Presentation on theme: "Viral hepatitis Dr. Abdulkarim Alhetheel and Dr. Malak Elhazmi"— Presentation transcript:
1Viral hepatitis Dr. Abdulkarim Alhetheel and Dr. Malak Elhazmi Assistant ProfessorCollege of Medicine & KKUH
2Hepatitis Etiology Is inflammation of the liver. Primary infection: Hepatitis A virus (HAV)Hepatitis B virus (HBV).Hepatitis C virus (HCV), was known as non-A non-B hepatitis,Hepatitis D virus (HDV) or delta virus.Hepatitis E virus (HEV).Hepatitis F virus (HFV).Hepatitis G virus (HGV).As part of generalized infection:(CMV, EBV, Yellow fever virus)
3Continued ….Hepatitis F has been reported in the literature but not confirmed.Viral hepatitis is divided into two large groups, based on the mode of transmission:1– Enterically transmitted hepatitis or water-born hepatitis. This group includes hepatitis A and E viruses.2– Parenterally transmitted hepatitis or blood-born hepatitis. This group includes hepatitis B, C, D & G viruses.
4Characteristics of HAV Family of Picornaviridae.Genus: Hepatovirus.Virion non-enveloped and consist of:Icosahedral capsid.Positive sense ss-RNA.Short incubation hepatitisInfectious hepatitisEpidemic hepatitis
6Epidemiology Distribution: Worldwide, endemic in tropical countries HAVDistribution:Worldwide, endemic in tropical countriesTransmission:Faecal-oral route [major route]Contaminated food &waterSexual contact (homosexual men)Blood transfusion (very rarely)Age:In developing countries; childrenIn developed countries; young adults
7PathogenesisHAVThe virus enters the body by ingestion of contaminated food. It replicates in the intestine, and then spread to the liver where it multiplies in hepatocytes.CMI Damage of virus-infected hepatocytesALT, AST & Bilirubin
11Lab Diagnosis Serology: Detection of anti-HAV IgM Current inf Detection of Anti-HAV IgG previous infimmunity
12Management Treatment: Supportive therapy Prevention: HAVTreatment:Supportive therapyPrevention:Sanitation & hygiene measuresHig: Given before or within 2 Ws of exposureIndication: travellers, unvaccinated, exposed patients.Vaccine: inactivatedGiven IM in two doses>1 Y of ageIndication: Patients at high risk of inf and severe disA combination vaccine (HAV & HBV)
13Characteristics of HEV Family of Hepeviridae.Genus: Hepevirus.Virion non-enveloped and consist of:Icosahedral capsid.Positive sense ss-RNA.
14HEPATITIS E VIRUS Epidemiology: Outbreak of water-borne & sporadic cases of VHAge; young adults4 routes of transmission;Water-borneZoonotic food-borneBlood-bornePerinatal
15HEPATITIS E VIRUS Clinical features: Similar to HAV infection with exceptions:Longer IP =4-8 WsFulminant diseaseMortality rate ~10 times > HAV~ 1-3% [20% in pregnancy]
16HEPATITIS E VIRUS Lab diagnosis: ELISA Anti-HE IgM Treatment: Not specificPrevention:Sanitation & hygiene measuresNo IgNo vaccine
17dsDNA , Icosahedral & Enveloped Virus Herpesviridae1- Herpes simplex virus type HSV-12- Herpes simplex virus type HSV-23- Varicella –Zoster virus VZV4- Epstein-Barr virus EBV5- Cytomegalovirus CMV6- Human herpes virus type HHV-67- Human herpes virus type HHV-78- Human herpes virus type HHV-8dsDNA , Icosahedral & Enveloped Virus
18Epstein – Barr Virus EBV It is lymphotropic.It has oncogenic properties;Burkitt’s lymphomaNasopharyngeal carcinomaEpidemiologyDistribution::worldwideTransmission:Saliva [kissing disease]Blood [rarely]Age:Socio-economic status: SELow SE class early childhoodHigh SE class adolescence
20Hematology: Serology: Diagnosis:EBVHematology: Serology:WBClymphocytosis(Atypical lymphocytes)Non-specific AB test ;Heterophile Abs +vePaul-Bunnell ormonospot testEBV-specific AB test:IgM Abs to EBV capsid antigen
21Management: Treatment: Antiviral drug is not effective in IMN EBVManagement:Treatment:Antiviral drug is not effective in IMNPrevention:No vaccine
22Cytomegalovirus CMV Special features; Distribution: worldwide . Its replication cycle is longer.Infected cell enlarged withmultinucleated.[cyto=cell, megalo=big]Resistant to acyclovir.Latent in monocyte,lymphocyte & other.Distribution: worldwide .Transmission;Early in life:TransplacentalBirth canalBreast milkYoung children: salivaLater in life: sexual contact, Blood transfusion & organ transplant.
23Acquired Infection; Congenital Infections Immunocompetent host CMVAcquired Infection;Immunocompetent hostAsymptomaticSelf-limited illnessHepatitisInfectious mononucleosis like syndrome[Heterophile AB is –ve]Immunocompromised hostEncephalitis , Retinitis , Pneumonia ,Hepatitis, Esophagitis, Colitis.Congenital Infections
24Lab Diagnosis Histology: Intranuclear inclusion bodies [Owl’s eye] CMVHistology:Intranuclear inclusion bodies [Owl’s eye]Culture:In human fibroblast1-4 wks CPEShell Vial Assay daysSerology :AB IgM: current inf IgG: previous exposureAg CMV pp65 Ag by IFAPCR
25is effective in the treatment of severe CMV inf. Gancicloviris effective in the treatment of severe CMV inf.Foscarnet: the 2nd drug of choice .Prevention:Screening;Organ donorsOrgan recipientsBlood donorsLeukocyte-depleted blood.Prophylaxis: Ganciclovir, CMVIG.No vaccine.
26Arthropod –borne Viruses (Arboviruses) Yellow Fever virusFamily: FlaviviridaeAsymptomatic to Jaundice + Fever ±hemorrhage ± renal failureEpidemiologyTropical Africa & South AmericaJungle Yellow FeverUrban Yellow Fever
27Urban Yellow Fever Jungle Yellow Fever: Vector: mosquito Reservoir: humanIt is a disease of humansJungle Yellow Fever:Vector: mosquitoReservoir: monkeysAccidental host: humansIt is a disease of monkeys
28Diagnosis: Reference Lab Lab Methods: A- Isolation (Gold standard) B - IgM-Ab - ELISA, IF: (most used)C - Arbovirus RNA by RT-PCRPrevention:1-Vector Control:Elimination of vector breading sitesUsing insecticidesAvoidance contact with vectors2-Vaccines:Yellow Fever vaccine (LAV, one dose /10 yrs)
29Reference books &the relevant page numbers Medical Microbiology.By: David Greenwood ,Richard Slack,John Peutherer and Mike Barer.17th Edition, 2007.Pages; , , ,Review of Medical Microbiology and Immunology.By: Warren Levinson.10th Edition, 2008.Pages; , , 301,