hepatitis B (redirected from Core antigen)

Hepatitis B 

Definition

Hepatitis B is a potentially serious form of liver inflammation due to infection by the hepatitis B virus (HBV). It occurs in both rapidly developing (acute) and long-lasting (chronic) forms, and is one of the most common chronic infectious diseases worldwide. An effective vaccine is available that will prevent the disease in those who are later exposed.

Description

Commonly called "serum hepatitis," hepatitis B ranges from mild to severe. Some people who are infected by HBV develop no symptoms and are totally unaware of the fact, but they may carry HBV in their blood and pass the infection on to others. In its chronic form, HBV infection may destroy the liver through a scarring process, called cirrhosis, or it may lead to cancer of the liver.

When a person is infected by HBV, the virus enters the bloodstream and body fluids, and is able to pass through tiny breaks in the skin, mouth, or the male or female genital area. There are several ways of getting the infection:

• During birth, a mother with hepatitis B may pass HBV on to her infant.
• Contact with infected blood is a common means of transmitting hepatitis B. One way this may happen is by being stuck with a needle. Both health care workers and those who inject drugs into their veins are at risk in this way.
• Having sex with a person infected by HBV is an important risk factor (especially anal sex).

Although there are many ways of passing on HBV, the virus actually is not very easily transmitted. There is no need to worry that casual contact, such as shaking hands, will expose one to hepatitis B. There is no reason not to share a workplace or even a restroom with an infected person.

More than 300 million persons throughout the world are infected by HBV. While most who become chronic carriers of the virus live in Asia and Africa, there are no fewer than 1.5 million carriers in the United States. Because carriers represent a constant threat of transmitting the infection, the risk of hepatitis B is always highest where there are many carriers. Such areas are said to be endemic for hepatitis B. When infants or young children living in an endemic area are infected, their chance of becoming a chronic hepatitis B carrier is at least 90%. This probably is because their bodies are not able to make the substances (antibodies) that destroy the virus. In contrast, no more than 5% of infected teenagers and adults develop chronic infection.

Causes and symptoms

With the exception of HBV, all the common viruses that cause hepatitis are known as RNA viruses because they contain ribonucleic acid or RNA as their genetic material. HBV is the only deoxyribonucleic acid or DNA virus that is a major cause of hepatitis. HBV is made up of several fragments, called antigens, that stimulate the body's immune system to produce the antibodies that can neutralize or even destroy the infecting virus. It is, in fact, the immune reaction, not the virus, that seems to cause the liver inflammation.

Acute hepatitis b

In the United States, a majority of acute HBV infections occur in teenagers and young adults. Half of these youth never develop symptoms, and only about 20%—or one in five infected patients—develop severe symptoms and yellowing of the skin (jaundice). Jaundice occurs when the infected liver is unable to get rid of certain colored substances, or pigments, as it normally does. The remaining 30% of patients have only "flu-like" symptoms and will probably not even be diagnosed as having hepatitis unless certain tests are done.

The most commom symptoms of acute hepatitis B are loss of appetite, nausea, generally feeling poorly, and pain or tenderness in the right upper part of the abdomen (where the liver is located). Compared to patients with hepatitis A or C, those with HBV infection are less able to continue their usual activities and require more time resting in bed.

Occasionally patients with HBV infection will develop joint swelling and pain (arthritis) as well as hives or a skin rash before jaundice appears. The joint symptoms usually last no longer than three to seven days.

Typically the symptoms of acute hepatitis B do not persist longer than two or three months. If they continue for four months, the patient has an abnormally long-lasting acute infection. In a small number of patients—probably fewer than 3%—the infection keeps getting worse as the liver cells die off. Jaundice deepens, and patients may bleed easily when the levels of coagulation factors (normally made by the liver) decrease. Large amounts of fluid collect in the abdomen and beneath the skin (edema). The least common outcome of acute HBV infection, seen in fewer than 1% of patients, is fulminant hepatitis, when the liver fails entirely. Only about half of these patients can be expected to live.

