Hepatitis:
symptoms, transmission path, forms
Hepatitis means inflammation of the liver. It is caused either by viruses, poisons, medicines or autoimmune diseases. Hepatitis occurs in various forms. Read here about which treatments are available and how to prevent hepatitis.
Hepatitis means inflammation of the liver. It can be caused by viruses, poisons such as alcohol or certain medications. Another possible cause is autoimmune disease, in which the body’s own defence system destroys the liver.
Hepatitis may be either acute (lasting fewer than six months) or chronic (lasting more than six months).
Not all cases of hepatitis are the same. Basically, a distinction can be made between infectious and non-infectious liver inflammation:
Infectious, virus-induced hepatitis (inflammation of the liver):
| Hepatitis A |
Hepatitis A is a form of acute viral hepatitis often transmitted by contaminated food during travel. The first symptoms appear 15 to 50 days after infection. Full recovery may take several months. After recovery, the person has lifelong immunity against hepatitis A viruses. |
| Hepatitis B |
The most widespread form of hepatitis is hepatitis B, which is also caused by a virus and is transmitted via close contact (living in the same house can already be sufficient). According to the World Health Organization (WHO), some 296 million people worldwide and about 14 million in Europe alone have hepatitis B. |
| Hepatitis C |
Also a viral disease, hepatitis C is often mild. As a result, the chronic type often remains unnoticed for several years. In later stages, the risk of developing liver cirrhosis or liver cancer is increased. |
| Hepatitis D |
Hepatitis D requires hepatitis B viruses to multiply. Accordingly, an infection with hepatitis B must already be present or a simultaneous infection of B and D hepatitis viruses must take place. The clinical picture corresponds to hepatitis B and often leads to severe chronic liver inflammation. |
| Hepatitis E |
Hepatitis E is an acute disease. The virus is transmitted through contaminated food and blood products and by smear infections. The symptoms are often mild and similar to those of hepatitis A – they appear about three to eight weeks after infection. It then takes another six weeks for them to disappear. Hepatitis E usually is not dangerous. In pregnant women, however, the symptoms can be severe and can even lead to death. |
Non-infectious hepatitis:
Autoimmune hepatitis
Unlike the aforementioned forms of hepatitis, autoimmune hepatitis is caused by the body’s own, misguided immune defences and not by viruses. Its course is almost always chronic and tends to go unnoticed for a long time. In severe cases, liver failure caused by cirrhosis of the liver may occur.
Substance-induced hepatitis
Toxins such as alcohol or certain medications (paracetamol, diclofenac and chlorpromazine or the cancer drug methotrexate) can lead to hepatitis. Heavy metals and chemicals such as carbon tetrachloride can also trigger liver inflammation. Environmental toxins (DDT or dioxin) may also be a possible cause.
Hepatitis symptoms can vary depending on the person and disease type. However, they can generally be divided into two categories:
Symptoms that may indicate acute hepatitis:
- Nausea
- Vomiting
- Stomach ache
- Muscle pain
- Joint pain
- Loss of appetite
- Loss of smell and taste
- Fever
- Skin rash
- Liver pain
- Yellowing of the skin and eyeballs
- Colour changes in urine and stool
Symptoms that may indicate chronic hepatitis:
In the early stages, similar symptoms may occur as in acute hepatitis (pain in the liver area, joint pain, loss of appetite). Chronic hepatitis may, however, lead to additional symptoms:
- Vascular changes (spider angiomas)
- Redness on the palms of the hands, soles of the feet, lips and tongue
- Itching
- Jaundice
- Enlarged mammary glands in men
- Shrinking of the testicles
- Loss of pubic and abdominal hair in men
- Menstrual disorders
- Itchy skin
In general, only those forms of hepatitis that are caused by viruses are transmitted. Depending on the form, hepatitis is transmitted in different ways:
| Hepatitis form | Transmission path |
|---|---|
| Hepatitis A | Smear or contact infection through close contact with people infected with hepatitis A, infected objects, food (especially seafood, vegetables or salad) and drinking water, or through sexual intercourse. |
| Hepatitis B | Via the blood, e.g. contaminated syringes or blood transfusions, bodily fluids such as saliva, tears, sperm, vaginal secretions or urine. |
| Hepatitis C | Mostly through infected blood, e.g. contaminated syringes. |
| Hepatitis D | Smear or contact infection via infected blood or bodily fluids. |
| Hepatitis E | Mainly via contaminated food (often infected pork), very rarely from person to person. |
A blood test will also be carried out. If the patient is infected with the hepatitis virus, specific antibodies can be found in the blood, for example.
