Porphyria Educational Services

PORPHYRIA EDUCATIONAL SERVICES BULLETIN
Vol. 1 No. 23                                               June 6, 1999
Focus:  Hepatitis

In the acute hepatic porphyrias and in some types of the non-acute porphyrias the liver is the key vital organ of activity in porphyria.

Hepatitis is an acute and extremely serious infection of the liver. It is primarily caused by several liver specific viruses.  Such infection can also come from parasites, bacteria, drugs, alcohol, and some metabolic disorders.

Porphyria is a metabolic disorder.  It is either inherited or acquired. Both can cause liver problems and hepatitis of one form or another.

We must first state that Hepatitis  appears in many different forms.

HAV [ Hepatits A virus]
HAVAb [Hepatitis A antibody]
HAVAb-M [The specific immunoglobulin M hepatitis antibody]
HBaAb or Anti-HBc [ Hepatitis B core antibody]
HBeAg [Hepatitis B core antigen]
HBsAb or Anti-HBs [Hepatitis B surface antibody]
HBsAg [*Formerly called Australian antigen or AU]
              [Now hepatitis B surface antigen]
NASH - [Non-alcoholic-steato-hepatitus a.k.a. microvescular
              fatty liver].

Depending on the strain of hepatitis specific virus, it will inflame the liver.  This is called type A.  It is also known as infectious or endemic hepatitis.

Type A hepatitis is commonly spread by contaminated feces that pollute water supplies and fods, particularly shellfish that are eaten raw. Type A strikes children and young adults most frequently.  It is not as serious as Type B.    Type A has nothing to do with porphyria, although a porphyric can, like anyone else, be affected by this strain.

Type B Hepatitis is a very severe disease that can occur at any age and to anyone.  Symptoms often do not appear for many months following exposure and infection.  Often they can be so slight that they can be overlooked.

How is Type B acquired?

Most often the diseased is acquired from contact with infected blood from improperly infected sterilized needles or other medical insruments that have had contact with infected blood.  Type B is also easily transmitted through sexual contact.   There is now a vaccine to help protect against hapatitis B.

Another factor to remember is that it is easy to have hepatitis and not to know that you have it,  At first the signs and symptoms resemble influenza.  If there is no evidence of jaundice and the urine does not turn dark, the condition can come and go without being diagnosed.

Such symptomology as just dsecribed  is potentially dangerous. Even a mild case of hepatitis can lead to severe liver damage months or even years later.   There are several specific antigen and antibody tests for hepatitis.  When the tests are performed as a panel, they reveal whether the patient has been exposed to hepatitis. It will also indicate what type of hepatitis virus, and furthermore it will indicate whether the infection exists at the moment.  Other idnications shows whether the the disease is in an early or late stage and whether the patient is a carrier or is recovery is taking place.

During the last few years a new hepatitus virus has been discovered. It is called the "Delta" virus  This strain of hepatitus seems to cause an infection only in the presence of the hepatitus Btype virus.  It occurs primarily among drug abusers who inject their drugs as opposed to those who take their drugs orally or inhale them.

Because elevation of liver panel testing can be indicative of many types of liver disease including porphyria, a series of various testings needs to be done including the hepatitis antigens or antibodies tests.  One of the best is the Comprehensive Multiple Test Screening.

NASH [non-alcoholic-steato-hepatitis] is associated with  the acute hepatic porphyrias.  Another name for this is "fatty liver".  The ordinary liver panel test will reveal elevations in the alkaline phospatase and often the SGOT and other components of the panel.

Liver biopsy can determine whether other liver problems have coccured such as cirrhosis, or the hepatic carcinoma.

In PCT porphyria Type B is often found.  PCT patients must then undergo treatment for both the PCT symptomology as well as for the Hepatitus B.