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International Journal of Research in Pharmaceutical and Biomedical Sciences

ISSN: 2229-3701

__________________________________________Review Article

Hepatitis: A Terse Overview


Ashutosh Pandey* and Ankur Rohilla Department of Pharmaceutical Sciences, Shri Gopi Chand Group of Institutions, Baghpat, Uttar Pradesh, India. __________________________________________________________________________________
ABSTRACT Viral hepatitis-related diseases accounts for about one death in every forty patients presented with them. Hepatitis has been considered as a liver infection causing inflammation of liver by inflammatory cells in it. Hepatitis can be divided into various types which include hepatitis A, B, C, D, and E infections. Various treatment strategies and vaccinations have been suggested in order to prevent the patients presented with hepatitis. The present review article critically discusses about various types of hepatitis. Moreover, various treatment strategies for the treatment and prevention of hepatitis have been highlighted in the review. Keywords: Hepatitis, Viral Infections. INTRODUCTION Viral hepatitis has been regarded as the most common cause of liver disease worldwide. In the past two decades, numbers of vaccines have gained assess to the medicinal markets for the treatment and prevention of viral hepatitis. Hepatitis, a deadly liver disease, has been suggested to be cause inflammation of liver by the inflammatory cells in the tissue organs.1-2 The common signs which have been shown to occur due to viral hepatitis include jaundice, anorexia, and malaise; which further develops fibrosis, ultimately leading to cirrhosis of liver. Hepatitis can be divided into two main types, i.e., acute hepatitis, which develops before six months of exposure; and chronic hepatitis that appears after six months. Various risk factors have been suggested to be involved in the progression and development of hepatitis which include alcohol, certain medications, industrial solvents, and autoimmune disease.3 Hepatitis has been categorized mainly in five types which include hepatitis A, B, C, D, and E. The hepatitis A is the short term infections disease of the liver caused by the hepatitis A virus (HAD), which has been suggested to spread by the oral faecal route, and transmitted by the direct contact of infected person.4-5 The hepatitis B disease caused by the hepatitis B virus (HDB), which can be characterized as an infectious inflammatory illness of liver, caused in various epidemic parts of Asia, Africa and China.6 Moreover, hepatitis C is a serious liver disease caused by hepatitis c virus (HDC) which results in the development of inflammation in the liver.7 The hepatitis D virus (HDV) has been noted to cause hepatitis D, which is classified as hepatitis delta virus, caused by a small circular enveloped RNA virus.8 Also, the hepatitis E has been regarded as a viral hepatitis caused by infection with a hepatitis E virus (HEV), which was firstly documented in 1955 during an out break in New Delhi, India.9-10 The present review article talks about various types of hepatitis alongwith treatment strategies to prevent the viral infections. Pathophysiology of hepatitis The hepatitis has been well reported to spread by hepatitis virus and other toxic reactions due to drugs and chemicals. The basic functional unit of liver called lobule has been damaged due to the damage in liver cells, which is followed by hepatic necrosis, caused by disruption of the normal blood supply to the cells.11-12 The inflammation of the liver viral infection leads to an increase in temperature, stretching the liver capsule, which forms the discomfort in the upper right abdominal quader. The jaundice is resulted as a result of damage to the parenchymal cell. Further, difficulty in transporting the bilirubin from liver occurs due to liver cell damage.13 Moreover, the damaged liver cells gets eliminated from the body by the immune system response and are replaced by the new cells to a healthy liver, and hence, most of the hepatitis patients have been noted to be recovered with normal liver function.14-15 Types of Hepatitis Hepatitis can be divided into two main types on the basis of duration of exposure, i.e., acute hepatitis, which develops before six months of exposure; and chronic hepatitis that appears after six months. In acute hepatitis condition, non specific flu like symptoms appear which may include malaise, muscle and joint ashes, fever, nausea, vomiting, diarrhoea, headache, loss of appetite, dark urine, yellowish of the eyes and skin, abdominal

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International Journal of Research in Pharmaceutical and Biomedical Sciences

ISSN: 2229-3701

discomfort, hepatomegaly, and splenomegaly.3-4 In chronic hepatitis condition, various symptoms have been included like enlargement of liver, peripheral edema, asciles, esophageal varices, hepatic encephalopathy and hepatorenal syndrome, abnormal menstruation, lung scarring, inflammation of the thyroid gland, and cirrhosis.16 Further, hepatitis can be pigeonholed mainly in five types which include hepatitis A, B, C, D, and E; however, hepatitis D and E have not been investigated completely. Hepatitis A in the infectious disease of liver caused by hepatitis A virus (HAV) which spreads mainly by the oral faecal route and direct contamination of infected person to person through the food and water. About ten million people have been reported to be infected by the hepatitis A virus worldwide per year.5 In 2009, 21000 new cases of hepatitis A infections were noted in USA, as reported in the CDC (centres for disease control and prevention). The hepaitits A virus causes the infection and symptoms appear between two to six weeks, with average incubation period of about 28 days.17 The incidence of ihepatitis A infection have been documented to be higher in developing countries and in regions with poor hygienic standards.18 The hepatitis A is a self limited disease that does not show result in chronic infections. Hepatitis A infection have been noted to shows various signs and symptoms like fatigue, fever, abdominal pain, nausea, appetite loss, jaundice, and dark amber coloured faeces. The hepatitis A infection has been noted to show no specific treatment. However, the patients are advised for the bed rest and avoid fatty foods and alcohol alongwith eating of well balanced diet.19 In addition, liver failure has been seen rarely in the hepatitis A infections (0.5%). However, the disease has been well reported to be prevented by the certain vaccinations including hepatitis A vaccines.5 Hepatitis B, also knows as serum hepatitis, is an infections inflammatory liver disease caused by the hepatitis B virus (HBV). The hepatitis B is a serious liver disease transmitted by the infections of blood or body fluid like vaginal fluids.20 In USA, 12 million people suffer from hepatitis B with 100,000 new patients every year, and 5,000 deaths due to it. Other risk factor which enhance the chances of the transmission of HBV include healthcare setting, transfusion, dialysis, acupuncture, and tattooing.21-22 Further, the hepatitis B shows various signs and symptoms in different stages. In acute infection condition, loss of appetite, nausea, vomiting, body aches, mild fever and dark urine develop into jaundice; whereas, in chronic hepatitis B condition it shows inflammation of the liver, leading cirrhosis, hepatocellular carcinoma (liver cancer) and its develop the membranous glomerulonephritis (MGN).23 In addition, other symptoms have been

