Diagnosis, Management and Prevention of Hepatitis B Virus Infected Patient

Mode of Transmission of Hepatitis B Virus (HBV):

1. Parenteral transmission:

  • Infected unscreened blood and blood products,
  • Tattoos/acupuncture needles,
  • A mode of spread most common among parenteral drug miss-users who share needles or other injecting paraphernalia,
  • Contaminated syringes and surgical instruments.

2. Sexual route:

  • Close personal contact seems necessary for transmission,
  • Sexual intercourse especially in male homo sexual and heterosexuals is an important route of transmission of infection.

3. Perinatal or Vertical transmission:

  • Before birth has not been documented,
  • During birth has not been documented,
  • During birth, most of the transmission occur, when placenta is separated, leakage of blood infect the baby,
  • Infection occur After birth, during HBV contaminated with breast milk.

4. Close living quarters or playground play as a toddler.

Hepatitis B Virus
Fig: Hepatitis B Virus

Diagnosis and Management of Hepatitis B Virus Infected Patient:

Clinical Features of Hepatitis B Virus:

1. Symptoms Hepatitis B Virus:

  • Headache,
  • Myalgia,
  • Arthralgia,
  • Yellow coloration of eye and skin,
  • Dark urine and pale stool,
  • Nausea and anorexia,
  • Vomiting,
  • Diarrhea,
  • Abdominal discomfort,
  • Fever.

2. Signs Hepatitis B:

  • Jaundice,
  • Enlarged tender liver,
  • Occasionally, mild splenomegaly and cervical lymphadenopath y are seen.

3. Investigation Hepatitis B Virus:

Blood examination: TC, DC, Hb%,ESR

Liver function test: Serum bilirubin, Serum AST and ALT -raised, PT, Serum alkaline phosphatase level

Viral markers:

  • Ig M- anti HAV (hepatitis A virus),
  • HBs Ag (Hepatitis B surface antigen),
  • Ig M- Anti HBc (Hepatitis B core antigen).

4. Management Hepatitis B Virus:

a) Acute hepatitis B:

There is no specific treatment only severely affected patients required hospitalization so that developing fulminate hepatic failure can be detected early.

  • Bed rest (3 to 5 weeks)
  • Diet: Normal diet with slight fat restriction)
  1. Nutritious diet containing 2000 – 3000 K Cal/d, good protein.
  2. If not tolerated light diet supplemented by fruit drink and glucose.
  3. If severe vomiting give IV fluid and glucose.
  • Drug (Sedative, Hypnotic); Should be avoided especially in severe hepatitis.
  • Clinical biochemical and imaging follow up.
  • Treatment of complication.

b) Chronic hepatitis B:

Treatments are still limited, with no drug able to eradicate hepatitis B infection completely. Supportive treatment plus.


  • Interferon –alpha,
  • larnivudin, 100mg/day orally,
  • Adefovir,
  • Entecavir (more effective than lamivudin),
  • Telbivudin,
  • Tenofovir, 300 mg/day.

Liver transplantation with prophylactic lamivudin and hepatitis B immunoglobulin’s.

Fate or Complication of Hepatitis B Virus Infection:

It includes-

  • Full recovery in 90 –95% of adults/resolution (fate),
  • Acute hepatic failure,
  • Relapsing hepatitis: Biochemical , Clinical,
  • Cholestatic hepatitis,
  • Post hepatitis syndrome,
  • Hyperbilirubinamia,
  • Aplastic anaemia,
  • connective tissue disease,
  • Renal failure,
  • Henoch schonlein purpura,
  • Papular acrodermatitis,
  • Chronic hepatitis,
  • Cirrhosis (hepatitis B, C),
  • Hepato cellular carcinoma.

How to Prevent and Control of Hepatitis B Virus:

Preventive and Controlling Measures of Hepatitis B:

1. Avoid risk factors:

  • Shared needles,
  • Homosexuality and illiegimate heterosexuality,
  • Prostitute,
  • Professional blood donors,
  • Carriers: They should not share razors and tooth brushes, Use barrier methods of contraception and should not donate blood.

2. Screening of blood donors and encouraging voluntary blood donation.

3. Standard safety precautions in hospitals and other health care settings: To avid accidental needle puncture and contact with infected body fluids.

4. Active immunization: HBV vaccine.

5. Passive immunization: By hepatitis immunoglobulin for immediate protection to acutely exposed HBs Ag positive blood, preferably within 6 hours-

  • Surgeons, nurses and laboratory workers,
  • Newborn infants of carrier mothers,
  • Sexual contacts of acute hepatitis B patients.

6. Passive active immunization.

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