HEPATITIS A,B,C, D,E.pptx

Hepatitis

1. HEPATITIS GROUP 5 FAITH MIYANDA FANCY CHEMBE LUBUTO CHANDA ISAAC MUSWELE

2. INTRODUCTION Definition: Hepatitis refers to inflammation of the liver, often caused by viral infections, leading to liver dysfunction. The liver is vital for detoxification, metabolism, and immune response. Hepatitis can range from acute, self-limiting infections to chronic conditions leading to cirrhosis or liver cancer.

3. TYPES OF HEPATITIS Hepatitis A (HAV ) Hepatitis B (HBV ) Hepatitis C (HCV ) Hepatitis D (HDV ) Hepatitis E (HEV )

4. MODES OF TRANSMISSION IN DENTAL SETTING Blood borne Pathogens (HBV, HCV, HDV): Contaminated instruments, needle stick injuries, exposure to blood and saliva. Hepatitis B potentially has the highest transmission risk in dental settings due to its high viral load in blood. Saliva and Oral Fluids: Presence of HBV DNA and HCV RNA in saliva, though transmission via saliva is rare.

5. IMPLICATION FOR DENTAL MANAGEMENT Medical History: Patient Assessment: Inquire about liver disease, hepatitis status, and any related symptoms. Laboratory Tests: Consider liver function tests (LFTs) like ALT, AST, and INR for patients with known hepatitis. Infection Control Measures: Standard Precautions: Universal precautions must be applied, including proper sterilization, use of PPE, and safe disposal of sharps. Vaccination: Ensure all dental healthcare workers are vaccinated against HBV. Emergency Preparedness: Managing Bleeding: Have protocols in place for managing excessive bleeding, especially in patients with coagulopathy. Referral: Know when to refer patients with advanced liver disease to specialists

6. HEPATITIS A Hepatitis A is an acute inflammation of the Liver that can cause mild to severe illness. It is also known as infectious Hepatitis or epidemic jaundice.

7. AETIOLOGY Hepatitis A is caused by the Hepatitis A virus(HAV). The HAV is a RNA virus which is an enterovirus of the picarnoviridae family. It multiplies mainly in hepatocytes (Liver cells). It is resistant to heat and chemicals but formalne is stated to be an effective disinfectant. The virus is also inactivated by ultraviolet rays and by boiling for 5 minutes or autoclaving.

8. PATHOLOGY Infection of HAV is more frequent in children than in adults. However people from all ages may be affected if susceptible. Unlike hepatitis B and C , HEPAITIS A does not cause chronic liver disease. This is because the infection only lasts for a short time

9. MODES OF TRANSMISSION The hepatitis A virus is transmitted primarily by fecal oral route that is when an uninfected person ingests food or water that has been contaminated with the fecal matter of an infected person. In families this can happen through dirty hands when an infected person prepares food for the family. Waterborne outbreaks though infrequent are usually associated with sewage contaminated or inadequately treated water. The virus can also be transmitted through close physical contact like oral to anal sex with an infected person

10. CLINICAL FEATURES The incubation period of hepatitis A is usually 14-28 days. Symptoms range from mild to severe and can include fever, loss of appetite, diarrhea, nauseas, abdominal discomfort, dark colored urine, yellowing of eyes and skin. Not everyone who is infected will have signs and symptoms. Adults have signs and symptoms of illness more often than children

11. DIAGNOSIS Specific diagnosis is made by the detection of HAV-specific immunoglobulin antibodies in the blood. Additional tests include reverse transcription polymerase chain to detect the hepatitis A virus RNA and may require specialized laboratory facilities. Diagnosis can also be done by demonstration of HAV in fecal matter.

12. MANAGEMENT NONE PHARMACOLOGICAL Improved sanitation, food safety, proper disposal of sewage within communities. Personal hygiene practices such as regular hand washing before a meal and after using the toilet. PHARMACOLOCICAL Passive immunization by hyper-immune globulin is effective against clinical illness, particularly is administered in the early incubation period. Severe vaccines of inactivated HAV

13. DENTAL SIGNIFICANCE Infection control: Hepatitis A is transmitted via the fecal-oral route, which means it can spread through contaminated food, water, or close contact with an infected person. Dental professionals must adhere to strict infection control protocols, including hand hygiene and the use of personal protective equipment to prevent the spread of the virus. Patient History: Dentists should take a thorough medical history, including any history of hepatitis A. If a patient is currently infected, elective dental procedures should be postponed until the patient has fully recovered and is no longer contagious. Vaccination: Dental healthcare workers are advised to be vaccinated against hepatitis A to protect themselves and reduce the risk of transmission to patients.

