Presentation on theme: "Viral hepatitis Dr. Abdulkarim Alhetheel and Dr. Malak Elhazmi"— Presentation transcript:
1 Viral hepatitis Dr. Abdulkarim Alhetheel and Dr. Malak Elhazmi Assistant ProfessorCollege of Medicine & KKUH
2 Hepatitis 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)
3 Continued ….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.
4 Characteristics of HAV Family of Picornaviridae.Genus: Hepatovirus.Virion non-enveloped and consist of:Icosahedral capsid.Positive sense ss-RNA.Short incubation hepatitisInfectious hepatitisEpidemic hepatitis
6 Epidemiology 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
7 PathogenesisHAVThe 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
11 Lab Diagnosis Serology: Detection of anti-HAV IgM Current inf Detection of Anti-HAV IgG previous infimmunity
12 Management 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)
13 Characteristics of HEV Family of Hepeviridae.Genus: Hepevirus.Virion non-enveloped and consist of:Icosahedral capsid.Positive sense ss-RNA.
14 HEPATITIS E VIRUS Epidemiology: Outbreak of water-borne & sporadic cases of VHAge; young adults4 routes of transmission;Water-borneZoonotic food-borneBlood-bornePerinatal
15 HEPATITIS 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]
16 HEPATITIS E VIRUS Lab diagnosis: ELISA Anti-HE IgM Treatment: Not specificPrevention:Sanitation & hygiene measuresNo IgNo vaccine
17 dsDNA , 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
18 Epstein – 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
20 Hematology: 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
21 Management: Treatment: Antiviral drug is not effective in IMN EBVManagement:Treatment:Antiviral drug is not effective in IMNPrevention:No vaccine
22 Cytomegalovirus 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.
23 Acquired 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
24 Lab 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
25 is 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.
26 Arthropod –borne Viruses (Arboviruses) Yellow Fever virusFamily: FlaviviridaeAsymptomatic to Jaundice + Fever ±hemorrhage ± renal failureEpidemiologyTropical Africa & South AmericaJungle Yellow FeverUrban Yellow Fever
27 Urban 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
28 Diagnosis: 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)
29 Reference 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,