Hepatitis (A, B, C, toxic) Causes, Symptoms and Treatment

This sheet covers viral hepatitis A ,  B and  C , as well as toxic hepatitis .

Hepatitis is an inflammation of the liver , most often caused by an infection with a virus, but sometimes by alcoholism, or intoxication by a drug or a chemical.

The symptoms vary a lot from person to person and depend on the cause of hepatitis. Some types of hepatitis cause the destruction of part of the liver.

The majority of hepatitis resolves spontaneously, without leaving any sequelae. Sometimes the disease persists for several months. When it lasts more than 6 months, it is considered chronic . When the liver is severely affected, a transplant of this organ may be the only solution.

Types of Hepatitis (A, B, C, toxic)

Hepatitis is grouped into 2 main categories:

• the viral hepatitis caused by infection with a virus. In developed countries, hepatitis A, B and C viruses account for about 90% of acute hepatitis cases. Hepatitis D, E and G viruses are also responsible for hepatitis.
• the non-viral hepatitis , mainly caused by the ingestion of toxic to the liver (alcohol, toxic chemicals, etc.). Non-viral hepatitis can also be the result of diseases affecting the liver, such as fatty liver (“fatty liver”) and autoimmune hepatitis (chronic inflammatory hepatitis of obscure origin, which is characterized by the production of autoantibodies ).

Frequency of hepatitis

In Canada, hepatitis C is the most common viral hepatitis: every year it affects about 45 people out of 100,000 . As for hepatitis B, it affects approximately 3 in 100,000 Canadians, and hepatitis A 1.5 per 100,000.

Viral hepatitis is much more common in non-industrialized countries . The hepatitis A is endemic in Africa, in some countries in South America and Asia. The same is true for hepatitis B. Indeed, in most countries in sub-Saharan Africa and Asia, where 8% to 10% of the population is infected with hepatitis B , it represents the one of the main causes of adult mortality (by liver cancer or cirrhosis). About 3% of the world’s population is infected with the hepatitis C virus . In Africa, the prevalence of this infection is the highest in the world: it exceeds 5%.

Public health authorities struggle to fight viral hepatitis, which often goes unnoticed for years. Before a diagnosis is made, the infection can not only have caused serious damage to the body, but has also been transmitted to others.

The role of the liver Often compared to a chemical plant, the liver is one of the largest internal organs. In adults, it weighs from 1 kg to 1.5 kg. It is located just under the ribcage on the right side of the body. The liver processes and stores (in part) nutrients from the intestines. These substances can then be used by the body when it needs them. The liver also helps to keep blood sugar stable. Toxic substances (present in alcohol, certain drugs, certain medications, etc.) that are ingested also pass through the liver. To prevent them from being harmful, the liver breaks them up and then throws them back into the intestine through the bile , or it returns them to the blood so that they are filtered through the kidneys and eliminated by the urine.

Contraction modes

• Hepatitis A . This is the least serious viral hepatitis. Usually, the body fights it in a few weeks and stays immune for life. This means that antibodies against the virus are present, but that the virus itself is no longer there. Hepatitis A virus is transmitted through ingestion of contaminated water or food. It can end up in the stool of an infected person and contaminate another person’s food, water or hands. Raw or undercooked foods are the most likely to transmit the infection. The virus can also be transmitted by seafood harvested in areas where untreated sewage is discharged. The risk of transmission is high in countries where hygiene conditions are poor. In these countries, almost all children have already been infected with the virus. A vaccine protects against it.
• Hepatitis B . This is the most common type of hepatitis in the world, and also the most deadly. The hepatitis B virus is transmitted at the time of sexual intercourse (sperm and other body fluids contain it) and blood . It is 50 to 100 times more infectious than the AIDS virus ³. The exchange of contaminated syringes can cause its transmission. The vast majority of infected people manage to completely fight the infection. About 5% remain chronically infected and are said to be “carriers” of the virus. Carriers have no symptoms, but they are at high risk of cirrhosis of the liver or liver cancer, life-threatening diseases. A surrogate mother can transmit the virus to her child at birth. A vaccine has been offered since 1982.
• Hepatitis C . Hepatitis C is the most insidious form of viral hepatitis because it is caused by a very resistant virus. Up to 80% of infections with the hepatitis C virus become chronic . The identification of the latter is relatively recent: it dates from 1989. The virus is transmitted most often by direct contact with contaminated human blood mainly through the exchange of syringes for injecting drugs, the transfusion of blood that has not been screened, and the reuse of needles and non-sterile syringes. More rarely, it contracts during unprotected sex with infected people, especially if blood is exchanged (menstruation, injuries in the genital or anal passages). This is the first cause of liver transplantation. There is no vaccine to protect against it.
• Toxic hepatitis . It is most often caused by alcohol abuse or medication use . Ingestion of inedible fungi , exposure to chemicals (eg, in the workplace), ingestion of natural health products or toxic herbsfor the liver (as the plants of the Aristolochiae family, because of the aristolochic acid they contain, and comfrey, because of the pyrrolizidines it contains) can also cause toxic hepatitis. Depending on the substance ingested, toxic hepatitis can occur hours, days or months after exposure. Usually, the symptoms resolve when you stop being exposed to the harmful substance. However, permanent damage to the liver can occur and suffer, for example, from cirrhosis.

