A Complete Guide to Hepatitis

This article features a complete guide to various types of hepatitis, including symptoms, causes, treatment and diagnosis. The information provided in this post are as accurate as possible and have been verified by a doctor.

What is hepatitis

The word hepatitis is derived from two Greek words: ‘hepat’ meaning liver and ‘itis’ meaning inflammation. So, hepatitis is actually inflammation of the liver. Inflammation can either be due to infection or injury to the liver. Most viruses are the causative agents. These viruses are known as “hepatitis viruses”. Hepatitis viruses are of several types, including hepatitis A virus, hepatitis B virus, hepatitis C virus, hepatitis D virus, hepatitis E virus and hepatitis G virus. Types A, B and C are the most common types. Many other viruses may be implicated in hepatitis, such as cytomegalo-virus, yellow fever virus, Epstein-Barr virus, herpes simplex virus and rubella virus. Misuse of many drugs, toxins, alcohol abuse, trauma and obesity can also cause hepatitis. Broadly hepatitis is divided into two categories: acute and chronic hepatitis. Acute viral hepatitis lasts less than six months. It can be caused by all types of hepatitis viruses. It varies widely from mildly symptomatic illness, requiring no treatment, to fulminate hepatic failure. Chronic hepatitis lasts more than six months. It may be caused by hepatitis B virus or hepatitis C virus. Patients with chronic hepatitis may remain asymptomatic or mildly symptomatic but can suffer from severe problems. Hepatitis is manifested by abnormal blood tests. Jaundice is a late feature of hepatitis and it indicates extensive damage.

Symptoms of both acute and chronic hepatitis depend upon the cause of hepatitis or extent of liver damage.

What are the different types of hepatitis?

Whenever people hear about hepatitis they perceive it as a lethal illness. But this is not really true as it is not always lethal. Hepatitis may be lethal and this depends on the type of virus causing hepatitis.

It is a misconception that there are only two types of hepatitis; hepatitis B and hepatitis C. There are several other types too. These include hepatitis A; hepatitis D, hepatitis E, hepatitis F and hepatitis G. Type B and C are the most common types. Types A, D, E are less common while type G and F hepatitis are rarely seen. The duration and severity of the disease are determined by the type of virus causing the disease.

Hepatitis A

Hepatitis A is an acute infectious disease caused by hepatitis A virus (HAV) and is also known as infectious hepatitis. HAV causes inflammation of the liver which affects normal liver functioning.

Usually the disease is not severe in nature. Complete recovery from hepatitis A can occur in weeks. The spectrum of the disease is characterized by numerous asymptomatic or subclinical cases. It does not lead to chronic or lifelong disease. The mortality rate of hepatitis A is low. However, it can also be severe, demanding immediate hospitalization. It is more common in children as compared to adults due to poor hygiene. About 10-50 persons per 100,000 are affected with HAV annually. According to Center for Disease Control and Prevention (CDC), 2,700 new cases of hepatitis A were reported in US during the year 2011.

Epidemiology of hepatitis A

Causative agent

Hepatitis A virus is the causative agent. This virus multiplies in the liver cells and sheds in the fecal matter. It is resistant to heat and chemicals. It can withstand heat up to 60 degree centigrade. It is not affected by usual chlorination of water and can survive more than 10 weeks in water. However, formalin can kill this virus effectively. Human cases are the only reservoir of infection. A reservoir is a person, animal, soil, object or substance in which an infectious agent lives, multiplies and depends for survival. As this virus is shed in the feces, its transmission can occur at a very rapid rate.

Sources of infection of HAV

Human feces are the main sources of infection. Blood, serum, urine and other body fluids can also be infective sources, but only for short periods.

Host and related factors

The host is a person or organism that affords lodgment to an infectious agent. Humans are the only host. People from all the ages may be infected, but infections are more frequent in children. HAV infections are mild in young children and severity increases with age. Both sexes are equally susceptible. One attack of hepatitis A gives lifelong immunity. In about 5% percent of people second attacks have been reported.

Environment

Cases of hepatitis A may occur throughout the year. Heavy rainfall is linked to the increased number of cases. Environmental factors that favor the spread of infection include overcrowding, poor hygiene and poor sanitation.