noted to appear like serum-sickness syndrome, acute necrotizing vasculitis, membranous glomrulonephritis and popular acrodermatitis of chidhood.24 However, a number of drugs have been suggested to treat hepatitis B which include interferon alpha, pegylated interferon, lamivudine, tenofovir, and certain other vaccines. Hepatitis C, another type of hepatitis, is a liver disease which is caused by the hepatitis C virus (HCV). It has been regarded as a very serious liver disease which results in the development of inflammation in liver.4, 25 Hepatitis C virus has been noted to develop into liver cancer, liver failure, and liver cirrhosis. It spreads directly by blood to blood contact given by IV route or medical equipments not properly sterilized.26 Approximately 170-180 billion people have been infected by this disease in the world. Only human and chimpanzees infected by the hepatitis C virus. The hepatitis C virus shows the effect with in six month of the exposure. The hepatitis C infection shows various sign and symptoms which include fatigue, nausea, muscle/joint pain, weight loss, rarly acute liver failure in the acute condition; and fatigue, cirrhosis, alcoholis, heptocellular carcinoma, portal hypertension, ascites, bleeding varices, hepatic encephalopathy dark urine, grey coloured stool in the chronic condition.27-28 The hepatitis C has been suggested to be transmitted by injecting the drug intravenously, sexual intercourse, transfusion of blood, and by certain other unknown means.26 The treacherous nature odf this infection has been supported by the fact that none of the vaccines were present to protect against hepatitis C virus till 2011. However, a combination of pregylated interferon alpha and antiviral drug robarivirin for 24-48weeks has been suggested to show beneficial effects in this infection.4-5 In addition, some alternative medicine have been claimed to show advantageous effects which include milk thistle, ginseng and colloidal silver29-30 CONCLUSION During this period of vaccination, there have been significant increases in the hepatitis patients. However, vaccination in order to eradicate viral hepatitis has been a long-term public health goal. However, a number of treatment regimes for hepatitis have been investigated from the last two decades, but further novel studies are needed in order to search potent agents which are completely involved in the treatment and prevention of patients presented with such a deadly viral hepatitis infection. REFERENCES 1. El-Serag HB. viral hepatitis and carcinoma. 2012;142:1264-73.

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16. Fried MW, Navarro VJ, Afdhal N, Belle SH, Wahed AS, Hawke RL, et al. Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon therapy: a randomized controlled trial. JAMA. 2012;308:274-82. 17. Connor BA. Hepatitis A vaccine in the last-minute traveler. Am J Med. 2005;118:58S-62S. 18. Steffen R. Changing travel-related global epidemiology of hepatitis A. Am J Med. 2005;118:46S-9S. 19. Ching KZ, Nakano T, Chapman LE, Demby A, Robertson BH. Genetic characterization of wild-type genotype VII hepatitis A virus. J Gen Virol. 2002;83:5360. 20. Lee-Ellen C. Pathophysiology. Missouri: Saunders. 2010; pp. 886887. 21. Hepatitis B. World Health Organization (WHO). Retrieved 2009-0919. 22. Sleisenger, MH; Feldman M, Friedman LS. Fordtran's gastrointestinal and liver disease: pathophysiology, diagnosis, management (8th ed.). Philadelphia: Saunders. 2006. 23. Terrault N, Roche B, Samuel D. Management of the hepatitis B virus in the liver transplantation setting: a European and an American perspective. LiverTranspl. 2005;11:716 32. 24. Liang TJ. Hepatitis B: the virus and disease. Hepatology. 2009;49:S1321. 25. Silva I, Filho RC, Feldner AC, Zaros I, Silva AE, Ferraz ML. Poor response to hepatitis C treatment in elderly patients. Ann Hepatol. 2013;12:392-8. 26. Houghton M. The long and winding road leading to the identification of the hepatitis C virus. J Hepatol. 2009;51:93948. 27. Maheshwari A, Ray S, Thuluvath PJ. Acute hepatitis C. Lancet. 2008;372:321 32. 28. Wilkins T, Malcolm JK, Raina D, Schade RR. Hepatitis C: diagnosis and treatment. Am Fam Physician. 2010;81:13517. 29. Lavanchy D. The global burden of hepatitis C. Liver Int. 2009;29:74-81. 30. McHutchison JG, Lawitz EJ, Shiffman ML. Peginterferon alfa-2b or alfa- 2a with ribavirin for treatment of hepatitis C infection. N Engl J Med. 2009;361:58093.

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