Hepatitis

• Main Author: Hamid kalantari
• Format: Article
• Language: fas
• Published: Vesnu Publications 2011-04-01
• Series: مجله دانشکده پزشکی اصفهان
• Online Access: http://jims.mui.ac.ir/index.php/jims/article/view/565
• ISSN: 1027-7595; 1735-854X

The five known causes of acute hepatitis are the hepatitis A (HAV), B (HBV), C (HCV), D (HDV), and E (HEV) viruses. Hepatitis A and E are forms of infectious hepatitis which spread largely by the fecal-oral route, occur in outbreaks a well as sporadically. Hepatitis B, C and D are forms of serum hepatitis, are spread largely by parenteral routes and less commonly by sexual exposure and occur sporadically and rarely cause outbreaks. Acute hepatitis B and C capable of leading to chronic hepatitis 10% and 80% retrospectively. Highlights of Hepatitis B: • The spectrum of clinical manifestations range from subclinical or anicteric hepatitis to icteric hepatitis and, in some cases, fulminant hepatitis; during the chronic phase, manifestations range from an asymptomatic carrier state to chronic hepatitis, cirrhosis, and hepatocellular carcinoma. • Approximately 70 percent of patients with acute hepatitis B have subclinical or anicteric hepatitis, while 30 percent develops icteric hepatitis. • The sequelae of chronic HBV infection vary from an inactive carrier state to the development of cirrhosis, hepatic decompensation, hepatocellular carcinoma (HCC), extrahepatic manifestations, and death. • In patients with acute hepatitis B, we suggest treatment with a nucleoside/tide analogue in those who have severe hepatitis [such as those who develop a coagulopathy (INR > 1.5)] or a protracted course (such as persistent symptoms or marked jaundice [bilirubin >10 mg/dl] for more than four weeks after presentation) • Treatment of chronic hepatitis B if indicated are as: conventional IFNα2α, PegIFNα2α (Pegasys) or oral nucleotide/tide included: Lamivudine, Adefuir Tenofovir, Entecavir, Telbivudin. Highlights of Hepatitis C: • Infection with the hepatitis C virus (HCV) can result in both acute and chronic hepatitis. The acute process is most often asymptomatic; if symptoms are present, they usually abate within a few weeks. Acute infection rarely causes hepatic failure. • The risk of chronic infection after an acute episode of hepatitis C is high. In most studies, 80 to 100 percent of patients remain HCV RNA positive, and 60 to 80 percent have persistently elevated liver enzymes. • Most patients with chronic infection are asymptomatic or have only mild nonspecific symptoms. • Treatment of choice, If indicated is: Combination therapy including: IFNα2α (Pegasys) + Ribavirin