hepatitis acute
DESCRIPTION
Acute Hepatitis, Viruses, Hepatitis BTRANSCRIPT
ACUTE HEPATITIS
Hepatitis
bull Any disease process characterized by a diffuse inflammatory infiltrate of liver tissue with or without a degree of hepatocellular necrosis and local fibrosis
bull Etiology
Infectious Chemical Toxic and Autoimmune
Clinical Forms
bull Acute viral hepatitisbull Recent infection and inflammation of the liver
bull Chronic viral hepatitisbull Persistent viral infection of liver tissue lasting
more than 6 months
bull Causes of Acute Hepatitisbull Viruses (ABCEEBVCMV)bull Alcoholbull Toxins (Carbon tetrachloride)bull Drugs (INH PZA)
Acute Hepatitis
bull Prodromal illness (Flu like)bull 1048590 Vomitingbull 1048590 Aversion to alcohol and cigarettesbull 1048590 ABDOMINAL discomfortbull 1048590 Pale faeces and dark urinebull 1048590 Jaundice
Agents of Viral Hepatitis
bull Enterically transmitted hepatitisbull Hepatitis A and Ebull Acute diseases with no chronic phase
bull Blood-borne viral hepatitisndash Hepatitis B C and D all chronic infections
bull Systemic agents not restricted to the liverndash HSV VZV EBV CMV HIV
Hepatitis A
bull Symptomatic Illnessbull Symptomatic in 80 of adults but not children (lt3)bull Malaise Vomiting and jaundice prominent
bull Transmission patternsbull Person to person contactbull Common source outbreaks especially seafood
HAV Pathogenesis
bull Ingested orally Resistant to stomach acidbull Reaches the liver via the intestinebull Replicates in hepatocyte cytoplasmbull Secreted in the bile and excreted in faecesbull Cell mediated immune clearance and cyto-pathologybull Symptoms last 2-3 weeks
Laboratory Diagnosis of HAV
bull Serological diagnosisbull Preferred method is EIA for anti-HAV IgMbull Acute antibody response with a rise in IgMbull Simultaneous gradual rise in IgG
HAV Prevention
bullInactivated whole-virus vaccine
Treatment
bull Supportive re-hydration and nutritionbull Avoid alcohol
bull Outcomebull 1048590Recovery in gt 99 clinical relapse in 4-20bull 1048590Rarely need to hospitalize or transplantbull 1048590Fulminant hepatitis lt035
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Hepatitis
bull Any disease process characterized by a diffuse inflammatory infiltrate of liver tissue with or without a degree of hepatocellular necrosis and local fibrosis
bull Etiology
Infectious Chemical Toxic and Autoimmune
Clinical Forms
bull Acute viral hepatitisbull Recent infection and inflammation of the liver
bull Chronic viral hepatitisbull Persistent viral infection of liver tissue lasting
more than 6 months
bull Causes of Acute Hepatitisbull Viruses (ABCEEBVCMV)bull Alcoholbull Toxins (Carbon tetrachloride)bull Drugs (INH PZA)
Acute Hepatitis
bull Prodromal illness (Flu like)bull 1048590 Vomitingbull 1048590 Aversion to alcohol and cigarettesbull 1048590 ABDOMINAL discomfortbull 1048590 Pale faeces and dark urinebull 1048590 Jaundice
Agents of Viral Hepatitis
bull Enterically transmitted hepatitisbull Hepatitis A and Ebull Acute diseases with no chronic phase
bull Blood-borne viral hepatitisndash Hepatitis B C and D all chronic infections
bull Systemic agents not restricted to the liverndash HSV VZV EBV CMV HIV
Hepatitis A
bull Symptomatic Illnessbull Symptomatic in 80 of adults but not children (lt3)bull Malaise Vomiting and jaundice prominent
bull Transmission patternsbull Person to person contactbull Common source outbreaks especially seafood
HAV Pathogenesis
bull Ingested orally Resistant to stomach acidbull Reaches the liver via the intestinebull Replicates in hepatocyte cytoplasmbull Secreted in the bile and excreted in faecesbull Cell mediated immune clearance and cyto-pathologybull Symptoms last 2-3 weeks
Laboratory Diagnosis of HAV
bull Serological diagnosisbull Preferred method is EIA for anti-HAV IgMbull Acute antibody response with a rise in IgMbull Simultaneous gradual rise in IgG
HAV Prevention
bullInactivated whole-virus vaccine
Treatment
bull Supportive re-hydration and nutritionbull Avoid alcohol
bull Outcomebull 1048590Recovery in gt 99 clinical relapse in 4-20bull 1048590Rarely need to hospitalize or transplantbull 1048590Fulminant hepatitis lt035
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Clinical Forms
