Hepatitis A,B, and C

1. Hepatitis A,B, and C Michelle and Alex

2. History & Facts • Hepatitis: Greek hepa meaning liver and -itis meaning “inflammation” • Reports of jaundice epidemic in China 5,000 years ago and in Babylon more than 2,500 years ago. • Effects of liver diseases such as hepatitis B include jaundice, characterized by Hippocrates and found to be infectious as early as the 8th century. • In the American Civil War, 40,000 cases occurred among Union troops. • In 1942, 28,585 soldiers became infected with hepatitis after inoculation with the yellow fever vaccine. • The number of cases of hepatitis during World War II was estimated to be 16 million. • Twentieth century was when the main agents causing viral hepatitis were identified. The hepatitis B virus was the first to be discovered. • The catalogue of hepatitis causing viruses are 6: • A, B, C, D, E, and F

3. Example of a case of Hepatitis C In 2013 a 40 year old female was arrested and booked in the county jail. She told deputies and the medical professional she was 6 months pregnant. A pregnancy test was administered, and the results were negative. Further questions revealed that the inmate was Hepatitis C positive. She contracted Hep C many years ago while injecting heroin intravenously from a dirty needle. More tests were conducted and evidence showed that the inmate was in fact not pregnant, but was experiencing ascites which is the accumulation of fluid in the peritoneal cavity due to severe liver disease brought on by Hepatitis C. Other symptoms she was experiencing were mild altered mental status. She was also not receiving any medical attention at the time due to her economic situation. This patient’s case is severeand indicates end stage liver disease.

4. Etiologic agent / Virulence factors • The shape of Hepatitis is spherical and rigid with the resemblance appearance of a raspberry. • Hepatitis A has an etiologic agent by the name of Picornavirus. This is a single stranded Polydenated positive sense RNA genome with an un-enveloped capsid. Size is about 28 nm in diameter. At the end of the RNA strand there is a VPg which is a viral protein. • Hepatitis B virus is a prototype virus of the hepadnavirus family and is a partly double stranded DNA virus. The Genome is associated with the Polymerase protein surrounded by the core antigens. Size is about 40 nm. • Hepatitis C is a falvivirus and is a positive strand DNA that acquires its envelope from its host. The viral particle is about 30 to 60 nm across.

5. What is Hepatitis? • Hepatitis is inflammation and necrosis of the liver. Each type has different symptoms, causes, and treatments. • Hepatitis C has emerged as the most important liver disease in the United States because it produces chronic liver infections.

6. Incubation Period & Pathogenicity • HCV has a viral incubation period of approximately 8 weeks. Most cases of acute HCV infection are asymptomatic. Even when it is symptomatic, acute HCV infection tends to follow a mild course, with aminotransferase levels rarely higher than 1000 U/L. Whether acute HCV infection is a cause of FHF remains controversial. • Approximately 15-30% of patients acutely infected with HCV lose virologic markers for HCV. Thus, approximately 70-85% of newly infected patients remain viremic and may develop chronic liver disease. In chronic hepatitis, patients may or may not be symptomatic, with fatigue being the predominant reported symptom. Aminotransferase levels may range from reference values (< 40 U/L) to values as high as 300 U/L. However, no clear-cut association exists between aminotransferase levels and symptoms or risk of disease progression.

7. Incubation Period & Pathogenicity • An estimated 20% of patients with chronic hepatitis C experience progression to cirrhosis. This process may take 10-40 years. All patients who are newly diagnosed with well-compensated cirrhosis must be counseled regarding their risk of developing symptoms of liver failure (ie, decompensated cirrhosis). Only 30% of patients with well-compensated cirrhosis are anticipated to decompensate over a 10-year follow-up period. • Patients with HCV-induced cirrhosis are also at increased risk for the development of HCC (see the image below), especially in the setting of HBV coinfection. In the United States, HCC arises in 3-5% of patients with HCV-induced cirrhosis each year. Accordingly, routine screening (eg, ultrasonography and AFP testing every 6 months) is recommended in patients with HCV-induced cirrhosis to rule out the development of HCC. End-stage liver disease caused by HCV leads to about 10,000 deaths in the US each year.

