Viral Hepatitis - PowerPoint PPT Presentation

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Viral Hepatitis

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Hugh B. Fackrell Filename: Hepatite.ppt Hepatitis Virus Outline Definitions Classification Structure Multiplication Clinical manifestations Epidemiology Diagnosis ... – PowerPoint PPT presentation

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Title: Viral Hepatitis


1
Viral Hepatitis
  • Hugh B. Fackrell
  • Filename Hepatite.ppt

2
Hepatitis Virus Outline
  • Definitions
  • Classification
  • Structure
  • Multiplication
  • Clinical manifestations
  • Epidemiology
  • Diagnosis
  • Control

Barons Web Site
3
Hepatitis
  • an ancient disease, the etiology has only
    recently (50 yrs.) been revealed.

4
Hepatitis
  • An inflammatory disease
  • necrosis of hepatocytes
  • mononuclear response destroys liver architecture
  • Liver excretion of bile pigments such as
    bilirubin into the intestine is interrupted

5
Bilirubin
  • Bilirubin greenish-yellow pigment accumulates
    in the blood and tissues
  • Jaundice -
  • yellow tinge in the skin and eyes
  • caused by bilirubin

6
Types of Jaundice
  • Pre hepatic Hemolytic Jaundice
  • normal feces, anemia, reticulocytes
  • Hepatic Hepatocellular Jaundice
  • fecal fat, bilirubinuria, Alkaline phosphatase
    high, gamma globulins high
  • Post Hepatic Obstructive Jaundice
  • fecal fat, bilirubinuria, alkaline phosphatase
    high

7
Jaundice of the Newborn
  • Premature infants
  • bilirubin increases from birth
  • peaks at one week
  • caused by
  • 1excessive hemolysis
  • 2immature liver function

8
Hepatitis symptoms
  • Swelling and tenderness of liver
  • Jaundice -yellow tinge in the skin and eyes
  • dark urine
  • transaminase, alkaline phosphatase levels
    increased

9
Viral Hepatitis
  • Liver infection caused by several UNRELATED
    VIRUSES
  • Inflammation and necrosis of the liver
  • 50 of HAV HBV are subclincal

10
Hepatitis types
  • Hepatitis A - HAV "infectious hepatitis"
  • Hepatitis B - HBV "serum hepatitis"
  • Hepatitis C - HCV non A, non B
  • Hepatitis D - HDV Delta virus
  • Hepatitis E - HEV similar to type A

11
Hepatitis A
  • Infectious hepatitis
  • Epidemic hepatitis
  • HAV

12
Hepatitis AClinical manifestations
  • asymptotic or anicteric in children
  • 3-5 week incubation period
  • liver inflammation
  • malaise - flu like symptoms
  • self limiting
  • low mortality

13
Hepatitis AStructure
  • Picornavirus
  • Only one serotype
  • Enterovirus type 72
  • 27-29 nm icosahedral
  • ssRNA

14
Hepatitis AHost Defenses
  • antibodies develop late in incubation period
  • IgM
  • within a week of dark urine
  • peaks a week later
  • lasts 40-60 days
  • IgG
  • after IgM
  • peaks 60-80 days
  • lasts many years

15
Hepatitis AEpidemiology
  • Global distribution- underreported
  • Fecal-oral route,
  • person to person
  • water
  • Overcrowding poor sanitation
  • Infected food handlers common vector

16
Annual Incidence Viral food borne diseases
  • Total Viral food borne 30,883,391


  • Total Microbial food borne incidence
  • 38,629,64


  • Norwalk-like viruses
  • 23,000,000
  • Rotavirus
  • 3,900,000
  • Astrovirus
  • 3,900,000
  • Hepatitis A
  • 83,391

CDC
17
Hepatitis ADiagnosis
  • Clinical manifestions
  • Viral antigens
  • Immunoelectron microscopy
  • RIA
  • ELISA
  • Immune Adherence hemagglutination (old method)
  • Viral antibodies

18
Hepatitis AControl
  • No specific control
  • Improve hygiene and sanitation
  • Human immunoglobulin
  • 2 IU anti Hepatitis A /kg body weight
  • HAV vaccines in clinical field trials

19
Hepatitis B
  • Serum hepatitis
  • HBV

20
Hepatitis BClinical Manifestations
  • typical viral hepatitis symptoms
  • 4-26 week incubation period
  • more severe than HAV
  • CHRONIC PERSISTENT HEPATITIS
  • CHRONIC ACTIVE HEPATITIS

21
Hepatitis BStructure
  • Hepadnavirus
  • dsDNA, circular, 3200 nucleotides
  • enveloped icosahedral virus
  • 42 nm

22
Australia antigenDane particle
  • small pelomorphic particles 20-22nm
  • tubular forms
  • excess viral capsids released into blood stream

