What Is A Bacterial Infection
Bacterial infection occurs when one or more bacteria have entered the body and begin to multiply. However, not all bacterial infections cause disease.
Bacteria have evolved to evade or manipulate the bodys immune system. So when pathogenic bacteria enter the body,
move from one person to another by :
- Touch: If people do not wash their hands, they can transmit bacteria and viruses onto other surfaces, including food.
- Droplets: When a person sneezes or coughs, they create droplets that carry viruses and bacteria, which another person can inhale.
- Injury: Some bacteria and viruses enter the body through cuts and puncture wounds.
To determine if a person has a viral or bacterial infection, a doctor will usually ask questions about their symptoms and perform a physical exam.
To confirm a diagnosis, they may request tests, such as:
- Enzyme-linked immunosorbent assay : This test can help to detect infection due to many viruses, including HIV and bacterial infections such as Lyme disease.
- Polymerase chain reaction : This test sequences the DNA of microorganisms, and can detect viral infections, such as HPV, in addition to bacterial infections including, Escherichia coli .
- Electron microscopy: This type of imaging can be used to identify rare viral and bacterial infections that require high resolution to detect. However, because electron microscopy is an expensive diagnostic tool, doctors rarely request it.
Who Is More Likely To Get Hepatitis B
People are more likely to get hepatitis B if they are born to a mother who has hepatitis B. The virus can spread from mother to child during birth. For this reason, people are more likely to have hepatitis B if they
- were born in a part of the world where 2 percent or more of the population has hepatitis B infection
- were born in the United States, didnt receive the hepatitis B vaccine as an infant, and have parents who were born in an area where 8 percent or more of the population had hepatitis B infection
People are also more likely to have hepatitis B if they
- are infected with HIV, because hepatitis B and HIV spread in similar ways
- have lived with or had sex with someone who has hepatitis B
- have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
- are men who have sex with men
- are injection drug users
- work in a profession, such as health care, in which they have contact with blood, needles, or body fluids at work
- live or work in a care facility for people with developmental disabilities
- have been on kidney dialysis
- live or work in a prison
- had a blood transfusion or organ transplant before the mid-1980s
In the United States, hepatitis B spreads among adults mainly through contact with infected blood through the skin, such as during injection drug use, and through sexual contact.12
Histological And Immunological Changes In The Colon
To investigate the histological and immunological changes in the colon, we measured the length and immune molecule expression in the colon, as well as performed HE staining. No significant difference was observed in the length of the colon among the control, pSM2/HBV HI, and pAAV/HBV1.2 HI mice on days 0, 14, and 49 after HI . HE staining showed that the structure of the colon was complete and that no obvious damage was observed in the control, pSM2/HBV HI, and pAAV/HBV1.2 HI mice on days 0, 14, and 49 after HI .
Figure 8. Pathological and immunological changes in the colon of the control, pSM2/HBV HI, and pAAV/HBV1.2 HI mice. Macropathologic changes in the colon and colon length, and histological changes in the colon of the control, pSM2/HBV HI, and pAAV/HBV1.2 HI mice at different time points. The mRNA expression levels of immune-related molecules in the colon on days 14 and 49 after HI as detected by real-time PCR. Control mice, n = 3 pSM2/HBV HI mice, n = 3 pAAV/HBV1.2 HI mice, n = 37. *p< 0.05.
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What Are The Risk Factors For Getting Hepatitis B
Due to the way that hepatitis B spreads, people most at risk for getting infected include:
- Children whose mothers have been infected with hepatitis B.
- Children who have been adopted from countries with high rates of hepatitis B infection.
- People who have unprotected sex and/or have been diagnosed with a sexually transmitted infection.
- People who live with or work in an institutional setting, such as prisons or group homes.
- Healthcare providers and first responders.
- People who share needles or syringes.
- People who live in close quarters with a person with chronic hepatitis B infection.
- People who are on dialysis.