Modes of transmission of hepatitis A

There are three modes of transmission of hepatitis A.

1. FECAL-ORAL ROUTE: This is the main route of transmission. Fecal-oral transmission can either occur directly or indirectly. Direct transmission occurs through person to person contact through contaminated hands and polluted objects. Indirect transmission is by contaminated water, food, milk and other fluids. One can also get hepatitis A from ingestion of raw or inadequately cooked shellfish from water polluted with fecal matter or from food prepared by infected people.
2. PARENTERAL ROUTE: Parenteral means administration other than oral route, particularly intramuscularly, intravenously or subcutaneously. Hepatitis A is rarely transmitted by the parenteral route. This mode of transmission is of minor importance and can occur only during the peak of disease.
3. SEXUAL ROUTE: Hepatitis A may also be transmitted sexually. Sexual transmission of hepatitis A occurs among homosexual men due to oral-anal contamination. Incubation period: The incubation period is the time interval between invasion of an infectious agent and appearance of the first sign or symptom of the disease. Incubation period of hepatitis A is 10-50 days. The duration of the disease is directly linked to the severity of the disease.

Signs and Symptoms

During the initial stage of the disease people usually experience generalized symptoms of illness like:

• Extreme fatigue.
• Loss of appetite.
• Vomiting.
• Nausea.
• Fever, which is usually low grade.
• Body aches including joint and muscle pain.

The characteristic symptoms of liver disease appear several days after infection and include:

• Dark colored urine
• Jaundice (yellow colored skin).
• The white of eye becomes yellow.
• Stomach upset.
• Itchiness of skin.

Diagnosis & Tests

The initial diagnosis of HAV infection is based on history. Doctor would ask you about your signs and symptoms, what you’ve eaten lately and where you’ve travelled in the past few months. The doctor might also examine you physically for detecting signs of jaundice.

The confirmatory diagnosis of Hepatitis A is largely based on the detection of antibodies against hepatitis A virus. Antibodies are protective substances that body produces in an attempt to prevent itself from any foreign attack.

Two types of antibodies are tested in the case of suspected hepatitis A:

• IgM anti-HAV: Presence of these antibodies in your blood means you had a recent attack of hepatitis A. The presence of these antibodies in the blood can be detected within 2 weeks after the initial attack of HAV.
• IgG anti-HAV: The presence of these antibodies in the blood confirms HAV infection.

These antibodies become detectable in the blood within 8-12 weeks after the initial attack of the virus.

Treatment options

The treatment options for HAV infection are very limited. In fact in most of the cases the infection doesn’t need any specific treatment. The infection mostly goes away on its own.

You can do following things to speed up the process of healing:

• Make sure not to involve yourself in strenuous physical activities. Try to take as much rest as possible and let your body heal itself.
• Try to stay as hydrated as possible. Drinking fruit juices can also help strengthen your immunity.
• Eat a healthy and balanced diet containing variety of fruits and vegetables.
• Don’t drink alcohol and stay away from other drugs as well.

Prevention & Vaccination

Prevention strategies against HAV infection include:

• Getting vaccinated is perhaps the best way you can save yourself and your family from hepatitis A infection. Twinrix is the brand name for vaccine used for generating immunity (resistance) type A and type B hepatitis virus. This vaccine comprises of three doses. After an initial dose the second dose is given at a 1 month interval and third dose is given at a 6 week interval.
• Adopt good hygiene. Make sure to wash your hands before eating, during making meals, after toilet or changing diapers of your children.
• Discourage your children from putting contaminated objects in their mouth.
• Don’t drink alcohol or use other drugs.
• Don’t eat poorly cooked shellfish.
• Go to your doctor for thorough examination if you observe above mentioned symptoms.

Prognosis

The prognosis is very good. Most of the people recover without any treatment with no or minimal evident signs.

Hepatitis B

Hepatitis B is an acute systemic infection that disturbs the normal functioning of the liver. It is caused by hepatitis B virus (HBV). Usually it is an acute infectious disease, but it in some individuals (about 15%) infections fails to resolve and the affected individual then becomes a persistent carrier of the virus.

