There is a wide spectrum of clinical manifestation of HBV infection, ranging from an asymptomatic state to mild acute infection to severe chronic disease. The patient may have anicteric hepatitis in which the patients are mostly asymptomatic and usually proceeds to chronic hepatitis. The other form is icteric hepatitis in which the patient may complain of low grade fever, anorexia, nausea, vomiting, myalgia, fatigue and altered sensation to smell and taste. Pain in the epigastric region or right upper quadrant pain might be present. Icterus indicated by yellowing of the sclera, nails and skin is common. The urine might become dark yellow too.

Physical examination and proper history are the guides to a correct diagnosis. Physical findings include low grade fever, jaundice which may last for months but may appear 10 days after constitutional symptoms, palmar erythema, spider naevi, mildly enlarged liver and spleen. Vasculitis may or may not be present. When cirrhosis develops one may find peripheral edema, ascites, icterus, caput medusa, variceal bleeding, testicular atrophy and gynaecomastia.

Patient with chronic hepatitis may be asymptomatic or may have same symptoms as an acute infection. Later in the disease, patient may present with mental confusion, decreased or no sleep, disturbed sleep, hepatic encephalopathy and even coma. They may also have gastrointestinal bleeding and ascites. Multi-organ affection manifests itself in the form of pleural effusion, hepato pulmonary syndrome, myocarditis, pericarditis, arrhythmias and diffuse intravascular coagulopathy (DIC) that can occur in fatal hepatitis.

Patient may develop aseptic meningitis, encephalitis, Guillain-Barré syndrome (GBS) in acute phase. Pancreatitis can also occur. Cutaneous manifestations are more common in women than men.

• Splenomegaly

  CASE REPORT: A 29-year-old man, with no significant prior medical history, presented with fever and massive splenomegaly. A diagnosis of HSTL was established by histologic examination and immunohistochemistry. [ncbi.nlm.nih.gov]

  If patients with chronic hepatitis B progress to cirrhosis (when the liver becomes severely scarred) they will develop signs and symptoms of liver failure, including: Jaundice Splenomegaly (an enlarged spleen) Ascites (fluid retention in the abdomen) [hopkinsmedicine.org]

  Often, the first findings are Signs of chronic liver disease or cirrhosis (eg, splenomegaly, spider nevi, palmar erythema) Serologic testing Liver biopsy The diagnosis of chronic hepatitis B is suspected in patients with any of the following: Suggestive [msdmanuals.com]

  Table 3 Signs and symptoms of liver cirrhosis Clinical Fatigue Muscle wasting Dupuytren's contracture Palmar erythema Spider naevi Splenomegaly Radiological Coarse echotexture Features of portal hypertension - dilated portal vein - recanalisation of para-umbilical [doi.org]

• Generalized Lymphadenopathy

  Generalized lymphadenopathy and hepatomegaly have been described. [ncbi.nlm.nih.gov]

• Pain

  Always discuss pain with your medical provider, particularly when pain is constant, severe or interferes with your quality of life. Call your medical provider if you have severe or chronic stomach pain. [hepmag.com]

  Pain in the epigastric region or right upper quadrant pain might be present. Icterus indicated by yellowing of the sclera, nails and skin is common. The urine might become dark yellow too. [symptoma.com]

  Internal bleeding is a risk, which may require that the patient stay in the hospital a few days longer, for rest, observation and pain medicine. [clinicaltrials.gov]

  […] isolated pulmonary artery stenosis in the presence of active hepatitis B and latent Mycobacterium tuberculosis infection in a middle-aged Asian woman who initially presented with severe dyspnea on exertion and recurrent syncope, occasional burning chest pains [ncbi.nlm.nih.gov]

  Symptoms that can occur include mild fever, headache, fatigue, loss of appetite, nausea and vomiting, diarrhea, muscle and joint pain, abdominal pain, a skin rash, and jaundice. [emoryhealthcare.org]

• Fever

  After 4 days, he became oriented, and fever was disappeared then we continued the treatment for 16 days. The patient discharged and followed by daily phone calls. [ncbi.nlm.nih.gov]

  The other form is icteric hepatitis in which the patient may complain of low grade fever, anorexia, nausea, vomiting, myalgia, fatigue and altered sensation to smell and taste. [symptoma.com]

