Brief Discussion on Different Types Of Hepatitis.

Which of the following forms of hepatitis does NOT have a chronic state?

A) Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) Hepatitis D

Answer and Discussion
The answer is A. (Hepatitis A)

Hepatitis is an inflammation of the liver that is characterized by nausea, anorexia, fever, right-upper abdominal discomfort, jaundice, and marked elevation of liver function tests.
The condition is usually classified into the following types:

• Hepatitis A. Also known as infectious hepatitis, the causative agent is an RNA virus. The disease is common and often presents subclinically. It is estimated that as much as 75% of the U.S. population has positive antibodies to hepatitis A.

The onset of clinical symptoms is usually acute, and children and young adults are usually affected. The transmission is via a fecal–oral route and has been linked to the consumption of contaminated shellfish (e.g., raw oysters). The course of the disease is usually mild, and the prognosis is usually excellent. There is neither an associated chronic state nor a carrier state. The diagnosis is made by the detection of elevated levels of IgM antibodies, which indicate active disease, and IgG antibodies, which indicate previous disease. Most cases require no special treatment other than supportive care, and symptoms usually resolve after several weeks. The disease can be prevented by administering Ig to those who are in close contact with those affected. Immunization, especially for travelers, is recommended to specifically prevent hepatitis A.

• Hepatitis B. This DNA viral disease is more severe than hepatitis A and causes more complications. It affects as much as 10% of the U.S. population. The infective Dane particle consists of a viral core and outer surface coat. The disease often develops insidiously and can affect persons of all ages. It is transmitted parenterally (through infected blood transfusions or infected needles used by intravenous drug abusers) and through sexual contact (especially in sexually active young adults and
homosexuals).
The symptoms are often severe and can be devastating to elderly patients or those who are debilitated. Approximately 10% of cases become chronic; up to 30% of affected patients become carriers of the virus after they are infected.
The detection of the hepatitis B surface antigen (formerly known as the Australian antigen) supports the diagnosis of acute illness, and values become positive between 1 and 7 weeks before the symptoms become evident. The hepatitis B antibody appears weeks to months after the development of the clinical symptoms. The presence of a hepatitis B surface antibody indicates previous disease and represents immunity. Those who have received hepatitis B vaccination also have positive titers if they are immune. An anticore antibody (IgM) usually develops at the onset of the illness, and the IgG anticore antibody (which develops shortly after IgM appears) can be used as a marker for the disease during the “window period,” which occurs when the hepatitis B surface antigen disappears and before the hepatitis B surface antibodies appear. The hepatitis B e antigen is found in those who are hepatitis B surface antigen–positive; its presence is associated with
greater infectivity and a greater chance of progression to the chronic state.

The delta agent (hepatitis D) is a separate virus that may coexist with hepatitis B; it is usually associated with a more severe case of hepatitis B and in cases of chronic hepatitis B in which there is
reactivation of the virus. Prophylaxis of hepatitis B can be achieved with hepatitis B vaccine given at 1 month and 6 months after the initial injection, for a total of three injections. Persons exposed to hepatitis B (e.g., by needle stick) should also receive hepatitis B Ig at the time of exposure.

• Hepatitis C. This disease (also known as non-A, non-B hepatitis, or posttransfusion hepatitis) accounts for as many as 40% of the cases of hepatitis in the United States. It is the main indication for liver transplant in the United States when cirrhosis is present. The disease is transmitted by infected blood and is commonly seen in intravenous drug abusers and those who had blood transfusions infected with the virus. The disease is usually insidious in its presentation, and the severity is variable. As many as 50% of these patients may develop chronic disease, which may eventually lead to cirrhosis. The diagnosis is made by serologic means, and pegylated α-interferon and ribavirin have been used for treatment.

• Hepatitis E. The transmission is similar to the hepatitis A virus. The disease is found in India and Southeast Asia, Africa, and Mexico. Cases in the United States are usually related to travel to these endemic areas.
Hepatitis E virus is associated with a high fatality in pregnant women