Persistent infections (lasting more than 6 months) can lead to chronic active hepatitis and hepatocellular carcinoma. Hepatitis B is endemic throughout the world. It is a global problem and more than 2 billion people worldwide have evidence of HBV infection. According to CDC the total number of cases of HBV virus is US alone are 1.4 million.

Epidemiology of hepatitis B

Agent

The agent is HBV. It is a DNA virus and multiplies in the liver cells. Man is the only reservoir of this infection. It can spread either from the carriers (asymptomatic individuals) or cases (symptomatic individuals). HBV is quite resistant and can survive up to 7 days in an environment. It can be destroyed by sodium hypoclorite or heat sterilization. The virus is communicable until the disease has completely resolved.

Host

It is age dependant disease. The percentages of acute hepatitis B infection are: 1% of perinatal (newborn) child, 10% in children between age group 1-5 years, 30% in people above 5 years of age. Certain high risk people are more susceptible to hepatitis B. These include surgeons, recipients of blood transfusion, health care and laboratory personnel, homosexuals, IV drug abusers, infants of HBV carrier mothers and immune-compromised people.

Environment

This disease occurs worldwide. Overcrowding and poor standards of life favor the progression of disease.

Modes of transmission

1. Parenteral route: Hepatitis B is a blood-borne disease. Infected blood and blood products are main sources of infection. Blood transfusion, dialysis, contaminated syringes, needles, skin pricks, razors and toothbrushes promote spread. Transmission can also occur through surgical and dental procedures, immunization, ear piercing, nose piercing, ritual circumcisions, acupuncture and tattooing.
2. Perinatal transmission: Spread of HBV from mothers to babies is an important factor in transmission. Transmission occurred at the time of birth due to mixing of maternal blood with the baby’s blood. Unless vaccinated, these children can become chronically infected.
3. Sexual transmission: Transmission can also occur through sexual contact. It particularly occurs among male homosexual.
4. Other ways of transmission: It also spreads from child to child. Physical contact between children with skin diseases is a less common way of transmission.

Incubation period

The incubation period is 30-180 days.

Signs & Symptoms

Most of the people with hepatitis B infection remain asymptomatic. However, the usual symptoms of type B hepatitis infection include:

• Extreme tiredness.
• Fever, which is mostly mild to moderate.
• Nausea.
• Vomiting.
• Loss of appetite.
• A constant discomfort in the upper right portion of the belly.
• Diarrhea or constipation.
• Generalized body aches including muscle and joint pain.
• Yellowing of the skin and white of the eye- signs of jaundice.
• Skin rash along with itching.

Diagnosis & Tests

The preliminary diagnosis is based on the history and physical examination. Your doctor would ask you about your signs and symptoms and history of blood transfusion, piercing with sharp objects or needles, unprotected sex and so on. The doctor might also examine you physically for any visible symptoms of liver damage like yellowing of skin, pain in the upper right region of the belly and so on.

Confirmation of hepatitis B infection is made on the basis of laboratory tests and imaging techniques.

Laboratory tests along with their interpretation is given as follows:

• HBV antigen & antibody: These tests are directed towards the detection of antigens (proteins present on the surface of hepatitis virus) and antibodies (proteins that body produce in response to hepatitis B virus). Detection of these antigens and antibodies is perhaps the most useful tool in the detection of hepatitis infection.
• Tests to assess liver damage: As mentioned before, hepatitis B infection is associated with significant liver damage. Damage to the liver abolishes its normal functions that are then detected through different tests. Such tests include:
• Blood clotting time (including PT, aPTT) are usually deranged due to the absence of blood clotting proteins.
• Lipid profile (including cholesterol) might also be abnormal showing underlying liver damage.
• Presence of certain chemicals in the blood is an indicative of liver damage. Such chemical markers include AST, ALT, and LDH etc.
• Imaging techniques: Several imaging techniques can be used to detect underlying damage to the liver. Such imaging techniques include:
• Abdominal ultrasound.
• MRI.
• CT-Scan.
• Liver biopsy can be done to microscopically detect liver damage.

