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Infective Hepatitis
By Dr Upul Udayaraj
Hepatitis may be acute or chronic
Depending on whether it lasts for less than or more than six months
Outcome
• Acute hepatitis
Can sometimes resolve on its own
Progress to chronic hepatitis
Rarely result in acute liver fail...
Causes
• Infectious
• Metabolic
• Ischemic
• Autoimmune
• Genetic
• Other Ex: Neonatal
Infectious Hepatitis
 Viral hepatitis
 Parasitic hepatitis
 Bacterial hepatitis
• Other
• Cytomegalovirus (CMV),
• Epstein–Barr virus (EBV),
• Yellow fever
Globally, symptomatic HAV infections are believed to occur in around 1.4
million people a year
Hepatitis A is most widespr...
Better to know about – HAV
Hepatitis A
 Transmission - fecal-oral
 You can get the infection from:
• Eating food prepared by someone with the infec...
Clinical picture
Incubation period 15 – 50 days
The symptoms of hepatitis A develop, on average,
around four weeks after b...
Clinical picture
The initial symptoms of hepatitis A can include:
 Feeling tired and generally unwell
 Joint and muscle...
Late symptoms
After the initial symptoms, the following symptoms may develop:
 Jaundice
 Dark urine
 Pale stools
 Itc...
Signs of a serious problem
 Hepatitis A isn't usually a serious illness, but in rare cases it can cause the
liver failure...
HEPATITIS B
 Double-stranded DNA Hepadnavirus
 Spread
 Through exposure to infected blood or body fluids
 Vertical tra...
Clinical picture -
 Many people with hepatitis B won't experience any symptoms and may
fight off the virus without realiz...
 Chronic hepatitis (5-10%)
 Fulminant liver failure (1%)
 Hepatocellular carcinoma
 Glomerulonephritis
 Polyarteritis...
 Surface antigen (HBsAg) is the first marker to appear and causes the production of anti-HBs
 HBsAg normally implies acu...
 Previous immunization:
anti-HBs positive, all others negative
 Previous hepatitis B (> 6 months ago), not a carrier:
an...
 There is no specific treatment for acute hepatitis B. Therefore, care is
aimed at maintaining comfort and adequate nutri...
 HBsAg positive source: if the person exposed is a known responder to HBV
vaccine then a booster dose should be given. If...
 All pregnant women are offered screening for hepatitis B
 Babies born to mothers who are chronically infected with hepa...
Transmission
 The risk of transmission during a needle stick injury is about 2%
 The vertical transmission rate from mot...
Clinical picture
 When symptoms do occur, they can be mistaken for another
condition
 Symptoms can include:
 Flu-like s...
Complications
 Chronic infection (80-85%) - only 15-20% of patients will clear the virus after
an acute infection and hen...
 Hepatitis C is diagnosed using two blood tests:
• Antibody test
• PCR test
 A positive antibody test indicates that pat...
Who should get tested?
• Ex-drug users and current drug users (particularly injected drugs)
• People who have lived or had...
 Treatment with antiviral medication is recommended in all people with
proven chronic hepatitis C who are not at high ris...
Hepatitis D
Single stranded RNA virus
Transmitted parenterally
An incomplete RNA virus that requires hepatitis B surface a...
Clinical picture
 Co-infection:
- Hepatitis B and Hepatitis D infection at the same time
 Superinfection:
- A hepatitis ...
Treatment and prevention of HDV
 The vaccine for hepatitis B protects against hepatitis D virus
because of the latter's d...
Hepatitis E
 Common in Central and South-East Asia, North and West Africa, and in Mexico
 It is a RNA hepevirus
 Spread...