23
3 forms of HBV
24
Dane Particles
25
Hepatitis BHost Defenses
  • Cell mediated Immunity
  • important for recover in acute phase
  • autoimmune liver damage in chronic infections
  • Humoral Immunity
  • not always protective
  • HBsAg for Vaccines
  • Interferon
  • not detected during infection
  • exogenous application effective

26
Hepatitis BEpidemiology
  • Parenterally ie via blood, saliva, menstrual and
    vaginal discharges, semen and breast milk
  • infected blood and blood products
  • sexual contact
  • perinatally from mother to child

27
Hepatitis BPrevalence
  • AREA HBsAg anti HBsAg
  • Western Europe 0.2-0.5 4-6
    USA
  • Eastern Europe 2-7 20-55 USSR
  • China 8-20 70-95
    Asia

28
Hepatitis BDiagnosis
  • Electron microscopy
  • Viral DNA polymerase
  • Viral DNA probes
  • Serology

29
Hepatitis BSerology
  • Hepatitis B surface antigen- HBsAg
  • 10 subtypes
  • Hepatitis B core antigen- HBsCAg
  • Soluble core associated antigen HBeAg

Corresponding antibodies to each antigen occur
30
Hepatitis BControl
  • No specific control
  • Passive Immunization
  • HBV immunoglobulin
  • 250-500 IU within 48 hours
  • neonates of infected mothers -immediately after
    birth
  • Active Immunization
  • HBsAg
  • recombinant DNA in yeast

31
HBV Cancer
  • 1. Transformation of the cell by virus
  • 2. Helper virus if the transforming virus is
    defective
  • 3. Co-carcinogen, chemical, cigarette smoke

32
Transformed cells
  • lose contact inhibition
  • continue to divide
  • form random aggregations
  • can become invasive
  • Not warts Papovavirus

33
Primary Hepatocellular Carcinoma
  • Highest incidence
  • Central Africa
  • Southeast China
  • Pacific Islands, Borneo, Sarawak, Taiwan
  • Icteric symptoms
  • jaundice, dark urine, pale stools
  • Global 250,000- 1,000,000 deaths /year
  • U.S.A. 5000 deaths / year

34
Acute HBV Cancer
  • Acute Hepatitis B
  • 90 1
    Resolution Fulminant Hepatitis
  • 50

Resolution
Chronic Active
AsymptomaticCarrier
Hepatitis
Chronic
Cirrhosis
HepaticCell Carcinoma
ExtrahepaticDisease
35
Hepatitis C
  • HCV
  • Non -A Non-B

36
Hepatitis CClinical Manifestations
  • resembles HBV
  • persistent carrier state
  • 50 of patients have chronic liver damage
  • associated with hepatocellular carcinoma

37
Hepatitis C is probably caused by several
different viruses
38
Hepatitis CEpidemiology
  • in USA causes 90 of post transfusion hepatitis
  • Mother to infant transmission

39
Hepatitis CDiagnosis
  • C100-3 recombinant viral antigen
  • anti c100-3 marker of chronic infection

40
Hepatitis A HAV
Hepatitis B HBV
Hepatitis C HCV
RNA yes endemic epidemic oral/fecal,water
food2-7 weeks fever, G-I tract disorder 1 case
in 10 acute/short not available yes
DNA no endemic blood/serum,close contact 1-6
months fever, rash, arthritis common gradual/chron
ic yes yes
HBV no endemic blood/serum,intimate contact 2-8
weeks similar to HBV common acute/chronic not
available yes
Structure Cultured in cells Epidemiology Transmiss
ion Incubation period Symptoms Jaundice Onset Vac
cine Diagnostic tests
41
Hepatitis D
  • HDV

42
Hepatitis D
  • Dependovirus, it is defective and cannot produce
    infection unless the cell is also infected with
    HBV.
  • Viroid - a naked strand of RNA that enters the
    cell in piggy-back fashion.

43
Hepatitis DClinical Manifestations
  • Dual infection is more severe than HBV
  • fulminating hepatitis
  • severe rapidly progressive hepatitis
  • severe exacerbations

44
Hepatitis D Structure
  • 35-37 nm virus particle
  • shares coat protein of HBV
  • small RNA genome
  • one serotype

45
Hepatitis DEpidemiology
  • hemophiliacs and IV drug users
  • Contaminated blood and blood products

46
Geographic distribution of HDV
47
Hepatitis DDiagnosis
  • Clinical manifestations
  • Delta antigen
  • Immunofluorescence
  • RIA
  • ELISA
  • Anti delta antigen
  • same as above

48
Hepatitis E Virus
49
Hepatitis E
  • fecal/oral route
  • predominantly found in developing countries but
    is world wide.
  • symptoms similar to HAV but mortality 1-2 (ten
    times that of Hepatitis A).
  • epidemics - India, Pakistan, Nepal, Burma, North
    Africa and Mexico.
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