Viral Hepatitis

Author: Dr. Veena

Category-Liver Health

Viral Hepatitis:

“Hepato” means liver and “itis” means inflammation. Thus, viral hepatitis refers to the inflammation of the liver due to a viral infection.

Causes of Viral Hepatitis:

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

Less Common Causes of Viral Infection:

• Cytomegalovirus
• Epstein-Barr virus

Rare Causes of Viral Infection:

• Herpes simplex
• Yellow fever

Hepatitis A:

The Hepatitis A Virus (HAV) belongs to the picornavirus group of enteroviruses. This infection is common in children, often asymptomatic, and up to 30% of adults show serological evidence of past infection without a history of jaundice. Generally, this infection occurs in crowded areas or areas where sanitation is poor.

Hepatitis A is not a serious illness, but proper diagnosis is important. Statistical data from 1999 and 2006 showed that around 6,000 to 9,000 cases of HAV and HBV were being diagnosed annually in Canada.

Causes:

• Contaminated water
• Close contact with an infected person
• Consumption of food, vegetables, or fruits handled by an infected person

It is highly infectious and spreads by the fecal-oral route. An infected person may be asymptomatic but can shed the virus through feces for about 2 to 3 weeks before symptoms appear.

Signs and Symptoms:

• Nausea
• Vomiting
• Fatigue
• Yellowing of the skin and eyes
• Abdominal pain
• Tenderness in the liver area
• Itchy skin
• Joint pain
• Fever

Acute liver failure is rare in Hepatitis A. However, HAV-infected patients with chronic liver disease may experience serious illness.

High-Risk Groups:

• Injecting and non-injecting drug users
• People traveling to countries where Hepatitis A is common
• Homosexual individuals

Hepatitis B:

Hepatitis B Virus (HBV) is a double-stranded DNA virus in the Hepadnaviridae family. It is a common cause of liver disease and hepatocellular carcinoma worldwide. The virus is known as the Dane particle, and an excess of its surface protein (Hepatitis B surface antigen) circulates in the blood.

Humans are the only source of infection. More than 125 million people in America are chronically infected with the virus, and as many as 5,000 die each year from HBV-related illnesses. Acute infection is often asymptomatic, and many with chronic hepatitis are also asymptomatic.

Modes of Transmission:

• Injection drug use
• Acupuncture needles
• Homosexual/heterosexual contact
• HBsAg-positive mother

Chronic Hepatitis B patients may develop complications like cirrhosis of the liver and hepatocellular carcinoma after many years.

Hepatitis D (HDV):

The Hepatitis D Virus is an RNA-defective virus that requires HBV for replication.

Modes of Transmission:

Similar to HBV

Chronic infection with HBV and HDV can cause rapidly progressive chronic hepatitis and cirrhosis. HDV is endemic in parts of the Mediterranean, Africa, and South America. Transmission in non-endemic areas often results from parenteral drug misuse.

The management of HBV can prevent HDV.

Hepatitis C (HCV):

Caused by an RNA flavivirus, acute symptomatic infection of Hepatitis C is rare. Initially, people are unaware of their infection until chronic liver disease develops. It's often called a silent illness because many people live with Hepatitis C for years without knowing it.

There is no specific natural cure for Hepatitis C, but natural remedies can extend lifespan.

Risk Factors for Chronic Hepatitis C Infection:

• Intravenous drug misuse (90% of new cases in the UK)
• Sharing of toothbrushes with infected individuals
• Needle-stick injury (30%)

Management:

Treatment aims to eradicate the infection. There is no active or passive protection against HCV. Progression from chronic hepatitis to cirrhosis occurs over 20-40 years. Risk factors for progression include immunosuppression, such as co-infection with HIV.

Hepatitis E (HEV):

Caused by an RNA virus, this type of hepatitis is prevalent in India and the Middle East, with increasing cases in Northern Europe. The incubation period is about 15 to 60 days. It spreads via the fecal-oral route and usually presents as self-limiting acute hepatitis without causing chronic liver disease.