  Offers new coverage of the treatment options for ruptured or complicated appendicitis · hepato-splenic "cat scratch" fever · periodic fever with ulcer · pharyngitis · adenitis · chronic fatigue syndrome · and hemophagocytic syndrome. [books.google.com]

• Fatigue

  Fatigue: In the acute phase, bed rest and low physical exertion may be advised. [hepmag.com]

  […] pulmonary artery stenosis in the presence of active hepatitis B and latent Mycobacterium tuberculosis infection in a middle-aged Asian woman who initially presented with severe dyspnea on exertion and recurrent syncope, occasional burning chest pains, and fatigue [ncbi.nlm.nih.gov]

  Mental fatigue can manifest as somnolence, lethargy, or directed attention fatigue.[4] Fatigue and 'feelings of fatigue' are sometimes confused.[5] Unlike weakness, fatigue usually can be alleviated by periods of rest. [en.wikipedia.org]

• Intravenous Drugs

  drug use, and medical procedure exposure) and are evident to varying degrees in every country. [ncbi.nlm.nih.gov]

  drug use) or by contact with other infected bodily fluids (such as semen) [M-W] [termin.eki.ee]

• Weakness

  A 68-year-old woman, who underwent long-term treatment with lamivudine and adefovir for chronic hepatitis B, developed proximal muscle weakness in the four extremities. [ncbi.nlm.nih.gov]

• Easy Bruising

  Damage to your liver results in high blood pressure in your liver veins along with rapid weight gain, trouble breathing, and easy bruising. [webmd.com]

  Signs of severe liver scarring (cirrhosis) may include: Ascites (accumulation of fluid and swelling of the abdominal cavity) Star-shaped vein pattern developing on the swollen belly Jaundice Itching Easy bruising and bleeding Chronic HBV infection can [sfcdcp.org]

  Symptoms of severe liver damage include the symptoms of hepatitis B and generalized itching a longer than usual amount of time for bleeding to stop easy bruising swollen stomach or ankles spiderlike blood vessels, called spider angiomas, that develop [transplant.surgery.ucsf.edu]

• Cough

  Babies are already vaccinated against diphtheria, tetanus, whooping cough, Hib and polio. Public Health England said the new vaccine had been "shown to be safe". [bbc.com]

  You cannot catch hepatitis B from: sneezing or coughing, kissing or hugging, sharing dishes or glasses, breastfeeding, food or water. What symptoms would I have? Many people have no symptoms. Others have symptoms when they first become infected. [hometesting.ie]

  PERTUSSIS (WHOOPING COUGH) Pertussis or whooping cough is a highly infectious airborne bacterial disease. It spreads easily from infected persons and is fatal in 1 in 200 cases among infants. [gavi.org]

  It is not spread through: Sharing food or water Sharing eating utensils or drinking glasses Tears, sweat, urine, or stool Coughing or sneezing Hugging or kissing Breastfeeding Mosquitoes [med.stanford.edu]

• Dyspnea

  We report a rare case of Takayasu's arteritis with isolated pulmonary artery stenosis in the presence of active hepatitis B and latent Mycobacterium tuberculosis infection in a middle-aged Asian woman who initially presented with severe dyspnea on exertion [ncbi.nlm.nih.gov]

• Nausea

  Hunger can intensify nausea, so try eating a cracker or other small piece of food every hour or two. Ginger helps with mild to moderate nausea. Peppermint, chamomile or raspberry leaf tea may also alleviate nausea. [hepmag.com]

  After ten days of TDF administration, nausea, vomiting and abdominal pain developed. High anion gap acidosis with elevated lactate level (pH 7.341, pCO2 29.7 mmHg, HCO3- 15.6mmHg, lactate 3.2mmol/L, anion gap 15.4 mEq/L) was developed. [ncbi.nlm.nih.gov]

  The other form is icteric hepatitis in which the patient may complain of low grade fever, anorexia, nausea, vomiting, myalgia, fatigue and altered sensation to smell and taste. [symptoma.com]

  Early in the disease, called the prodromal phase, symptoms may include: Fever Joint pain or arthritis Rash Edema (swelling) Symptoms of the next phase, the preicteric phase, include: Fatigue Myalgia (muscle pain) Anorexia Nausea and/or vomiting Fever [hopkinsmedicine.org]