bull Acute viral hepatitisbull Recent infection and inflammation of the liver
bull Chronic viral hepatitisbull Persistent viral infection of liver tissue lasting
more than 6 months
bull Causes of Acute Hepatitisbull Viruses (ABCEEBVCMV)bull Alcoholbull Toxins (Carbon tetrachloride)bull Drugs (INH PZA)
Acute Hepatitis
bull Prodromal illness (Flu like)bull 1048590 Vomitingbull 1048590 Aversion to alcohol and cigarettesbull 1048590 ABDOMINAL discomfortbull 1048590 Pale faeces and dark urinebull 1048590 Jaundice
Agents of Viral Hepatitis
bull Enterically transmitted hepatitisbull Hepatitis A and Ebull Acute diseases with no chronic phase
bull Blood-borne viral hepatitisndash Hepatitis B C and D all chronic infections
bull Systemic agents not restricted to the liverndash HSV VZV EBV CMV HIV
Hepatitis A
bull Symptomatic Illnessbull Symptomatic in 80 of adults but not children (lt3)bull Malaise Vomiting and jaundice prominent
bull Transmission patternsbull Person to person contactbull Common source outbreaks especially seafood
HAV Pathogenesis
bull Ingested orally Resistant to stomach acidbull Reaches the liver via the intestinebull Replicates in hepatocyte cytoplasmbull Secreted in the bile and excreted in faecesbull Cell mediated immune clearance and cyto-pathologybull Symptoms last 2-3 weeks
Laboratory Diagnosis of HAV
bull Serological diagnosisbull Preferred method is EIA for anti-HAV IgMbull Acute antibody response with a rise in IgMbull Simultaneous gradual rise in IgG
HAV Prevention
bullInactivated whole-virus vaccine
Treatment
bull Supportive re-hydration and nutritionbull Avoid alcohol
bull Outcomebull 1048590Recovery in gt 99 clinical relapse in 4-20bull 1048590Rarely need to hospitalize or transplantbull 1048590Fulminant hepatitis lt035
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
bull Causes of Acute Hepatitisbull Viruses (ABCEEBVCMV)bull Alcoholbull Toxins (Carbon tetrachloride)bull Drugs (INH PZA)
Acute Hepatitis
bull Prodromal illness (Flu like)bull 1048590 Vomitingbull 1048590 Aversion to alcohol and cigarettesbull 1048590 ABDOMINAL discomfortbull 1048590 Pale faeces and dark urinebull 1048590 Jaundice
Agents of Viral Hepatitis
bull Enterically transmitted hepatitisbull Hepatitis A and Ebull Acute diseases with no chronic phase
bull Blood-borne viral hepatitisndash Hepatitis B C and D all chronic infections
bull Systemic agents not restricted to the liverndash HSV VZV EBV CMV HIV
Hepatitis A
bull Symptomatic Illnessbull Symptomatic in 80 of adults but not children (lt3)bull Malaise Vomiting and jaundice prominent
bull Transmission patternsbull Person to person contactbull Common source outbreaks especially seafood
HAV Pathogenesis
bull Ingested orally Resistant to stomach acidbull Reaches the liver via the intestinebull Replicates in hepatocyte cytoplasmbull Secreted in the bile and excreted in faecesbull Cell mediated immune clearance and cyto-pathologybull Symptoms last 2-3 weeks
Laboratory Diagnosis of HAV
bull Serological diagnosisbull Preferred method is EIA for anti-HAV IgMbull Acute antibody response with a rise in IgMbull Simultaneous gradual rise in IgG
HAV Prevention
bullInactivated whole-virus vaccine
Treatment
bull Supportive re-hydration and nutritionbull Avoid alcohol
bull Outcomebull 1048590Recovery in gt 99 clinical relapse in 4-20bull 1048590Rarely need to hospitalize or transplantbull 1048590Fulminant hepatitis lt035
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Acute Hepatitis
bull Prodromal illness (Flu like)bull 1048590 Vomitingbull 1048590 Aversion to alcohol and cigarettesbull 1048590 ABDOMINAL discomfortbull 1048590 Pale faeces and dark urinebull 1048590 Jaundice
Agents of Viral Hepatitis
bull Enterically transmitted hepatitisbull Hepatitis A and Ebull Acute diseases with no chronic phase
bull Blood-borne viral hepatitisndash Hepatitis B C and D all chronic infections
bull Systemic agents not restricted to the liverndash HSV VZV EBV CMV HIV
Hepatitis A
bull Symptomatic Illnessbull Symptomatic in 80 of adults but not children (lt3)bull Malaise Vomiting and jaundice prominent
bull Transmission patternsbull Person to person contactbull Common source outbreaks especially seafood