The largest outbreaks were reported in Northeast China in 1986 and 1988. Symptoms are similar to Hepatitis A, but infection during pregnancy can lead to acute liver failure with high mortality.

Hepatitis F:

A hypothetical virus linked to hepatitis. Symptoms appear in the final stage of the disease, including loss of appetite, abdominal pain, nausea, and vomiting. It is different from HAV and HEV.

Hepatitis G:

Described in 1996, it is unclear whether this virus causes hepatitis or is associated with it. Patients with Hepatitis G often also have Hepatitis B or C. The incubation period is unknown, and most infected individuals are asymptomatic. Transmission occurs through blood and sexual contact.

Reference:

Hepatitis G Virus Fact Sheet. While the exact association between Hepatitis G virus and liver disease is not established, some flu-like symptoms may occur.

Other Forms of Viral Hepatitis:

Other viruses, such as Cytomegalovirus and Epstein-Barr virus, can affect liver function, resulting in abnormal liver function tests and occasionally causing icteric hepatitis. Herpes simplex is a rarer cause of hepatitis in adults, primarily affecting immunocompromised patients.

Reference:

Davidson’s Principles and Practice of Medicine

Herbs to Treat Hepatitis:

Before taking these herbal medicines, please consult your doctor. Useful herbs include Kutki (Picrorrhiza kurroa), Trikatu, Punarnava (Boerhaavia diffusa), Kalmegh (Andrographis paniculata), Bhringraj (Eclipta alba), Bhumiamalaki (Phyllanthus urinaria), Yashtimadhuk (Glycyrrhiza glabra), Guduchi (Tinospora cordifolia), Daruharidra (Berberis aristata), Kakmachi (Solanum nigrum), Sharpunkha (Tephrosia purpurea), and Yellow Dock.

Silymarin:

Silymarin enhances the activity of hepatocyte RNA-polymerase and protects cell membranes from radical-induced damage.

References:

• Pietrangelo A, et al. Gastroenterology 1995;109:1941-194. 34
• Mira L, et al. Biochem Pharmacol 1994;48:753-759
• Vailati, A. et al. Fitoterapia Vol. LXIV pp. 219-228 [1993]

Thistle seed preparations are ideal for chronic and post-acute stages of hepatitis, rapidly improving appetite and well-being.

Reishi Mushroom (Ganoderma lucidum):

Antioxidant and anti-inflammatory, hepatoprotective action observed in mice. Frequently used for chronic hepatitis in China, available in dried form or tablet form.

Ginseng:

Helps boost immunity, potentially useful for treating hepatitis, but more research is needed.

Nut Grass and Nagarmotha:

Research indicates these herbs are useful in treating hepatitis.

Burdock and Dandelion:

Useful for treating hepatitis.

Glycyrrhiza glabra:

Useful for treating hepatitis, but not recommended for people with high blood pressure.

Turmeric (Curcuma longa):

Effective in treating hepatitis due to its curcuminoid content.

Natural Home Remedies:

• Reduce workload
• Avoid excessive exercise
• Drink plenty of water (avoid contaminated water)
• Wear cotton clothes to alleviate itching
• Olive leaf extract is advisable
• Inform your partner if you have HBV, explaining the risk of transmission
• Do not share your toothbrush or shaving brush with others
• Take 30 mg of zinc daily

In the market, colloidal silver products are available as a treatment for hepatitis, but the U.S. Food and Drug Administration does not consider them safe. A mega dose of vitamin C is advisable. Use sea salt moderately.

If a hepatitis patient experiences anxiety and insomnia, herbs like skullcap and chamomile can be useful (consult a doctor first).

Avoid:

• Alcohol
• Soft drinks
• Coffee
• Soy
• Aspirin
• Ibuprofen
• Pesticides
• Chocolate
• Stress and strain

Granthokta Preparations:

• Kumari Asav
• Rohitakarishta
• Triphala
• Trikatu

Though the quantity of ingredients in some natural home remedies is mentioned, it is advisable to consult an Ayurvedic physician before use.