• Vomiting

  After ten days of TDF administration, nausea, vomiting and abdominal pain developed. High anion gap acidosis with elevated lactate level (pH 7.341, pCO2 29.7 mmHg, HCO3- 15.6mmHg, lactate 3.2mmol/L, anion gap 15.4 mEq/L) was developed. [ncbi.nlm.nih.gov]

  Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea. [web.archive.org]

  Some develop a rapid onset of sickness with vomiting, yellowish skin, feeling tired, dark urine and abdominal pain. [youtube.com]

  If a patient has had a large amount of vomiting or has not been able to take in liquids, blood electrolytes may also be checked to ensure that the patient's blood chemistry is in balance. [emedicinehealth.com]

• Loss of Appetite

  The hepatitis B virus can cause: Acute (short-term) illness, the symptoms of which are flu-like and include loss of appetite, tiredness, joint and muscle pain, diarrhea, vomiting and jaundice. [walgreens.com]

  Symptoms that can occur include mild fever, headache, fatigue, loss of appetite, nausea and vomiting, diarrhea, muscle and joint pain, abdominal pain, a skin rash, and jaundice. [emoryhealthcare.org]

  The symptoms of this condition include: Nausea and vomiting Fatigue Loss of appetite General aches and pains Headaches Symptoms of jaundice (yellowing of the skin and eyes) People do not know they ate infected with Hepatitis A at first because symptoms [news-medical.net]

  Hepatitis B causes typical symptoms of viral hepatitis (including loss of appetite, a general feeling of illness, and jaundice) and may cause a severe form of hepatitis called fulminant hepatitis. Doctors diagnose hepatitis B based on blood tests. [msdmanuals.com]

  In the classical form of hepatitis B, non-specific general symptoms such as loss of appetite, nausea, vomiting, stomach pains, sometimes also painful joints, fever and a skin rash may appear 45 to 180 days after infection. [bag.admin.ch]

• Abdominal Pain

  After ten days of TDF administration, nausea, vomiting and abdominal pain developed. High anion gap acidosis with elevated lactate level (pH 7.341, pCO2 29.7 mmHg, HCO3- 15.6mmHg, lactate 3.2mmol/L, anion gap 15.4 mEq/L) was developed. [ncbi.nlm.nih.gov]

  Some develop a rapid onset of sickness with vomiting, yellowish skin, feeling tired, dark urine and abdominal pain. [youtube.com]

  Definitsioon: an acute or chronic hepatitis that is caused by a DNA virus (species Hepatitis B virus of the genus Orthohepadnavirus, family Hepadnaviridae), is marked chiefly by fatigue, fever, nausea, vomiting, abdominal pain, darkened urine, jaundice [termin.eki.ee]

  Symptoms that can occur include mild fever, headache, fatigue, loss of appetite, nausea and vomiting, diarrhea, muscle and joint pain, abdominal pain, a skin rash, and jaundice. [emoryhealthcare.org]

• Diarrhea

  Symptoms that can occur include mild fever, headache, fatigue, loss of appetite, nausea and vomiting, diarrhea, muscle and joint pain, abdominal pain, a skin rash, and jaundice. [emoryhealthcare.org]

  Side effects of lamivudine include fatigue, muscle aches, fever and chills, sore throat, nausea, stomach pain or cramps, and diarrhea. Serious side effects are rare, occurring in less than 1% of people taking lamivudine. [clinicaltrials.gov]

  Integrase inhibitor Bictegravir (BIC) Available only as fixed-dose combination tablet with FTC and TAF See fixed-dose combination products below BIC may cause the following: Diarrhea, nausea Dolutegravir (DTG) Tablets: 10, 25, and 50 mg Also available [msdmanuals.com]

• Jaundice

  Group I consisted of patients who had received the implicated vaccine and had jaundice; Group II had received the implicated vaccine but remained well; Group III had received a new, serum-free vaccine, with no subsequent jaundice. [ncbi.nlm.nih.gov]

  Rat fever (leptospirosis) can also cause jaundice due to the liver. In jaundice due to the liver, there is invariably cholestasis. [en.wikipedia.org]

  IgM antibody typically develops early in the infection and peaks about 1 to 2 weeks after the development of jaundice. [msdmanuals.com]

  Symptoms of liver disease emerge as the condition progresses and include dark urine, pale stools, jaundice with icterus (jaundice of the sclera of the eye), and pain in the abdomen. Acute symptoms last anywhere from one to four months. [britannica.com]

