Hepatitis B, Its Variants, Spread, Diagnosis, Treatment and Outcomes - Report Example

LITERATURE RESEARCH PROJECT & REPORT: HEPATITIS B By Name Pathology Professor University City/State Date Table of Contents Underlying Molecular and Pathophysiology 5 Signs and Symptoms 6 Variants 6 Spread 8 Diagnosis 8 Outcomes 10 Recommendation 13 Executive Summary Hepatitis B can be described as one of the most life threatening diseases. In spite of the existence of immunization and cure, the disease is a key health care concern in the whole world. Statistics reveal that approximately 400 million individuals in the world suffer from hepatitis B. With early diagnosis and proper treatment most victims of hepatitis B virus recover from acute infection. However, some patients may get to the chronic stage that exposes them to acquiring other health complications such as cirrhosis, hepatocellular carcinoma, and liver failure, and in some cases death. The Hepatitis B virus is activated by a number of factors which include the position of the viral infection, duration of the infection, and the host’s immune system among others. Subsequent to the discovery of various forms of the various, medical personnel have now improved their understanding of the nature of the viral infection. Consequently, they have been able to devise improved methods of delivering efficient treatment and care for the victims. It is, however, advisable to be careful of patients with HBeAg-negative chronic hepatitis B virus because they have inferior prognosis as compared to the patients with HBeAg-positive. Although there is commendable improvement in the understanding of the behavior and the clinical course of the illness, its natural course is still tremendously complicated. This, therefore, demands for further research and more studies so as to advance the manner in which chronic conditions are dealt with while combating other the related problems. Individuals need to take the required precautions in preventing the continuity of the disease by having protected sex, avoiding sharing sharp items, vertical contamination and transfusion of contaminated blood. However, hepatitis B is treatable and earlier medication is greatly advised. Hepatitis B, Its Variants, Spread, Diagnosis, Treatment and Outcomes Background Hepatitis B is a communicable viral disease and a major concern globally. It is caused by Hepatitis B virus (HBV). HBV infects the human liver, causing liver inflammation (hepatitis) (Zoulim & Perrillo 2008). According to Zoulim et al (2008) and Wei (2008), there are over 400 million people suffering from this disease in the world, with approximately 75% of them residing in the West Pacific and Asia. This condition is also prevalent in the United States, Europe and the developing nations as a result of changing patterns of immigration (Badur & Akgun 2001). The hepatitis B virus is a minute enveloped virus with double-stranded DNA. The disease undergoes four distinct phases, namely immune tolerance, immune clearance, low or non-replication and reactivation, making its natural history intricate (Wei 2008). Juszczyk (2000) asserts that severe hepatitis B is exemplified by the presence of serum HBV markers, including surface antigen (HBsAg) and IgM anti-HBC, which vanish during convalescence. A carrier condition is indicated if HBsAg continues for over six months. Hepatitis B virus causes a significant number of chronic infections in the world in spite of the fact that its control and eradication has been classified as among the key public health challenges in the 21st century (Raimondi et al 2010). This has profoundly impacted on the infected individuals, as well as the community at large with regard to death of care givers and medical related costs. Human beings are susceptible to either symptomatic or asymptomatic infections (Pan et al 2005) Hepatitis B is known to cause liver cancer, liver cirrhosis and liver failure, especially in people with early life acquisition (Zoulim et al 2008). The development of the viral infection may take a long time. Susceptibility to infection with this virus, its progression and development of liver illnesses may be accelerated by various factors, such as the viral genotype, length of infection, persistence/reactivation, mode of transmission, immune suppression/competence, vaccine efficacy and the presence of other infections and allied factors such as alcohol (Hennig et al 2010). Molecular biology has contributed to significant progress in diagnosis and prevention of the illness. An effectual vaccine was recently made available to serve as a common tool for managing hepatitis B (Badur et al 2001). The motive of this report is to highlight the present state of hepatitis B with regard to its spread, variants, treatment, diagnosis and outcomes. In doing so, the report will rely on evaluating the research carried out by various researchers on hepatitis B and its related issues. A conclusion pertaining to the literature review, as well as recommendations, will be included. Underlying Molecular and Pathophysiology Hepatitis B virus is the cause of clinical presentations, which range from an asymptomatic carrier state to the self-limited, severe to chronic hepatitis, which may progress to hepatocellular carcinoma and cirrhosis. While