Possible complications

Hepatitis undiagnosed in time or poorly managed is likely to lead to very serious complications.

• Chronic hepatitis . This is the most common complication . Hepatitis is said to be chronic if it is not cured after 6 months. In 75% of cases, it is the consequence of hepatitis B or C. Chronic hepatitis treated properly is usually cured in one year to 3 years.
• Cirrhosis . Cirrhosis is an excessive production of “scars” in the liver, formed as a result of repeated attacks (by toxins, viruses, etc.). These “fibrous barriers” eventually hinder the free flow of blood in the organ. From 20% to 25% of chronic hepatitis develop into cirrhosis if the treatment is not working well or if it is not well followed.
• Liver cancer . This is the ultimate complication of cirrhosis. It should be noted, however, that liver cancer can also result from a localized cancer in another organ that extends to the liver through metastases . Hepatitis B and C, as well as toxic hepatitis caused by excessive alcohol consumption, are the most likely to progress to cancer.
• Fulminant hepatitis. Very rare, fulminant hepatitis is characterized by major insufficiency of the liver, which can no longer fulfill its functions. Massive destruction of liver tissue occurs and organ transplantation is necessary. It occurs mostly in people with hepatitis B or toxic hepatitis. For about 1 in 4 people, it is deadly in the near future.

Symptoms of hepatitis (A, B, C, toxic)

Hepatitis is not necessarily betrayed by the various symptoms mentioned below. In many cases, the disease remains silent for years, or is simply a flu-like illness (fever, muscle aches, fatigue, and headache). It may have caused some serious damage.

Typical symptoms of acute hepatitis

• Fever or sweats at the end of the day.
• A loss of appetite and weight loss.
• Nausea.
• Abdominal discomfort (especially on the right side).
• Jaundice (skin and cornea jaundiced).
• Dark urine (the color of tea).

Symptoms of fulminant hepatitis

• Red spots on the skin, signs of bleeding, and nosebleeds.
• A mental confusion sometimes going as far as coma.

Note. In case of cirrhosis , there is swelling of the stomach and legs (caused by water retention), confusion, easy bleeding and loss of muscle mass.

People at risk for hepatitis (A, B, C, toxic)

• People who engage in risky behaviors , such as those described in the Risk Factors section , may develop hepatitis.
• Health professionals are at a higher risk than other people of contracting hepatitis B and C because they frequently handle syringes, needles, sharp objects and blood products that may have been contaminated.
• Food handlers or liquids that may have been contaminated with the hepatitis A virus are at high risk of contracting the infection.
• In Canada, people who received a blood , tissue or organ transfusion before 1990 may have been infected with the hepatitis C virus. Tests to detect this virus in blood products are now being used; they reduce the risk of contracting the disease at the time of a blood transfusion to 1 in 100,000.
• In Canada, individuals who have received blood clotting factors, mainly hemophiliacs , prior to 1992 may have been exposed to the hepatitis C virus.
• People receiving hemodialysis treatments are at a higher risk of contracting hepatitis B or C.
• Infants born to mothers infected with hepatitis B or C virus can get the infection, but this is still rare.
• People with liver disease (viral hepatitis, cirrhosis, “fatty liver” or fatty liver , etc.), those who consume a lot of alcohol and women (who metabolize certain toxins more slowly than men) have more risk of contracting toxic hepatitis if exposed to toxic products .

Risk factors for hepatitis (A, B, C, toxic)

The importance of risk factors varies from one region of the globe to another. The order of importance presented here is relative to the industrialized countries.

Hepatitis A

• Consuming contaminated food or water. The risk mainly concerns people who travel, work or live in certain communities where sanitation facilities are inadequate and where there is no safe source of drinking water. The following regions are particularly at risk: Mexico, Central America, South America, several parts of the Caribbean, Asia (except Japan), Eastern Europe, the Middle East, the Middle East, Africa and some rural or remote areas in North America.
• Although this remains a rare phenomenon, outbreaks of hepatitis A transmitted by contaminated food have already occurred in industrialized countries. For example, in Michigan in 1997, about 150 people were infected with the hepatitis A virus after ingesting frozen strawberries imported from Mexico39. Outbreaks of hepatitis A have also occurred among employees and customers of Canadian restaurants: infected people had handled food in violation of hygiene. The foods most often causing an epidemic are bivalve shellfish, fruits and raw vegetables.
  • The use of drugs by injection. Although hepatitis is an infrequently transmitted through the blood, there is an early onset of an epidemic among people who inject drugs.
• Having some sexual practices including anal contact – another means of transmitting the virus (especially between men).

