27 July 2020

Hepatitis B – what is it, how it is transmitted, symptoms of the disease, treatment of acute and chronic forms of hepatitis B 

Viral hepatitis B is a viral disease of an inflammatory nature that mainly affects the liver tissue. After recovering from this disease, a person forms a stable lifelong immunity. However, the transition from acute to chronic progressive form is possible.

What is the disease, how it is transmitted among adults, the first signs and symptoms of hepatitis B and what are the consequences for the body if treatment is not started on time.


Hepatitis B: what is it?  

 

Hepatitis B is a viral infection that mainly affects the liver and leads to a chronic progressive form of the disease, the carriage of the virus, the development of cirrhosis and liver cancer.

The main signs of hepatitis B are: 

  • nausea, 
  • loss of appetite, 
  • increased fatigue, 
  • jaundice,
  • discomfort in the right hypochondrium, 
  • darkening of the urine.

What are the features of the hepatitis B virus? 

For a few minutes, the virus can easily withstand heating up to 100°C, and resistance to temperature increases if the pathogen is in the blood serum.

Repeated freezing does not affect its properties, it will still be infectious after thawing.

The virus cannot be cultured in the laboratory, which makes it difficult to study.

The microorganism is found in all human biological fluids, and its infectivity exceeds even HIV by a hundred times.

The inactivation of the virus is carried out by processing in autoclaves when heated to 120°C for 45 minutes, or in a dry heat cabinet at 180°C for 60 minutes.

The virus dies when exposed to chemical disinfectants: chloramine, formalin, hydrogen peroxide.

Causes and ways of transmission

According to WHO estimation, more than 2 billion people worldwide are infected with hepatitis B, and 75% of the world's population lives in regions with a high incidence of the disease. Every year 4 million people are diagnosed with an acute form of infection.

After the virus of hepatitis B enters the blood of a healthy person, it reaches the hepatocytes (liver cells) with the blood flow. Then the virus , which affects an increasing number of new cells, replicates (multiplies), while some sections of the virus DNA are embedded in the DNA of hepatocytes.

The immune system does not recognize the altered cells and perceives them as foreign. The production of antibodies begins to destroy the altered hepatocytes. Thus, the liver is destroyed, which leads to an inflammatory process and hepatitis.

The vast majority of people with hepatitis B are aged 15-30 years. The share of drug addicts among those who died from this disease is 80 %. People who inject drugs have the highest risk of infection.

How is hepatitis B transmitted?

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People should know how hepatitis B is transmitted so that they can take action if they are near a carrier of the virus. The virus is located in:

  • blood;
  • vaginal discharge;
  • sperm.

The concentration of the virus in these biological fluids of the carrier is in larger quantities.

There are several ways to transmit hepatitis B:

  • if you transfuse infected blood to a healthy person;
  • using the same syringe several times;
  • through medical equipment, if not properly cleaned; 
  • during sexual contact;
  • to a newborn child from the mother; 
  • infection at home.

The main way of infection with the hepatitis of group B is through blood or any other biological fluid. In this case the virus is very active, an infection can pass in a few days after the blood, for example, completely dries on clothing or hygiene items. Therefore, the risk of infection is wherever contact with the biological fluids of other people may occur.

The risk of getting hepatitis B appears when visiting: 

  • beauty salons, 
  • manicure procedures, 
  • pedicure, 
  • tattooing or piercing if the instruments are not sterile enough.

Hepatitis transmits to the child during childbearing from the mother. To reduce the risk of further transfusion of the virus, the infant is vaccinated. Hepatitis B can manifest in the future.

If the skin and mucous membranes of a healthy person come into contact with any of the patient's fluids, the probability of infection is not very high, which means that the virus of hepatitis B does not spread in everyday life. Micro-injuries to the skin increase the risk of infection several times. The patient's fluids are dangerous even when dry!

The virus is transmitted through saliva, so there is a chance to get infected during a kiss if a healthy partner has microtrauma in the mouth, diseases of the teeth and gums, accompanied by bleeding.

Risk group

A specialist will quickly determine how hepatitis B was transmitted, finding out the scope of activities and lifestyle of the person.

  • Hepatitis B is transfused from a person who practices homosexual and promiscuous sexual relations.
  • Healthcare workers.
  • Addicts.
  • Persons who are in penal institutions.
  • Patients on hemodialysis.
  • Blood recipients.
  • Babies born to a virus-infected mother.
  • Family members of the infected person.
  • Tourists who have chosen endemic areas as their holiday destination.

