HEPATITE
HEPATITE
HEPATITE
Hugh B. Fackrell
Filename: Hepatite.ppt
8/17/2019
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Hepatitis Virus Outline
Definitions
Classification
Structure
Multiplication
Clinical manifestations
Epidemiology
Diagnosis
Control 8/17/2019
2 Baron’s Web Site
Hepatitis
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Hepatitis
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Bilirubin
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Types of Jaundice
Premature infants
bilirubin increases from birth
peaks at one week
caused by
1:excessivehemolysis
2:immature liver function
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Hepatitis symptoms
Swelling and
tenderness of liver
Jaundice -yellow
tinge in the skin and
eyes
dark urine
transaminase, alkaline
phosphatase levels
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Viral Hepatitis
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Hepatitis types
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Hepatitis A
“Infectious hepatitis”
“Epidemic hepatitis”
HAV
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Hepatitis A
Clinical manifestations
asymptotic or anicteric in children
3-5 week incubation period
liver inflammation
malaise - flu like symptoms
self limiting
low mortality
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Hepatitis A
Structure
Picornavirus
Only one serotype
Enterovirus type 72
27-29 nm icosahedral
ssRNA
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Hepatitis A
Host Defenses
antibodies develop late in incubation period
IgM
within a week of dark urine
peaks a week later
lasts 40-60 days
IgG
after IgM
peaks 60-80 days
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Hepatitis A
Epidemiology
Global distribution- underreported
Fecal-oral route,
person to person
water
Overcrowding & poor sanitation
Infected food handlers common vector
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Annual Incidence Viral food
borne diseases
Norwalk-like viruses Total Viral food borne
23,000,000 30,883,391
Rotavirus Total Microbial food
3,900,000 borne incidence
38,629,64
Astrovirus
3,900,000
Hepatitis A
83,391 CDC
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Hepatitis A
Diagnosis
Clinical manifestions
Viral antigens
Immunoelectron microscopy
RIA
ELISA
Immune Adherence hemagglutination (old
method)
Viral antibodies
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Hepatitis A
Control
No specific control
Improve hygiene and sanitation
Human immunoglobulin
2 IU anti Hepatitis A /kg body weight
HAV vaccines in clinical field trials
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Hepatitis B
“Serum hepatitis”
HBV
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Hepatitis B
Clinical Manifestations
typical viral hepatitis symptoms
4-26 week incubation period
more severe than HAV
CHRONIC PERSISTENT HEPATITIS
CHRONIC ACTIVE HEPATITIS
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Hepatitis B
Structure
Hepadnavirus
dsDNA, circular, 3200 nucleotides
enveloped icosahedral virus
42 nm
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Australia antigen
“Dane particle”
small pelomorphic particles 20-22nm
tubular forms
excess viral capsids released into blood
stream
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3 forms of HBV
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Dane Particles
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Hepatitis B
Host Defenses
Cell mediated Immunity
important
for recover in acute phase
autoimmune liver damage in chronic infections
Humoral Immunity
not
always protective
HBsAg for Vaccines
Interferon
notdetected during infection
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exogenous application effective
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Hepatitis B
Epidemiology
Parenterally ie via blood, saliva, menstrual
and vaginal discharges, semen and breast
milk
infected blood and blood products
sexual contact
perinatally from mother to child
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Hepatitis B
Prevalence
AREA HBsAg anti HBsAg
Western Europe 0.2-0.5% 4-6%
USA
Eastern Europe 2-7 % 20-55%
USSR
China 8-20 % 70-95%
Asia
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Hepatitis B
Diagnosis
Electron microscopy
Viral DNA polymerase
Viral DNA probes
Serology
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Hepatitis B
Serology
Hepatitis B surface antigen- HBsAg
10 subtypes
Hepatitis B core antigen- HBsCAg
Soluble core associated antigen HBeAg
Corresponding antibodies to
each antigen occur
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Hepatitis B
Control
No specific control
Passive Immunization
HBV immunoglobulin
250-500 IU within 48 hours
neonates of infected mothers -immediately after
birth
Active Immunization
HBsAg
recombinant DNA in yeast 8/17/2019
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HBV & Cancer
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Transformed cells
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Primary Hepatocellular Carcinoma
Highest incidence:
Central Africa
Southeast China
Pacific Islands, Borneo, Sarawak, Taiwan
Icteric symptoms:
jaundice, dark urine, pale stools
Global 250,000- 1,000,000 deaths /year
U.S.A. 5000 deaths / year
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Acute HBV & Cancer
Acute Hepatitis B
90% 1%
Resolution
Fulminant Hepatitis
Resolution Chronic Active
Asymptomatic Hepatitis
Carrier Chronic
Cirrhosis
50%
Hepatic
Extrahepatic Cell Carcinoma
Disease
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Hepatitis C
HCV
Non -A Non-B
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Hepatitis C
Clinical Manifestations
resembles HBV
persistent carrier state
50% of patients have chronic liver damage
associated with hepatocellular carcinoma
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Hepatitis C
is probably caused by several
different viruses
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Hepatitis C
Epidemiology
in USA causes 90% of post transfusion
hepatitis
Mother to infant transmission
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Hepatitis C
Diagnosis
C100-3 recombinant viral antigen
anti c100-3 marker of chronic infection
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Hepatitis A Hepatitis B Hepatitis C
HAV HBV HCV
Symptoms fever, G-I tract disorder fever, rash, arthritis similar to HBV
HDV
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Hepatitis D
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Hepatitis D
Clinical Manifestations
Dual infection is more severe than HBV
fulminating hepatitis
severe rapidly progressive hepatitis
severe exacerbations
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Hepatitis D
Structure
35-37 nm virus particle
shares coat protein of HBV
small RNA genome
one serotype
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Hepatitis D
Epidemiology
hemophiliacs and IV drug users
Contaminated blood and blood products
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Geographic distribution of HDV
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Hepatitis D
Diagnosis
Clinical manifestations
Delta antigen
Immunofluorescence
RIA
ELISA
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Hepatitis E Virus
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Hepatitis E
fecal/oral route
predominantly found in developing
countries but is world wide.
symptoms similar to HAV but mortality 1-
2% (ten times that of Hepatitis A).
epidemics - India, Pakistan, Nepal, Burma,
North Africa and Mexico.
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