National Journal of Homoeopathy - Hepatitis B

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CASES	MATERIA MEDICA	GENERAL ARTICLES	ABSTRACT	MISCELLANEOUS	Q & A

Hepatitis B - A Dreaded Disease
NATIONAL JOURNAL OF HOMOEOPATHY 1993 May / Jun Vol II No 3.
Dr Shivani Mittal.

Introductions:
The liver is the largest gland in the body and the fact that it contains one fourth of the blood in the body, shows the important role it plays in the body metabolism.

The symptoms due to disorders of the liver are not so clearly defined as those of cardiac or pulmonary diseases. The liver has considerable reserve and much power of regeneration. Approximately one tenth of the normal parenchyma is adequate to maintain its various functions. However when liver cells become gradually destroyed as in hepatitis, serious disturbances in the general health ensue, leading gradually to lethargy and coma.

Hepatitis B :
Hepatitis B is a highly infectious disease caused by a virus which affects the liver. It may progress to Chronic Liver disease, Liver cirrhosis even liver cancer. Doctors and the paramedical staff who handle such patients are at a high risk of acquiring the disease.

Causation:
It is caused by Hepatitis B Virus which is a 42 nm double -celled virus, previously called as Dane Particle. Hepatitis B surface Antigen (HBsAg), also known as Australia Antigen is found on the surface of the virus. Its detection in serum is diagnostic of active HBV infection or carrier stage.

Antibody to Hepatitis B surface antigen (Anti Hbs Ag) is diagnostic of previous HBV infection as well as on immunisation which confers immunity against HBV infection.

Mode of Infection : Transmission occurs through three routes -

Percutaneous,
Nonpercutaneous and
Vertically (from mother to foetus).

HBV is responsible for 10 percent of Posttranfusional hepatitis. Transmission occurs by haemodialysis via transplantation and through cracks in the skin. Serologic evidence of HBV is present in over 50 percent of drug addicts. HBsAg has been identified in faeces, urine, saliva, vaginal secretions, semen, colostrum and other body fluids. Thus, high attack rates occur in spouses and sexual partners of affected patients, in family members of chronic carriers,among male homosexuals and among institutionalised children with Downs syndrome. In addition, HBV may be transmitted vertically from mother to infant during prenatal period. (by contact with blood and or secretions during delivery or in immediate postnatal period.) The risk is greatest when the mother has acute hepatitis during the last trimester of pregnancy. Carrier mothers may also infect their infants transplacentally.
Incubation period : 40-180 days.

Clinical stages :

Anticetric Phase - Infection starts insidiously and occasionally. Serum sickness like syndrome is marked in an acute attack. The first symptom is abdominal discomfort with an enlarged, tender liver. By now serologic studies would be helpful to mark the causative agent.
Icteric Phase - Lasts few days to a week or more. Deep jaundice appears with severe pruritis (reaction of bile salts).
Convalescent Phase - Two or more weeks. Bilirubin and enzyme levels as also liver tenderness and enlargement slowly come down.

In some cases extrahepatic manifestation may occur, viz Serum sickness like syndrome, Essential Mixed Cryoglobulinemia, Polyarteritis nodosa, Membranous or Membrano proliferative glomerulonephritis, severe Aplastic anaemia, Pleural effusion, Myocarditis and Pericarditis occur less frequently.

Laboratory Investigations:
Various immunologic assays are available for specific diagnosis of HBV. These include Haemagglutination assays, ELISA techniques and Radioimmunoassays (RIA).

Prevention and Treatment:
There is no effective treatment for this disease except supportive therapy. Prevention from acquiring the disease is possible. Active immunization is available by Hepatitis B Vacc. 3 doses of the vaccine are given to achieve immunity.

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