• Hepatomegaly

  Physical findings range from minimal nonspecific abnormalities to jaundice and hepatomegaly (often tender), and occasionally extend to extrahepatic features reflecting immune-complex phenomena such as vasculitis, immune complex nephritis, arthritis, a [academic.oup.com]

  Generalized lymphadenopathy and hepatomegaly have been described. [ncbi.nlm.nih.gov]

• Scleral Icterus

  The presence of scleral icterus indicates a serum bilirubin of at least 3 mg/dL. The conjunctiva of the eye are one of the first tissues to change color as bilirubin levels rise in jaundice. This is sometimes referred to as scleral icterus. [en.wikipedia.org]

  It usually presents as a subclinical, mild illness, with only up to 30% of people developing scleral icterus, nausea, vomiting, and right‐upper quadrant tenderness ( Bodihar 2004 ). [doi.org]

• Hepatosplenomegaly

  It is similar to chronic liver disease because of signs and symptoms such as fever, weight loss, hepatosplenomegaly, and pancytopenia. [ncbi.nlm.nih.gov]

• Arthralgia

  METHODS: A 52-year-old woman presented with unilateral eye pain and photophobia, arthralgia, remnants of a maculopapular rash, and subsequently facial numbness several weeks later. [ncbi.nlm.nih.gov]

  Abstract Eighteen patients with acute viral hepatitis had initial symptoms of arthralgia, arthritis or urticaria. [doi.org]

  Flu-like symptoms, fevers, rigors, fatigue, myalgia, arthralgia, and headaches are very common immediately after injection. These symptoms respond to analgesics (acetominophen or nonsteroidal antiinflammatory drugs). [academic.oup.com]

  […] bruising or itching at the injection site Generally feeling unwell Uncommon (affecting up to 1 in 100 people at each dose): Feeling dizzy Aching muscles Flu-like symptoms Rare (affecting up to 1 in 1000 people at each dose): Low blood pressure Joint pain (arthralgia [vk.ovg.ox.ac.uk]

• Myalgia

  The patient was diagnosed with Hepatitis B envelope Antigen positive CHB, cirrhosis, LA and RM characterized by myalgia and elevated myoglobin. He was given tenofovir alone as antiviral treatment instead. [ncbi.nlm.nih.gov]

  Patients might report mild flu-like symptoms such as anorexia, myalgia, nausea, vomiting, fatigue, malaise and low-grade fevers, Ali said. [web.archive.org]

  Early in the disease, called the prodromal phase, symptoms may include: Fever Joint pain or arthritis Rash Edema (swelling) Symptoms of the next phase, the preicteric phase, include: Fatigue Myalgia (muscle pain) Anorexia Nausea and/or vomiting Fever [hopkinsmedicine.org]

  The other form is icteric hepatitis in which the patient may complain of low grade fever, anorexia, nausea, vomiting, myalgia, fatigue and altered sensation to smell and taste. [symptoma.com]

• Pruritus

  A 52-year-old man complained of worsening appetite, abdominal distension, and pruritus. [ncbi.nlm.nih.gov]

  Your doctor will call it pruritus. Alopecia. Hair loss from hepatitis C treatment is rare, but it has happened. Pagination [webmd.com]

  The following adverse reactions were reported: Incidence Equal To or Greater Than 1% of Injections General Disorders And Administration Site Conditions Injection site reactions consisting principally of soreness, and including pain, tenderness, pruritus [rxlist.com]

  As HS commonly affects apocrine sweat gland-bearing skin, there is prolonged exposure to sweat and humidity in these regions that exacerbates HS lesions and associated pain and pruritus [14, 15]. [karger.com]

  […] however, occur in many liver conditions and are therefore not a reliable clinical feature to distinguish obstruction from liver causes of jaundice.[22] People also can present with elevated serum cholesterol, and often complain of severe itching or "pruritus [en.wikipedia.org]

• Urticaria

  Abstract Eighteen patients with acute viral hepatitis had initial symptoms of arthralgia, arthritis or urticaria. [doi.org]

  Urticaria These itchy raised welts, also known as hives, often show up with hepatitis. Unlike an allergic reaction, they may last longer than a few hours and leave behind a brown stain. Doctors treat hives with antihistamines. [webmd.com]

