Hepatitis D, which belongs to the group of liver diseases, is basically a notifiable health-attacking disease caused by infection. Hepatitis D has a great epidemiological importance. Specific microorganisms come into question as triggers for hepatitis D.
What is hepatitis D?
Hepatitis D is a disease affecting the liver, which can occur in the patients who already suffer from contagious hepatitis B or are healthy. The term hepa- means that the liver is severely affected in hepatitis D. The suffix -itis’ indicates that hepatits D mainly involves inflammatory processes. Basically, hepatitis D results in pathological and definitive damage to the liver cells, which are absolutely necessary for metabolism in the body, by specific triggers. However, in Germany, hepatitis D is considered a disease that hardly occurs.
Causes
The causes of hepatitis D are easy to explain, because as a result of scientific research, it has been shown that specific viruses can be considered as causative agents. Hepatitis D is about the pathogen known as hepatitis D virus. This virus is derived from hepatitis B and is characterized by a protein found on its cell surface, HBsAg. For this reason, people who have already been infected by a hepatitis B virus almost always contract hepatitis D as well. Healthy people can become infected by ingesting food and by transmitting the virus from people who have the disease. This can occur through contact fluids such as semen, tear fluid, the mother’s milk when breastfeeding, and saliva. Blood and all other transmission media also enter the healthy organism through the mucous membranes or injuries and contribute to hepatitis D infection.
Symptoms, complaints, and signs
Hepatitis D occurs only along with hepatitis B because the HD virus requires the envelope protein of the HB virus to replicate. Symptoms are similar to those of HBV infection. However, the course and severity of symptoms depend on whether the patient becomes infected with both viruses simultaneously (simultaneous infection) or whether the HDV infection occurs after an HBV infection (superinfection). In simultaneous infection, chronic courses rarely occur because both viruses interfere with each other. However, the acute course of the disease can still be severe. As with HBV infection, simultaneous infection begins with nonspecific symptoms such as fatigue, loss of appetite, lassitude, headache, joint pain, fever, and pressure in the right upper abdomen. Furthermore, diarrhea, nausea and vomiting may also occur. In addition, jaundice often occurs. The skin and eyes turn yellow and the stool is discolored and the urine is dark. In most cases, hepatitis with simultaneous infection with both viruses heals completely after a severe acute course of the disease. However, if HDV infection occurs after HBV infection is almost over, similar symptoms are observed, but they are usually more severe. Often the infection then progresses fulminantly to fatal liver failure. At the same time, a chronic course with the development of liver cirrhosis to liver cancer is also very common.
Course
After a so-called incubation period, during which the viruses multiply, both chronic and acute signs occur in the course of hepatitis D. Those suffering from infection with the hepatitis D virus tend to show nonspecific signs of illness that are flu-like and manifest as fatigue, tiredness, aching limbs, and general discomfort. In many cases, the skin and mucous membranes turn yellowish and icterus develops. About 90 percent of those who contract hepatitis D recover. In addition to destruction of the liver and liver cancer, as well as severe impairment of the liver, those affected by hepatitis B suffer from constant bouts of fever and general weakness. In the vast majority of cases, the prognosis is very poor if hepatitis B and a so-called superinfection are present at the same time as hepatitis D. If the patient is already suffering from hepatitis B, then an infection with the pathogen typical of hepatitis D will, as it were, intensify the signs of the disease.
Complications
Infection with hepatitis D virus alone is not possible; a previous infection with hepatitis B virus is a prerequisite. Thus, infection with hepatitis D is rather harmless. It becomes more dangerous if the affected person is infected with both the hepatitis B and the hepatitis D virus at the same time. This greatly increases the likelihood of developing chronic hepatitis. It is even more dangerous if a person who already has hepatitis B becomes infected with the hepatitis D virus. This increases the risk of developing a chronic course and also the probability of developing cirrhosis of the liver. In the case of liver cirrhosis, the quality of life is severely restricted. The affected person is no longer able to synthesize proteins for the blood in sufficient quantities. In particular, these are proteins that maintain oncotic pressure and coagulation proteins. As a result, water retention can occur (edema) and bleeding time is also prolonged. Furthermore, the liver can no longer detoxify sufficiently, the cell toxin ammonia accumulates, which can lead to disorders and paralysis in the central nervous system (hepatic encephalopathy). The probability of developing liver cancer in the course with liver cirrhosis is greatly increased. Life expectancy in general is limited in affected individuals.
When should you see a doctor?
