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Hepatitis is an inflammation of the liver characterized by the attendance of inflammatory cells in the tissue of the organ. The name is from the Greek hepar, the root being hepat- (á¼¡Ï€Î±Ï„-), meaning liver, and suffix -itis, meaning "inflammation" . The condition can be self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis.
Hepatitis may happen with little or no symptoms (subclinically), but often leads to jaundice, anorexia (poor appetite) and malaise. hepatitis is acute, when it lasts less than six months and chronic if it lasts longer. A group of viruses known as (the hepatitis viruses) cause most cases of hepatitis worldwide, but it can also be due to toxins (notably alcohol, certain medications and plants), other infections and autoimmune diseases.
Hepatitis C is an infectious disease affecting the liver, caused by the hepatitis C virus (HCV). The infection cause no symptoms , but once established, chronic infection can progress to scarring of the liver (fibrosis), and advanced scarring (cirrhosis) which is generally apparent after many years. In some cases, those with cirrhosis will go on to develop liver failure or other complications of cirrhosis, including liver cancer or life threatening esophageal varices and gastric varices.
The Hepatitis C Virus
Illustration of the HCV Viral Components showing the envelope 1 and 2 protein complex with its nucleocapsid protein and the RNA genome.
HCV is a small (40 to 60 nanometers in diameter), enveloped, single-stranded RNA virus of the family Flaviviridae and genus hepacivirus. Because the virus mutates rapidly(much more than DNA viruses) , changes in the envelope proteins may help it evade the immune system. There are at least six major genotypes and more than 50 subtypes of HCV. The different genotypes have different geographic distributions. Genotypes 1a and 1b are the most common in the United States (about 75 percent of cases). Genotypes 2 and 3 are present in only 10 to 20 percent of patients. There is little difference in the severity of disease or outcome of patients infected with different genotypes. However, patients with genotypes 2 and 3 are more likely to respond to interferon treatment.
The hepatitis C virus is spread by blood-to-blood contact. Most people have few, if any symptoms after the initial infection, yet the virus persists in the liver in about 85% of those infected.
An estimated 270-300 million people worldwide are infected with hepatitis C. Hepatitis C is a strictly human disease. It cannot be contracted from or given to any other animal. Chimpanzees can be infected with the virus in the laboratory, but do not develop the disease, which has made research more difficult. No vaccine against hepatitis C is available. The existence of hepatitis C (originally "non-A non-B hepatitis") was postulated in the 1970s and proven finally in 1989. It is one of five known hepatitis viruses: A, B, C, D, and E. recent research has shown that hepatitis C affects a number of other areas of the body including the digestive system, the lymphatic system, the immune system and the brain.
Hepatitis C death statistics by worldwide region:
Hepatitis C cause about 8,000 deaths in Africa 2002, (The World Health Report, WHO, 2004)
Hepatitis C cause about 7,000 deaths in The Americas 2002, (The World Health Report, WHO, 2004)
Hepatitis C cause about 14,000 deaths in South East Asia 2002, (The World Health Report, WHO, 2004)
Hepatitis C cause about 4,000 deaths in Europe 2002, (The World Health Report, WHO, 2004)
Hepatitis C cause about 5,000 deaths in Eastern Mediterranean 2002, (The World Health Report, WHO, 2004
Hepatitis C cause about 14,000 deaths in Western Pacific 2002, (The World Health Report, WHO, 2004)
World map - prevelance levels of hepatitis C
Highest Rates of Hepatitis C Virus Transmission has found in Egypt
The highest rates of new hepatitis C virus (HCV) infection in the world has found in the Arab Republic of Egypt , according to a new study published today in the prestigious Proceedings of the National Academy of Sciences. more than 500,000 new HCV infections occur in Egypt every year, the study also estimates that, likely signaling an epidemic in a country of more than 77 million people. This high rate of HCV transmission may be due to the lack of sufficient standard safety precautions in medical and dental facilities, the authors suggest.
The recently released Egyptian Demographic Health Survey [EDHS]* tested a representative sample of the whole country for HCV antibody. Â The sample included both urban and rural populations and included all 27 governorates of Egypt. Over 11,000 individuals were tested. The overall prevalence (percentage of people) positive for antibody to HCV was 14.7%.Â Â
Â Hepatitis C virus in Egypt compared to other countries in the world is shown below in the graph.
Hepatitis C is primarily transmitted through blood or blood products.
