Introduction
Hepatitis B is a liver infection caused by the hepatitis virus (HBV). The DNA virus spreads through percutaneous routes. Hepatitis B is also transmitted sexually. Cases of HBV may vary from mild to severe from one patient to another. Chronic cases that lead to liver failure, cirrhosis, or carcinoma are common in patients that acquired HBV in early childhood. It is estimated that more than 250 million people are living with the hepatitis B virus in the world (Berger, 2019). According to the research, in 2015, there were more than 800,000 deaths resulting from complications related to the infection (Berger, 2019). The numbers are rising with almost 2 million diagnoses every year; most of the new infections are in children (Berger, 2019). Mother-to-child transmission contributes to this statistic. Highly endemic areas of the disease are Africa, China, and parts of Asia; half of all infections in the world are in these areas. Europe and America have proven to be regions of low prevalence of HBV infections. It is crucial to implement effective strategies to appropriately care for hepatitis B infection especially in high endemic areas where care for the infected patients faces challenges due to health disparity.
Etiology and Risk Factors
Hepatitis B infection (HBV) belongs to the hepadnaviruses family; it is an enveloped, highly contagious DNA virus. According to Liang (2020), the external envelope of the infection contains three related surface antigens, the most bountiful of which is the S protein. The progression of cell and humoral invulnerability to the S protein is defensive. Inside the envelope is the viral nucleocapsid, also known as the core. It contains hepatitis B core antigen [HBcAg], a partially double-stranded circular DNA (Liang, 2020). HBcAg-inferred peptides initiate an essential host cell insusceptible reaction against HBV. Hepatitis B e antigen, a hepatitis B viral protein, fills in as a marker for dynamic replication, yet its capacity is obscure (Liang, 2020). The X protein may facilitate the occurrence and progression of hepatocellular carcinoma. According to Liang (2020), DNA polymerase serves an opposite transcriptase function for the synthesis of both negative and positive strands of HBV DNA.
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Hepatitis B is caused by contact of bodily fluids, blood, or semen with an already infected person. Common causes include mother to child infections, sharing of needles, needle accidents, razor accidents, toothbrush sharing, and sexual contact with HBV patient. According to Berger (2019), chances of infection are higher for people who share needles for drug use, have sex with anyone infected with HBV, live with someone with chronic hepatitis B, infants born to infected mothers, and work in places where one is exposed to human fluids. Even though HBV can be passed from mother to child during birth, the disease is not hereditary; it is not a genetic disease. Research reveals that in the U.S, instances of the diseases are most prevalent among adults aged 40-49 years, indicating low HBV immunization inclusion among the age group (Berger, 2019). Even though both males and females can contract the disease, more chronic conditions have been reported in males than females.
Pathophysiology
It is believed that the patient’s immune response to the viral antigens causes liver injury contrary to the assumption that the virus destroys the hepatocytes (Hubert & VanMeter, 2018). Research reveals that the cellular immune response is primarily involved in HBV pathogenesis, and not the humoral immune response. When the patient's T lymphocytes are presented with viral epitopes by antigen-presenting cells in lymphoid organs, the induction of antigen-specific T-lymphocyte response occurs (Hubert & VanMeter, 2018). These antigen-explicit T cells develop and extend and afterward move to the liver.
Clinical Manifestations and Complications
Normally, signs of hepatitis B first appear between one to four months from infection; in rare cases, symptoms appear within two weeks whereas young children may not show any symptoms. Signs and symptoms of HBV include dark urine, fever, abdominal pain, jaundice, joint pain, and loss of appetite (Hubert & VanMeter, 2018). If exposed to the virus, early or preventive treatment within one day from exposure may reduce the risk of infection. Hepatitis B has more than one clinical presentation. The first is the presence of an enlarged liver in the patient, liver injury, and evidence of liver mass (Hubert & VanMeter, 2018). In other cases, there might be no liver injury but the presence of clinical symptoms of the disease. Fulminant hepatic failure is a complication associated with HBV that occurs to less than 1 % of the virus patients (Liang, 2020); liver transplantation is recommended to the patients that develop this complication to avoid mortality. Cirrhosis and hepatocellular cancer (HCC) are other complications associated with HBV. Cirrhosis, which occurs in about 20% of acute HBV patients, can be treated (Berger, 2019). According to Liang (2020), 50% of all HCC cases are HBV related; liver transplantation in early stages helps reduce mortality in HBV-related hepatocellular cancer.
Diagnostics
Laboratory investigations and physical examinations are conducted to investigate the presence of the virus in patients. In those with symptomatic acute HBV infection, a normal physical examination attempts to find tender hepatomegaly and jaundice which indicates infection. Imaging in the form of baseline abdominal ultrasound and liver biopsy are used to evaluate the state of the patient’s liver.
References
Berger, S. (2019). Hepatitis B Statistics .
Hubert, R., & VanMeter, K. (2018). Gould's pathophysiology for the health professions . St. Louis, Missouri: Elsevier.
Liang, T. (2020). Hepatitis B: The Virus and Disease. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809016/
