports, the first patient who contracted MERS from a travel visit to the middle east when returned to Korea was left undiagnosed for a week. In that time period, many health professionals and other people who came in contact got infected.
  • There was not enough infection control taken. Bad ventilated hospital rooms may have aided the spread of the virus.
  • South Korea has also been quick to report MERS cases to the World Health Organization as compared to other countries.
  • The worst possibility that the virus may have mutated and become more infectious. Although further research needs to be done to know the exact cause as of now the World Health Organization (WHO) reports, “”There is no evidence to suggest sustained human-to-human transmission in communities and no evidence of airborne transmission. However, MERS-CoV is a relatively new disease and information gaps are considerable.”

The Ministry of Health (MOH) in Singapore continues to closely monitor the recent progress on research regarding MERS-CoV infections. As of now, no cases of MERS-CoV have been detected in Singapore. Nonetheless, given today’s globalised travel patterns. Awareness and strict precautionary measures should be undertaken.

Who is at risk of being infected?

  • Travelers: People who have come in close contact with infected people while travelling to high-risk countries.
  • Consumption of Camel products.
  • Compromised immune system: People who have lung, heart or other conditions or diseases have lower immunity and are more susceptible to the viral infection.
  • Contact with infected person such as health care professionals in hospitals. Also, people who take care of animals like bats and camels may be at increased risk. 

How does MERS-CoV spread? 

The virus can spread between people in close contact. It can spread through the air as the infected person sneezes and releases viral droplet in the air which could spread across to other individuals in close contact. 

The average incubation period has been reported to be 5 days but there are cases that occurred up to 14 days after exposure. Incubation period refers to the amount of time when a person is first exposed to the virus and when the symptoms starts to occur.

How is MERS diagnosed?

There are two main ways to determine if an infection is with MERS-CoV.

  •  Polymerase chain reaction (PCR) analysis: PCR tests are done with respiratory samples and can quickly indicate if a person has an active infection with MERS-CoV.
  • Serology testing: blood samples designed to look for antibodies to MERS-CoV that would indicate a person had previously been infected with the virus hence developed an immune response.

Other tests

  • X-ray to determine the extent of the damage: All patients with MERS have an abnormal chest X-ray. Pneumonia is commonly seen as shown in Fig 1.  The black portion shows the normal air-filled spaces in the lungs and the white portion on the left lung is called infiltrates (filling of air spaces with infectious fluid) that identifies the presence of pneumonia infection. 
image016 (1)

Fig 1: Pneumonia in the Right lung

How to prevent and treat MERS?

There is no known vaccine for MERS and no known medications that have been proved to be effective for the treatment of coronavirus infections. Clinical research is still working on establishing an effective treatment.

Infection prevention and control measures: Especially in healthcare settings, this is important to prevent the possible spread of MERS-CoV.

Early identification of people with MERS-CoV is difficult as like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, standard precautions should be taken with all patients, regardless of diagnosis.

General precautionary measures

  • When in contact with a person with any symptoms of acute respiratory infection, contact precautions and eye protection should be taken. As the infection is airborne, it can spread through the mucosal lining of the eyes and nose. 
  • Even touching contaminated objects or surfaces and then touching the eyes, nose, or mouth can lead to the spread of the infection. 
  • General hygiene measures – regular hand washing before and after touching animals and avoiding contact with sick animals.
  • Food hygiene practices should be observed. People should avoid camel food products.

Until research reveals more about MERS-CoV, people with diabetes, renal failure, chronic lung disease and people with compromised immunity are considered to be at high risk from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels when visiting farms, markets or barn areas where the virus is known to be potentially circulating.