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Hepatitis A
Virus Characteristics
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Piconaviridae!
Hepadnaviridae !
Flaviridae!
Single-stranded RNA! Double-stranded
Single-stranded RNA
DNA!
Replication:!
*HbS Ag (hepatocyte
Cytoplasm
receptor)!
*HbC Ag (hepatocyte
nucleus)!
*HbE Ag
(nucleus&blood)!
*HbX Ag
Deltaviridae!
Caliciviridae!
Single-stranded RNA! (+) & (-) RNA!
Route of transmission
Fecal-Oral
Childbirth, needles,
sex, transfusion
Childbirth, needles,
sex, transfusion
Childbirth, needles,
sex, transfusion
Fecal-Oral
Incubation period
15-30 days!
1 month
75 days!
1-6 months
1-6 months!
insidious onset
35 days-1 month!
40-65 days!
(minimum 30 days)
Course of infection
95% Acute
5%Chronic
5% Acute!
95% Chronic
Acute (co-infection of
HBV)!
Chronic
(superinfection of
HBV)!
Mild-Moderate !
Mortality (0.2%)
Moderate-Severe
Mild-Moderate-Severe!
Genotype 3- severe/
fulminant acute HD!
Mortality (2-20%)!
Mild-Moderate!
*pregnant women
leads to abundant
uterine bleeding ->
death
Severity
Replication:!
Membrane and
Endoplasmic
reticulum
!
!
Envelops: NONE!
EPIDEMIC
Ivan Yeoh
Main Signs/Syndromes
Jaundice!
Flu-like syndrome!
Dyspeptic syndrome!
Asthenic syndrome!
Pale colour of stool!
Hepatomegaly!
Itching (cholestasis)
Intoxication signs
increase after icteric
period (unlike HAV)!
Icteric:!
Flu-like syndrome!
Dyspeptic syndrome!
Asthenic syndrome!
Arthral syndrome!
20-30% Jaundice!
10-30% Non specific
symptoms!
Arthralgia!
6 months- Chronic!
10-20 years- Cirrhosis!
25-30 years- HCC
Intoxication!
Jaundice!
LIver dysfunction!
Flu-like syndrome!
Dyspeptic syndrome!
Asthenic syndrome
Jaundice!
Flu-like syndrome!
Dyspeptic syndrome!
Asthenic syndrome!
Pale colour of stool!
Hepatomegaly!
Itching (cholestasis)!
Severe:!
Fever!
Hemorrhagic
syndrome!
Diagnostic Criteria
Hepato&
Splenomegaly!
(normalisation after
3-4 weeks)!
Lympho-monocytosis!
!
!
Dark urine!
(Increased bilirubin)!
Albumin !
(decrease) lead to
cirrhosis
I: ALT!
Chronicity follows
I: Bilirubin!
1-3% co infection!
I: ALT!
Chronicity follows 70%
of superinfection!
Superfinfection- IgM
decreases in a few
weeks, but IgG
persists for 1-2 weeks.!
Ivan Yeoh
Biological Markers
ALT>AST (preictric/
prodromal)!
AST>ALT (toxic
hepatitis)!
*may persist for 2-3
weeks but <4 weeks)!
First incidence!
*IgM AB!
*IgM anti-HAV!
*IgG anti-HAV!
PAST infection!
*IgG anti-HAV
I: ALT!
I: AST!
I: AP!
I: Gamma transferase!
I: Liver enzymes!
HBV DNA
(quantitative marker of
viral replication)!
CORE ANTIGEN!
HbC Ag!
cytotoxic lymphocytes
expressed on
hepatocyte surface
with HLA-A2
molecules!
HbC antibody!
IgM acute!
IgG chronic!
EARLY ANTIGEN!
HbE Ag!
*early appearance
during infective and
replicative period!
HbE antibody!
*decrease by the end
of replication period!
SURFACE ANTIGEN!
HbS Ag!
>6 months!
(chronic infection)!
marker of infectivity!
HbS antibody!
vaccination or
passively acquired Ab!
Anti HCV!
(4-10 WEEKS)!
Detect HCV RNA!
(PCR)
Co-infection:!
HbS Ag!
HbE Ag!
Anti HbC IgM!
Anti HbC IgG!
Anti HDV IgM!
Anti HDV IgG!
Superinfection!
HbS Ag!
Anti HbC IgG!
Anti HbE!
Anti HDV IgM!
Anti HDV IgG!
DO PCR! Because
Anti HDV develops
very slowly
Anti-HEV IgM!
(41st day infection till
2 years)!
HEV RNA !
(22 days)!
FALSE DIAGNOSIS!
Anti-HAV IgM
Ivan Yeoh
Prognosis/Complications
Prolonged jaundice
leads to fever and
pruritus (cholestatic
hepatitis)!
Passive immunization
of human Ig !
Vaccine
Acute hepatic
encephalopathy!
Vaccine!
Anti-HbS Ag (6
months)!
Vaccination to HBV
3 dose
Absent!
(Mutation is high)!
Endotoxin theory!
Ammonia theory!
Absent
Tx: Detoxification
+Symptomatic
treatment!
!
!
TREATMENT:!
1. Detoxification therapy:!
Crystalloid- Colloids (3:1)!
Enterogel!
2. Osmotic Diarrhea!
Lactulose!
Duphalac!
3. Low absorption antibiotics!
Aminoglycosides!
!
!
!
*if present of liver encephalopathy, give chilled plasma and amino acid to correct hemorrhagic syndrome, osmotic diarrhea drugs to eliminate
ammonia.