Important: Hepatitis Cases In Children
The number of cases of hepatitis in children has increased recently. Public health doctors and scientists are looking into what could be causing this.
See a GP if your child has symptoms of hepatitis, including yellowing of the eyes and skin .
Good hygiene, including supervising hand washing in young children, can help to prevent infections that can cause hepatitis.
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Recipients Of Chemotherapy Immunosuppression Or Organ Transplants
Individuals who are inactive HBsAg carriers and undergo cancer chemotherapy or immunosuppressive therapy are at risk of acute reactivation of hepatitis B, which can present as fulminant hepatitis. As HBV persists as highly stable cccDNA within hepatocyte nuclei, reactivation can occur in virtually all patients infected with HBV, even in patients who experience spontaneous resolution of infection or successful antiviral therapy. The risk of HBV reactivation varies within an individual based on their HBV serologic status, type of immunosuppressive therapy, and potential disruption of immunologic control. The greatest risk of reactivation has been associated with the presence of detectable serum HBV DNA, HBeAg positivity, HBsAg positivity, and the use of systemic cancer chemotherapy, B cell depleting agents such as rituximab, or high dose steroids . Reactivation can occur in those who are HBsAg negative and has been described in association with biologic agents such as tumor necrosis factor alpha inhibitors as well as in the setting of transarterial chemoembolization for hepatocellular carcinoma .
Correlations Of Microbial Products With Immune Markers
Correlations of microbial products with cytokines, macrophage activation markers, and clinical parameters were performed to assess potential influences of microbial factors on the immune system . Within controls and HDV cohorts, LPS correlates with soluble-CD14 , a marker of macrophage activation . Within HBV subjects, LPS positively correlates with several cytokines that aid in antimicrobial immune responses, such as IL-2, IL-12, CXCL9, and CXCL10 . For all 3 cohorts, peptidoglycan assessed by the polyclonal-antibody assay correlates with proinflammatory cytokine IL-8, HMGB-1, and type-2 inflammatory cytokine IL-13 . Within HBV and HDV subjects, poly-PG correlates with proinflammatory cytokines IL-1b and CCL3, type-1 cytokines IL-2 and IL-12p70 and type-2 cytokine IL-4 . Polyclonal-peptidoglycan also shows strong correlations with other cytokines within the HBV cohort alone. Monoclonal-peptidoglycan and beta-glucan demonstrate only a few weaker correlations with the cytokines assessed.
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What Is The Role Of Liver Transplantation In Hepatitis B
Liver transplantation has been successful in patients who have irreversible, life-threatening complications of hepatitis B. This includes patients with liver failure due to end-stage cirrhosis or unusually severe hepatitis. Liver transplantation does not cure hepatitis B, and hepatitis may occur in the new liver. The incidence of recurrent hepatitis has been reduced to less than 10% through use of lamivudine and HBIG in transplant recipients. Use of these agents has also improved long-term survival, with 75% of patients alive after five years.
What Is The Treatment For Viral Hepatitis
Treatment of acute viral hepatitis and chronic viral hepatitis are different. Treatment of acute viral hepatitis involves resting, relieving symptoms, and maintaining an adequate intake of fluids. Treatment of chronic viral hepatitis involves medications to eradicate the virus and taking measures to prevent further liver damage.
Acute hepatitis
In patients with acute viral hepatitis, the initial treatment consists of relieving the symptoms of nausea, vomiting, and abdominal pain . Careful attention should be given to medications or compounds, which can have adverse effects in patients with abnormal liver function . Only those medications that are considered necessary should be administered since the impaired liver is not able to eliminate drugs normally, and drugs may accumulate in the blood and reach toxic levels. Moreover, sedatives and “tranquilizers” are avoided because they may accentuate the effects of liver failure on the brain and cause lethargy and coma. The patient must abstain from drinking alcohol since alcohol is toxic to the liver. It occasionally is necessary to provide intravenous fluids to prevent dehydration caused by vomiting. Patients with severe nausea and/or vomiting may need to be hospitalized for treatment and intravenous fluids.