Treatment options

The treatment options for hepatitis B infection range from home remedies to liver transplant.

These treatment options are explained in detail as follows:

Home remedies

The home remedies for hepatitis don’t cure the infection but help abate the symptoms and speed up the healing process of body. Such remedies include:

• The first thing that you can do is take as much rest as possible. This will help boost the natural immunity of your body. Avoid strenuous exercise and try to take a few days off from work.
• Try to stay as much hydrated as possible. Drink as much water as you can each day. In addition, make fruits and vegetable juices an essential part of your regular diet.
• Eating becomes very difficult due to nausea and vomiting. But try to eat balanced diet. Don’t eat heavy fat rich diets as they are difficult to digest. Try to fill your plate with fruits, vegetables and white meat.
• Itching is another major complication of hepatitis. To control itching keep it moisturized and avoid coming into direct contact with sun and dry air.
• Avoid alcohol as it can speed up liver damage.
• Absolutely abstain from drugs and unnecessary medicines.

Medicines

Medical therapies for hepatitis B infection include: o Medical therapy is usually not recommended for patients with acute hepatitis. Unless complications occur, the patients with acute hepatitis are treated symptomatically i.e. attempts are made manage the symptoms.

Attempts are made to strengthen the immunity so that body can heal on its own.

• Antiviral therapy is usually recommended for patients with chronic hepatitis B infection i.e. patients who had hepatitis infection for more than 6 months. Antiviral therapy is also recommended for patients with liver cirrhosis. Anti-viral therapy for hepatitis B include:
• Interferon like interferon alpha 2b.
• NTRIs (Nucleoside reverse transcriptase inhibitors) like lamivudin and tenofovir.

A few things must be mentioned here. The use of medicines is of little value if the disease has already progressed to its advanced stages. So the success of medical therapy for hepatitis B infection depends on early diagnosis and timely treatment. Also the use of aforementioned drugs is associated with a number of complications and unwanted side effects. For instance the use of interferon drugs is associated with fever, depressed immunity, hair loss and significant fatigue. So make sure never to use these medicines without the recommendation of your doctor.

Liver transplant

If hepatitis is treated early and proper treatment is started in a timely fashion full recovery is possible. But untreated hepatitis can progress to full blown damage liver failure. Liver is a critical organ of human body. It is as important as heart or brain and life without this organ is almost impossible. There is no surgery that could help patients with chronic or untreated hepatitis. Liver transplant is the only therapy can help patients such patients. But this method has a lot of limitations of its own.

Other treatments

A number of herbs have proven to help patients with hepatitis B infection. Such herbs include:

• Licorice.
• Schizandra.
• Salvia.
• Hu-Chang.
• Curcuma.
• Ligustrum.
• Silybum.

Prevention & Vaccination

Hepatitis vaccine is perhaps the best way to prevent this illness. As mentioned before Twinrix is a vaccine containing combination of hepatitis A and hepatitis B virus and this vaccine is 95% effective. It gives immunity for a very long time i.e. for 20 years. This vaccine is given in three doses divided into 0 months (first time when the vaccine is given), 1 month (1 month after initial shot) and 6 months (6 months after the initial shot).

Some vaccines are specially designed to provide protection against hepatitis B virus. There are a number of protective measures that can keep you safe from getting this infection in first place.

Such preventive measures include:

• Don’t share needles or sharp objects.
• Don’t share toothbrushes with others.
• Don’t share shaving razors with others.
• Avoid unprotected sex.
• Ensure proper screening of blood before transfusion.
• Dispose of needles (this is for people working in hospitals) after use.
• Sterilize objects (like surgical instruments) after use.

Prognosis

If the disease is detected in early stages and timely treatment is stared then prognosis is mostly very good. Most of the patients recover completely. However, untreated and complicated cases can lead to full blown liver damage that might require liver transplant.

Liver transplant, as mentioned above, has a lot of limitations of its own. First, finding a liver that matches the patient is very difficult. Second, the best such transplants last is 5-15 years.