Chronic hepatitis b

HBV infection lasting longer than six months is said to be chronic. After this time it is much less likely for the infection to disappear. Not all carriers of the virus develop chronic liver disease; in fact, a majority have no symptoms. But, about one in every four HBV carriers develop liver disease that gets worse over time, as the liver becomes more and more scarred and less able to carry out its normal functions. A badly scarred liver is called cirrhosis. Patients are likely to have an enlarged liver and spleen, as well as tiny clusters of abnormal blood vessels in the skin that resemble spiders.

The most serious complication of chronic HBV infection is liver cancer. Worldwide this is the most common cancer to occur in men. Nevertheless, the overall chance that liver cancer will develop at any time in a patient's life is probably much lower than 10%. Patients with chronic hepatitis B who drink or smoke are more likely to develop liver cancer. It is not unusual for a person to simultaneously have both HBV infection and infection by HIV (human immunodeficiency virus, the cause of AIDS). A study released in 2003 reported that men infected with both HIV and HBV were more likely to die from liver disease than people infected with just one of the diseases.

Diagnosis

Hepatitis B is diagnosed by detecting one of the viral antigens—called hepatitis B surface antigen (HBsAg)—in the blood. Later in the acute disease, HBsAg may no longer be present, in which case a test for antibodies to a different antigen—hepatitis B core antigen—is used. If HBsAg can be detected in the blood for longer than six months, chronic hepatitis B is diagnosed. A number of tests can be done to learn how well, or poorly, the liver is working. They include blood clotting tests and tests for enzymes that are found in abnormally high amounts when any form of hepatitis is present.

Treatment

In the past, there was no treatment available for hepatitis B. But developments have been made in recent years on drugs that suppress the virus and its symptoms. In early 2003, a drug called adefovir was reported as an effective treatment. Another drug called tenofovir was demonstrated as effective in patients infected with both hepatitis B and HIV. Two studies also reported on the effectiveness of a drug called Preveon, which was more expensive than others. Patients also should rest in bed as needed, continue to eat a healthy diet, and avoid alcohol. Any non-critical surgery should be postponed.

Prognosis

Each year an estimated 150,000 persons in the United States get hepatitis B. More than 10,000 will

Hepatitis B virus (HBV) is composed of an inner protein core and an outer protein capsule. The outer capsule contains the hepatitis B surface antigen (HBsAg). The inner core contains HBV core antigen (HBcAg) and hepatitis B e-antigen (HBeAg). This cell also contains polymerase, which catalyzes the formation of the cell's DNA. HBV is the only hepatitis-causing virus that has DNA, instead of RNA.

(Illustration by Electronic Illustrators Group.)

require hospital care, and as many as 5,000 will die from complications of the infection. About 90% of all those infected will have acute disease only. A large majority of these patients will recover within three months. It is the remaining 10%, with chronic infection, who account for most serious complications and deaths from HBV infection. In the United States, perhaps only 2% of all those who are infected will become chronically ill. The course of chronic HBV infection in any particular patient is unpredictable. Some patients who do well at first may later develop serious complications. Even when no symptoms of liver disease develop, chronic carriers remain a threat to others by serving as a source of infection.

Prevention

The best way to prevent any form of viral hepatitis is to avoid contact with blood and other body fluids of infected individuals. The use of condoms during sex also is advisable.

If a person is exposed to hepatitis B, a serum preparation containing a high level of antibody against HBV may prevent infection if given within three to seven days of exposure. Babies born of a mother with HBV should receive the vaccine within 24 hours. An effective and safe vaccine is available that reliably prevents hepatitis B. Vaccination is suggested for most infants and for children aged 10 and younger whose parents are from a place where hepatitis B is common. Teenagers not vaccinated as children and all adults at risk of exposure also should be vaccinated against hepatitis B. Three doses are recommended.

Key terms

Antibody — A substance formed in the body in response to a foreign body, such as a virus, which can then attack and destroy the invading virus.

Antigen — Part of an invading microorganism, such as a virus, that causes tissue damage (in hepatitis, to the liver), and that also stimulates the body's immune system to produce antibodies.