Chronic hepatitis
Medications for chronic hepatitis C infection include:
- oral daclatasvir
Medications for chronic hepatitis B infection include:
- oral entecavir
- oral tenofovir
Fulminant hepatitis
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What Are The Types Of Hepatitis B
There are two types of hepatitis B infection: acute and chronic.
Acute
An acute infection happens at the beginning, when you first get infected with hepatitis B. Many people are able to clear it from their bodies and recover. In fact, this is true of about 4 in 5 adults who are infected.
Chronic
If you are not able to clear the infection within six months or longer, you have chronic hepatitis B. It is chronic hepatitis B that leads to inflammation and the serious, and possibly fatal, illnesses of cirrhosis of the liver and liver cancer. Treatment can slow disease progress, reduce the chance of liver cancer and increase your chances of surviving.
Prevention Or Infection Control Measures
A significant reduction in the incidence of HCC in some populations can be directly attributed to the HBV vaccine. One large study in Taiwan based on data from the Taiwan National Cancer Registry over a 13-year period found a significant decrease in HCC incidence and mortality in the years following the implementation of a national HBV immunization program in 1984 . In another large cohort study from Korea, a trend towards a reduced relative risk of HCC was seen in vaccinated patients compared with unvaccinated patients after only 4 years of follow up . Additional studies in Taiwan revealed that HCC incidence following implementation of the immunization program may be associated with vaccine failure or lack of hepatitis B immunoglobulin being given to infants with HBsAg-positive mothers .
Although these studies demonstrate the potential benefit of HBV vaccination in the prevention of HCC, some endemic areas are still at risk due to insufficient resources to support an immunization program . As the incidence of HCC increases with age, it is likely that the full positive impact of HBV immunization on the development of HCC will be seen in the years to come and in future generations.
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Influence Of Genotype And Mutations
Infection with specific HBV genotypes may have an impact on the clinical course of infection, development of advanced liver disease, and response to antiviral therapy. Genotype D has been reported with a higher prevalence in patients presenting with ALF associated with acute HBV infection . Several studies in mostly Asian populations have reported an increased risk of HCC in patients infected with genotype C and possibly subgenotype Ce . In Alaska natives, a population known to have a very high prevalence of chronic HBV infection, genotype C infection was associated with a delayed onset of spontaneous HBeAg seroclearance and increased vertical transmission rates . Factors such as prolongation of the interval to immune clearance and an increased incidence of reactivation may contribute to the increased risk of cirrhosis and HCC associated with this population . Genotype A has been associated with increased efficacy of interferon alfa therapy with a higher potential of achieving clearance of HBeAg and HBsAg, while genotype C may be less IFN-responsive . Genotype A has also been associated with higher efficacy in the setting of oral nucleotide therapy based on rates of HBeAg clearance and seroconversion with tenofovir therapy .
Willowbrook State School Experiments
A New York University researcher named Saul Krugman continued this research into the 1950s and 1960s, most infamously with his experiments on mentally disabled children at the Willowbrook State School in New York, a crowded urban facility where hepatitis infections were highly endemic to the student body. Krugman injected students with gamma globulin, a type of antibody. After observing the temporary protection against infection this antibody provided, he then tried injected live hepatitis virus into students. Krugman also controversially took feces from infected students, blended it into milkshakes, and fed it to newly admitted children.
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Extrahepatic Manifestations Of Hepatitis B
Extrahepatic manifestations of HBV infection includes various forms of vasculitis, renal disease, and arthritis, typically associated with circulating immune complexes within the host . Polyarteritis nodosa as well as glomerulonephritis, including membranoproliferative, membranous, and mesangial proliferative variants, appear to be associated with immune complex deposition and may improve with antiviral therapy, although data are limited. Essential mixed cryoglobulinemia can also occur in association with HBV infection, initially presenting with purpura, recurrent arthritis, and weakness, but can then progress to advanced disease characterized by features of vasculitis, glomerulonephritis, and pulmonary involvement. Additional extrahepatic manifestations of HBV may include palpable purpura and generalized arthralgias, which can appear at the time of acute infection or once chronic infection is established.