Hepatitis C

Hepatitis C is caused by hepatitis C virus (HCV). It is the most common blood-borne viral infection. 3% of world population is infected with HCV. It causes inflammation of the liver. It is also called as a silent illness, because one can get hepatitis C for many years and not even know that. Usually it is a mild disease, but can be lethal in some instances.

About 50% to 70% of patients with acute HCV infection develop chronic hepatitis and it is notorious for chronic infections. Chronic HCV patients are a continuous source of infection for others. Chronic carriers are at risk of developing liver cirrhosis, liver cancer and liver failure. It is the most common disease that demands liver transplantation worldwide. There are around 3.5 million people with chronic HCV infections in the United States.

Hepatitis C was previously known as non A, non B hepatitis (NANB) because causative agent was not identified till 1989. According to CDC the burden of hepatitis C is far more than hepatitis B. Hepatitis C has infected 4 million Americans.

Epidemiology of hepatitis C

Agent

HCV is a single stranded RNA virus. Infections with HCV can be mild, severe or chronic.

Host

Humans are only host. Drug abusers, sex workers and immune-compromised people are the most susceptible persons.

Environment

Poor hygiene and overcrowding promote the spread of infection.

Mode of transmission

Hepatitis C spread through contact with infected blood or blood products, contaminated needles and infected tattoo needles. Sharing of needles among drug abusers, hemodialysis and blood transfusion and needle sticks spread hepatitis C. Approximately 90% of hepatitis is transfusion associated. Screening of blood greatly reduces the number of cases. Sexual transmission of hepatitis C can also occur.

Sources of infection

Blood, semen and bodily fluids are the main sources of infection.

Signs & Symptoms

Like other types of hepatitis, hepatitis C goes unnoticed in majority of the patients till it has progressed to advanced stages.

However, the major symptoms of hepatitis C infection include:

• Tiredness.
• Body pains including muscle and joint pain.
• Pain in the upper right portion of the belly.
• Dark colored urine.
• Yellowing of skin and white of eye.

In addition to these symptoms other symptoms that signify liver damage might also be seen. Such symptoms include:

• You might experience redness of hands.
• You might experience swelling of feet and ankles. This is perhaps due to decreased synthesis of proteins by the liver.
• Bleeding is another complaint. This is due to decreased synthesis of blood clotting proteins by the liver.

Diagnosis & Tests

Like all other forms of hepatitis, the diagnosis of hepatitis C starts from history taking and general physical examination. History taking includes the doctor asking you questions regarding your signs and symptoms, any history of piercing and unprotected sex and so on. General physical examination includes assessing the symptoms of liver damage like detecting yellowing of skin and whites of eye. There are a number of ways hepatitis C virus can be detected in the blood.

Such ways include:

• Detecting antibodies: This test detects the level of antibodies that body produces to defend itself against viral infection.
• Serological testing: This method is quite modern and very specific. It is directed towards detecting viral DNA in the blood.
• Liver function tests: In cases of hepatitis C infection the liver function tests are usually deranged. These tests include lipid profile, clotting profile, and presence of blood markers of liver damage (ALT, AST, LDH etc.).
• Liver biopsy: This method includes taking out a small piece of liver and seeing it under the microscope. This can show the microscopic picture of liver damage due to the virus.
• Imaging: A number of imaging techniques can be used to detect liver damage. Such techniques include:
• MRI.
• CT-Scan.
• Ultrasound.

Treatment options

Like other forms of hepatitis, the treatment for hepatitis type C virus includes:

• Use of interferons.
• Use of ribavarin.
• Use of preoteease inhibitors.

In addition to that, keep following things in mind:

• Take as much rest as you can.
• Stay hydrates.
• Eat healthy.
• Stay away from alcohol and other drugs.

Liver transplant is the last resort if all other treatments fail.

Prevention & Vaccination

There is no vaccine for hepatitis C infection. However, you can significantly reduce the chances of getting this disease if you follow some important guidelines as mentioned below:

• Make sure that you don’t receive a blood until it is properly screened for HIV and hepatitis viruses.
• Avoid getting pierced with contaminated objects.
• Don’t share razors, needles, syringes, blades or toothbrushes with other individuals.
• Avoid unprotected sex.