infection caused by this virus is regarded to as among the most common viral illnesses that affect man, both host immune responses and viral factors have been linked to the pathogenesis and clinical results of HBV infection (Baumert et al 2007). Additionally, it has become evident that certain hepatitis B mutants may impact on the usual route of the infection, and are related to exclusive clinical manifestations and bestow resistance to antiviral agents. In the context of diverse genotypes, mutations that occur naturally have been found in the structural and non-structural genes, over and above regulatory aspects of the virus. In this case, the best mutants are regarded as pre-core (pre-C) stop codon mutations which lead to loss of HBeAg. Signs and Symptoms Severe infection with hepatitis B virus is associated with serious viral hepatitis (Badur et al 2001). General bad health, appetite’s loss, nausea, vomiting, mild fever, dark urine and whole body pains are symptoms of this disease, which develop to jaundice, characterized by yellow skin or white eyes. However, in the greater part of those affected, this condition is short-term and gradually improves (Coffina et al 2010). Severe hepatitis B develops to chronic hepatitis B in approximately 5 to 10 percent of the infected individuals whilst over 90 percent of patients develop antibodies that assist the immune system to recuperate from the disease (Coffina et al 2010). In some cases, patients may develop acute liver illnesses (fulminant hepatic failure), which may result in death. In addition, chronic infection with hepatitis B is associated with prolonged liver inflammation, which may eventually result in cirrhosis. This infection amplifies the incidences of hepatocellular carcinoma (liver cancer). Similarly, associated with hepatitis B is membranous glomerulonephritis. Conversely, diagnosis of hepatitis B virus in some patients may fail (European Association for the Study of the Liver [EASL] 2009). Variants Hepatitis B virus is categorized as a type of orthohepadnavirus species (Juszczyk 2000). This species comprises of viruses such as ground squirrel hepatitis virus, woolly monkey hepatitis B virus and woodchuck hepatitis virus. Hepatitis B genus is classified as part of hepadnaviridae family, which is made up of other genera, as well as one which is not categorized and the avihepadnavirus. Hepatitis B virus’ DNA sequence displays the presence of eight viral genotypes (A-H), which differ in accordance to geographical distribution (pan et al 2005). As such, while genotype A is widespread in India, Northern Europe, Africa and North America, genotype B and C are common in Asia. Genotype D prevails in India, the Middle East and Southern Europe. Additionally, genotype E is prevalent in West and South Africa, genotype F in central and South America, genotype G in the United States and genotype H in individuals residing in Central America and California. Five types of HBV, as well as pre-core mutants, core promoter mutants, asparagines to theronine (rtN236T) mutants, tyrosince-methionine-aspartateaspartate (YMDD) mutants and wild-type HBV have been associated clinically with hepatitis B virus. In this case, every genotype codes for at least one protein (Juszczyk 2000). The surface protein gene codes for three polypeptides, including HGsAg, thus creating the viral envelope. On the other hand, genotype A codes for inverse transcriptase and RNAase. The C gene codes for core protein or capsid, while H gene codes for transactivated proteins. An imperative viral variant is established by a point mutation in the pre-core region’s nucleotides, which aids in thwarting conversion of HBeAg (Hall 2007). Viruses analogous to hepatitis B virus have been found in sizeable apes such as gorillas, which imply an exceedingly old origin of the virus from the primates. The virus is scientifically categorized into four key serotypes, namely adr, ayw, adw and ayr. The categorization is grounded on the antigens established on envelop proteins of the virus. Spread The spread of Hepatitis B is due to exposure of infectious blood and other blood-containing bodily fluids, including semen and vaginal fluids (Pan e al 2005; Kwan et al 2011). In this case, the potential form of spread includes sexual contact, blood transfusion, re-using contaminated needles and/or other sharp objects, or through mother to child vertical transmission during birth. In case it is not prevented, a mother suffering from hepatitis B carries a 20% possibility of conveying the virus to her baby during birth. In addition, the viral DNA has been found in saliva, urine and tears of patients with a higher titer DNA serum (Henning et al 2010). Peri-natal infection has been considered as the chief cause of infection in the majority of developing nations. Other risk aspects that ease the spread of HBV include acupuncture, working within a healthcare setting, enhanced overseas travel, dialysis, tattooing and residence in an institution. Additionally, the virus can be spread among family members or within the family, through contact of mucous membrane with secretions and non-intact skin (Coffina et al 2010). Hepatitis B virus makes use of reverse transcription as an element of its replication process, where it enters the human cells