8. Pathophysiology • The mononuclear cells are taken over by the agent of Hepatitis which replicates and begins the inflammation process in the parenchyma and portal ducts. This causes hepatic cell necrosis, cellular collapse, and necrotic tissue in the lobules and portal ducts. The bilirubin will then be interfered with. • In the case of cirrhosis, the liver becomes fatty and fibrous and its activity is depressed.

9. Mode of Transmission & Prevention • HAV • Contaminated food and water. • Hepatitis A vaccine • HBV • Infected blood, sex, and needles. • From an infected mother to her newborn. • Hepatitis B vaccine • HCV • Infected blood and needles. • No vaccine • HDV • Must already have hepatitis B. • Infected blood, sex, and needles. • From an infected mother to her newborn. • Hepatitis B vaccine • HEV • Contaminated water. • No vaccine

10. Symptoms • The most common symptoms of hepatitis are: • Loss of appetite • Fatigue • Mild fever • Muscle or joint aches • Nausea and vomiting • Abdominal pain • Less common symptoms include: • Dark urine • Light-colored stools • Jaundice (yellowing of the skin and whites of the eyes) • Generalized itching • Altered mental state, stupor, or coma • Internal bleeding

11. Diagnostic process • Hepatitis can be diagnosed by: • Symptoms (such as jaundice as shown in picture) • Physical exams • Blood tests (most common) • Imaging studies • Liver biopsy

12. Treatment • Recently successful treatment has occurred from a combination of drug therapy: • Either the immune-suppressing steroid prednisone and genetically engineered alpha interferon or • Ribaviron, an antiviral drug, and interferon, depending on the hepatitis strain

13. Statistics • More than 10,000 Americans die annually due to hepatitis C virus (HVC). • In 1995, there were nearly 3,000 cases of hepatitis A in Oregon. Vaccination has lead to the amount of 100 cases less annually. • There has been a berry outbreak between at least 5 different states. It is known that since April 29th of 2013 at least 30 people have become sick with Hepatitis A and it is linked to frozen berries sold by an Oregon company. Many of those people bought their berries through Costco.

15. Why Hepatitis important to study • To try and prevent future outbreaks • Learn more about agent so we can find more and better treatments against possible agents • To educate and aware people with information and how to prevent being a victim

16. References • Fact sheet. (2008, August). Retrieved from • http://public.health.oregon.gov/diseasesconditions/diseasesaz/hepatitisa/pages/facts.aspx • Provided the statistics • Hepatitis a. (2013, July). Retrieved from • http://www.who.int/mediacentre/factsheets/fs328/en/index.html • Same as “Hepatitis c” reference. • Hepatitis b. (2013, July). Retrieved from • http://www.who.int/mediacentre/factsheets/fs164/en/index.html • Same as “Hepatitis c” reference. • Hepatitis c. (2013, July). Retrieved from • http://www.who.int/mediacentre/factsheets/fs204/en/index.html • This website had information about the disease, as well as other diseases. The subjects it included were symptoms, treatments, preventions, and what the disease was. • Hunt, R. (2011, May). Retrieved from • http://pathmicro.med.sc.edu/virol/hepatitis-virus.htm • This website gives the information about the eptiologic agent and virulence factors. • Hepatitis A outbreak linked to Oregon berry farm, Costco . (2013, June). Retrieved from • http://www.nydailynews.com/news/national/hepatitis-outbreak-linked-ore-farm-article-1.1361049

17. References • Online Etymological Dictionary • http://www.etymonline.com/index.php?search=hepatitis&searchmode=none • PubMed: Citations for biomedical literature • http://www.ncbi.nlm.nih.gov/pubmed/20563505 • Hepatitis B Foundation dedicated to the global problem of hepatitis B • http://www.hepb.org/hepb/abc.htm • Information from Stanford University’s website • http://www.stanford.edu/group/virus/1999/tchang/history.htm • Pathophysiology of Hepatitis from Medscape, WebMD • http://emedicine.medscape.com/article/775507-overview#a0104 • Symptoms of Hepatitis from WebMD • http://www.webmd.com/hepatitis/understanding-hepatitis-symptoms • Textbook • Marieb, E. (2001). Human anatomy & physiology. (5th ed., pp.  920).