Immediate medical evaluation is necessary for hepatitis D. There is no self-cure with this disease and it usually leads to death if the disease is not treated. In addition to symptoms, the affected person should pay attention to whether he or she has been in an area affected by hepatitis D in recent weeks and months. The visit to the doctor is necessary when jaundice occurs. Jaundice represents the main symptom of all hepatitis diseases. Usually, high fever and fatigue or exhaustion also indicate hepatitis D and must be examined by a medical professional. Those affected suffer from weight loss, severe abdominal pain and loss of appetite. If hepatitis D is not treated, the affected person’s liver will be completely destroyed. Hepatitis D can be diagnosed and treated by a general practitioner or in a hospital. Since a direct and complete cure of the disease is not possible, patients are usually dependent on long-term therapy.
Treatment and therapy
Although hepatitis D is an extremely debilitating and prolonged dangerous disease that can be associated with severe health consequences, therapeutic options are largely limited. Beyond that, treatments are available in the form of addressing the individual symptoms of hepatitis D. In principle, a one-year therapy with interferon can be realized. In the case of hepatitis D, this can lead to the pathogenic virus being rendered harmless. However, this drug is considered controversial in terms of its effects in hepatitis D. The treatment of hepatitis D is usually carried out with the same methods that are indicated for hepatitis B. Nevertheless, not all therapeutic measures are equally effective. No medications can currently cure hepatitis D. Only pain medications to relieve the painful symptoms and medications to relieve nausea and vomiting are used in the treatment of hepatitis D.
Outlook and prognosis
Timely diagnosis is especially important for the progression of hepatitis D. Therefore, anyone with acute or chronic hepatitis B should definitely also be screened for hepatitis D infection. The test is simple and can be performed by means of a simple blood test. The course of the disease often cannot be predicted with certainty, since the therapy of hepatitis D is very challenging. However, the virus-induced chronic inflammation of the liver can be treated successfully today. For example, interferon therapy, as used in the treatment of the B virus, is also effective for hepatitis D. The treatment of hepatitis D with interferon has been shown to reduce the number of infections. This preparation has been shown to reduce the viral replication rate very significantly. However, the therapy is not always one hundred percent effective. Frequently, the infection reoccurs after a temporary stop. Therefore, relapses can occur after the end of therapy. Sometimes these often do not show up until years after treatment.Hepatitis D can lead to severe liver damage and liver inflammation and even liver failure. This can be accompanied by a number of (sometimes serious) functional disorders of the organism. Stopping the progressive and ever-increasing strain on the liver is therefore particularly important. Although interferon cannot stop the progression of the disease with a guarantee of permanence, it nevertheless enables long, symptom-free phases.
Prevention
Prevention of hepatitis D is particularly recommended if travel to Mediterranean countries and to other, predominantly tropical and subtropical continents is planned or if there is increased contact with people who may be infected. This applies to special occupational groups. In this context, vaccination against hepatitis D is the only sensible precaution. In this regard, it is true that a preventive vaccination against hepatitis B with attenuated pathogens is equally effective as hepatitis D prophylaxis.
Follow-up
In most cases of hepatitis D, follow-up care proves to be relatively difficult. As a rule, this involves first treating the disease comprehensively to prevent further complications or further worsening of symptoms. The sooner hepatitis D is detected, the better the further course of the disease usually is. The disease can only be treated symptomatically. The affected person should always ensure strict bed rest so as not to put unnecessary strain on the body. Physical or stressful activities should be avoided in any case. In many cases, medication can be taken to alleviate the symptoms of hepatitis D. The correct dosage must be observed. The correct dosage and regular intake of these medications must be ensured in order to alleviate the symptoms. Regular examinations by an internist are also of high importance, with the affected person’s liver being examined in particular. During treatment, the patient must change his diet to a light one to relieve the liver. It is also possible that hepatitis D may cause the affected person to have a reduced life expectancy.
What you can do yourself
An outbreak of hepatitis D must be clarified and treated by a doctor in any case. Against the individual symptoms, a number of measures and remedies from the household and nature can be used. Especially essential is a healthy and balanced diet with sufficient vitamins, minerals and trace elements. This allows the immune system to quickly return to its optimal performance. Patients should also drink plenty of water. Stimulants such as alcohol, nicotine or caffeine should be avoided as far as possible. Patients should exercise regularly and cure the disease well by resting in bed. For liver complaints, various teas (e.g. milk thistle, yarrow, birch leaves), artichoke juice and baths with sativa oats or essential oils are recommended. For pain, soothing preparations such as calendula ointment or valerian drops help. Alternatively, the ozone own-blood treatment is offered, in which the own blood is enriched with ozone. At home, sufferers can use a shiatsu treatment and other methods of Chinese medicine. However, the best measure is to avoid the outbreak of hepatitis D by consulting a physician already with hepatitis B.