by attaching itself to an anonymous receptor situated on the cell surface, thus entering it through endocytosis. However, the virus cannot be spread via casual contact such as holding hands, kissing, hugging, sharing utensils, coughing, sneezing or breastfeeding (Henning et al 2010). Diagnosis The infection of Hepatitis B virus is diagnosed via serum and blood tests in a procedure medically referred to as assays (Mayer et al 2005). The outcomes of this procedure are evaluated either via viral proteins (antigens) or the presence of antibodies from the host. Normally, the surface of HBsAg, which is first noted as a viral antigen, is used in revealing the infection (Badur et al 2001). The antigen can, however, not be noticed in the early stages of infection, and may also fail to be detected later on since the host clears it off. The host remains infected during this window stage, although he/she successfully eliminates he virus. In such cases, hepatitis B antibodies of core antigen (anti-HBc IgM) serve as the sole proof of the illness. Shortly after HBsAg emerges, another antigen, the e antigen of hepatitis B (HBeAg), appears. In a majority of instances, HBeAg present in the serum of a host is often assumed to be allied to a high rate of viral replication and enhanced infectivity (Badur et al 2001). Conversely, hepatitis B virus variants generate no e antigen. In this case, the notion cannot be employed. During natural infection, the body gets rid of HBeAg, resulting in an immediate rise in the e antigen antibodies (Hall 2007). This change results in a decrease in viral replication. After the host eliminates the infection, HBsAg becomes untraceable and later followed by antibodies found in lgG on the hepatitis B’s surface antigen and main antigen. An individual who has anti-HBs but lacks HBsAg is said to have either been recently vaccinated or eliminated an infection (Kukka 2008). In contrast, individuals who, within six months, test HBsAg positive are said to be carriers of hepatitis B. The carriers may have chronic hepatitis B, which is normally identified through elevated serum as shown by biopsy or liver’s inflammation. Nonetheless, carriers who switch to HBeAg negative status, particularly those that got infected as adults show minimal viral multiplication. Such patients can be at a lesser risk of long-term complications and spreading of infections (Pollicino et al 1996). Outcomes Hepatitis B is complication experienced world wide and its major effects is in the prevalent areas. The pathogenic device responsible for the damaging of the liver plus the viral persistence is not clearly defined (Pollicino et al 1996). The illness may also advance to hepatocellular carcinoma (HCC), hepatic disintergretion or liver cirrhosis. People suffering from hepatitis B virus infection are more vulnerable to developing liver related complications just like people with immunodeficiency virus HIV (Coffina et al 2010). The way the disease appears and the rate of advancement in the victims of chronic hepatitis B virus infection are influenced by factors that include the genetic makeup of the host, his environment, as well as the virus (Raimondi, et al 2010). The rate of advancement as well as its outcomes varies depending on the different phases of infection and the reaction of the host to the infection. Its outcomes may also be determined by the shortcomings of the immune reaction and the viral genetic heterogeneity ((Pollicino et al 1996). Shortcomings in the immune system occur when the distorted variants are let to escape from the immune supervision or if the virus has a benefit of growth. This helps it to choose its favorable place for survival. Hepatitis B has caused a lot of agony to its victims, their significant others and the society. In the case where, the breadwinner of the family succumbs to the disease, the other members of the family lack basic necessities especially food, and education hence they suffer.tha management of the disease and conducting research requires a lot of money which is a problem to the government as well as the families. Prevention Even though hepatitis B immunization is available, the viral infection is very common and accountable for a significant morbidity and deaths Pan et al 2010). So as to avoid the heightened risk for liver cirrhosis and cancer, the chronic carrier patients are counseled on stopping the intake of alcohol. Similarly, some there has been innovations of some vaccines that stop hepatitis B or HBsAg (wei et al 2008). The vaccine can be made from the recombination of DNA expertise that does not need blood products. Originally, the vaccine was derived from the plasma obtained from the sufferers with relentless infections. Correspondingly, vertical transmission of the infection can be avoided by giving immune globulin of hepatitis B (HBIG) and its vaccine (HBVI) on the babies between twelve hours of birth, the second dose after 1-2 months and the third dosage after 6months. Bearing in mind that the immunity does not grow at once, the infected mothers should be checked after nine months for the hepatitis B antibody surface antigen and hepatitis B surface antigen. If the kid continues to exhibits signs of infection another dosage series fro zero, one and six months must be given (Raimondi