The most common ways are:
Transfusion with infected blood or blood products, hemodialysis, or transplantation of organs from infected donors was once a common mode of transmission butÂ is now rare. In 1992, a test became available for checking blood for HCV. Blood and blood products are now tested to ensure that they are not contaminated (infected). As a result, cases of hepatitis C related to transfusion, hemodialysis, or transplantation have decreased to almost zero since then. Transfusion of blood or blood products before 1992 is a serious factor for hepatitis C, the current transmission rate through blood transfusions is estimated at less than 1 per 1,000,000 units transfused.
Sharing of infected needles among IV drug users is the most common method of transmission. Using a needle to inject recreational drugs, even onceÂ several years ago, is a risk factor for hepatitis C, 60% of all new cases of hepatitis C.. Among frequent drug users, 50-80% are infected by HCV within the first 12 months of beginning injecting.
By equipment that has not been cleaned between users, HCV may be transmitted by using razors, needles, toothbrushes, nail files, a barber's scissors, tattooing equipment, body piercing or acupuncture needles if these items are contaminated by blood of an infected person. Until recently, health departments, doctor's offices, dentist offices , clinics and hospitals did not sterilize their equipment nor did they dispose of their hazardous waste safely. Syringes and needles were cleaned with alcohol to "sterilize" them.a procedure that we now know simply does not work. Both patients as well as medical practitioners could have contracted hepatitis c this way.
Sharing of straws in snorting drugs are also a potential source of infection of HCV. The hepatitis C virus is found mainly in blood.
Organ transplants and blood transfusions prior to 1992.
Sex at an early age.
Sex with multiple partners.
Presence of other STDs(sexually transmitted disease).
Sex with trauma (for example: rough sex, rape or sexual abuse) Transmission through oral sex has not been documented.
Neonatal transmission , a baby may carry the disease from his infected mother.
The rate of infection is the same regardless of method of delivery (Caesarean section or vaginal).
There are no recommendations to avoid pregnancy or breast-feeding if infected with HCV.
Transmission of HCV infection through breast milk has not been documented.
Hepatitis C does not affect everybody in exactly the same way or always with the same intensity. Although most affects the liver, infection rates vary and the actual progress of the disease in each individual depending on many factors involved.
Less common causes of HCV transmission include the following:
From a mother to her infant, atÂ the time of childbirth.
Through sexual intercourse with an infected person: Having multiple sex partners is a risk factor.
Needle sticks with HCV-contaminated blood: This is mostly seen in health care workers. The risk of developing HCV infection after a needle stick is about 5-10%.
Once hepatitis C comes into the blood and start reproducing, the chances for liver harm increases. This process may take years, and you may experience no symptoms throughout that time and not even know you are infected.
In 85% of people who have hepatitis C, the virus becomes a chronic infection that stays in the body and damages the liver. Once the damage becomes wide the liver may stop working correctly, this condition called cirrhosis. Hepatitis C can also lead to liver disease and even liver cancer. If end-stage liver disease (liver failure) sets in, the only treatment is a liver transplant.
If you do not take care of hepatitis C, the consequences can be serious and expensive. The aim of treatment for hepatitis C is to remove the virus from your body. Starting treatment with PEGINTRONÂ® offers you a possibility to become virus free, avoid a relapse, and meet your treatmentÂ goals.
Over the next 10-20 years chronic HCV is predicted to become a main trouble on the health care system as patients who are presently asymptomatic with relatively mild disease progress to end-stage liver disease and develop hepatocellular carcinoma. Predictions in the USA show that there will be about 60% increase in the occurrence of cirrhosis, about 68% increase in hepatoma occurrence, about 279% increment in occurrence of hepatic decompensation, about 52% increase in the need for transplantation, and about 22% increase in liver death rate.
Generally the liver processes a pigment called bilirubin which is a byproduct of aged blood cell clearance. This pigment is yellow and is disposed of as bile
where it flows from the liver to gall bladder and is expelled onto the duodenum in the digestive tract. Bilirubin gives faeces its brown color. When the liver is irritated the bilirubin is not processed accurately and it there is a back log that builds up in the blood stream. The body tries to get it out of the blood stream. The kidneys eliminate some, while the rest is deposited in skin and eyes. So, the patient with hepatitis C will observe an obvious darkening of urine colour (almost like tea colour) and paleness of faeces, an obvious yellowness of the whites of the eyes occurs and a distinctive yellow colour occurs in the skin - particularly obvious in the lines of the palms of the hands. This process does not indicate the cause of the hepatitis, but does point to a problem happening in the organ. Hepatitis may also cause pain or tenderness under the lower right rib edge due to liver swelling.
Although hepatitis C damages the liver, 80% of people with the disease are asymptomatic. In those who do,Â symptoms may not appear forÂ 10-20 years, or even longer. Even then, the symptoms usually come and go and are mild and vague. Unfortunately, by the time symptoms appear, the damage may be very serious.