HAV Pathogenesis
bull Ingested orally Resistant to stomach acidbull Reaches the liver via the intestinebull Replicates in hepatocyte cytoplasmbull Secreted in the bile and excreted in faecesbull Cell mediated immune clearance and cyto-pathologybull Symptoms last 2-3 weeks
Laboratory Diagnosis of HAV
bull Serological diagnosisbull Preferred method is EIA for anti-HAV IgMbull Acute antibody response with a rise in IgMbull Simultaneous gradual rise in IgG
HAV Prevention
bullInactivated whole-virus vaccine
Treatment
bull Supportive re-hydration and nutritionbull Avoid alcohol
bull Outcomebull 1048590Recovery in gt 99 clinical relapse in 4-20bull 1048590Rarely need to hospitalize or transplantbull 1048590Fulminant hepatitis lt035
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Agents of Viral Hepatitis
bull Enterically transmitted hepatitisbull Hepatitis A and Ebull Acute diseases with no chronic phase
bull Blood-borne viral hepatitisndash Hepatitis B C and D all chronic infections
bull Systemic agents not restricted to the liverndash HSV VZV EBV CMV HIV
Hepatitis A
bull Symptomatic Illnessbull Symptomatic in 80 of adults but not children (lt3)bull Malaise Vomiting and jaundice prominent
bull Transmission patternsbull Person to person contactbull Common source outbreaks especially seafood
HAV Pathogenesis
bull Ingested orally Resistant to stomach acidbull Reaches the liver via the intestinebull Replicates in hepatocyte cytoplasmbull Secreted in the bile and excreted in faecesbull Cell mediated immune clearance and cyto-pathologybull Symptoms last 2-3 weeks
Laboratory Diagnosis of HAV
bull Serological diagnosisbull Preferred method is EIA for anti-HAV IgMbull Acute antibody response with a rise in IgMbull Simultaneous gradual rise in IgG
HAV Prevention
bullInactivated whole-virus vaccine
Treatment
bull Supportive re-hydration and nutritionbull Avoid alcohol
bull Outcomebull 1048590Recovery in gt 99 clinical relapse in 4-20bull 1048590Rarely need to hospitalize or transplantbull 1048590Fulminant hepatitis lt035
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
bull Blood-borne viral hepatitisndash Hepatitis B C and D all chronic infections
bull Systemic agents not restricted to the liverndash HSV VZV EBV CMV HIV
Hepatitis A
bull Symptomatic Illnessbull Symptomatic in 80 of adults but not children (lt3)bull Malaise Vomiting and jaundice prominent
bull Transmission patternsbull Person to person contactbull Common source outbreaks especially seafood
HAV Pathogenesis
bull Ingested orally Resistant to stomach acidbull Reaches the liver via the intestinebull Replicates in hepatocyte cytoplasmbull Secreted in the bile and excreted in faecesbull Cell mediated immune clearance and cyto-pathologybull Symptoms last 2-3 weeks
Laboratory Diagnosis of HAV
bull Serological diagnosisbull Preferred method is EIA for anti-HAV IgMbull Acute antibody response with a rise in IgMbull Simultaneous gradual rise in IgG
HAV Prevention
bullInactivated whole-virus vaccine
Treatment
bull Supportive re-hydration and nutritionbull Avoid alcohol
bull Outcomebull 1048590Recovery in gt 99 clinical relapse in 4-20bull 1048590Rarely need to hospitalize or transplantbull 1048590Fulminant hepatitis lt035
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Hepatitis A
bull Symptomatic Illnessbull Symptomatic in 80 of adults but not children (lt3)bull Malaise Vomiting and jaundice prominent
bull Transmission patternsbull Person to person contactbull Common source outbreaks especially seafood
HAV Pathogenesis
bull Ingested orally Resistant to stomach acidbull Reaches the liver via the intestinebull Replicates in hepatocyte cytoplasmbull Secreted in the bile and excreted in faecesbull Cell mediated immune clearance and cyto-pathologybull Symptoms last 2-3 weeks
Laboratory Diagnosis of HAV
bull Serological diagnosisbull Preferred method is EIA for anti-HAV IgMbull Acute antibody response with a rise in IgMbull Simultaneous gradual rise in IgG
HAV Prevention
bullInactivated whole-virus vaccine
Treatment
bull Supportive re-hydration and nutritionbull Avoid alcohol
bull Outcomebull 1048590Recovery in gt 99 clinical relapse in 4-20bull 1048590Rarely need to hospitalize or transplantbull 1048590Fulminant hepatitis lt035