An ultrasound examination provides information on the size and condition of the liver.
A liver biopsy, i.e. a tissue sample, can be used to determine whether the liver is inflamed.
Special medications are available for severe, chronic conditions. For hepatitis B and C, these are antiviral drugs. Hepatitis C can now be completely cured with 8 to 12 weeks of treatment with direct acting-antivirals (DAAs). Autoimmune hepatitis can be treated with drugs that suppress the immune system (e.g. cortisone, azathioprine).
A liver transplant may be required in severe hepatitis cases.
The consumption of alcohol and medicines that damage the liver should generally be avoided, as they also burden the liver.
Hepatitis A vaccination is advised for people who are travelling to areas with poor hygiene conditions and for men who have sex with other men.
Hepatitis B vaccination should be given in infancy, preferably with a hexavalent vaccine, or to young people aged 11 to 15 who have not yet been vaccinated. Travellers to high-risk areas and at-risk groups should get vaccinated at any age. These include, for example, people who work in healthcare and injection drug users. Here, too, a combination vaccination with hepatitis A and B is available.
If you are diagnosed with hepatitis, there is no need to panic. A normal day-to-day life is still possible if you follow certain rules. For example, if you have hepatitis A, it is important to wash your hands thoroughly after going to the toilet, as excrement is contagious. In the case of hepatitis B, family members and sexual partners should be vaccinated.
A consultation with a doctor will make it easier to follow the appropriate rules for a specific form of hepatitis. Regular examinations prevent any complications. People with hepatitis can also get support from self-help groups.
For more information and support services, please visit:
- Schweizerischer Impfplan 2022, Stand Januar 2022, Bundesamt für Gesundheit und Eidgenössische Kommission für Impffragen https://www.bag.admin.ch/bag/de/home/gesund-leben/gesundheitsfoerderung-und-praevention/impfungen-prophylaxe/schweizerischer-impfplan.html
- Deutsche Leberhilfe e. V., unter: www.leberhilfe.org (Abrufdatum: 07.12.2022)
- Hepatitis A, über Universitätsspital Zürich, unter https://www.usz.ch/krankheit/hepatitis-a/ (Abrufdatum 05.12.2022)
- Leben mit Hepatitis über Hepatitis Schweiz, unter: https://hepatitis-schweiz.ch/ (Abrufdatum 08.12.2022)
- Selbsthilfegruppen über Selbsthilfe Schweiz, unter: https://www.selbsthilfeschweiz.ch/shch/de/selbsthilfe-gesucht/themenliste~thema~Hepatitis---Hepatite---Epatite~.html (Abrufdatum 6.12.2022)
- S3-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) unter Beteiligung der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie (ÖGGH), der Schweizerischen Gesellschaft für Gastroenterologie (SGG) et al.: "Prophylaxe, Diagnostik und Therapie der Hepatitis-C-Virus(HCV)-Infektion", Stand: Dezember 2017 (in Überarbeitung), unter: www.awmf.org (Abrufdatum: 05.12.2022)
- S3-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwelchselkrankheiten (DGVS) et al.: "Prophylaxe, Diagnostik und Therapie der Hepatitis-B-Virusinfektion" (Stand: Juni 2021, in Überarbeitung), unter: www.awmf.org (Abrufdatum: 05.12.2022)
- World Health Organisation: Hepatitis B vaccines: WHO position paper – July 2017. Weekly epidemiological record. WHO Position Paper No. 27, 2017; 92: 369–392 (Abrufdatum: 23.06.2022)
- World Health Organisation: Hepatits B, unter: www.who.int (Abrufdatum: 05.12.2022)
- World Health Organisation: Hepatits C, unter: www.who.int (Abrufdatum: 05.12.2022)