Note. Transmission through the blood is very rare.

Hepatitis B and hepatitis C

The risk factors are the same for these 2 types of hepatitis.

• Having unprotected sex with a person infected with the hepatitis B or C virus. The risk of transmission increases for HIV carriers and those with other sexually transmitted infections.
• The exchange of syringes or other objects associated with the injection of drugs . There is also a risk of sharing straws during cocaine inhalation because the mucous membranes of the nose can be irritated by this practice, in addition to being irritated by drugs.
• The fact of getting a tattoo or piercing the skin with unsterilized tools.
• Receiving acupuncture treatment with reusable, unsterilized or poorly sterilized needles . Make sure your acupuncturist uses disposable needles or sterilizes needles using an approved method.

Prevention of hepatitis (A, B, C, toxic)

Screening measures for viral hepatitis

Hepatitis A The screening is recommended to individuals with cirrhosis, hepatitis B, chronic hepatitis C or other chronic liver disease . Vaccination is recommended for those who do not have antibodies against hepatitis A virus. Hepatitis B A screening test for the hepatitis B virus is offered to all pregnant women at their first prenatal visit. It will be done at the latest during the delivery. The infection can be deadly for pregnant women and for babies whose mothers are infected. People at high risk are asked to be tested because the disease can remain silent for a few years. The screening test is recommended for all persons infected with the human immunodeficiency virus (HIV). Hepatitis C People at high risk are asked to be screened, and the disease may remain silent for a few years. The screening test is recommended for all people infected with HIV.

Basic preventative measures to prevent hepatitis

Hepatitis A At all times Buy seafood from a reliable merchant and clean them well if you plan to eat them raw. Do not eat raw seafood only in restaurants whose hygiene is not questionable. Do not eat mussels or other marine products found at the seaside. Traveling to areas of the world where hepatitis A virus infection is prevalent Consult a doctor 2 to 3 months before departure. Learn about preventative measures at a travel clinic (see the Sites of Interest section for a list). Never drink tap water . Also avoid using it to brush your teeth, and do not add ice cubes to your drinks. Drink more water from uncapped bottles in front of you. Otherwise, sterilize the tap water by boiling it for 5 minutes. This eliminates not only the hepatitis A virus, but other microorganisms that may be present. Refrain from consuming soft drinks and locally produced beers. Eliminate from your diet all raw products , even washed, as the wash water may be contaminated: uncooked fruits and vegetables (except those with peel), green salads, meats and vegetables. raw fish, seafood and other raw shellfish. Especially in areas at risk, these foods can also be infected by other pathogens. In case of injury , never clean a wound with tap water. Use a disinfectant. During intercourse , always use condoms . It is better to think of bringing with you to ensure their quality. Vaccination In Canada, there are 4 vaccines against hepatitis A virus (Havrix Vaqta, Avaxim and Epaxal Berna) and 2 vaccines against hepatitis A and B (Twinrix and Twinrix Junior). Immunity is acquired about 4 weeks after vaccination; it persists one year after the first dose (the duration of the vaccine becomes longer if the booster doses are received). The National Advisory Council on Immunization recommends vaccination to all high-risk individuals. These vaccines have a degree of efficacy of over 95%. When rapid immunization (in less than 4 weeks) and short duration is required, immunoglobulins may be administered. They can be given within two weeks of exposure to the virus, and their effectiveness rate is 80% to 90%. They are mostly used in the case of infants and people whose immune system is weakened. Hygiene measures in case of contact with an infected person or if you are infected yourself Wash hands routinely after bowel movements, before handling food and before eating; this, to avoid any contagion. Hepatitis B and hepatitis C At all times Use condoms during sex with new partners. Wear gloves before touching a person’s blood , whether infected or not. This precaution is particularly relevant in the case of nursing staff. Also avoid using another person’s razor or toothbrush, or lend their own. If you are getting tattooed or “pierced” , make sure your staff uses well sterilized or disposable equipment. Never share syringes or needles . Vaccination Routine vaccination of children (9 years and 10 years old) against hepatitis B is now recommended, as well as that of individuals at risk who would not be vaccinated (such as those working in the health field). Two vaccines are registered in Canada: Recombivax HB and Engerix-B. They can be safely administered to pregnant and nursing women. In Canada, there are 2 combined vaccines that protect against hepatitis A and B , indicated for people at risk of contracting these 2 infections (Twinrix and Twinrix Junior). Hepatitis B vaccination of people with chronic liver disease (other than hepatitis B, such as cirrhosis or hepatitis C) reduces the risk of their becoming infected with this virus and their health condition does not deteriorate further. For those people with liver already affected, the consequences of hepatitis B are more serious. Hepatitis B immunoglobulin injection is recommended for anyone who has recently come into contact (7 days or less) with infected blood or body fluids. Administration of immunoglobulins is recommended for neonates whose mothers carry the virus. There is no vaccine against the hepatitis C virus yet . Hygiene measures in case of contact with an infected person or if you are infected yourself Any items soiled with blood (sanitary napkins, needles, dental floss, dressings, etc.) must be placed in a resistant container that will be thrown out of the reach of all. Any bathroom equipment (razor, toothbrush, etc.) must be strictly reserved for its owner. Note. There is no risk of contamination in the following cases: a simple touch (provided there is no contact with a wound), a cough and sneezing, a kiss, contact with sweat , handling of everyday objects (dishes, etc.). Toxic hepatitis Follow the dosage on the drug package (including over-the-counter medications such as acetaminophen) and natural health products . Watch out for interactions between drugs and alcohol . For example, it is contraindicated to consume alcohol and take acetaminophen (for example, Tylenol and Acet). Ask your pharmacist. Store medications and natural health products in a safe place away from children. Adopt the appropriate safety measures in the workplace. People who consume traditional Chinese herbal or Ayurvedic remedies (from India) or who plan to do so should make sure of the quality of these remedies. Some cases of toxic hepatitis caused by poor quality products have been reported : a contamination (voluntary or not) by a toxic plant, a drug or heavy metals had occurred. Weight loss products and those to treat impotence are most often incriminated. Before buying a natural remedy made in China or India, it is important to consult a trained practitioner, naturopath or herbalist. Cautions on non-compliant products published by Health Canada are also available on a regular basis. For more information, see the Sites of Interest section.