END
THANK YOU
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PPT Infective Hepatitis

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Hepatitis ppt

  1. 1. Infective Hepatitis By Dr Upul Udayaraj
  2. 2. Hepatitis may be acute or chronic Depending on whether it lasts for less than or more than six months
  3. 3. Outcome • Acute hepatitis Can sometimes resolve on its own Progress to chronic hepatitis Rarely result in acute liver failure • Chronic hepatitis May progress to Cirrhosis Liver failure or hepatic insufficiency Liver cancer
  4. 4. Causes • Infectious • Metabolic • Ischemic • Autoimmune • Genetic • Other Ex: Neonatal
  5. 5. Infectious Hepatitis  Viral hepatitis  Parasitic hepatitis  Bacterial hepatitis
  6. 6. • Other • Cytomegalovirus (CMV), • Epstein–Barr virus (EBV), • Yellow fever
  7. 7. Globally, symptomatic HAV infections are believed to occur in around 1.4 million people a year Hepatitis A is most widespread in parts of the world where standards of sanitation and food hygiene are generally poor, such as parts of Africa, the Indian subcontinent, the Far East, the Middle East, and Central and South America
  8. 8. Better to know about – HAV
  9. 9. Hepatitis A  Transmission - fecal-oral  You can get the infection from: • Eating food prepared by someone with the infection who hasn't washed their hands properly or washed them in water contaminated with sewage • Drinking contaminated water (including ice cubes) • Eating raw or undercooked shellfish from contaminated water • Close contact with someone who has hepatitis A • Less commonly, having sex with someone who has the infection (particularly a risk for homosexual men) or injecting drugs using contaminated equipment  Someone with hepatitis A is most infectious from around two weeks before their symptoms appear until about a week after the symptoms first develop
  10. 10. Clinical picture Incubation period 15 – 50 days The symptoms of hepatitis A develop, on average, around four weeks after becoming infected, although not everyone with the infection will experience them
  11. 11. Clinical picture The initial symptoms of hepatitis A can include:  Feeling tired and generally unwell  Joint and muscle pain  A mild fever – usually no higher than 39’C  Loss of appetite  Feeling or being sick  Right hypochondriac pain  A headache  Sore throat and cough  Constipation or diarrhea  A raised, itchy rash (hives) These symptoms usually last from a few days up to a couple of weeks Initial symptoms
  12. 12. Late symptoms After the initial symptoms, the following symptoms may develop:  Jaundice  Dark urine  Pale stools  Itchy skin  Right hypochondriac swelling and tenderness Most people make a full recovery within a couple of months, although the symptoms can come and go for up to six months
  13. 13. Signs of a serious problem  Hepatitis A isn't usually a serious illness, but in rare cases it can cause the liver failure  In addition to the symptoms above, signs of liver failure can include:  Sudden, severe vomiting  A tendency to bruise and bleed easily (for example, frequent epistaxis or bleeding gums)  Irritability  Problems with memory and concentration  Drowsiness and confusion  Must get medical advice as soon as possible if experience these symptoms  Liver failure can be life-threatening if not treated quickly
  14. 14. HEPATITIS B  Double-stranded DNA Hepadnavirus  Spread  Through exposure to infected blood or body fluids  Vertical transmission from mother to child  The incubation period is 6-20 weeks
  15. 15. Clinical picture -  Many people with hepatitis B won't experience any symptoms and may fight off the virus without realizing they had it  If symptoms do develop, they tend to occur two or three months after exposure to the hepatitis B virus.  Symptoms of hepatitis B include:  Flu-like symptoms, including tiredness, a fever, and general aches and pains  Loss of appetite  Feeling and being sick  Diarrhea  Abdominal pain  Jaundice  These symptoms will usually pass within one to three months (acute hepatitis B), although occasionally the infection can last for six months or more (chronic hepatitis B)
  16. 16.  Chronic hepatitis (5-10%)  Fulminant liver failure (1%)  Hepatocellular carcinoma  Glomerulonephritis  Polyarteritis nodosa  Cryoglobulinaemia
  17. 17.  Surface antigen (HBsAg) is the first marker to appear and causes the production of anti-HBs  HBsAg normally implies acute disease (present for 1-6 months)  If HBsAg is present for > 6 months then this implies chronic disease (i.e. Infective)  Anti-HBs implies immunity (either exposure or immunization) It is negative in chronic disease  Anti-HBc implies previous (or current) infection IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months IgG anti-HBc persists  HbeAg results from breakdown of core antigen from infected liver cells as is therefore a marker of infectivity
  18. 18.  Previous immunization: anti-HBs positive, all others negative  Previous hepatitis B (> 6 months ago), not a carrier: anti-HBc positive, HBsAg negative  Previous hepatitis B, now a carrier: anti-HBc positive, HBsAg positive