et al 2010). After immunization, the surface antigens of hepatitis B can still be seen in the serum. Here, the vaccine is given in the schedule of two, three or four doses to both kids and adults. Whereas protection for this vaccine lasts for approximately 12 years in persons with sufficient initial reaction over the initial course of vaccinations, the immunity can last for at least 25 years. In addition, to avoid spread of the illness through fluids, people should be conscious of infected blood transfusions, unprotected sexual intercourse, vertical transmissions as well as re -using contaminated needles and syringes (EASL 2009). Treatment In some cases, management of acute hepatitis B is not always required in adults this is because they are able to clear the infection unpredictably. Early administration of antiviral treatment is necessary to those whose infection is very belligerent (Mayer et al 2005). Usually, treatment is given to adults and children suffering from hepatitis to stop the virus from duplicating and escalating the HBV viral load. The treatment also reinforces the immunity to successfully attack the infection, prevents and deals with any damages in the liver, as well as producing antibodies that enhances the recuperation from the infection as well as stimulates the immune system so that hepatitis B antibody is created. Additionally, management of chronic infection should be done so as to reduce the danger of liver cancer as well as cirrhosis. The available drugs may not completely clear the infection, they aid in decreasing the duplication rate of the virus minimizing damage predisposed to the liver. Some of The approved medications for treating hepatitis B presently include adefovir (Hepsera), antiviral drugs lamivudine (Epivir), tenofovir (viread), entecavir (Baraclude) and telbivudine (Tyzeka) (Kukka 2008). Correspondingly, several immune system modulators like PEGylated interferon alpha-2a (pegasys) and interferon alpha-2a are also used. Interferon that requires everyday or three times weekly injection has been kept out due to the existence of PEGylated interferon only needs one inoculation weekly. In the course of treatment, different patients react in dissimilar ways depending on heredity factors as well as the infecting genotype (Henning & Hall 2010). Kids from positive mothers can be treated using hepatitis B virus antibodies (HBIg). Therefore management options must be subjected between twelve hours after birth, to reduce 90% rate of getting infected. Additionally, the management strategy also ensures that the caregiver is safe to breastfeed her child. Although earlier stages of the disease can managed, the cure for acute hepatitis B has not yet been discovered. However, victims of chronic viral hepatitis B have used silymarin from the milk thistle herb, even though its efficiency is not yet known. Recommendation The recent innovation in HBV infection with regard to the modified variants, viral and ecological factors, genotype subgroups, host awareness, and treatment are rather encouraging. There is still a lot to be done before hepatitis B is fully defeated even though scientists still attempt to learn the natural history of the infection. Therefore, many more research projects should be conducted to help us in elaborating the relationship between mutant variants, the advancement of hepatocellular carcinoma and the genotypes. (Pan et al 2005). Researchers should provide insights on how to manage patients when they exhibit signs of mild liver disease. Studies done in the future should provide a follow ups to assist researchers and medical personnel to cope with dissimilar behaviors of HBV in each person. Studies on the .long term effects and results of the infection should be explained through research. Conclusion Curing hepatitis B is more strenuous and expensive not mentioning painful as compared to preventing it. Hepatitis B infection is the most effective way of suppressing the prevalence and the spread of hepatitis B and all the other consequences. It is obvious that the vulnerability of this ailment is general. One can only be safe if they have acquired anti-HBs antibodies after HBV infection or have gone through successful immunization. Vaccination against hepatitis B to children has become a common practice in a majority of countries. Some countries such as India and china are now presenting lower rate of hepatitis B and decline in frequency of hepatocellular carcinoma, subsequently the price of hepatitis B immunization has greatly decreased as compared to other countries. (Pan et al 2005). If poorly managed, the illness can advance to a chronic state, resulting to cirrhosis, liver cancer, and liver cancer and in some cases death. Chronically infected victims happen to spread the disease at a higher rate as opposed to acute infection. Chronic infections mainly strike people who were infected when young; the rate of acute infections and new infections is high among adults. The most common cause of infection is peri-natal and blood contact with infected people, thus making the disease preventable. People should try to minimize the acquisition and spread of Hepatitis B. Given that particular cure for Hepatitis B has not been discovered, prevention remain the most favorable. Read More