A minority of people have symptoms during the early acute stage of the infection. These symptoms typically develop 5-12 weeks after exposure to HCV. Some people describe the symptoms as beingÂ flulike. The symptoms may last a few weeks or months.
Loss of appetite
Pain over the liver (on the right side of the abdomen, just under the rib cage)
Dark-colored urine (may look like cola or tea)
StoolsÂ become pale in color (grayish or clay colored)
Prolonged nausea and vomiting can cause dehydration. If you have been vomiting repeatedly, you may notice the following symptoms:
Fatigue or weakness
Confusion or difficulty concentrating
About half of all hepatitis patients have light colored feaces, pain in the muscle, drowsiness, irritability, and itching, usually mild.
Diarrhea and joint aches occur in about a quarter of patients. The liver may be tender and enlarged and most people have mild anemia.
In about 10% of patients, the spleen is enlarged.
The symptoms of chronic autoimmune hepatitis range from minimal to severe, including fatigue, jaundice, fever, and weight loss. The liver and spleen are often enlarged. In addition, patients with this condition may experience skin disorders, including palmar erythema (red palms) and spider angioma (a blood-red spot, the size of a pinhead, from which tiny blood vessels radiate like spider legs). Itching is not common, however. The abdomen or legs may be swollen due to the accumulation of fluid.
Symptoms of Fulminant Hepatitis. In very rare cases, a period of two months of onset of acute hepatitis, a very serious condition known as fulminant hepatitis develops. A large swollen abdomen (known as ascites) and a peculiar hand-flapping tremor (called asterixis). These symptoms may be followed by stomach and intestinal bleeding and mental confusion, stupor, or coma caused by brain injury (encephalopathy).
Chronic hepatitis C can lead toÂ cirrhosis of the liver in many people, a condition traditionally associated with alcoholism. Cirrhosis is a condition in which healthy liver tissue is replaced by fibrous tissue,Â followed byÂ scarlike hardening. As this happens, the liver gradually begins to fail, or lose its ability to carry out its normal functions. Eventually, symptoms develop. Symptoms of cirrhosisÂ include the following:
Disturbances in sleeping
Loss of appetite, weight loss, wasting
Vomiting with blood in the vomit
Jaundice - A condition in which the skin and the whites of the eyes turn yellow. (Children tend not to develop jaundice.).
Fluid retention causing swelling of the belly (ascites), legs, or whole body.
Mental disturbances such as confusion, lethargy, extreme sleepiness, or hallucinations (hepatic encephalopathy).
Hepatic encephalopathy is caused by disorders affecting the liver. These include disorders that reduce liver function (such as cirrhosis or hepatitis) and conditions where blood circulation bypasses the liver. The exact cause of the disorder is unknown. The liver cannot properly metabolize and detoxify substances in the body. Accumulation of toxic substances causes metabolic abnormalities that lead to damage in the central nervous system (brain and spinal cord). The most common toxic substance is ammonia, which is produced by the body when proteins are digested, but normally is detoxified by the liver. Many other substances also deposeit in the body and damage the nervous system.
In people with otherwise stable liver disorders, hepatic encephalopathy may be triggered by episodes of gastrointestinal bleeding, excessive dietary protein, or electrolyte abnormalities (especially decrease in potassium, which may result from vomiting or treatments such as diuretics or paracentesis). The disorder may also be triggered by any condition that results in alkalosis (alkaline blood pH), decreased oxygen levels in the body, use of medications that suppress the central nervous system (such as barbiturates or Benzodiazepine tranquilizers), infections including viral hepatitis, bile duct obstruction, surgery, or any coincidental illness.
Disorders that mimic or mask symptoms of hepatic encephalopathy include Reye's syndrome, alcohol intoxication, sedative overdose, complicated alcohol withdrawal, Wernicke-Korsakoff syndrome, subdural hematoma, meningitis, metabolic abnormalities such as decreased blood glucose level and Wilson's disease.
Hepatic encephalopathy occurs in approximately 4 out of 100,000 people. It may happen as an acute, potentially reversible disorder or as a chronic, progressive disorder.
Between 20- 30 % of HCV sufferers are able to have a sustained viral response with suitable treatment. Between 70 - 80% of the HVC infections reported each year become classified as chronic. Chronic HCV refers to infections that do not clear up within 6 months after the acute infection. Within the chronically infected group, about 20% go on to develop cirrhosis (scarring of the liver). Of this group, 25% may develop liver failure, even though this may take 30-40 years. Cirrhosis slows the blood flow through the liver and causes increased pressure in the vein that carries blood from the stomach and the intestines to the liver. As a result, varicose veins (e.g., "varices") may develop in the stomach and esophagus. Without warning these large veins can break causing a person to vomit blood or have black, tarry feaces. An estimated 8,000-10,000 deaths occur each year resulting from the complications of HCV.