  19. 19.  There is no specific treatment for acute hepatitis B. Therefore, care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids lost from vomiting and diarrhea.  Chronic hepatitis B infection can be treated with drugs, including oral antiviral agents. Treatment can slow the progression of cirrhosis, reduce incidence of liver cancer and improve long term survival.  Treatment options • Antivirals • Tenofovir • Entecavir • Interferon injections
  20. 20.  HBsAg positive source: if the person exposed is a known responder to HBV vaccine then a booster dose should be given. If they are in the process of being vaccinated or are a non-responder they need to have hepatitis B immune globulin (HBIG) and the vaccine  Unknown source: for known responders the green book advises considering a booster dose of HBV vaccine. For known non-responders HBIG + vaccine should be given whilst those in the process of being vaccinated should have an accelerated course of HBV vaccine
  21. 21.  All pregnant women are offered screening for hepatitis B  Babies born to mothers who are chronically infected with hepatitis B or to mothers who've had acute hepatitis B during pregnancy should receive a complete course of vaccination + hepatitis B immunoglobulin  Studies are currently evaluating the role of oral antiviral treatment (e.g. Lamivudine) in the latter part of pregnancy  There is little evidence to suggest caesarean section reduces vertical transmission rates  Hepatitis B cannot be transmitted via breastfeeding (in contrast to HIV)
  22. 22. Transmission  The risk of transmission during a needle stick injury is about 2%  The vertical transmission rate from mother to child is about 6%. The risk is higher if there is coexistent HIV  Breast feeding is not contraindicated in mothers with hepatitis C  The risk of transmitting the virus during sexual intercourse is probably less than 5%
  23. 23. Clinical picture  When symptoms do occur, they can be mistaken for another condition  Symptoms can include:  Flu-like symptoms, such as muscle aches and a high temperature  Feeling tired all the time  Loss of appetite  Abdominal pain  Feeling and being sick
  24. 24. Complications  Chronic infection (80-85%) - only 15-20% of patients will clear the virus after an acute infection and hence the majority will develop chronic hepatitis C  Cirrhosis (20-30% of those with chronic disease)  Hepatocellular cancer  Cryoglobulinemia  Porphyria cutanea tarda (PCT): it is increasingly recognised that PCT may develop in patients with hepatitis C, especially if there are other factors such as alcohol abuse
  25. 25.  Hepatitis C is diagnosed using two blood tests: • Antibody test • PCR test  A positive antibody test indicates that patient has been infected at some stage. It doesn't necessarily mean the person currently infected  The only way to tell if currently infected is to have a second blood test the PCR
  26. 26. Who should get tested? • Ex-drug users and current drug users (particularly injected drugs) • People who have lived or had medical treatment in an area where hepatitis C is common – high- risk areas include north Africa, the Middle East and central and east Asia • Babies and children whose mothers have hepatitis C • Anyone accidentally exposed to the virus, such as health workers • People who have received a tattoo or piercing where equipment may not have been properly sterilized • Sexual partners of people with hepatitis C • People who received blood transfusions before September 1991 • Recipients of organ or tissue transplants before 1992
  27. 27.  Treatment with antiviral medication is recommended in all people with proven chronic hepatitis C who are not at high risk of dying from other causes  Hepatitis C medications  Until relatively recently, treatment for chronic hepatitis C usually involved taking two main drugs: o Pegylated interferon o Ribavirin  These medications were frequently just taken together  Nowadays they often combined with a third medication o Simeprevir o Sofosbuvir
  28. 28. Hepatitis D Single stranded RNA virus Transmitted parenterally An incomplete RNA virus that requires hepatitis B surface antigen to complete its replication and transmission cycle It is transmitted in a similar fashion to hepatitis B
  29. 29. Clinical picture  Co-infection: - Hepatitis B and Hepatitis D infection at the same time  Superinfection: - A hepatitis B surface antigen positive patient subsequently develops a hepatitis D infection  Both superinfection and coinfection with HDV results in more severe complications compared to infection with HBV alone
  30. 30. Treatment and prevention of HDV  The vaccine for hepatitis B protects against hepatitis D virus because of the latter's dependence on the presence of hepatitis B  Latest evidence suggests that Pegylated interferon alpha is effective in reducing the viral load
  31. 31. Hepatitis E  Common in Central and South-East Asia, North and West Africa, and in Mexico  It is a RNA hepevirus  Spread by the faecal-oral route as HAV  Incubation period: 3-8 weeks  Causes a similar disease to hepatitis A,  Carries a significant mortality (about 20%) during pregnancy  Does not cause chronic disease or an increased risk of hepatocellular cancer  A vaccine is currently in development*, but is not yet in widespread use
  32. 32. END THANK YOU

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