  Immune System Disorders Hypersensitivity reactions including anaphylactic/anaphylactoid reactions, bronchospasm, and urticaria have been reported within the first few hours after vaccination. [rxlist.com]

  […] to emotions, symptoms and function (Skindex-France).38 Similarly, patients with HS had worse self-perceptions and mood, more physical discomfort and greater impairment in daily activities and social functioning (VQ-Dermato) than patients with chronic urticaria [pmj.bmj.com]

  Local pain and tenderness at the injection site, urticaria, and angioedema might occur; anaphylactic reactions, although rare, have been reported following the injection of human immune globulin (IG) preparations ( 1 ). [cdc.gov]

• Yellow Discoloration of the Skin

  This illness is characterised by: Tiredness Loss of appetite Unexplained weight loss Darkened urine Stomach pains Pale faeces Yellowing of the eyes and skin The most well-known symptom of hepatitis B is a yellow discoloration of the skin (jaundice) which [goshh.ie]

  […] disease".[11] Signs and symptoms[edit] The main sign of jaundice is a yellowish discoloration of the white area of the eye (sclera) and the skin. [en.wikipedia.org]

• Dizziness

  Tell your provider if you feel dizzy, or have vision changes or ringing in the ears. Some people get shoulder pain that can be more severe and longer-lasting than the more routine soreness that can follow injections. This happens very rarely. [healthychildren.org]

  Common side effects include headache, fever, dizziness, nausea or feeling faint shortly after receiving the vaccine. Reactions are usually mild and lasts only a few days. [toronto.ca]

  Common side effects of these medicines include feeling sick, vomiting and dizziness. [nhs.uk]

  Mild-to-moderate problems: Soreness, redness, or swelling where the shot was given Headache, tiredness, fever and loss of appetite Severe problems (rare): Difficulty breathing Wheezing Hives Pale skin Fast heartbeat Dizziness Over-the-counter pain relievers [walgreens.com]

  […] dose): High temperature (fever) above 37.5 degrees Feeling sick or being sick Diarrhoea or pain in the stomach Swelling, bruising or itching at the injection site Generally feeling unwell Uncommon (affecting up to 1 in 100 people at each dose): Feeling dizzy [vk.ovg.ox.ac.uk]

• Dark Urine

  Some develop a rapid onset of sickness with vomiting, yellowish skin, feeling tired, dark urine and abdominal pain. [youtube.com]

  Symptoms include fatigue, jaundice, nausea, vomiting, dark urine, light stools. Diagnosis is by blood test. Treatment is via anti-viral drugs and/or hepatitis B immunoglobulin (HBIG). Chronic hepatitis B may be treated with a variety of medications. [medicinenet.com]

  Most people do not experience any symptoms during acute infection but may have symptoms, such as yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. 4 5 In the U.S., individuals at highest risk [nvic.org]

  However, some people get an acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, pale faeces (poo), extreme fatigue, nausea, vomiting and abdominal pain. [man2man.ie]

  But in some, it could result in an illness with symptoms of fatigue, lost of appetite, dark urine and yellow discoloration of the eyes, lasting for several months and even death from liver failure. [med.stanford.edu]

• Kidney Failure

  Persistent infection may lead to liver failure or liver cancer. [travelhealthpro.org.uk]

  In some cases, hepatitis B can lead to liver failure and death. Each person’s symptoms may vary. [hopkinsmedicine.org]

  Only rare chronic infections have been documented.[70] Vaccination is particularly recommended for high risk groups including: health workers, people with chronic kidney failure, and men who have sex with men.[71][72][73] Both types of the hepatitis B [en.wikipedia.org]

  Portal hypertension can also cause kidney failure or an enlarged spleen resulting in a decrease of blood cells and the development of anemia, increased risk of infection and bleeding. [medicinenet.com]

Patients may present with minimal to wide range of symptoms. Laboratory tests are done to confirm the diagnosis and include, liver function tests, liver enzyme studies like alanine amino transferace (ALT), asparate amino transferace (AST) which are 100 times higher (almost 1000-2000IU/ml) and are the hallmark of acute hepatitis. ALT is usually higher than AST but if AST is higher than ALT, then one must consider cirrhosis. Gamma glutamyl transpeptidase (GGT) and alkaline phosphate levels (ALP) are also elevated.

