Rare Hepatitis

21.10.2019
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Rare Hepatitis

What are rare hepatities?

Rare hepatitis is defined as inflammatory liver diseases with a frequency of less than 20% of all hepatitis, symptomatic or asymptomatic, with fluctuating balance. Of these, the most common are:

  • autoimmune hepatitis
  • drug hepatitis
  • metabolic hepatitis
  • and hepatitis E, G virus

For autoimmune, drug and metabolic hepatitis, the clinical picture is common, with certain features depending on the aetiology. Often, the disease is without significant clinical manifestations for a long time or is manifested only by an asthenic, adynamic, inexplicable syndrome. Food intolerance is associated with non-specific abdominal pain at work or after meals.

Autoimmune hepatitis is an uncommon disease, accounting for approximately 20% of total chronic hepatitis in Western Europe. It is more common in women, with an age distribution that has peaks of maximum prevalence between 10-20 years and after 40 years.

Its appearance is due to genetic predisposition or to exogenous factors, such as the intervention of subtle viral infections or the administration of some drugs, sensitization to drugs can generate an autoimmune response.

The symptoms of presentation are general, physical asthenia, nausea, fever without chills, lack of appetite, which is why very important for the diagnosis are the laboratory analyses, with transaminases with high values and the presence of autoantibodies. There are also very rare situations when autoantibodies are absent, the diagnosis being determined by performing the liver biopsy score and the response to the therapeutic test.

Corticotherapy is the standard treatment for autoimmune hepatitis, a treatment that must be initiated as soon as there is the certainty of the diagnosis, provided by the biological balance sheet, completed with autoantibody testing and liver biopsy. Treatment should be continued for at least 6 months or until the complete biological response is obtained.

Undiagnosed and untreated in time, autoimmune hepatitis has an inexorable evolution towards liver cirrhosis and its complications.

Other categories of hepatite

Another category of rare hepatitis is drug hepatitis. Although the list of hepatotoxic drugs has grown a lot, it is not to be concluded that hepatopathies are common diseases. About 10% of hepatitis cases have drug aetiology. The diagnosis is difficult to establish, as there are no reliable clinical, biological and histological criteria. The diagnostic difficulties make the detection of early liver lesions impossible in all cases.

The clinical diagnosis is based on the chronology of the disease onset, the regression of the symptomatology at the interruption of the treatment and the relapse after the re-administration of the drug.

Treatment of drug hepatitis consists mainly of stopping the respective drug.

Continuation of the causative treatment and after the occurrence of biological changes can cause acute fulminant hepatitis, which is a serious form, with a very severe prognosis, since mortality is very high (80-90% of cases).

Metabolic hepatitis is also a rare form of hepatitis, is Wilson's disease, hemochromatosis and alpha 1 antitrypsin deficiency, genetic diseases with similar symptoms, whose correct diagnosis, in time, is extremely important, thus preventing progression to advanced forms. liver disease.

Viral hepatitis E is an endemic form of hepatitis due to poor hygiene conditions, which is transmitted by faecal - oral route, the consumption of drinking water contaminated with faeces being responsible for the occurrence of most epidemics. Another type of infection is the ingestion of insufficiently prepared animal products or the consumption of crustaceans.

The clinical picture is similar to that of hepatitis A. After an incubation period of 15 to 60 days, patients infected with HEV develop signs and symptoms of hepatitis (fever, hepatomegaly, moderate increase of transaminases), with the appearance of anti-HEV antibodies.

Under normal conditions, the disease heals spontaneously, without treatment. Rest, balanced diet, alcohol avoidance and hepatoprotective treatment are recommended. There is no specific viral therapy for hepatitis E. Long-term follow-up of patients has denied the possibility of chronic infection.

Viral hepatitis G is a very rare form of hepatitis, with parenteral transmission, through various routes of transmission. Hepatitis G virus was discovered when people had hepatitis after transfusion, and its cause could not be associated with any of the existing liver viruses. It is transmitted through frequent contacts with blood or blood derivatives, parenteral drug injection, tattoos, piercings, joint use of toothbrushes, shaving devices, manicure and pedicure kits, unprotected sex. The only way to avoid infection with the hepatic G virus is to adopt rigorous measures of personal health and hygiene, associated with avoiding drug use, performing tattoos in dubious places, avoiding borrowing personal hygiene tools, avoiding sexual contact with unstable partners.

In conclusion, rare hepatitis are liver diseases that can be prevented and diagnosed in a timely manner, through a healthy lifestyle and through periodic, complete medical checks, carried out by the primary care physician later, by the specialist doctor. 

Prof. Irinel Popescu is a prominent surgeon and a member of the Romanian Academy of Sciences. He is a leader in surgical oncology and liver-related medical procedures. For the last three decades, Prof Popescu has been the pioneer and motivator of liver transplants in Romania and the founder of a Romanian school for liver transplantation.
Prof. Popescu is a social contributor in raising the public awareness for organ donation, which Romania is still showing a very sluggish progress in.
He is a member of many local and international medical associations and a respectable writer and speaker in the most important medical and surgical conferences.
Prof. Popescu serves as the President of the Romanian Academy of Medical Sciences and as a Corresponding Member of the Romanian Academy.


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