Cirrhosis — The end result of many forms of liver disease, the condition of the liver when its cells have been damaged or destroyed and are replaced by scar tissue.

Vaccine — A substance prepared from a weakened or killed virus which, when injected, helps the body to form antibodies that will attack an invading virus and may prevent infection altogether.

Those at increased risk of getting hepatitis B, and who therefore should be vaccinated, include:

• household contacts of a person carrying HBV
• healthcare workers who often come in contact with patients' blood or other body fluids

• patients with kidney disease who periodically undergo hemodialysis
• homosexual men who are sexually active, and heterosexuals who have multiple sex partners
• persons coming from areas where HBV infection is a major problem
• prisoners and others living in crowded institutions
• drug abusers who use needles to inject drugs into their veins

Studies released in 2003 showed increased risk of nonresponse to hepatitis B vaccines among adults over age 30. This may be related to age-associated changes in the immune system.

Resources

Periodicals

"Antiviral Effective Against Hepatitis B Virus in HIV-coinfected." Virus Weekly January 28, 2003: 16.

Bauer, Jeff. "Co-infection with Hepatitis B and HIV Increases Men's Risks of Death from Liver Disease." RN March 2003: 97.

Elliott, William T. "Warfarin Effectively Prevents Venous Thromboembolism (Pharmacology Watch)." Critical Care Alert April 2003.

"Hepatitis B Vaccine Loses Effectiveness in Older Adults." Vaccine Weekly January 29, 2003: 23.

Organizations

Hepatitis B Foundation. 101 Greenwood Ave., Suite 570, Jenkintown, PA 19046. (215) 884-8786. 〈info@hepb.org〉.

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hepatitis /hep·a·ti·tis/ (hep″ah-ti´tis) pl. hepati´tides   Inflammation of the liver.

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hepatitis A  a self-limited viral disease of worldwide distribution, usually transmitted by oral ingestion of infected material but sometimes transmitted parenterally; most cases are clinically inapparent or have mild flu-like symptoms; any jaundice is mild.

anicteric hepatitis  viral hepatitis without jaundice.

hepatitis B  an acute viral disease transmitted primarily parenterally, but also orally, by intimate personal contact, and from mother to neonate. Prodromal symptoms of fever, malaise, anorexia, nausea, and vomiting decline with the onset of clinical jaundice, angioedema, urticarial skin lesions, and arthritis. After 3 to 4 months most patients recover completely, but some may become carriers or remain ill chronically.

hepatitis C  a viral disease caused by the hepatitis C virus, commonly occurring after transfusion or parenteral drug abuse; it frequently progresses to a chronic form that is usually asymptomatic but that may involve cirrhosis.

cholangiolitic hepatitis  cholestatic h. (1).

cholestatic hepatitis 

1. inflammation of the bile ducts of the liver associated with obstructive jaundice.

2. hepatic inflammation and cholestasis resulting from reaction to drugs such as estrogens or chlorpromazines.

hepatitis D , delta hepatitis infection with hepatitis D virus, occurring either simultaneously with or as a superinfection in hepatitis B, whose severity it may increase.

hepatitis E  a type transmitted by the oral-fecal route, usually via contaminated water; chronic infection does not occur but acute infection may be fatal in pregnant women.

enterically transmitted non-A, non-B hepatitis  (ET-NANB) h. E.

hepatitis G  a post-transfusion disease caused by hepatitis G virus, ranging from asymptomatic infection to fulminant hepatitis.

infectious hepatitis  h. A.

infectious necrotic hepatitis  black disease.

lupoid hepatitis  chronic active hepatitis with autoimmune manifestations.

neonatal hepatitis  hepatitis of uncertain etiology occurring soon after birth and marked by prolonged persistent jaundice that may progress to cirrhosis.

non-A, non-B hepatitis  a syndrome of acute viral hepatitis occurring without the serologic markers of hepatitis A or B, including hepatitis C and hepatitis E.

posttransfusion hepatitis  viral hepatitis, now primarily hepatitis C, transmitted via transfusion of blood or blood products, especially multiple pooled donor products such as clotting factor concentrates.

serum hepatitis  h. B.

transfusion hepatitis  posttransfusion h.

viral hepatitis  h. A, h. B, h. C, h. D, and h. E.