Complete blood count, platelet count, haematologic and coagulation tests are also done. Serologic tests to determine HBsAg, antibody to HBc and IgM are necessary to diagnose acute hepatitis. HBeAg and HBV DNA quantification should be done to know patient’s level of infection.

Radiographic tests include abdominal ultrasonography, CT scan and MRI to look for biliary obstruction as the echogenecity of the liver parenchyma increases.

Histologic testing is done by performing a liver biopsy especially for chronic hepatitis cases in which the findings show ground glass appearance of hepatocytes due to infiltration of viral cells. In acute phase, one can see dying hepatocytes with lymphocytic infiltration. Once the diagnosis is confirmed, an immediate treatment plan is necessary [7].

• Leukopenia

  […] illness, fever, rigors, arthralgia, myalgia, fatigue Hematologic Leukopenia, thrombocytopenia Alopecia Neuropsychiatric Depression, insomnia, irritable Weight loss Ocular Autoimmune Hypothyroidism, diabetes Table 5. [academic.oup.com]

  Peripheral blood counts may show mild leukopenia, with or without relative lymphocytosis. Loss of HBsAg and the development of HBsAb signify recovery from the acute infection and the development of immunity ( Fig. 1 ). [clevelandclinicmeded.com]

• Neutropenia

  The benefits of pegylated interferon can persist even after treatment, and relapse rates appear to be less than with non-pegylated interferon. 4 Adverse effects include neutropenia and thrombocytopenia which require monthly blood monitoring, and dose [doi.org]

• Hepatocellular Carcinoma

  Treatment aims at halting the progress of disease which causes liver failure and finally hepatocellular carcinoma. [symptoma.com]

  Key words: antiviral drugs, cirrhosis, hepatocellular carcinoma, liver. [web.archive.org]

  Potential long-term sequelae include cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Increased viral load is associated with greater risk for cirrhosis, hepatocellular carcinoma, liver-related death, and disease transmission. [doi.org]

The plan of action for treatment of hepatitis B is to take care of the acute cases by admitting them in the ICU. Patients with acute hepatitis should be given tenofovir disoproxil fumarate (TDF) or entecavir (ETV) as the first line of treatment. Biochemic tests should be done regularly to see the improvement.

National Institute of Health recommends nucleotide therapy for acute phase as well as for those fulminant phases in which complications like cirrhosis, fibrosis, HBV DNA positive and chronic HBV cases which reactivate during chemotherapy. Antiviral treatment is given using pegylated interferon and nucleotide analogues. Patient’s immunity is increased using immunotherapeutic intervention. The goal is to stop the progress of disease.

Patients with chronic hepatitis and eventually hepatic failure should be admitted in the hospital and considered for liver transplant in case the disease progresses to end stage [8] [9].

Vaccine or immunoglobulins should be administered to the newborn of a positive HBsAg mother. Also, if there is an accidental needle prick or contact with a material like blade of the infected person, then they should receive Hepatitis B immunoglobulin and first dose of Hepatitis B vaccine at the same time. These individuals should be kept under observation and regular blood tests should be done to check for the disease [10].

The prognosis is bad as nearly one million people die of hepatitis B globally every year. The fatal outcomes are those related to hepatocellular carcinoma and cirrhosis. Old age, low immunity, alcohol intake, infection, cirrhosis, thrombocytopenia and mutation in the core can increase the risk of HCC.

However, individuals who have negative HBe Antigen and in whom HBV DNA is not detected, have a good prognosis, as in their body the disease progresses slowly and their survival period prolongs. The complications are lesser as well [6].

Hepatitis B is caused by the Hepatitis B Virus (HBV) which is a DNA virus. It is transmitted through the infected person via body fluids like blood, saliva, semen and vaginal secretion. Thus sharing of needles, blades, having a sexual contact with the infected person and procedures like blood transfusion and organ transplant can put one at the risk of catching the infection. It is also transmitted to the newborn via infected mother during labour.

Thus proper laboratory tests before any procedure are a must. Various genes are found to be associated with the disease; however the subject is still under research [1] [2] [3].