14. HEPATITIS B WHAT IS HEPATTIS B? Is a serious liver infection caused by hepatitis B virus that is easily preventable by a vaccine. It is classified into two types; Acute Hepatitis B: is an infectious disease caused by hepatitis B virus, which develops within 6 months after the virus invades the organism. Chronic hepatitis B: is a chronic infection caused by HBV which develops after 6 months from acute phase of infection

15. AETIOLOGY Hepatitis B is caused the hepatitis B virus. The HBV is an enveloped virus containing a partially double standard, circular DNA genome, and classified within the family hepadnavirus .

16. PATHOLOGY The virus interferes with the function of the liver while replicating in the hepatocytes. Hepatocytes are cells found in the liver. The immune system is then activated to produce a specific reaction to combat and possibly eradicate the infectious agent. which causes damage and liver inflammation .

17. MODES OF TRANSMISSION OF HEPATITIS B The HBV can be transmitted when blood, semen, or other body fluids from an infected person enters the body of someone who is not infected. The virus can be transmitted through: Sex with an infected person. Contaminated injections Outbreaks birth sharing needles

18. SIGNS AND SYMPTOMS OF HEPATITIS B Fever Feeling tired Loss of appetite Upset stomach Dark urine Joint pain Yellow skin and eyes Light colored stool vomiting diarrhea fatigue

19. DIAGNOSIS Diagnosis is done by clinical and laboratory findings CLINICAL FINDINGS these include clinical features like fever, diarrhea, and yellowish eyes together with excessive vomiting ,loss of appetite. LABOROTORY FINDINGS Liver biopsy -To determine the grade and stage of inflammation in chronic Hepatitis B. Blood Tests -Taken to determine the exert type of Hepatitis present. The presence of specific hepatitis B antibodies can also help diagnose the presence of HBV

20. MANAGEMENT OF HEPATITIS B prevention of the spread and transmission of hepatitis B can be achieved through non-pharmacological and pharmacological ways. NON-PHARMACOLOGICAL Carriers should practice good hygiene so that close contact are not directly exposed to their blood and other body fluids. Carriers should not share razors, toothbrushes or any other objects that may be contaminated with blood. Carriers should practice safe sex if their partners are not immunized. PHARMACOLOGICAL Vaccination: a vaccine to prevent hepatitis B is safe and effective. Hepatitis B immunoglobulin: This is available to people who are not vaccinated and are exposed to the virus within 48hrs of the incident. Screening of blood donors can also be an effective precaution

21. DENTAL SIGNIFICANCE Infection Control: Dental professionals must follow strict infection control procedures, including the use of personal protective equipment (PPE) and proper sterilization of instruments, to prevent the transmission of HBV. Vaccination: Dental healthcare workers are recommended to be vaccinated against Hepatitis B due to their risk of exposure to blood. Management of Infected Patients: Patients with HBV should be carefully managed in dental settings, with appropriate measures taken to minimize the risk of transmission. Elective procedures may be delayed in acute cases, and liver function should be considered in treatment planning.

22. HEPATITIS C Hepatitis C is a liver infection caused by the Hepatitis C virus (HCV). It can range from a mild illness lasting a few weeks to a serious, lifelong condition. Unlike Hepatitis A and B, there is no vaccine for Hepatitis C, making prevention and treatment essential in managing the disease.

23. AETIOLOGY Hepatitis C virus (HCV), an RNA virus belonging to the Flaviviridae family. Hepatitis C is caused by the Hepatitis virus, a small, enveloped single-stranded RNA virus. Genotypes: HCV has multiple genotypes (1-6) and numerous subtypes, which influence treatment options and outcomes. Genotype 1 is the most common in the United States and Europe.

