Talk:Hepatitis/Archive 2

Deletion of File:Hepatitis.gif

This is a pretty table image, but I am preparing to delete it because it has numerous factual errors and cannot be edited directly. It should probably to replaced with a wiki-table to support collaborative editing. Here are a few of the problems:

Transmission:

"Parentral" should be "parenteral"

Maternal-fetal transmission should also be listed, particularly for HBV since that's the #1 mode worldwide

Classification:

HEV is not a calicivirus (also note spelling error "calcivirus"), it is a hepevirus

HCV is not a flavivirus, it is a member of the Flaviviridae

HDV is a "Deltavirus"

Viral antigens (presumably this is the ones for which tests exist):

HAV: does not have any antigen test licensed, does it?

HEV: does not either

HBV: HBcAg should be removed

HCV: Core antigen should be the only entry

Chronic hepatitis:

The cryptic abbreviation "a/c" should not be used here

That is why I'm deleting. Re-creating this as a table, for those who are proficient in such things, seems like a good idea. --Scray (talk) 12:16, 10 February 2009 (UTC)

Ok.Thank you for the details.HEV is calicivirus in the microbiology textbook we follow and its the same in most websites.But hepevirus seems to be the right version as per new sources on the web. Have uploaded new image with the changes as per your instruction.

Have simplified the antigens section. Will be adding the image back to hepatitis after the changes.Please do revert if needed.

-thank you Nishanthb (talk) 14:21, 10 February 2009 (UTC)

@ Scray Have replaced image with a wiki table.That is my first table by the way.Please edit the data if required.The image looked attractive than the present wiki table.But,it will be better once some color is thrown in to those columns.

Nishanthb (talk) 20:15, 10 February 2009 (UTC)

Nice work!! That is definitely an improvement - accuracy and collaborations are more important than aesthetics. I wonder whether this more properly belongs on the Viral hepatitis page, though? Let's see if anyone else comments and get a consensus. Also, I am not proficient with tables, but other editors are. --Scray (talk) 22:21, 10 February 2009 (UTC)

Can you give me the 'families' of Hepatitis viruses A to E please?Can add to the table. And should 'Classification' be changed to 'Type' ?

Nishanthb (talk) 03:01, 11 February 2009 (UTC)

You can find the families of the respected viruses in their own articles—look for the taxobox, although I would question the necessity. While comparing the images and the table, there are some missing points such as "Chronic Hepatitis" and "Symptoms"; although it may be reasonable to assume that some of them may be unnecessary, I can add them if you want (use the colspan attribute to get table cells to stretch across multiple columns).

A lot of the information in the table are provided in the linked articles, and reproducing (here at least) seems to be an overemphasis and a perhaps a waste. In my opinion I believe the best course of action would be to begin a section in Viral hepatitis discussing the multiple viruses holistically (in prose) with this table giving a quick and easy method of understanding the comparisons. I can begin if you guys want, however let's try for a consensus first so that we don't have to keep revising each other's edits. ChyranandChloe (talk) 04:02, 11 February 2009 (UTC)

The 'Chronic hepatitis' column can be added.The details can be limited to 'No' and 'Yes' if the % details make the table cluttered.

This table can be moved to Viral hepatitis too as it is. We can add more clinical features and treatment modalities of the different hepatitis which will probably make the table relevant in an article on hepatitis.I favor tables and believe its easier for new readers to understand the facts when they can be effortlessly compared.Also it may be alright to float the table to the right of the list of links in subsection 'Types' so that it doesnt expand the article vertically. Nishanthb (talk) 04:56, 11 February 2009 (UTC)

 Done See Talk:Viral hepatitis for the new discussion. ChyranandChloe (talk) 04:41, 12 February 2009 (UTC)

Fine.Thank you.Nishanthb (talk) 14:35, 12 February 2009 (UTC)

MEDMOS

I have had a quick stab at organising this in a WP:MEDMOS kind of fashion. The best source for this kind of content is probably the average medical textbook, because few high-quality WP:MEDRS will be devoted to undifferentiated hepatitis.

The section discussing all the subtypes could easily be shortened to the bare minimum, because there are subarticles for all of them.