Most genotypes are now divided into subgenotypes with distinct virological and epidemiological properties. In addition, recombination among HBV genotypes increases the variability of HBV. [ncbi.nlm.nih.gov]

Infection Control & Hospital Epidemiology ISSN: 0899-823X EISSN: 1559-6834 URL: /core/journals/infection-control-and-hospital-epidemiology × Metrics Full text views Full text views reflects the number of PDF downloads, PDFs sent to Google Drive, Dropbox [dx.doi.org]

Hepatitis B Virus is a spherical, double shelled particle with rods and spheres and it can withstand extremes of temperature. It is a DNA virus that encodes four genes: surface gene S, core gene C, e antigen, X gene and polymerase gene P. The surface gene encodes viral envelope. The core antigen encloses viral DNA and is found on hepatocytes during immune response. The ‘e antigen’ is a marker of viral replication. The X gene encodes protein that helps in viral replication; thus it is involved in carcinogenesis.

If after the treatment a person develops antibodies to HBsAg, it suggests that the patient has recovered from HBV infection. Also, if a person is vaccinated, he will show anti-HBsAg antibodies positive. If the person has anti-HBcAg antibody, it is suggestive of a previous infection with HBV and has high chances of recurrence as the virus is still present. Anti-HBeAg suggest non-replicative state if HBV DNA is not found. However, HBeAg negative strains have also emerged [4].

When the immune system recognizes HBV on the surface of hepatocytes, it releases cytokines and other antibodies. CD4, CD8 lymphocytes are activated and attack HBV. However, in this the liver is injured and can also get cirrhosed. The patient can develop hepatocellular carcinoma.

Once the virus has entered the host, the disease begins. There are five stages of disease progression:

Stage 1

The incubation period of HBV is 2-4 weeks during which the patient remains asymptomatic. It can even be decades for a new born. The virus replicates itself without any manifestation of symptoms or increase in aminotransferase levels. It is an immune tolerance stage.

Stage 2

This is an active immune stage wherein the body reacts by producing inflammatory changes. It lasts for 3 to 4 weeks and HBeAg can be identified in the serum. HBV DNA starts decreasing in the patients who are clearing the infection.

Stage 3

This is an inactive, chronic stage in which the replication of virus is slow or nil and anti-HBeAg antibodies are detected. However, HBsAg is still present in the serum.

Stage 4

This is chronic disease in which HBeAg-negative disease can occur.

Stage 5

This is a stage of recovery when no HBV DNA or HBsAg is detected in the blood and there are antibodies against HBV antigens.
It can cause polyarteritis nodosa which is a serious complication during the earlier course of disease. In the chronic stage, HBV infection can cause cirrhosis of liver, glomerular nephritis and hepatocellular carcinoma (HCC) [5].

The disease is transmitted via body fluids hence people should be educated to not share needles, scissors and shaving blades. One must avoid sexual contact with multiple partners and use contraceptive measure like condoms in case of affected partner.

Hepatitis B is transmitted via mother to the child during delivery hence screening the mother during the pregnancy for Hepatitis B is a must [11]. If the newborn is born to hepatitis B mother he/she is given a hepatitis B immunoglobulin [HBIG] with hepatitis B vaccine within 12 hours of birth. They should then follow the recommended vaccination schedule for children [12].

Also candidates who donate blood or organs are screened for the presence of virus. Healthcare workers are given Hepatitis B vaccine as they have high chances of getting infected with the disease.

Hepatitis B is a common problem worldwide as one third of the global population is infected with Hepatitis B Virus (HBV). It is transmitted via body fluids.

The patient may remain asymptomatic for months before the clinical symptoms manifest. It is a disease of global concern and the vaccine against HBV is compulsory in nearly all the countries.

Hepatitis B is a viral disease which has affected almost the whole world. It is transmitted via contaminated blood, saliva, semen and vaginal secretion. People in contact with the affected patients should avoid sharing of blades, needles, shaving kit. One should refrain from having sexual contact with infected individuals. Mothers should be screened during pregnancy for Hepatitis B as it is transmitted to the child during the process of delivery.

Hepatitis B symptoms range from no symptoms to the dreaded liver cancer (hepatocellular carcinoma) which can cause death. Patient may complain of low grade fever, reduced appetite, muscular pain, jaundice, nausea, vomiting and pain in the right upper quadrant of abdomen.

Laboratory tests show altered liver function tests and blood counts. Treatment aims at halting the progress of disease which causes liver failure and finally hepatocellular carcinoma.

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