Hepatitis B is also called serum hepatitis and silent killer because most of the patient remains asymptomatic for many years. It is one of the major global health and life-threatening issue.
By Ayat Fatima Malik, Hafiz Muhammad Afzal, Muhammad Yasin, Shahid Ali
Introduction:
Hepatitis B is a chronic viral infection, which develops cirrhosis, end-stage liver disease, and hepatocellular carcinoma, until liver transplantation in patients. The hepatitis B virus (HBV) is transmitted by sexual, parental, and vertical routes. Some blood tests and liver biopsy has required for proper diagnosis of Hepatitis B. It has significant morbidity and mortality rate. Early, accurate diagnosis and vaccination are the two important steps for the elimination of diseases.
Causes:
Hepatitis B is caused by the virus of the family hepadnaviridae which is a circular, double-standard DNA virus. HBV causes inflammation in the liver and liver diseases. The incubation period of HBV is 1 to 4 months.
Transmission:
According to WHO, HBV has been transmitted by parenteral contact with blood and body fluids. HBV is present on the surface for weeks when comes in contact with an infected person, without losing infectivity such as table-tops, razer-blades, and blood strains. HBV is transmitted by breaks in the skin membrane or the mucus membrane, blood transfusion, and needle injury, HBV does not cross the placenta and is transmitted by the infected pregnant woman to their babies at birth. Most cases of Hepatitis B infection are asymptomatic.
Symptoms:
In the case of Acute Hepatitis B:
Only one-third of patients with acute hepatitis develop symptoms such as nausea, jaundice, dark urine, fatigue, the sudden appearance of fever, abdominal pain, vomiting, body aches, disorientation, confusion, coma and two third of patients remain asymptomatic. During the prodromal period, the ALT level increases, the hepatitis B surface Antigen level (HBsAg) rises and the hepatitis B virus (HBV) is detected. Acute liver failure occurs in approximately 1% of patients with acute hepatitis B.
In the case of Chronic Hepatitis B:
During the early stages of infection, HBsAg, HBeAg, and HBV are usually increased in number. Some patients with chronic hepatitis are asymptomatic and some have non-specific symptoms such as fatigue, mild right upper quadrant, spider angiomata, palmar erythema, splenomegaly, gynecomastia, fetor hepaticas, Ascites, peripheral edema, encephalopathy, and gastrointestinal bleeding, cirrhosis, Hepatocellular carcinoma (HCC) and end-stage liver diseases. Bilirubin, prothrombin, and albumin often become abnormal in patients with chronic hepatitis B. Platelets level also decrease in some cases.
Anti-Hepatitis B core IgM (Anti-HBc IgM) is one of the useful markers which distinguish between acute and chronic Hepatitis B. Anti-HBc IgM is detected in patients with severe chronic hepatitis B. In patients, an increase in the level of Alpha-fetoprotein (AFP) is a sign of HCC suspected. In chronic hepatitis B, the prognosis of patients is directly related to the acuteness of the disease. Chronic hepatitis is less common in children than in adults.
Specimen collection and transport:
For the diagnosis of hepatitis B virus, we prefer a blood sample. Blood, serum, or plasma are separated, and used for diagnostic screening. Antigen and Antibody of HBV are remaining stable at room temperature for days, at 4 degrees centigrade for months, and frozen at -20 to -70 degree centigrade for years. The serum is collected from clotted blood within 4 hours of collection. PCR-based test use serum\plasma, and Hybridization-based tests use the serum.
Serological markers for HBV infection:
HBsAg:
Hepatitis B surface antigen is the first serological marker for HBV infection. It is persistent for more than 6 months.
Anti-HBs:
It is a recovery of immunity marker of hepatitis B.
HBeAg:
It shows active replication of the hepatitis B virus and a high risk of transmission.
Anti-HBe:
It shows decrease infectivity and remission of disease and less active HBV replication.
IgM anti-HBc:
It shows the presence of a high index value during acute HBV infection and usually disappears within 6 months.
IgG anti-HBc:
Its presence shows exposure to HBV.
Diagnosis:
Usually, three basic methods are used for the diagnosis of HBV.
- Blood tests
- Liver biopsy
- Liver ultrasound
Blood screening method:
For the diagnosis of the HBV from blood, by screening method, patient serum is used. Patient blood is taken in a clot vial. Then blood is placed in a centrifuge machine for 5 minutes. After that, the serum is separated and 2-3 drops of serum are added to a kit that contains HB buffer. Place the test device on a clean and level surface at room temperature for 15 minutes. Then examine the test device if only the control line is formed, the test is negative. If two lines are formed, the control line and the test line, the test is positive. This figure indicates that the test is negative because only one control line is formed.
Safety Precautions:
Protective gloves, eye goggles, and, lab coats must be worn during performing tests. All the plastics and glassware contaminated with serum are placed in a container for proper disposal. After performing the HB test, wash the work surface with 10% bleach solution. Microscopic examinations do not apply to the HBV test procedure. Biosafety level 2 are recommended for HBV infection for handling test specimen and kit reagents.
Effects of Covid-19 on HB patients:
A patient having hepatitis B has on high risk of developing the SARS-Cov-2 virus. Those peoples who have severe chronic hepatitis B, and have 65 years of age or older, are at the highest risk. Some of the medicines which are used in covid-19 treatment such as corticosteroids can cause hepatotoxicity and liver damage, which can increase the risk of reactivation of HBV. If a person has HB, he needs to take safety precautions against covid-19. Covid-19 vaccines are safe for Hepatitis B patients.
Summary:
HB is a life-threatening issue in the whole world, most cases are asymptomatic. Proper vaccination and early diagnosis is the best method for the elimination of the disease. HBV causes severe liver disease so, proper care and proper precaution must be needed for laboratory workers who are performing the test. Older age peoples and peoples who are using corticosteroids are at the risk of developing HB infection.
Author: Ayat Fatima Malik, Hafiz Muhammad Afzal, Muhammad Yasin, Shahid Ali
Corresponding Author: Ayat Fatima Malik, Hafiz Muhammad Afzal, Muhammad Yasin, Shahid Ali
University: University of Veterinary and Animal Science, Lahore.