. HEPATITIS

HEPATITIS Hepatitis-Is inflammation of the liver (itis means inflammation and Hepar- Liver) Characterised by irritation or swelling of liver cells(hepatocytes) There are many forms of hapatitis ie: (Viral , Autoimmune ,Fatty liver , Alcoholic and Toxic induced hepatitis) Hepatitis might progress into fibrosis, liver cancer or cirrhosis with eventual death.

HEPATITIS Stages of Hepatitis: Hepatitis presents in three stages(Acute,Chronic and Fulminant) Acute stage: Characterized by inflammation of the liver lasting less than six months can heal on its own without causing any damage though can progress to chronic and damage liver through fibrosis , cirrhosis , Ca with eventual death

HEPATITIS VIRAL HEPATITIS: Hepatitis caused by viral agents Is a systemic disease primarily involving the liver Hepatitis viral agents is a group of viruses that infect Liver resulting to mild , severe acute and chronic disease Transmission and Onset of hepatitis: The hepatitis virions shade and transmissible before the onset of symptoms and during asymptomatic phase of chronic infection

HEPATITIS Main causes of viral hepatitis are of five types: (hepatitis A, B, C, D, and E) The hepatitis viruses cause acute inflammation of the liver resulting to fever &GIT symptoms and are difficulty in management and possibility of death is high. Hepatitis B and hepatitis C result in chronic illnesses. Are also considered to be major sources of cancer and liver cirrhosis.

HEPATITIS Epidemiology: 250 million people are affected by HCV 400 million are chronic carrier of hepatitis B HBV and HCV are most common cause of Liver Cancer and Liver cirrhosis

HEPATITIS Symptoms of Hepatitis(General): Jaundice(Yellowish colouration of sclera)-due to accumulation of bilirubin which stains yellow colour to bile) is liver waste product When liver is damaged fails to work properly leading to accumulation of bilirubin which leak to blood circulation and nearby tissues. But lacking of jaundice does not rule out hepatitis. In acute hepatitis symptoms are similar regardless of viral type other common symptoms are: loss of appetite, muscle aches , nausea and vomiting

HEPATITIS Differences between the Five Hepatitis Viruses: Understanding the differences enables determining effective treatments to cure the disease Hepatitis types A, B, C, D and E are all different from each other. As do not have the same level of severity, transmission and treatment except during acute phase . While Hepatitis A and E are due to ingestion of contaminated water or food ,hepatitis B, C and D are due to parenteral contact of diseased body fluids.

HEPATITIS Hepatitis A virus(HAV ) Presents in the infected person’s feces It causes short incubation period hepatitis Transmittable by the consumption of unclean food and water and sexual intercourse rarely transmittable by parenteral route tentatively classified as enterovirus. It is a 27-nm particle with cubic symmetry Has a linear single stranded RNA genome

HEPATITIS Hepatitis A virus(HAV )Cont.. Can remain infective for years if preserved at -20⁰C Can be destroyed by autoclave(121⁰C for 20minutes,boiling in water for 20mts dry heat(180⁰C for 1hour) The infections are mild, easily recovery and immune system clears HAV infections. Occasionally HAV can be serious to threaten life Can be prevented through vaccination

HEPATITIS Treatment of HAV Acute state: Supportive in nature –No antiviral therapy Hospitalization for dehydrated patients In case of liver failure close monitoring is crucial to avoid fulminant hepatic (Acute liver failure)

Image of HAV

HEPATITIS Hepatitis B virus (HBV) Is 42-nm double shelled particle formerly called Dane particle has small circular DNA molecular and DNA polymerase It has HBsAg exists as a separate small 22-nm particle also present on larger virus particle HBeAg Hepatitis B e antigen which is related to infectivity of a carrier’s blood.

HEPATITIS Hepatitis B virus (HBV)Cont.. The virus is transmitted by too much exposure of infective semen, blood and some body fluids Also via contaminated blood transfusions and other medical procedures Virus is Transmissible from mothers to babies during birth

HEPATITIS Hepatitis B virus (HBV)cont.. Accidental injuries to healthcare personnel when caring for infected hepatitis B patients can be a source of transmission It causes long incubation hepatitis Men are six times more infected than females HBV can be barred through effective and safe vaccines.