24. PATHOLOGY Liver Damage: HCV infects hepatocytes (liver cells), leading to inflammation and fibrosis. Over time, this can progress to cirrhosis (scarring of the liver) and increase the risk of liver cancer (hepatocellular carcinoma). Acute vs. Chronic: Acute Hepatitis C: The initial phase of infection, often asymptomatic, occurs within the first 6 months after exposure. About 15-25% of people clear the virus spontaneously. Chronic Hepatitis C: In about 75-85% of cases, the infection becomes chronic, potentially leading to long-term liver complications.

25. MODE OF TRANSMISSION OF HEPATITIS C Blood-to-Blood Contact: HCV is primarily spread through direct contact with infected blood. Injection Drug Use: The most common mode of transmission, especially through sharing needles or other drug paraphernalia. Blood Transfusions: Before routine screening began in 1992, Hepatitis C was often spread through blood transfusions and organ transplants. Healthcare Exposure: Accidental needle sticks or improper handling of blood products. Other Routes: Less commonly, HCV can be transmitted through sexual contact, from mother to baby during childbirth (perinatal transmission), and through sharing personal items like razors or toothbrushes .

26. SIGNS AND SYMPOMTS OF HEPATITIS C Incubation Period: Typically 2 weeks to 6 months after exposure. Acute Hepatitis C: Often asymptomatic. When symptoms occur, they may include jaundice, fatigue, nausea, vomiting, abdominal pain, and dark urine. Chronic Hepatitis C: Often remains asymptomatic for years or even decades. As the disease progresses, symptoms may include chronic fatigue, joint pain, jaundice, fluid retention, and signs of liver failure (e.g., ascites, varices bleeding).

27. DIAGNOSIS Blood Tests: Anti-HCV Antibodies: Indicate exposure to the virus but do not confirm active infection. HCV RNA (PCR): Confirms active infection and quantifies the viral load. Genotyping: Determines the HCV genotype, which is crucial for selecting the appropriate treatment. Liver Function Tests: Assess liver damage. Liver Biopsy or Elastography : May be used to evaluate the extent of liver fibrosis or cirrhosis.

28. PREVENTION OF HEPATITIS C No Vaccine Available: Unlike Hepatitis A and B, there is no vaccine for Hepatitis C, making prevention efforts crucial. Harm Reduction: Programs to reduce needle sharing among people who inject drugs, such as needle exchange programs. Safe Medical Practices: Proper sterilization and handling of medical equipment to prevent transmission in healthcare settings. Screening: Blood donor screening, routine screening for at-risk populations (e.g., people born between 1945-1965), and testing of pregnant women.

29. MANAGEMENT OF HEPATITIS C Acute Hepatitis C: Monitoring for spontaneous clearance of the virus. Early treatment in some cases to prevent progression to chronic infection. Chronic Hepatitis C Direct-Acting Antivirals (DAAs): The mainstay of treatment, offering a high cure rate (over 90%). DAAs target different stages of the HCV lifecycle and are typically well-tolerated with fewer side effects than older therapies. Liver Transplant may be necessary in cases of advanced liver disease or liver cancer. Lifestyle Modifications: Avoiding alcohol, maintaining a healthy diet, and regular monitoring of liver health

30. DENTAL SIGNIFICANCE Infection Control: As with all bloodborne pathogens, dental professionals must adhere to strict infection control protocols, including the use of gloves, masks, and proper sterilization of instruments. Screening and Precautions: Awareness of a patient’s Hepatitis C status can guide precautions during dental procedures, especially those involving bleeding. Oral Health Considerations: Chronic Hepatitis C can be associated with oral manifestations such as lichen planus and xerostomia (dry mouth), which may require specific dental management. Medication Interactions: Some antiviral medications used to treat Hepatitis C may have interactions with drugs commonly used in dentistry, requiring careful consideration during treatment planning.