Chronic Hepatitis B Complications
Chronic hepatitis B can lead to
- cirrhosis, a condition in which scar tissue replaces healthy liver tissue and prevents your liver from working normally. Scar tissue also partly blocks the flow of blood through the liver. As cirrhosis gets worse, the liver begins to fail.
- liver failure, in which your liver is badly damaged and stops working. Liver failure is also called end-stage liver disease. People with liver failure may require a liver transplant.
- liver cancer. Your doctor may suggest blood tests and an ultrasound or another type of imaging test to check for liver cancer. Finding cancer at an early stage improves the chance of curing the cancer.
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What Is Delta Hepatitis
Delta hepatitis is caused by a virus that only infects people who already have hepatitis B. The delta hepatitis virus is an RNA virus, meaning that its genetic material is made up of ribonucleic acid. It is spread through exposure to contaminated blood, especially with illicit, intravenous drug use, and by sexual contact. Delta hepatitis can be acquired at the same time as acute hepatitis B. When this happens, infected people are quite sick but most are eventually able to eliminate the viruses from their bodies. People who already have chronic hepatitis B can acquire delta hepatitis as well. This often causes severe inflammation of the liver, and the viruses are less likely to be cleared.
Delta hepatitis makes chronic hepatitis B much worse. It increases the risk of complications, especially cirrhosis, which occurs in up to two-thirds of patients.
There is no vaccine against delta hepatitis. Interferon treatment may cause improvement in the hepatitis, but relapse is common after therapy is stopped. Prevention includes avoiding contaminated needles and practicing safer sex . Universal vaccination of newborns with hepatitis B vaccine effectively prevents delta hepatitis because the delta hepatitis virus only causes disease in the presence of hepatitis B virus.
How Do Medical Professionals Diagnose Hepatitis B
Infection with hepatitis B is suspected when the medical history and the physical examination reveal risk factors for the infection or symptoms and signs that are suggestive of hepatitis B. Abnormalities in the liver tests also can raise suspicion however, abnormal liver tests can result from many conditions that affect the liver. The diagnosis of hepatitis B can be made only with specific hepatitis B virus blood tests. These tests are known as hepatitis “markers” or “serologies.”
HBsAg and anti-HBs
The presence of hepatitis B surface antigen in the blood indicates that the patient is currently infected with the virus. HBsAg appears an average of four weeks after initial exposure to the virus. Individuals who recover from acute hepatitis B infections clear the blood of HBsAg within approximately four months after the onset of symptoms. These individuals develop antibodies to HBsAg . Anti-HBs provides complete immunity to subsequent hepatitis B viral infection. Similarly, individuals who are successfully vaccinated against hepatitis B produce anti-HBs in the blood.
Patients who fail to clear the virus during an acute episode develop chronic hepatitis B. The diagnosis of chronic hepatitis B is made when the HBsAg is present in the blood for at least six months. In chronic hepatitis B, HBsAg can be detected for many years, and anti-HBs does not appear.
Anti-HBc
HBeAg, anti-HBe, and pre-core mutations
Hepatitis B virus DNA
How are the hepatitis B blood tests interpreted?
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Who Should Be Vaccinated
Children
- All children aged 1223 months
- All children and adolescents 218 years of age who have not previously received hepatitis A vaccine
People at increased risk for hepatitis A
- International travelers
- Men who have sex with men
- People who use or inject drugs
- People with occupational risk for exposure
- People who anticipate close personal contact with an international adoptee
- People experiencing homelessness
People at increased risk for severe disease from hepatitis A infection
- People with chronic liver disease, including hepatitis B and hepatitis C
- People with HIV
Other people recommended for vaccination
- Pregnant women at risk for hepatitis A or risk for severe outcome from hepatitis A infection
Any person who requests vaccination
There is no vaccine available for hepatitis C.