I'm not sure how much content should be placed in a "diagnosis" or "treatment" section. I don't think there is a "generic" approach to the treatment of hepatitis. With regards to diagnosis it might be nice to make a reference to the "full liver screen" (UK terminology) or the "liver database" (USA terminology). JFW | T@lk 18:47, 10 March 2010 (UTC)

I made some additions to Diagnosis section. The serology tables are nice but I think too much detail. I created Viral hepatitis subsection for the existing Hep A & C content. I would like to add Hep B and consider removing some of the detail here. This is the model I would propose for the Treatment section (along with Epidemiology and Prevention when I get there): brief general intro followed by specific details about viral hepatitis since it is the most prevalent. Emhawkins (talk) 07:09, 5 December 2013 (UTC)

Redirect from Hepatitis virus

This redirect does not seem to be appropriate, because all types of hepatitis are explained. Instead, "Hepatitis virus" should redirect to Viral hepatitis. Then this lemma can be linked in the introduction: "A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide, ...". If there are no reasons against it, I'll change the redirect. --Jwollbold (talk) 11:35, 5 January 2011 (UTC)

Completeness?

Should this page also include links to hepatitis F and hepatitis G ...? I ask because the hepatitis A page links to both of those. — Preceding unsigned comment added by 82.1.117.11 (talk) 10:44, 31 August 2011 (UTC)

They don't seem to be causing liver disease, hence not included. JFW | T@lk 18:54, 22 November 2011 (UTC)

Parvovirus B19

DrMicro (talk · contribs) added parvovirus B19 to the list of viral causes. The reference provided was not WP:MEDRS-compatible, but only provided limited clinical information on the natural of parvovirus hepatitis. Looking around on Pubmed, there is very little solid evidence that this is an actual disease entity. PMID 12721938 (2003) reports negative findings of parvovirus in specimens from patients with fulminant hepatitis. I therefore submit that this is not at all clear-cut, and it probably makes sense to provide more definite evidence from a suitable source. JFW | T@lk 18:54, 22 November 2011 (UTC)

doi:10.1016/S0889-857X(05)70014-4 covers this. Added therefore. JFW | T@lk 19:28, 22 November 2011 (UTC)

It appears that JFW may have been having some difficulties with the association between B19 and hepatitis. This association was reported a number of years ago. I have listed some of the reports and reviews of this association below since JFW seems to have had some difficulty finding these materials in PubMed. More can be provided if required. DrMicro (talk) 14:36, 23 November 2011 (UTC)

• Larsen L (2011) Parvovirus B19 acute hepatitis in an immunocompetent adult. Ugeskr Laeger 173(43):2719-2720

• Sun L, Zhang JC, Zhao J (2011) Acute fulminant hepatitis with bone marrow failure in an adult due to parvovirus B19 infection. Hepatology doi: 10.1002/hep.24720.

• Brodin-Sartorius A, Mekki Y, Bloquel B, Rabant M, Legendre C (2011) Parvovirus B19 infection after kidney transplantation. Nephrol Ther

• Yang SH, Lin LW, Fang YJ, Cheng AL, Kuo SH (2011) Parvovirus B19 infection-related acute hepatitis after rituximab-containing regimen for treatment of diffuse large B-cell lymphoma. Ann Hematol

• Rauff B, Idrees M, Shah SA, Butt S, Butt AM, Ali L, Hussain A, Irshad-Ur-Rehman, Ali M (2011) Hepatitis associated aplastic anemia: a review. Virol J 8:87

• Sun L, Zhang JC, Jia ZS (2011) Association of parvovirus B19 infection with acute icteric hepatitis in adults Scand J Infect Dis. 43(6-7):547-579

• Mogensen TH, Jensen JM, Hamilton-Dutoit S, Larsen CS (2010) Chronic hepatitis caused by persistent parvovirus B19 infection. BMC Infect Dis 10:246.

• Krygier DS, Steinbrecher UP, Petric M, Erb SR, Chung SW, Scudamore CH, Buczkowski AK, Yoshida EM (2009) Parvovirus B19 induced hepatic failure in an adult requiring liver transplantation. World J Gastroenterol 15(32):4067-4069

• Ichaï P, Saliba (2009) Fulminant and subfulminant hepatitis: causes and treatment. Presse Med 38(9):1290-1298

• Kim BJ, Yoo KH, Li K, Kim MN (2009) Parvovirus B19 infection associated with acute hepatitis in infant. Pediatr Infect Dis J 28(7):667

• Dwivedi M, Manocha H, Tiwari S, Tripathi G, Dhole TN (2009) Coinfection of parvovirus b19 with other hepatitis viruses leading to fulminant hepatitis of unfavorable outcome in children. Pediatr Infect Dis J 28(7):649-50

• Al-Abdwani RM, Khamis FA, Balkhair A, Sacharia M, Wali YA (2008) A child with human parvovirus B19 infection induced aplastic anemia and acute hepatitis: effectiveness of immunosuppressive therapy. Pediatr Hematol Oncol 25(7):699-703.

• Giørtz-Carlsen B, Rittig S, Thelle T (2007) Neurological symptoms and acute hepatitis associated with parvovirus B19. Ugeskr Laeger 169(47):4075-4077

• Mylonas I, Gutsche S, Anton G, Jeschke U, Weissenbacher ER, Friese K (2007) Parvovirus B 19 infection during pregnancy. Z Geburtshilfe Neonatol 211(2):60-68.

