Hepatitis Definition of hepatitis l l l Inflammation

Hepatitis

Definition of hepatitis l l l Inflammation of the liver Acute liver failure-acute severe impairment of liver function with mental changes in patients who have liver disease less than 8 weeks Chronic liver failure-combination of ascites and jaundice and or encephalopathy

Etiology of hepatitis l l l Viral hepatitis(acute and chronic) Bacterial hepatitis Drug induced hepatitis Autoimmune hepatitis Metabolic hepatitis

Classification of Hepatitis Viruses DNA or RNA Virus Family HAV Picornaviridae RNA HBV Hepadnaviridae DNA HCV Flaviviridae RNA HDV Deltavirus (genus) RNA HEV ? (Previously classified as a calicivirus) RNA

Basic Features of Hepatitis Viruses Chronic Infection Virus Transmission Incubation Period* A fecal-oral 4 No B parenteral 8 -12 Yes C parenteral 6 -9 Yes D parenteral (2 -10) Yes E fecal-oral 4 No * Weeks

Mechanism of Injury Hepatotropic viruses • Acute infection: direct cytotoxicity , immune response to infection or combination of the two • Chronic infection: immune response probably more important

Clinical Manifestations of Acute Viral Hepatitis Asymptomatic Symptomatic Fulminant liver failure and death Typical Symptoms and Signs • • • Fever Malaise Anorexia Nausea Vomiting • Jaundice • Abdominal/RUQ pain • Hepatomegaly • Arthritis

Laboratory Findings in Acute Viral Hepatitis Laboratory indicators of liver pathology • Elevated ALT (SGPT) and AST (SGOT) • Elevated bilirubin • Elevated alkaline phosphatase Laboratory indicators of infection • Increased WBC All non-specific with regard to making an etiologic diagnosis

Clinical Features of Hepatitis A Incubation period 4 weeks Jaundice <6 years: 10% 6 -14 years: 40 -50% Case fatality Overall: 0. 3% Chronic infection No

Clinical Features of Hepatitis A 1 -Pre-icteric(anicteric) phase l Nonspecific ( anorexia, nausea, vomiting, fever, headache abdominal pain ) 2 -Icteric phase l Regression of non specific symptoms l Jaundice l Liver is enlarged and tender and splenomegaly (20%-30% of cases) l Urine is dark

Transmission of HAV Virus transmitted from person to person l Primarily through fecal-oral route Blood exposure (very rare) l Virus shed in feces of infected persons (both symptomatic and asymptomatic persons) l l Greatest period of communicability: 2 weeks before onset of jaundice

Diagnosis of HAV l l l Elevated liver enzymes Increased serum bilirubin Ig. M anti HAV Ig. G anti HAV Fecal HAV antigen by PCR

Prevention of Hepatitis A Isolation Careful hand washing HAV vaccine Immunoglobulin Treatment-(supportive)

Clinical Features of Hepatitis B Incubation period Average: 8 -12 weeks Jaundice < 5 years: <10% >5 years: 30 -50% Case-fatality rate 0. 5 -1. 0% Chronic infection YES

Outcome of HBV Infection Liver cancer and cirrhosis Asymptomatic acute hepatitis B Chronic infection Resolved & immune Infection Symptomatic acute hepatitis B Chronic infection Asymptomatic carrier Liver cancer and cirrhosis Asymptomatic carrier Resolved & immune

Chronic HBV Infection

Modes of Transmission of HBV l l l Blood transfusion Sexual – homosexual and heterosexual Perinatal – From mother to child during labor and delivery (in utero transmission rare)

Risk for HBV Infection l l l l High-risk heterosexual men and women Sexually active homosexual men Injection drug users Health care workers Household and sex partners of persons with chronic infection Hemodialysis patients Recipients of blood products

Diagnosis of HBV l l l Elevated liver enzymes Increased serum bilirubin Serological testing

HBs. Ag l l Serology Present in acute or chronic infection Detectable 1 to 2 weeks after infection HBe. Ag l l Appears shortly after HBs. Ag Indicates viral Replication and highly Infectious HBs. Ab l l Present after vaccination or clearance of HBs. Ag(Usually 1 to 3 months) Indicates immunity to HBV Hb core Antibody (Ig. M anti-Hbc or Ig. G anti-HBc) Single most reliable marker of HBV infection

Complication of HBV l l 1 -Chronic hepatitis----- cirrhosis and hepatocellular carcinoma 2 -Acute liver cell failure

Prevention of HBV Infection Hepatitis B Immune Globulin (HBIG) • Post-exposure prophylaxis Hepatitis B Vaccine (Recombivax and Engerix-B) • Pre-exposure prophylaxis • Post-exposure prophylaxis

Treatment of HBV l l l Supportive treatment Interferon Ribavarin

Features of HCV Infection(TNANB) l Incubation period Average, 6– 9 wk l Jaundice Mild (20%– 30%) l Chronic hepatitis 70% l Immunity No protective antibody

Mode of Transmission of HCV Blood transfusion Vertical transmission Sexual contact Intravenous drugs abuses Hemodialysis

Diagnosis of HCV Elevated liver enzymes l Increased serum bilirubin Serological testing l Anti HCV antibody l PCR Liver biopsy l

Treatment of HCV l l l Supportive treatment Interferon Lamivudine

Children Playing with Medical Waste

Hepatitis E (HEV) l l l Hepatitis E virus (HEV) RNA virus of the genus Hepevirus Enterically transmitted infection; fecal-oral route, typically self-limited Most outbreaks occur in developing countries. Symptoms of acute hepatitis Incubation period of hepatitis E virus is 4 weeks Case fatality rate is 4%

Hepatitis E: diagnosis PCR detect viral RNA in the serum and stool samples. l Anti-HEV antibodies by immunoassay Ig. M (acute) Ig. G (chronic) AST & ALT are elevated. Treatment: supportive l

Hepatitis D Clinical l Parenteral transmission Co-infection ; with HBV Super infection ; first infected by HBV then added by HDV Diagnosis l l l Elevated liver enzymes Anti HDV antibodies PCR--- detect viral RNA in the serum

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