Prognosis

The prognosis of this disease is usually good if proper diagnosis and timely treatment is insured. However, sloppiness in initiating the treatment can lead to full blown liver damage with extremely poor prognosis.

Hepatitis D

Hepatitis D infection occurs only in those persons who are infected with hepatitis B. As it involves two active viruses at the same time it is a very dangerous disease and the outcomes of this disease can be worse. It is a less common disease and is prevalent only in the Middle East, Central Asia, West Africa, South America and Italy.

Epidemiology of hepatitis D

Agent

It is caused by the hepatitis D virus (HDV) which is also known as delta virus. It is a small virus that cannot survive on its own and requires concomitant infection with hepatitis B virus. It lacks “surface antigen” - a protein necessary for infections. HBV provides machinery for replication to HDV. The latter causes swelling of the liver and infects hepatocytes (liver cells).

Host

Host can be all those persons who are infected with HBV or are frequently exposed to blood and blood products. Intravenous drug abusers, sex workers, those receiving multiple transfusions, immune-compromised and close contacts of a diseased person are at high risk. Hepatitis D is more common in children as compared to adults.

Environment

There are no typical environmental factors associated with hepatitis D.

Mode of transmission

HDV can spread by essentially the same ways as those of hepatitis B. It can spread perinatally from mother to child. Use of contaminated needles among drug abusers promotes spread. Other routes of transmission include transfusion of contaminated blood and sexual contact with infected people.

Incubation period

The incubation period varies from 2-12 weeks.

Signs & Symptoms

The signs and symptoms seen in case of hepatitis D infection are same that of other types of hepatitis and include:

• Extreme tiredness.
• Fever, which is mostly mild to moderate.
• Nausea.
• Vomiting.
• Loss of appetite.
• A constant discomfort in the upper right portion of the belly.
• Diarrhea or constipation.
• Generalized body aches including muscle and joint pain.
• Yellowing of the skin and white of the eye - signs of jaundice.
• Skin rash along with itching.

Tests & Diagnosis

The tests and diagnosis are same as that used for other types of hepatitis and include:

• Proper history.
• Complete examination.
• Detection of antibodies.
• Liver function tests.
• Imaging techniques.
• Liver biopsy.

Treatment options

There is no effective treatment for hepatitis D. Use of high doses of interferon is the only treatment that has shown enough promise.

Prevention & Vaccine

As this disease develops along with type B hepatitis, so giving vaccine against type B hepatitis provides immunity against type D hepatitis as well. Preventive strategies include:

• Avoid unprotected sex.
• Avoid use of contaminated needles, razors and toothbrushes etc.
• Proper screening of blood before transfusion.

Prognosis

The prognosis of this type of hepatitis is very poor because of two main reasons:

• There is no specific treatment and no treatment has shown enough promise.
• Hepatitis D occurs along with hepatitis B, making it more virulent.

Hepatitis E

Hepatitis E is caused by the hepatitis E virus (HEV). HEV induces an acute form of hepatitis. It causes swelling of the liver, but there is no long-term consequence of hepatitis E. It is waterborne disease. Mortality rate ranges from 0.5% to 4%. Hepatitis E can take a fulminate form in pregnant females. This disease is rare in the United States. However, cases of Hepatitis E have been reported in the Asia, Middle East, Africa and Central America. HEV is increasingly recognized as an important cause of hepatitis in both developed and developing countries. This disease is usually self-limiting and lasts for a period of several weeks.

Epidemiology of hepatitis E

Agent

EV virus is the causative agent. It is an RNA virus.

Host

Hepatitis E can occur in all groups, but it predominantly affects people between age group 15 to 40 years. The disease can be seen in both sexes, however, females are affected more especially pregnant females.

Environment

Hepatitis E is most prevalent in areas with poor sanitation as it is mainly caused by ingestion of fecal matter.

Source of infection

Contaminated water is the typical source of infection.

Mode of transmission

Mode of transmission of HEV is similar to HAV. Fecal contamination is the main route of spread and transmission. One can become infected with hepatitis E by drinking fecally contaminated water and eating contaminated food. Spread of hepatitis E can also occur through oral-anal contact and sex.