• Ozçay F, Bikmaz YE, Canan O, Ozbek N (2006) Hepatitis A and parvovirus B19 infections in an infant with fulminant hepatic failure. Turk J Gastroenterol 17(2):148-150.

• Eid AJ, Brown RA, Patel R, Razonable RR (2006) Parvovirus B19 infection after transplantation: a review of 98 cases. Clin Infect Dis 43(1):40-48

• Aydin M, Bulut Y, Poyrazoglu G, Turgut M, Seyrek A (2006) Detection of human parvovirus B19 in children with acute hepatitis. Ann Trop Paediatr 26(1):25-28

• Ho JK, Tha SP, Coupland R, Dalal BI, Bowie WR, Sreenivasan GM, Krajden M, Yoshida EM (2005) Parvovirus B19 in an immunocompetent adult patient with acute liver failure: an underdiagnosed cause of acute non-A-E viral hepatitis. Can J Gastroenterol 19(3):161-162

• Fattet S, Cassinotti P, Popovic MB (2004) Persistent human parvovirus B19 infection in children under maintenance chemotherapy for acute lymphocytic leukemia. J Pediatr Hematol Oncol 26(8):497-503.

• Nobili V, Vento S, Comparcola D, Sartorelli MR, Luciani M, Marcellini M (2004) Autoimmune hemolytic anemia and autoimmune hepatitis associated with parvovirus B19 infection. Pediatr Infect Dis J 23(2):184-185

• Toshihiro M, Takikawa Y, Fukuda Y, Sato S, Endou R, Suzuki K (2003) A case of acute hepatitis associated with parvovirus B19. Nihon Shokakibyo Gakkai Zasshi 100(11):1312-1316

• Barash J, Dushnitzky D, Sthoeger D, Bardenstein R, Barak Y (2002) Human parvovirus B19 infection in children: uncommon clinical presentations. Isr Med Assoc J 4(10):763-5.

• Hayakawa F, Imada K, Towatari M, Saito H (2002) Life-threatening human parvovirus B19 infection transmitted by intravenous immune globulin. Br J Haematol 118(4):1187-1189

• Díaz F, Collazos J (2000) Hepatic dysfunction due to parvovirus B19 infection. J Infect Chemother 6(1):63-4.

Don't worry, I found a reasonable quality secondary source, which I added. JFW | T@lk 14:56, 28 November 2011 (UTC)

Sources

On 23 November I reverted the addition of about 10 KB of content relating to infectious agents that have been linked with hepatitis. I have asked DrMicro (talk · contribs) (on my talkpage) why it is not possible for WP:MEDRS-compatible secondary sources, such as textbooks, to be used as sources. Instead of coming to an agreement, DrMicro has now reinserted the same content.

Rather than reverting, I have asked on WT:MED if this is how we want this article to be sourced. I was hoping we might get some further views on this. JFW | T@lk 15:04, 28 November 2011 (UTC)

Editing of Alcoholic Hepatitis section

For this section, I added a reference from PubMed to a statement that was unreferenced. In my search for a reference, I also found this really nice summary (with references) of evidence from the National Institute on Alcohol Abuse and Alcoholism that focuses on alcoholism and HCV. This may be of help for future editors hoping to strengthen this section of the entry. Lauren maggio (talk) 20:37, 4 November 2013 (UTC)

Added some references regarding HCV and alcoholism correlation but I think this topic could have less focus in this subsection. Will look over the primary article on alcoholic hepatitis and try to make some improvements here. Emhawkins (talk) 18:29, 19 November 2013 (UTC)

Editing of Causes section and subsections

• Plan to rewrite the first two subsections (acute and chronic) in prose, linking to main pages as available, and eliminating much of the detail. Emhawkins (talk) 22:37, 19 November 2013 (UTC)
  • Same for drug-induced — Preceding unsigned comment added by Emhawkins (talk • contribs) 22:50, 19 November 2013 (UTC)

Nice work! Hope you don't mind when I fix typos while you're working. I see that there's a WP:Redlink for "[[liver cell damage]]", but you might just want to remove that wikilink since there's a valid link above that (under the "Drug induced" heading) to "liver [[cell damage]]" - and that latter seems appropriate. -- Scray (talk) 00:18, 26 November 2013 (UTC)

Thanks, Scary. And thanks for the help with typos while I'm working! I think the Redlink issue here is fixed now. Emhawkins (talk) 05:51, 26 November 2013 (UTC)