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
HAV Pathogenesis
bull Ingested orally Resistant to stomach acidbull Reaches the liver via the intestinebull Replicates in hepatocyte cytoplasmbull Secreted in the bile and excreted in faecesbull Cell mediated immune clearance and cyto-pathologybull Symptoms last 2-3 weeks
Laboratory Diagnosis of HAV
bull Serological diagnosisbull Preferred method is EIA for anti-HAV IgMbull Acute antibody response with a rise in IgMbull Simultaneous gradual rise in IgG
HAV Prevention
bullInactivated whole-virus vaccine
Treatment
bull Supportive re-hydration and nutritionbull Avoid alcohol
bull Outcomebull 1048590Recovery in gt 99 clinical relapse in 4-20bull 1048590Rarely need to hospitalize or transplantbull 1048590Fulminant hepatitis lt035
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Laboratory Diagnosis of HAV
bull Serological diagnosisbull Preferred method is EIA for anti-HAV IgMbull Acute antibody response with a rise in IgMbull Simultaneous gradual rise in IgG
HAV Prevention
bullInactivated whole-virus vaccine
Treatment
bull Supportive re-hydration and nutritionbull Avoid alcohol
bull Outcomebull 1048590Recovery in gt 99 clinical relapse in 4-20bull 1048590Rarely need to hospitalize or transplantbull 1048590Fulminant hepatitis lt035
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
HAV Prevention
bullInactivated whole-virus vaccine
Treatment
bull Supportive re-hydration and nutritionbull Avoid alcohol
bull Outcomebull 1048590Recovery in gt 99 clinical relapse in 4-20bull 1048590Rarely need to hospitalize or transplantbull 1048590Fulminant hepatitis lt035
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Treatment
bull Supportive re-hydration and nutritionbull Avoid alcohol
bull Outcomebull 1048590Recovery in gt 99 clinical relapse in 4-20bull 1048590Rarely need to hospitalize or transplantbull 1048590Fulminant hepatitis lt035
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Hepatitis E
bull Epidemiologybull 1048590A major cause of sporadic and epidemic
hepatitisbull 1048590Water-bornebull 1048590Only 5 of adult cases have jaundice
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
HEV Pathogenesis
bull 1048590Entry across intestinal mucosa (unknown)bull 1048590Secreted in faecesbull 2 weeks before and 1 week after symptomsbull 1048590Detected in serum for two weeks after onsetbull 1048590Affects liver Kupffer cells and hepatocytesbull 1048590Cholestasis is a feature in 50 of casesbull 1048590Injury appears immune mediated
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Laboratory Diagnosis of HEV
bull EIA based assays for IgM and IgG
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
HEV Prevention and Treatment
bull Treatmentbull Supportive therapybull No specific treatment
bull Preventionbull 1048590No vaccines availablebull 1048590Recombinant protein in animal amp human trialsbull 1048590Immune serum globulin is ineffective
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
bull Alcoholic Hepatitisbull Can be acute or chronicbull Risk of cirrhosis variablehellipgenetics sex (womenbull more susceptible) presence of chronic hepatitisbull possibly nutritional factorbull Presentation can range from an asymptomaticbull person to a critically ill one
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
bull Drug induced Liver Diseasebull 3 subtypesbull 1048590 Direct hepatotoxic groupbull 1048590 Idiosyncratic reactionsbull 1048590 Cholestatic reactions
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
bull Direct hepatotoxic Groupbull 1048590Dose related severitybull 1048590Latent period after exposurebull Exampleshellipacetominophen alcohol carbonbull tetrachloride niacin vitamin A
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
bull Idiosyncratic Reactionsbull 1048590 Sporadic and rarebull 1048590 Not dose relatedbull 1048590 Occasionally fever and eosinophiliabull suggesting an allergic type reaction
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
