Hepatitis acute

Acute Hepatitis, Viruses, Hepatitis B

1. ACUTE HEPATITIS

2. Hepatitis
•Any disease process characterized by a diffuse inflammatory
infiltrate of liver tissue, with or without a degree of hepatocellular
necrosis and local fibrosis.
•Etiology
Infectious, Chemical, Toxic and Autoimmune

3. Clinical Forms
•Acute viral hepatitis
•Recent infection and inflammation of the liver
•Chronic viral hepatitis
•Persistent viral infection of liver tissue lasting
more than 6 months

4. •Causes of Acute Hepatitis
•Viruses (A,B,C,E,EBV,CMV)
•Alcohol
•Toxins (Carbon tetrachloride)
•Drugs (INH, PZA)

5. Acute Hepatitis
•Prodromal illness (Flu like)
•?????? Vomiting
•?????? Aversion to alcohol and cigarettes
•?????? ABDOMINAL discomfort
•?????? Pale faeces and dark urine
•?????? Jaundice

6. Agents of Viral Hepatitis
•Enterically transmitted hepatitis
•Hepatitis A and E.
•Acute diseases with no chronic phase

7. •Blood-borne viral hepatitis
–Hepatitis B, C and D, all chronic infections
•Systemic agents not restricted to the liver
–HSV, VZV, EBV, CMV, HIV.

8. Hepatitis A
•Symptomatic Illness
•Symptomatic in 80% of adults but not children (<3%)
•Malaise, Vomiting and jaundice prominent
•Transmission patterns
•Person to person contact
•Common source outbreaks especially seafood

9. HAV Pathogenesis
•Ingested orally, Resistant to stomach acid
•Reaches the liver via the intestine
•Replicates in hepatocyte cytoplasm
•Secreted in the bile and excreted in faeces
•Cell mediated immune clearance and cyto-pathology
•Symptoms last 2-3 weeks

10. Laboratory Diagnosis of HAV
•Serological diagnosis
•Preferred method is EIA for anti-HAV IgM
•Acute antibody response with a rise in IgM
•Simultaneous gradual rise in IgG

12. HAV Prevention
•Inactivated whole-virus vaccine

13. Treatment
•Supportive re-hydration and nutrition
•Avoid alcohol
•Outcome
•???Recovery in > 99%, clinical relapse in 4-20%
•???Rarely need to hospitalize or transplant
•???Fulminant hepatitis <0.35%

14. Hepatitis E
•Epidemiology
•???A major cause of sporadic and epidemic
hepatitis
•???Water-borne
•???Only 5% of adult cases have jaundice

15. HEV Pathogenesis
•???Entry across intestinal mucosa (unknown)
•???Secreted in faeces
•2 weeks before and 1 week after symptoms
•???Detected in serum for two weeks after onset
•???Affects liver Kupffer cells and hepatocytes
•???Cholestasis is a feature in 50% of cases
•???Injury appears immune mediated

16. Laboratory Diagnosis of HEV
•EIA based assays for IgM and IgG

17. HEV Prevention and Treatment
•Treatment
•Supportive therapy
•No specific treatment
•Prevention
•???No vaccines available
•???Recombinant protein in animal & human trials
•???Immune serum globulin is ineffective

18. •Alcoholic Hepatitis
•Can be acute or chronic
•Risk of cirrhosis variable…genetics, sex (women
•more susceptible,) presence of chronic hepatitis,
•possibly nutritional factor
•Presentation can range from an asymptomatic
•person to a critically ill one

19. •Drug induced Liver Disease
•3 subtypes
•??? Direct hepatotoxic group
•??? Idiosyncratic reactions
•??? Cholestatic reactions

20. •Direct hepatotoxic Group
•???Dose related severity
•???Latent period after exposure
•Examples…acetominophen, alcohol, carbon
•tetrachloride, niacin, vitamin A

21. •Idiosyncratic Reactions
•??? Sporadic and rare
•??? Not dose related
•??? Occasionally fever and eosinophilia
•suggesting an allergic type reaction

22. •Cholestatic Reactions
•??? Non-inflammatory (direct effect on bile
•secretion)…examples estrogens, anabolic steroids,
•azathioprine
•??? Inflammatory (portal areas with cholangitis) often
•with allergic features…examples erythromycin,
•ampicillin-clavulanic and semi-synthetic penicillins,
•chlorpropamide

23. •Autoimmune Hepatitis
•?????? Generally affects young females (less often postmenopausal)
•?????? ANA and anti-smooth muscle antibodies each present
•in 70%
•?????? Hypergammaglobulinemia
•?????? Extrahepatic manifestations are clues…amenorrhea,
•thyroiditis, acne, Sjogrens, arthritis, Coomb-positive
•hemolytic anemia, nephritis
•?????? Old name was Lupoid Hepatitis

24. Hepatitis B

25. Parenteral - IV drug abusers, health workers are
at increased risk.
Sexual - sex workers and homosexuals are
particular at risk.
Perinatal(Vertical) - mother(HBeAg+) →infant.
HBV: HBV: Modes of TransmissionModes of Transmission

26. Pathogenesis & Immunity
•Virus enters hepatocytes via blood
•Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface
responsible for clinical syndrome
•5 % become chronic carriers (HBsAg> 6
months)

27. Clinical Features
Incubation period: Average 60-90 days

Insidious onset of symptoms : Tends to cause a more severe disease than
Hepatitis A.
Premature mortality from
chronic liver disease: 15%-25%

29. Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5% of adult-
acquired infections
95% of infant-
acquired infections
Cirrhosis
Chronic hepatitis
12-25% in 5 years
Liver failure Hepatocellular
carcinoma
Liver transplant
6-15% in 5 years 20-23% in 5 years
Death
Death

30. Prevention
•Vaccination
• - highly effective recombinant vaccines
•Hepatitis B Immunoglobulin (HBIG)
• -exposed within 48 hours of the incident/
neonates whose mothers are HBsAg and HBeAg
positive.
•Other measures
• -screening of blood donors, blood and body fluid
precautions.
•

33. Hepatitis B Vaccine
•Infants: several options that depend on status of the mother
–If mother HBsAg negative: birth, 1-2m,6-18m
–If mother HBsAg positive: vaccine and Hep B immune globulin within 12
hours of birth, 1-2m, 6m
•Adults
* 0,1, 6 months
•Vaccine recommended in
–All those aged 0-18
–Those at high risk

34. Hepatitis C

35. Pathology of HCV
•Acute Hepatitis C:
–Generally benign:
•No jaundice (80%)
•Usually asymptomatic
–Can be severe, but liver failure rare
Only real threat of acute Hepatitis C is its ability to
reach chronic stages undetected and untreated.

36. Pathology of HCV
•Chronic Hepatitis C:
–70% of patients become chronic
–Possible results:
•Cirrhosis
•End-stage liver disease
•Hepatocellular carcinoma

37. Transmission
•Direct blood or fluid exposure
•Perinatal Transmission
•Transmission:
•Other things thought to be associated with HCV:
–Tatoos
–Acupuncture
–Ear Piercing

39. •Indications For Treatment
–Increased ALT activity
–Liver biopsy fibrosis
–Detectible serum HCV RNA

40. •Vaccine:
–Difficult:
•High mutation rate

44. THANKS