• I am considering removing the metabolic disorders, obstructive, alpha-1 antitrypsin deficiency, and giant cell hepatitis subsections as these seem to be either minor causes or hepatitis is a rare side effect. Thoughts? Emhawkins (talk) 05:51, 26 November 2013 (UTC)

While segregating rare causes seems reasonable, I'm not sure removing them from this article would improve it. It's reasonable to expect hepatitis when there is a problem with blood supply, and the same goes for problems with obstruction. When you look at a book chapter or review article on hepatitis, how are these causes handled? -- Scray (talk) 06:14, 26 November 2013 (UTC)

(←) The metabolic causes and protein accumulation disorders are usually listed in the differential diagnoses of hepatitis in medical textbooks. If I encounter a person with suspected hepatitis, a "liver screen" will usually include markers of autoimmunity and iron overload. Depending on the scenario (young patients, coexisting lung disease) there might also be testing for the rarer causes such as Wilson's or alpha-1-antitrypsin deficiency. I believe these causes should get at least passing mention on this page.

I am unsure about the rare entity of "giant cell hepatitis". The section was added by DrMicro (talk · contribs), who also authored the very long list of infectious causes. JFW | T@lk 15:39, 26 November 2013 (UTC)

Thanks both for your input. Maybe adding a differential diagnosis subsection in the diagnosis section for these and other entities is best. Emhawkins (talk) 17:01, 26 November 2013 (UTC)

I am again considering deleting the giant cell hepatitis (GCH) subsection. There are few acceptable sources on this topic and the few I have found tend to refer to GCH as the histopathological result of various hepatitis etiologies. Emhawkins (talk) 23:03, 2 December 2013 (UTC)

No hepatitis B and other serious issues.

- This page has sections on hepatitis A and C, but appears to have no reference to hepatitis B, which is deeply confusing to the newcomer.

- This page is the top google result for 'hepatitis' but does not offer any support for newcomers seeking knowledge on hepatitis A, B, C, and other rarer varieties. There is no clear way to see that one should go to a different page viral hepatitis for more information on these varieties.

- The other wiki page, viral hepatitis has full details on A, B, C, etc but is missing some information contained in this page. I suggest looking at merging hepatitis and viral hepatitis.

I note that some people have made suggestions for rewriting this page, however they have not yet been implemented.

For now, I have inserted a few words in the overview suggesting that more information on hepatitis A, B, and C etc can be found at viral hepatitis. I hope this is ok. I do not wish to reignite old wars if any exist. I merely wish to assist newcomers who may be in serious need of finding quick information on this condition.

Best wishes RedTomato (talk) 16:09, 2 December 2013 (UTC)

• @RedTomato:, thank you for your edits. This article has been nominated for the collaboration of the month, so hopefully if it is successful things will improve. Would you be interested in helping further? Lesion (talk) 14:53, 9 December 2013 (UTC)

@Lesion: Thank you Lesion for the compliment. Sadly I know nothing about hepatitis. I'm merely someone who came looking for information and was deeply confused by the structure of the page. I only seek to contribute a small tweak to help other confused people following in my footsteps. RedTomato (talk) 23:17, 12 December 2013 (UTC)

I note that @Jfdwolff: reverted my edit, noting: "already linked in intro - avoid self-reference". It took me some close reading of the intro to identify the link he was referring to. I did not know, when I first came to this page, that hep A, B, C etc are examples of viral hepatitis; and nor would many other people searching for info on these widely publicised types of hepatitis who get directed by Google to this page. This information is not stated clearly or accessibly *anywhere* on the page. I will respect Jfdwolff's edit, however there is a moral imperative to be accessible to newcomers on this particular issue, so if Jfdwolff does not mind, I will add some signposting to where he has indicated the right location for the link is.

I agree that the individual hepatitis viruses were not mentioned in the introduction (or in fact anywhere). I agree with the current way of mentioning the viruses individually in the correct context, considering the worldwide burden of disease. JFW | T@lk 00:20, 13 December 2013 (UTC)

Setting up a "to do" list for improvements to the article

These are mostly notes for my own purposes, just leaving them here for the sake of transparency and with the vain hope that someone else might get infected by the WP:SOFIXIT virus.

• Rewrite lead.

1. No medical jargon unless immediately preceded by an explanation (fibrosis, cirrhosis, etc...)
2. Account for content of article (diagnosis, etc...)

• Add a mechanism section
• Clean up diagnosis section:

1. Move the pathology section under the diagnosis heading
2. Provide a summary and clear links to the viral hepatitis article instead of repeating content in this article

• Add a prevention section
• Add a management section
• Add a prognosis section
• Add an epidemiology section
• Add a history section

Off to find some sources. 24.18.193.73 (talk) 17:18, 20 January 2014 (UTC)