31. HEPATITIS D Hepatitis D, also known as Hepatitis Delta, is a liver infection caused by the Hepatitis D virus (HDV). It is unique because it only occurs in people who are already infected with Hepatitis B virus (HBV). This co-infection can lead to more severe liver disease than Hepatitis B alone. Here’s a detailed overview of Hepatitis D;

32. AETIOLOGY Hepatitis D virus (HDV) is a defective RNA virus that requires the presence of Hepatitis B virus (HBV) to replicate and infect liver cells. Dependency on HBV: HDV can only infect individuals who have Hepatitis B because it uses the Hepatitis B surface antigen ( HBsAg ) to enter liver cells

33. PATHOLOGY HDV causes liver inflammation similar to HBV but often more severe. The combination of HDV and HBV can accelerate the progression of liver disease, leading to a higher risk of cirrhosis and hepatocellular carcinoma (liver cancer). HDV and HBV infect a person simultaneously. The clinical course can be severe, often leading to acute hepatitis, which might resolve or progress to chronic hepatitis. Chronic HDV infection can lead to rapid progression of liver fibrosis, ultimately resulting in cirrhosis. The cell damage stimulate fibrotic changes.

34. MODE OF TRANSMISSION OF HEPATITIS D Blood-to-Blood Contact: HDV is primarily spread through direct contact with infected blood, similar to HBV. Injection Drug Use: A common mode of transmission, particularly through sharing needles. Sexual Contact: Less common, but possible, especially in those with high-risk behaviors. Vertical Transmission: Transmission from mother to child is less common than with HBV but can occur

35. CLINICAL FEATURES Incubation Period: Typically 3 to 7 weeks after exposure, but this can vary. Acute Hepatitis D: Symptoms may be similar to those of acute Hepatitis B, including jaundice, fatigue, nausea, vomiting, abdominal pain, and dark urine. Co-infection with HBV can cause a more severe acute illness. Chronic Hepatitis D: Persistent liver inflammation leading to progressive liver damage. Patients may develop symptoms of chronic liver disease, such as jaundice, ascites (fluid accumulation in the abdomen), and varices bleeding (bleeding from dilated veins in the esophagus). More rapid progression to cirrhosis and liver failure compared to HBV infection alone.

36. DIAGNOSIS Blood Tests: Anti-HDV Antibodies: Presence indicates exposure to the Hepatitis D virus. HDV RNA: Confirms active infection and measures the level of virus in the blood. HBsAg (Hepatitis B surface antigen ): Indicates co-infection with HBV. Liver Function Tests: To assess the extent of liver damage. Liver Biopsy: May be used to assess the degree of liver inflammation and fibrosis

37. MANAGEMENT OF HEPATITIS D Acute Hepatitis D: Supportive care, as the body may clear the infection on its own if it's a co-infection. Monitoring for liver complications. Chronic Hepatitis D: Interferon Therapy: The primary treatment option is pegylated interferon-alpha, which can help suppress viral replication, though the response rate is limited, and the treatment can be associated with significant side effects. Antiviral Therapy for HBV: Managing the HBV infection with antiviral drugs (e.g., tenofovir or entecavir ) to reduce liver damage, though these do not directly affect HDV. Liver Transplant: May be necessary in cases of advanced liver disease or liver failure .

38. PREVENTION OF HEPATITIS D HBV Vaccination: Since HDV requires HBV to infect, vaccination against Hepatitis B effectively prevents Hepatitis D. Safe Practices: Similar to HBV, prevention involves avoiding exposure to infected blood and body fluids, using condoms, and avoiding needle sharing. Post-Exposure Prophylaxis (PEP): In some cases, receiving the HBV vaccine and/or hepatitis B immunoglobulin after exposure can prevent HBV (and subsequently HDV) infection.

39. DENTAL SIGNIFICANCE Infection Control: Strict adherence to infection control procedures in dental settings is crucial to prevent transmission of HBV and HDV, especially when dealing with blood and sharp instruments. Management of Infected Patients: Special precautions should be taken when treating patients known to have Hepatitis D, particularly those with advanced liver disease, as they may have an increased risk of bleeding and other complications. Vaccination: Dental healthcare workers should be vaccinated against Hepatitis B to protect against both HBV and HDV . Hepatitis D is less common than other forms of hepatitis, but it is more severe, particularly when it occurs as a super infection in individuals with chronic Hepatitis B. Prevention through HBV vaccination is the most effective way to avoid Hepatitis D infection

