Hepatitis is an inflammation of the liver. It has several causes, but the various types have similar symptoms.

For the first few days, hepatitis may resemble the flu, producing mild headache, low fever, fatigue, lack of appetite, nausea and vomiting, and perhaps stiff joints. Between days 3 and 7, more distinctive symptoms appear: a rash, pain in the upper right quadrant of the chest, dark and foamy urine, and pale feces. About this time the skin and sclera of the eyes begin to turn yellow from accumulating bile pigments. (This is a form of jaundice.) Great fatigue may continue for two or three weeks, and then gradually the person begins to feel better.

This is hepatitis in its most common, least dangerous acute guise. It is not always so. About half a million people develop hepatitis in the United States each year, and only 6,000 die. In a rare form, called fulminant hepatitis, symptoms occur suddenly and severely, along with altered behavior and personality. Medical attention is necessary to prevent kidney or liver failure, or coma. Hepatitis that persists for more than 6 months is termed chronic. Perhaps as many as 300 million people worldwide are carriers of hepatitis. They do not have symptoms, but can infect others. Five percent of carriers develop liver cancer.

Rarely, hepatitis results from alcoholism, autoimmunity, or use of certain drugs. It is usually caused by one of five types of viruses, designated A through E in order of their discovery. The type of virus causing a particular case of hepatitis is often suspected by the route of infection, and a diagnosis is confirmed by detecting a surface molecule specific to a particular virus type. Distinctions between the viral types are discussed below:

Hepatitis A

This virus is spread by contact with food or objects that have been contaminated with virus-containing feces. In day-care centers, for example, the infection is frequently spread through diaper changing. Infected food handlers can spread hepatitis A to many people. In one Missouri restaurant, 110 sick customers ate lettuce on the particular day that a worker who did not yet realize that she had hepatitis A shredded the lettuce. The course of hepatitis A is short and mild.

Hepatitis B

This form of the illness is spread by contact with virus-containing body fluids, such as blood, saliva, or semen. It may be transmitted by blood transfusions, hypodermic needles, or sexual activity. Recently, twenty patients who had spent time on the same ward in a California hospital came down with hepatitis B. All of the patients had diabetes, and the hepatitis infection was traced to a spring-loaded fingerstick device used to sample blood from their fingers. Although nurses routinely discarded the lancet portion of the device between patients, they did not replace the platform on which the lancet rests. This was the source of the hepatitis B virus, which can live for up to a week outside of the body.

Hepatitis C

About half of all cases of hepatitis are now believed to be caused by the hepatitis C virus. It is primarily transmitted in blood--from sharing razors or needles, from pregnant woman to fetus, or in blood transfusions or use of blood products. For example, 112 cases of hepatitis C recently reported to U.S. health officials were traced to intravenous gamma globulin each person had received. The tainted treatment came from blood donated to the American Red Cross. As many as 60% of individuals infected with the hepatitis C virus suffer chronic symptoms.

Hepatitis D

This form of hepatitis occurs in people already infected with the hepatitis B virus. It is blood borne, and associated with blood transfusions and intravenous use of drugs. About 20% of individuals infected with this virus die.

Hepatitis E

The hepatitis E virus is usually transmitted in water contaminated with feces in developing nations--not to residents, who are immune, but most often to visitors. One woman contracted hepatitis E from crushed ice in her margaritas on a trip to Mexico. Several college students developed hepatitis E after swimming in the Ganges river while visiting India.

Because hepatitis is most often caused by a virus, antibiotic drugs, which are effective against bacteria, are not helpful. Usually the person must just wait out the symptoms, Hepatitis C, however, sometimes responds to a form of interferon, an immune system biochemical.

Copyright ©1998 The McGraw-Hill Companies. All rights reserved. Any use is subject to the Terms of Use and Privacy Policy.
McGraw-Hill Higher Education is one of the many fine businesses of The McGraw-Hill Companies.
For further information about this site contact mhhe_webmaster@mcgraw-hill.com.