HEPATITIS Sign and Symptoms of HBV: In severe forms victim becomes severely sick while other forms may present with flue like symptoms Common symptoms are jaundice , fever, abdominal pains, poor apetite , nausea , fatigue , dark coloured urine ,light colour stool ,muscle and joint pains and tender hepatomegally. Chronic HBV symptoms are vague complaints such as:mild or restless, fatigue, jaundice and hepatomegally- failure treatment leads to liver failure

HEPATITIS Treatment: Acute stage:(No specific antiviral available) Supportive management –recommended Lamivudine,Defovir dipivoxil and other antiviral are useful Chronic HBV infection: The aim is to achieve loss HBV surface antigen(HBsAg) since its loss is associated with decreased incidence of hepatocellular Ca(HCC) and incidence of HBV induced Cirrhosis

HEPATITIS Treatment cont. Key aims of antiviral Treatment are: Inhibition of viral replication To reduce symptoms if any To delay the progression of chronic hepatitis , Cirrhosis or HCC

HEPATITIS

HEPATITIS Liver CA caused HBV

HEPATITIS Hepatitis C virus(HCV): It occurs through the transfusions of HCV blood products and contaminated blood, as well as contaminated injections Mainly during the medical procedures and injections of drugs. Sexual contact is also one of the causes though not that common. There’s no vaccine available for HCV.

HEPATITIS Treatment: Acute HCV infection( Not frequently detected) But when detected Early IFN therapy should be commenced) IFNᶕ-2b at 5ml.Units/day Chronic HCV infection genotype 1or 4 undergo treatment for 48wks,genotype 2 and 3 undergo treatment for 24wks. Long treatment period is appropriate for genotype 1

HEPATITIS Why Interferon used in Treatment of HCV? Decreases viral replication or eradication To prevent progression of disease To decrease the prevalence of Cirrhosis To decrease the frequency HCC as complication of cirrhosis To ameliorate symptoms such as fatigue and joint pains To treat extrahepatic complications HCV ie: Glomerulonephritis

HEPATITIS .

HEPATITIS Hepatitis D Virus(HDV): Occurs in those who are already diagnosed with HBV(Therefore HBV and HDV coinfect) HDV and HBV may lead to more severe disease and even death The vaccine for hepatitis B confers protection to HDV infection as well.

HEPATITIS Treatment of HDV and HEV: Treatment of HBV and HDV coninfection not known yet as they are less responsive to IFN therapy than HBV alone Therefore treatment for patients with HEV is supportive

HEPATITIS

HEPATITIS Hepatitis E virus(HEV) This can be transmitted through consumption of contaminated food and water Effective and safe vaccines greatly prevent HEV infection in a given population however some, vaccines are not always readily available.

HEPATITIS Diagnosing Hepatitis(General) Liver Enzymes Tests-Normally Liver keeps tight control of its enzymes but with liver is damaged enzymes escape into circulation. Common enzymes tested are: Alanine aminotransaminase(ALT) Aspartate aminotransferase(AST) Gammaglutamyltransaminase(GGT) Increase of enzymes indicates liver damage but not cause of damage.

HEPATITIS Antibodies Test When body attacked by virus produces IgM but at the end of infection produces IgG which is specific and provides future immunity.(IgM and G are indicative for HAV and HBV) Direct viral measurement With evidence of viral hepatitis–PCR is done to confirm HBV and HCV Advanced tests are: Diagnosis is done in combination with diagnostic tests such as:- Ultra Sound , CT scan , Magnetic resonance imaging ,liver biopsy etc

HEPATITIS Prevention: HAV- Improved sanitation is very mandatory so strict personal hygiene should be exercised Hand washing helps prevention in transmission Unsafe water and eating of raw seafood should be avoided Household bleach and heating should be exercised Vaccination for: People travelling in endemic area Homosexual individuals

HEPATITIS Vaccination for cont: Illicit drug users People at risk of occupational hazards People receiving clotting factor concentrates Susceptibles with chronic liver disease Susceptibles who have received liver transplants Active Immunization: Passive post exposure immunization with Hepatitis A immune globulin(HAIG).

HEPATITIS (Prevention) HBV-Plasma derived and recombinant HBV vaccines use HBsAg to stimulate production of Anti HBs in non infected individuals-very effective Recommended for all infants as part of the usual immunization schedule and adults at high risk Passive Immunity: Immunoglobulin(Hepatitis B immunoglobulin HBIG) used as passive immunization for recent exposures and infected ones

HEPATITIS Passive Immunity cont: Administered after liver transplantation to pts infected with HBV to prevent HBV induced damage to allograft Recommendation for post exposure prophylaxis for contacts of pts positive for HBsAg: Pre natal exposure(HBIG plus HBV vaccine) at time of birth Sexual contact with acutely infected pts-HBIG plus HBV vaccine Sexual contact with chronic carrier-HBV vaccine Household contact with acutely infected known exposure-HBIG +/-HBV vaccine

HEPATITIS HCV No vaccination against HCV known so far Only preventive measures such as avoidance of infected blood , organs and semen HDV : Since HDV infects only when there is HBV so immunization against HBV confers prevention to HDV HEV –Vaccination is available

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