Forms of development 

Hepatitis B  
fulminating

In this case, the symptoms of the pathology develop rapidly, accompanied by severe brain edema and a comatose state. Treatment is not effective. The entire pathological process takes only a few hours and ends with the death of the patient.

acute hepatitis B This form has several stages of development: the stage of general symptoms, jaundice and the stage of resolution or further pathology progression.
chronic The chronic form may occur after acute hepatitis, or it may be without the acute phase of the disease. Its manifestations can range from asymptomatic (carriage of the virus) to active hepatitis with a transition to cirrhosis.

Almost 90% of infected infants develop a chronic infection. The risk decreases as the child grows older. Approximately 25%-50% of children infected between the ages of 1 and 5 years will develop chronic liver disease caused by the virus.

The probability depends on the age at which the person has caught a disease. The younger person, the more likely it is to develop a chronic stage. What is the probability that acute hepatitis B will become chronic?

The risk of chronic disease in adulthood is about 10%. Worldwide, most people with chronic hepatitis were infected at birth or in early childhood.

First signs of hepatitis B for women and men

The first signs of hepatitis B:

Weakness, slight fever, headache, lack of appetite.

Then such signs as nausea, abdominal pain, vomiting are added. They are caused by digestive disorders. Violation of bilirubin metabolism induces the darkening of the urine and fecal discoloration.

When these symptoms begin to fade away, jaundice develops - the corresponding coloring of the skin and sclera of the eyes.

Most patients don’t have any signs of the disease. Therefore, doctors treat any person as potentially infected, observing the necessary precautions during medical manipulations and using disposable tools.

Symptoms of hepatitis B in adults

The incubation period of viral hepatitis B varies quite widely, the interval from the moment of infection to the development of clinical symptoms can be from 30 to 180 days. It is often impossible to estimate the incubation period of a chronic form.

Acute viral hepatitis B often begins in the same way as viral hepatitis A, but its pre-jaundice period can also occur in the arthralgic form, as well as in the asthenovegetative or dyspeptic variant.

With any type of intoxication, the central nervous system first suffers. Clinically it is manifested by the appearance of cerebrotonic symptoms: 

  • sleep disturbance; 
  • fatigue, weakness;
  • apathy;
  • violations of consciousness.

In severe forms of the disease, the hemorrhagic syndrome can develop – periodic nosebleeds and increased bleeding of the gums occur.

Hepatitis in acute form can result in complete recovery with the formation of a stable immune system or go into a chronic form, which is often accompanied by wave-like periods of exacerbations, often of a seasonal nature.

There are three periods in the acute course of the disease: 

  • pre-jaundice phase;
  • icteric phase;
  • recovery.

Non-jaundice period

There are no specific manifestations of pathology in this period. Symptoms that are typical for most viral diseases come to the fore: 

  • headache;
  • the person's health gradually deteriorates;
  • loss of appetite is observed;
  • lethargy;
  • weakness;
  • muscle and joint pain;
  • the appearance of respiratory manifestations (cough, runny nose) is observed.

Jaundice is associated with the accumulation of bilirubin in the blood: it is the product of the breakdown of erythrocytes (red blood cells). Normally, bilirubin enters the liver, where it binds to proteins and enters the intestines as part of the bile, and then is removed from the body.

When the liver is damaged, this function worsens, which leads to the accumulation of bilirubin in the blood and soft tissues, which causes the latter to turn yellow.

An icteric phase of hepatitis B

Gradually, the symptoms pass into the icteric phase. They also appear in a certain sequence: 

  • there is a darkening of the urine, the color is similar to dark beer; 
  • the sclera and mucous membranes of the mouth turn yellow, especially if you raise your tongue to the roof of the mouth;
  • the palms and skin are colored.

When jaundice appears, the general symptoms of intoxication decrease and the condition improves. You may be concerned about pain or heaviness in the right hypochondrium at the site of the liver projection. Sometimes there may be an illumination of the feces due to blockage of the bile passages.

In the case of timely use of specific drugs, the symptoms gradually disappear and recuperation occurs. If the body does not cope with the infection, a chronic form of pathology occurs, often turning into cirrhosis of the liver.