bull Cholestatic Reactionsbull 1048590 Non-inflammatory (direct effect on bilebull secretion)hellipexamples estrogens anabolic steroidsbull azathioprinebull 1048590 Inflammatory (portal areas with cholangitis) oftenbull with allergic featureshellipexamples erythromycinbull ampicillin-clavulanic and semi-synthetic penicillinsbull chlorpropamide
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
bull Autoimmune Hepatitisbull 1048590 Generally affects young females (less often postmenopausal)bull 1048590 ANA and anti-smooth muscle antibodies each presentbull in 70bull 1048590 Hypergammaglobulinemiabull 1048590 Extrahepatic manifestations are clueshellipamenorrheabull thyroiditis acne Sjogrens arthritis Coomb-positivebull hemolytic anemia nephritisbull 1048590 Old name was Lupoid Hepatitis
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Hepatitis B
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Parenteral - IV drug abusers health workers are at increased risk
Sexual - sex workers and homosexuals are particular at risk
Perinatal(Vertical) - mother(HBeAg+) rarrinfant
HBV Modes of TransmissionHBV Modes of Transmission
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Pathogenesis amp Immunitybull Virus enters hepatocytes via blood bull Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface responsible for clinical syndrome
bull 5 become chronic carriers (HBsAggt 6 months)
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Clinical FeaturesIncubation period Average 60-90 days Insidious onset of symptoms Tends to cause a more severe disease than
Hepatitis APremature mortality from chronic liver disease 15-25
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5 of adult-acquired infections
95 of infant-acquired infections
Cirrhosis
Chronic hepatitis
12-25 in 5 years
Liver failure Hepatocellular carcinoma
Liver transplant
6-15 in 5 years 20-23 in 5 years
DeathDeath
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Prevention
bull Vaccinationbull - highly effective recombinant vaccinesbull Hepatitis B Immunoglobulin (HBIG) bull -exposed within 48 hours of the incident neonates whose
mothers are HBsAg and HBeAg positive bull Other measuresbull -screening of blood donors blood and body fluid precautions
bull
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Hepatitis B Vaccine
bull Infants several options that depend on status of the mother ndash If mother HBsAg negative birth 1-2m6-18m ndash If mother HBsAg positive vaccine and Hep B immune globulin within 12
hours of birth 1-2m 6m bull Adults 01 6 months bull Vaccine recommended in
ndash All those aged 0-18 ndash Those at high risk
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Hepatitis C
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Pathology of HCV
bull Acute Hepatitis Cndash Generally benign
bull No jaundice (80)bull Usually asymptomatic
ndash Can be severe but liver failure rareOnly real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Pathology of HCV
bull Chronic Hepatitis Cndash 70 of patients become chronicndash Possible results
bull Cirrhosisbull End-stage liver diseasebull Hepatocellular carcinoma
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
Transmission
bull Direct blood or fluid exposurebull Perinatal Transmissionbull Transmissionbull Other things thought to be associated with HCV
ndash Tatoosndash Acupuncturendash Ear Piercing
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
bull Indications For Treatment ndash Increased ALT activityndash Liver biopsy fibrosisndash Detectible serum HCV RNA
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
bull Vaccinendash Difficult
bull High mutation rate
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-
THANKS
- ACUTE HEPATITIS
- Hepatitis
- Clinical Forms
- PowerPoint Presentation
- Acute Hepatitis
- Agents of Viral Hepatitis
- Slide 7
- Hepatitis A
- HAV Pathogenesis
- Laboratory Diagnosis of HAV
- Slide 11
- HAV Prevention
- Treatment
- Hepatitis E
- HEV Pathogenesis
- Laboratory Diagnosis of HEV
- HEV Prevention and Treatment
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Hepatitis B
- Slide 25
- Pathogenesis amp Immunity
- Clinical Features
- Slide 28
- Slide 29
- Prevention
- Slide 31
- Slide 32
- Hepatitis B Vaccine
- Hepatitis C
- Pathology of HCV
- Slide 36
- Transmission
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- THANKS
-