The therapy for chronic hepatitis C has evolved steadily since alpha interferon was first approved for use in this disease more than 10 years ago. At the present time, the optimal regimen appears to be a 24- or 48-week course of the combination of pegylated alpha interferon and ribavirin.
Alpha interferon is a host protein that is made in response to viral infections and has natural antiviral activity. Recombinant forms of alpha interferon have been produced, and several formulations (alfa-2a, alfa-2b, consensus interferon) are available as therapy for hepatitis C. These standard forms of interferon, however, are now being replaced by pegylated interferon (peginterferon).
Peginterferon is alpha interferon that has been modified chemically by the addition of a large inert molecule of polyethylene glycol. Pegylation changes the uptake, distribution, and excretion of interferon, prolonging its half-life. Peginterferon can be given once weekly and provides a constant level of interferon in the blood, whereas standard interferon must be given several times weekly and provides intermittent and fluctuating levels. In addition, peginterferon is more active than standard interferon in inhibiting HCV and yields higher sustained response rates with similar side effects. Because of its ease of administration and better efficacy, peginterferon has replaced standard interferon both as monotherapy and as combination therapy for hepatitis C.
Ribavirin is an oral antiviral agent that has effect against a broad range of viruses. By itself, ribavirin has little effect on HCV, but adding it to interferon increases the sustained response rate by two- to three-fold. For these reasons, combination therapy is now recommended for hepatitis C, and interferon monotherapy is applied only when there are specific reasons that prevent using ribavirin.
Combination therapy leads to rapid improvements in serum ALT levels and disappearance of detectable HCV RNA in up to 70 percent of patients. However, long-term improvement in hepatitis C occurs only if HCV RNA disappears during therapy and stays undetectable once therapy is stopped. Among patients who become HCV RNA negative during treatment, some will relapse when therapy is stopped. The relapse rate is lower in patients treated with combination therapy compared with monotherapy. Thus, a 48-week course of combination therapy using peginterferon and ribavirin yields a sustained response rate of about 55 percent. A similar course of peginterferon monotherapy yields a sustained response rate of only 35 percent. A response is considered "sustained" if HCV RNA remains undetectable for 6 months or more after stopping therapy.
Preventing HCV Infection
There is NO vaccine to prevent HCV. Vaccines for Hepatitis A and B do not provide immunity against hepatitis C. There are different genotypes of HCV and the virus undergoes mutations making it difficult to develop a vaccine.
Avoid handling anything that may carry the blood of an infected person on it, such as toothbrushes, scissors, razors, nail clippers or files, tampons or sanitary napkins,...etc. Detergent and a 10% solution of household bleach is believed to destroy the virus.
Don' t share drug needles, cocaine straws or any drug paraphernalia.
Practice safe sex (use latex condoms).
Notify your physician and dentist that you have hepatitis .
Get vaccinated against hepatitis A and B.
Those infected with hepatitis C should not drink alcohol, as it leads to the liver damage.
Self-Care at Home
If you have symptoms, these measures will help you feel better faster. Take it easy; get a lot of rest. Drink a lot of fluids to prevent dehydration.
Avoid drinking alcohol of any kind, including (beer, wine, and hard liquor).
Avoid drugs and substances that can cause injury to the liver such as acetaminophen (Tylenol) and other preparations that contain acetaminophen.
Avoid prolonged, energetic exercise until symptoms start to improve.
My name is Yasser. Im doing research on hepatitis c in Egypt. I would greatly appreciate a few minutes of your time to fill out this questionnaire.
1-Do you think that hepatitis c is a common disease in egypt?
c)like any disease
d)i don't know
2-who are the most people suffer from this disease?
d)i don't know
3-what do you think the causes of spreading hepatitis c?
c)both of them
4-have you ever made a test for hepatitis c?
if the answer of previous question is "yes" answer the following question, if the answer is "no" move to the question number 6.
5-why you made the test?
a)i donated blood
b)i had other blood tests done for a routine physical that showed I might have liver disease
c)i were sick with symptoms like fatigue,nausea,stomach pain(known as jaundice)
6-why you didn't make it?
a)i didn't suffer from anything
b)i don't make tests for blood
7-have egypt the enough facilities to prevent spreading of this disease?
c)i don't know