Incubation period

The virus has an incubation period of 2-9 weeks. Persons infected with hepatitis E may be contagious for up to 2weeks after the appearance of the first symptom.

Signs & Symptoms

Signs and symptoms include:

• Fatigue.
• Nausea.
• Vomiting.
• Jaundice.
• Body aches.
• Abnormal liver function.

Tests & Examination

Diagnosis is based on:

• History.
• Examination.
• Detection of antibodies.
• Imaging techniques.
• Biopsy.
• Liver function tests.

Treatment options

Interferone and ribavarin remain the mainstay for the treatment of type E hepatitis. Other things that you should do include:

• Stay hydrated.
• Proper diet.
• Take rest.
• Eat right.

Prevention & Vaccine

There is no vaccine for type E hepatitis. Preventive strategies include:

• Use of properly treated water.
• Avoid unprotected sex.
• Avoid use of contaminated needles, razors and toothbrushes etc.
• Ensure proper screening of blood before transfusion.

Hepatitis G

Hepatitis G is a rare type of hepatitis. The causative agent of the illness is hepatitis G virus (HGV). HGV was first discovered in 1996. The virus is distributed globally. It usually spreads parenterally by way of contaminated blood and needles. It can also be transferred by sexual contact. Volunteer blood donors, blood recipients, IV drug abusers and hemodialysis patients are at high risk. The disease is more frequent in males as compared to females.

The chances of HGV infections increase significantly with age. Often hepatitis G infections are associated with hepatitis B or C, or both and can occur at the same time. Usually hepatitis G is an asymptomatic disease, but mild symptoms can appear in some infected persons. There is no specific treatment for any form of acute hepatitis.

Hepatitis F

Hepatitis F is caused by a hepatitis F virus (HFV). HFV is a newly identified virus and differs from all other viruses. It is a double stranded DNA virus. Its size ranges from 60-70nm. It causes infections of the liver and is found in the Far East. There is still insufficient information available about this virus. Hepatitis F is the least common hepatitis.

Hepatitis X

If hepatitis cannot be attributed to the hepatitis viruses A, B, C, D, or E, it is called hepatitis X. It is a hepatitis caused by an unknown virus.

Non-viral hepatitis

Hepatitis may occur due to non-viral causes. Non-viral hepatitis is less common and is of minor importance.

Autoimmune hepatitis

Autoimmune hepatitis occurs due to an autoimmune response in which a person's body makes auto-antibodies that attack the liver. It damages the hepatocytes and causes the liver to swell.

Fatty liver hepatitis

Fatty liver hepatitis occurs due to fat buildup in the liver.

Alcoholic hepatitis

Hepatitis can also be caused by alcohol. Heavy alcohol consumption causes excessive liver damage. Alcohol causes the swelling and inflammation of the liver. This is known as “alcoholic hepatitis.”

Comparison of different types of viral hepatitis

Hepatitis A 

Causative Agent

HAV 

Mode of transmission

• Faeco-oral
• Sexual
• Parenteral

Principal age distribution

Children and young adults

Incubation period

10 - 50 days

Complications

Uncommon, no chronicity

Hepatitis B 

Causative Agent

HBV 

Mode of transmission

• Parenteral
• Percutaneous
• Sexual
• Horizontal
• Perinatal 

Principal age distribution

Persons between 15-29 years

Incubation period

30 - 180 days

Complications

Chronicity in 5-10%

Hepatitis C 

Causative Agent

HCV 

Mode of transmission

• Parenteral
• Sexual
• Perinatal

Principal age distribution

Adults

Incubation period

6 - 7 weeks

Complications

Chronicity in 50 % or more

Hepatitis D 

Causative Agent

HDV 

Mode of transmission

• Similar to HBV

Principal age distribution

Children and young adults

Incubation period

2 - 12 weeks

Complications

Uncommon, no chronicity

Hepatitis E 

Causative Agent

HEV 

Mode of transmission

• Contaminated water

Principal age distribution

Persons between 15-40 years

Incubation period

2 - 9 weeks

Complications

Uncommon, no chronicity