Chronic form

Chronic hepatitis B manifests itself in the following symptoms: 

  • increased fatigue;
  • weakness;
  • drowsiness;
  • decreased appetite;
  • nausea, vomiting;
  • abdominal distention;
  • characteristic symptoms of chronic hepatitis B, such as the darkening of the urine, jaundice, appear much later than in the acute form.

There are atypical forms of the disease: 

  • anicteric;
  • erased;
  • subclinical (almost without symptoms);
  • light, medium and significant severity; 
  • cacoethic.

Complications

According to statistics, up to 90% of people after an infection get rid of the disease almost forever. But their "complete" recovery is considered relative since it is most often accompanied by residual phenomena in the form of: 

  • the difference between normal skin and yellowed skin dyskinesia or inflammation of the biliary tract; 
  • residual asthenic-vegetative syndrome;
  • infection can be the trigger for the development of Gilbert's syndrome.

Acute viral hepatitis B rarely leads to a fatal outcome (only in cases of severe fulminating flow), the prognosis is significantly worse with concomitant chronic liver pathologies when combined with hepatitis C and D viruses.

Death of people infected with hepatitis B often occurs several decades later as a result of chronic course and development of cirrhosis and liver cancer. 

Diagnostics

If a person has symptoms that indicate hepatitis B or he has a reason to believe that he has been infected with this disease, he should urgently visit a medical facility. During the reception, the specialist will conduct an examination, survey a liver via palpation and collect anamnesis of the disease.

Laboratory tests of blood and urine will help to confirm or deny the primary diagnosis.

To diagnose this disease, in addition to the usual biochemical analysis for bilirubin and ALT, specific markers of hepatitis B are used: 

  • HBsAg antigen; 
  • HBeAg antigen.

Also, specific diagnostics use the detection of antibodies to these antigens and to the specific protein HBcore, which appears in acute hepatitis B: 

  • anti-HBcore;
  • anti-HBe.

Treatment

The treatment of hepatitis begins with a doctor's visit and a mandatory examination. This will allow assigning an accurate treatment map, as well as identifying other possible diseases if they are present. In any case, hepatitis B is treated comprehensively.

The treatment of hepatitis B includes: 

  • detoxification therapy;
  • maintenance therapy;
  • strengthening the immune system;
  • diet;
  • therapy to suppress symptoms.

 The treatment of acute hepatitis B

With mild forms of hepatitis B, a sparing diet is prescribed, a fractional diet – 5-6 times a day, a half-bed regime (you are allowed to get out of bed for eating, visiting the toilet and hygiene procedures).

In the case of moderate hepatitis, intravenous drip of detoxification solutions is prescribed.  The treatment involves hepatoprotectors – medications that protect liver cells from destruction, vitamins, sorbents – medications that remove toxins from the body.

The patient with severe hepatitis B is transferred to the intensive care unit, where, depending on the condition, symptomatic therapy is performed.

The period of rehabilitation (recovery from acute viral liver damage) is different for each patient. Someone is cured in a few weeks, someone may need 4-6 months to improve their health.

In general, the prognosis for acute hepatitis B is positive: full recovery of the disease ends in 90% of patients.

In 5-10% of cases, while maintaining HBsAg, the body develops a chronic form of the disease, accompanied by a high risk of complications (cirrhosis, hepatic cell cancer, impaired motility of the gallbladder, Oddi sphincter).

It is interesting to note that the transition to a chronic form of the disease is more typical for mild hepatitis (anicteric, with a latent course).

How to treat a chronic form of hepatitis B? 

When chronic hepatitis B is diagnosed, treatment is carried out comprehensively:

  • medications with antiviral effect, such as lamivudine, adefovir and others are used;
  • medications that inhibit the growth of liver sclerosis, i.e. interferons, are prescribed;
  • a patient also needs immunomodulators that normalize the immune responses of his body
  • hepatoprotectors that help the liver to fight at the cellular level are important; 
  • you can't do without vitamins and minerals.

Also patients are recommended to drink plenty of water every day to detoxify the body.

Depending on the severity of the disease, the therapy can be performed either as an outpatient or inpatient. The decision on whether the patient needs to be hospitalized or not is made by the doctor individually, depending on the clinical manifestations of hepatitis and the severity of the exacerbation.