Medical treatments for hepatitis (A, B, C, toxic)

Hepatitis A

Normally, the body manages to fight the hepatitis A virus. This disease does not require special medical treatments, but rest and good nutrition are indicated. The symptoms disappear after 4 to 6 weeks.

Hepatitis B

In the vast majority of cases (95%), hepatitis B virus infection spontaneously heals and no pharmacological treatment is required. The recommendations are then the same as for hepatitis A: restand healthy eating .

When the infection persists beyond 6 months, it means that the body can not eliminate the virus. He needs help. In this case, several drugs can be used.

Interferon alpha and long-acting interferon. Interferon is a substance naturally produced by the human body; it is known to hinder the reproduction of a virus after infection. It works by increasing the body’s immune activity against the hepatitis B virus. These drugs must be administered by injection every day (interferon alpha) or once a week (long-acting interferon), for 4 months.

Antivirals (telbivudine, entecavir, adefovir, lamivudine) work directly against the hepatitis B virus. Clinical studies have shown that they can help control the course of the disease by suppressing the reproduction of the virus in the liver. most of the patients treated. They are taken orally, once a day. They are usually well tolerated.

Hepatitis C

The best-known drugs to treat this condition are long-acting interferon with ribavirin. They usually remove the virus by 24 to 48 weeks, and they are effective in 30% to 50% of cases, according to the World Organization for Health .

Toxic hepatitis

In the case of drug hepatitis, stopping the use of the drugs in question is an obligation: their reintroduction can be very serious. Exposure to the toxic product involved should also be avoided, if applicable. Usually, these measures allow the patient to recover health in a few weeks.

In case of aggravation

In the most severe cases and if possible, partial removal or liver transplantation should be performed .

Tips to relieve discomfort and promote healing Refrain from consuming alcohol . Alcohol can alter and even destroy liver cells. To rest . Do it as soon as you feel the need. Consult your doctor before taking any medicine . Some over-the-counter or prescription drugs contain toxic substances for the liver. This is the case of acetylsalicylic acid (Aspirine) and acetaminophen (Tylenol). Do not smoke . Tobacco can harm a liver weakened by hepatitis. Avoid hearty meals . In case of nausea, vomiting or loss of appetite, it is good to take 3 small meals and snacks rather than 3 main meals. In addition, eliminating spices, fried foods, high-fiber foods and high-fat foods from their diet alleviates symptoms in some people. Get support . Physical, psychic and sexual fatigue often occurs. The accompanying role of the family and the medical team is essential. Avoid exposure to toxic products . Prolonged exposure to toxic products for the liver, as can occur in industrial settings or in certain types of occupation (painter, mechanic, shoemaker, etc.), can hinder the healing of liver affected by hepatitis.