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hepatitis B

n.

A form of viral hepatitis caused by a DNA virus that often persists in the blood serum and can cause chronic liver damage. Hepatitis B is usually transmitted by infected blood products (as through transfusion), by contaminated needles, or by exposure to infected bodily fluids through sexual intercourse. Also called serum hepatitis.

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hepatitis B (HB),

a viral hepatitis caused by the hepatitis B virus (HBV), a hepadnavirus. The virus is transmitted by transfusion of contaminated blood or blood products, by sexual contact with an infected person, by the use of contaminated needles and instruments, or in utero. It can cause acute and chronic hepatitis. Ninety-five percent of patients clear the infection and develop antibodies to HBV. The remaining 5% who are unable to clear the virus develop chronic infections that put them at risk for long-term complications. Severe infection may cause prolonged illness, destruction of liver cells, cirrhosis, increased risk of liver cancer, or death. A vaccine is available and recommended for infants, teenagers, and adults at risk for exposure. Treatment may involve transplantation. Also called serum hepatitis. See also viral hepatitis.

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hepatitis B

Hepatology Liver inflammation by HBV, a small, highly contagious DNA virus of the Hepadnaviridae family Epidemiology 60-110 day incubation, via exchange of body fluids–eg, blood, semen, etc Clinical Sx from malaise to death; acute HBV infection is similar to HAV, with headache, anorexia, nausea, ± vomiting, low fever, jaundice, itching, RUQ tenderness Lab ↑ transaminases, ↑ BR, mild hemolysis, normal/↓ hematocrit & Hb concentrations, mild hemolysis, ↓ PMNs, relative lymphocytosis–total WBC ± 12,000/mm Stages of HBV infection Acute, convalescent, chronic, determined by various viral antigens & antibodies; early hepatitis B is characterized by sublobular involvement of all cells, later stages by scattered antigen-positive hepatocytes Serology See Hepatitis panel.

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Patient discussion about hepatitis B.

Q. Should I vaccinate my newborn against Hepatitis B? I am 9 months pregnant and am expecting to give birth anytime soon. I understood that my newborn will receive a vaccine against Hepatitis B in the hospital. Why is this so?

A. because this is bullshit! Hey! Wake up! the lymph system of your baby will only be "ready and finished" after three years! so how should your baby manage a toxic vaccination? do you know what they put in the vaccination? they put hepatitis B pathogens/virus with the hope that your baby will be able to build an anti-hepatitis B pathogen and so manage itself in the future hepatitis B! how should your baby do that, when his lymph-system just started to develop itself and will only be ready in three years? please read in the links i send to you:

before you would like to go on with any vaccination, you should check out this very long list of links:

http://www.aegis.ch/neu/links.html

at the bottom you will also find links in english. vaccinations in general are very disputable/dubious and it is probably time that we learn about it.

Q. What is the difference between hepatitis c and hepatitis b? and also can it be possible to have a false positive on a Hepatitis B test?

A. These are seperate viruses, that both can cause liver disease and both infect through contact with infected body fluids, although C is more violent. In addition, there's a vaccination against Hepatitis B, but not against Hepatits C.

Q. What is the difference between hepatitis c and hepatitis b? and also can it be possible to have a false positive on a Hepatitis B test?

A. The main difference is that they are both caused by different viruses… they are both very unpleasant diseases , I hope you don’t have any one of them. the other differences are that most people (80% or so) exposed to the hep B virus clear it on their own, through their own body's immune response system. With hep C, only about 15-20% of those exposed to it clear it through their own immune system; the rest go on to have chronic, active hepatitis c.
he other major difference is that hep B can progress directly to liver cancer (without progressing to cirrhosis first, as hep c does).