For patients who have been diagnosed with hepatitis B, there are several scenarios: 

  • A person undergoes complex therapy and gets rid of a viral infection, gaining a stable immunity to this disease;
  • The acute form of hepatitis B becomes chronic, which can be accompanied by serious complications for the body;
  • The patient after treatment becomes a carrier of the hepatitis B antigen, which will not cause him concern for decades. This virus can be present in the patient's blood for 20 years without visible clinical manifestations;
  • The organism of a patient who did not go to a medical institution prematurely develops cirrhosis or liver cancer, which requires emergency surgery.

When treatment is completed, the virus antigen is produced in the blood of individuals for many years. These people become carriers of the infection and must be systematically examined. Also they need to undergo medical tests.

Diet and proper nutrition

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In the acute period, bed rest and strict dietary nutrition are indicated. The diet for hepatitis B in the acute period is aimed at maximum sparing of the organ with a full diet. The acute process requires compliance with the diet №5A, in which food is prepared only mashed or well-boiled. Soups can be made with finely chopped vegetables. Individual dishes are prepared in baked form but without a pronounced crust. The food regime is 5 times a day.

In the case of chronic hepatitis B, diet №5 is not mandatory, but it is worth keeping an eye on it when preparing the menu. Experts say that in the chronic stage it is important to adhere to a healthy diet. Proper healthy nutrition implies the use of sufficient amounts of protein, fat, carbohydrates and micronutrients.

What is not allowed to eat? 

It is forbidden to eat: 

  • fresh and rye bread;
  • products made of pastry or puff pastry;
  • millet and all legumes;
  • broths;
  • fatty meats, fried meats, sausages, smoked meats;
  • by-products and canned food;
  • cream and full-fat cottage cheese;
  • mushrooms, legumes, pickled vegetables, turnips, radishes, cabbage, sorrel, garlic, onions;
  • sour fruits and fruits rich in fiber;
  • cocoa, coffee, chocolate, carbonated drinks.

Permitted foods

Dishes and food allowed for consumption in acute and chronic forms of hepatitis B:

  • yesterday's bread;
  • fresh pastries with various fillings;
  • graham crackers, marshmallows;
  • soups made with water, milk, low-fat broth;
  • chicken ham and sausage;
  • from meat – chicken, veal, rabbit;
  • from fish – pollock, hake, whiting;
  • steamed and baked omelets;
  • steamed meatballs and burgers;
  • milk, low-fat dairy products;
  • all types of cereals;
  • vermicelli and pasta;
  • vegetable salads dressed with sunflower oil or low-fat sour cream;
  • vegetable fats;
  • bee honey;
  • fruits and vegetables in baked, boiled, raw form;
  • non-acidic vegetable, berry and fruit juices;
  • green tea.

With hepatitis, the processes of bile formation are disrupted, which leads to a violation of the absorption of vitamin K in the gastrointestinal tract and its insufficiency. Foods containing vitamin K: 

  • parsley, 
  • watercress, 
  • basil, 
  • coriander, 
  • cabbage (broccoli, Peking, white cabbage), 
  • celery root, 
  • prunes,
  • avocado,
  • cashews, pine nuts.

Forecast 

Acute viral hepatitis B is rarely fatal. The prognosis worsens with mixed infection with viruses of hepatitis C and D, the presence of concomitant chronic diseases of the hepatobiliary system, and the fulminating course of the disease.

Patients with chronic form die several decades after the onset of the disease as a result of the development of primary cancer or cirrhosis of the liver.

Is re-infection with hepatitis B possible?

No, after you have had hepatitis B, you have developed antibodies that protect you from the virus for life. An antibody is a substance contained in the blood that the body produces in response to a virus. Antibodies defend the body from diseases associated with viruses and destroy them.

Prevention of hepatitis B 

To avoid hepatitis B, doctors recommend complying the following recommendations: 

  • vaccinate a child, but with a separate, expensive medicine instead of the standard, planned one.
  • follow the rules of personal hygiene – do not use other people's hygiene products;
  • try to eat food enriched with vitamins and trace elements, as well as refuse from harmful foods;
  • give up alcohol and smoking;
  • do not take various medicines unnecessarily, because many of them weaken the liver;
  • try to avoid visiting beauty salons of dubious nature;
  • try not to give birth at home, resorts, etc.

Hepatitis B is a liver disease that can lead to serious consequences for the entire body. If you experience unpleasant symptoms, be sure to make an appointment with a gastroenterologist to undergo diagnostics and make an accurate diagnosis.

Valeologist       U. Čarnoŭ

The information is compiled using medical literature