40. HEPATITIS E Hepatitis E is a liver disease caused by the Hepatitis E virus (HEV). It is similar to Hepatitis A in that it is primarily spread through the fecal-oral route, often via contaminated water. However, Hepatitis E can cause more severe disease, especially in certain populations. Here's an in-depth look at Hepatitis E:

41. AETIOLOGY Hepatitis E virus (HEV), an RNA virus belonging to the Hepeviridae family. Genotypes: HEV has several genotypes: Genotypes 1 and 2: Found mainly in developing countries and are usually spread through contaminated water. Genotypes 3 and 4: Found in both developed and developing countries, often linked to consumption of undercooked meat from infected animals (such as pork or deer) .

42. PATHOLOGY Liver Damage: HEV targets the liver, leading to inflammation and liver cell damage. The infection is usually self-limiting, but it can be more severe in certain groups, such as pregnant women and individuals with pre-existing liver disease. Acute vs. Chronic: Acute Hepatitis E: Most infections are acute, with the body typically clearing the virus without the need for specific treatment. Chronic Hepatitis E: Chronic infection is rare and usually occurs in immune-compromised individuals, such as organ transplant recipients, leading to persistent liver inflammation and potential progression to fibrosis.

43. MODE OF TRANSMISSION Fecal-Oral Route: The primary mode of transmission, typically through ingestion of food or water contaminated with feces from an infected person. Contaminated Water: Outbreaks are often associated with poor sanitation and contaminated water supplies, particularly in developing countries. Zoonotic Transmission: Genotypes 3 and 4 can be transmitted from animals to humans, often through the consumption of undercooked or raw meat from infected animals, particularly pork and game. Person-to-Person Transmission: Less common but possible through close contact with an infected person.

44. CLINICAL FEATURES Incubation Period: Typically 2 to 9 weeks after exposure. Symptoms: Similar to other forms of viral hepatitis, including jaundice, fatigue, nausea, vomiting, abdominal pain, dark urine, and pale stools. Many cases are asymptomatic or cause mild illness. Severe Disease: In pregnant women, particularly in the third trimester, Hepatitis E can lead to severe disease with a high risk of acute liver failure, maternal death, and fetal loss. Fulminant Hepatitis: A severe and rapidly progressing form of hepatitis that can occur in some cases, leading to acute liver failure.

45. DIAGNOSIS Blood Tests: Anti-HEV IgM Antibodies: Presence indicates recent infection with HEV. Anti-HEV IgG Antibodies: Presence indicates past exposure to HEV. HEV RNA: Detection of viral RNA in blood or stool confirms active infection. Liver Function Tests: To assess the extent of liver damage .

46. MANAGEMENT Supportive Care: There is no specific antiviral treatment for Hepatitis E; management focuses on relieving symptoms and maintaining hydration. Hospitalization: May be necessary in severe cases, particularly in pregnant women or individuals with pre-existing liver conditions. Antiviral Therapy: In rare cases of chronic Hepatitis E (usually in immune-compromised individuals), antiviral therapy such as ribavirin may be considered. Avoidance of Alcohol and Certain Medications: Since these can further damage the liver.

47. PREVENTION Improved Sanitation: Ensuring access to clean water and proper sewage disposal is critical in preventing the spread of Hepatitis E, especially in endemic areas. Safe Food Practices: Avoiding consumption of undercooked or raw meat, particularly in areas where Hepatitis E is known to be transmitted zoonotically . Vaccination: A vaccine for Hepatitis E exists ( Hecolin ), but it is not widely available and is primarily used in China

48. DENTAL SIGNIFICANCE Infection Control: As with other forms of hepatitis, dental professionals must adhere to strict infection control protocols to prevent the potential spread of Hepatitis E, particularly through contaminated water or instruments. Screening and Precautions: Knowledge of a patient’s Hepatitis E status can help guide infection control practices during dental procedures. Management of Pregnant Patients: Extra caution is needed when treating pregnant patients with Hepatitis E due to the higher risk of severe disease. Hepatitis E is a significant cause of viral hepatitis, particularly in regions with poor sanitation. While it is generally self-limiting, the potential for severe disease in certain populations, such as pregnant women, underscores the importance of prevention and effective management.

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