HEPATITIS C.pptx

Paediatric

1. 1 Ms.LINITHA.K.B.

2. DEFINITION: Ms.LINITHA.K.B. 2 Hepatitis C infection is a liver disease caused by the hepatitis C virus (HCV). HCV accounts for approximately 15-20% cases of acute hepatitis. The virus can cause both acute and chronic hepatitis, ranging in severity from a mild illness lasting a few week to a serious and lifelong illness. Hepatitis C is a major cause of liver cancer.

3. ETIOLOGY: Ms.LINITHA.K.B. 3 Hepatitis C virus is a blood borne virus. It is an important cause of post- transfusion hepatitis. HCV is a small-enveloped RNA virus belonging to the family Flaviviridae and genus Hepacivirus. It is an enveloped, linear, and single-strand RNA Flavivirus with six genotypes and several subtypes based on genomic differences.

4. EPIDEMIOLOGY: Ms.LINITHA.K.B. 4 Hepatitis C infection is transmitted more often by blood and blood products as compared to body secretions. It is therefore not as infective as hepatitis B but results in more morbidity. Hepatitis C virus is less common in children as compared to adults, with a prevalence of 0.2% in children younger than 11 years of age and 0.4% in children more than 11 years of age. The risk factor for hepatitis C transmission in children includes repeated blood transfusion or illegal drug usage by adolescents. Perinatal transmission of hepatitis C virus is much less as compared to hepatitis B virus infection and depends on the maternal hepatitis C viral load and HIV status.

5. MODES OF TRANSMISSION: Ms.LINITHA.K.B. 5 The hepatitis C virus is a blood-borne virus. It is most commonly transmitted to children through: the reuse or inadequate sterilization of medical equipment, especially syringes and needles in healthcare settings. The transfusion of unscreened blood and blood products. Injecting drugs through the sharing of injections and needles (in case of adolescents). From am infected mother to her baby; is less common. Hepatitis C does not spread through breast milk, food, water or casual contact such as hugging, kissing and sharing food or drinks with an infected person.

6. PATHOGENESIS: Ms.LINITHA.K.B. 6 Chronic hepatitis C infection is not a consequence of direct cytopathic effect but rather an intermediate immune response that is sufficient to induce hepatic cell destruction and fibrosis but not sufficient enough to clear the virus. Natural targets of hepatitis C virus are hepatocytes and possibly B lymphocytes. Viral clearance is associated with the development and persistence of strong virus specific responses by cytotoxic T lymphocytes and helper T cells. In most infected people, viremia persists and is accompanied by variable degrees of hepatic inflammation and fibrosis. Findings from studies suggest that at least 50% of hepatocytes may be infected with hepatitis C virus in patients with chronic hepatitis C.

7. CLINICAL FEATURES: Ms.LINITHA.K.B. 7 Incubation Period of hepatitis C virus infection 7-9 weeks. Early signs and symptoms of Acute Hepatitis C: Abdominal pain. Clay-colored stool. Dark urine. Fatigue. Fever. Jaundice. Arthralgia (Joint pain). anorexia,. Nausea. Vomiting. Symptoms usually show up between 2 and 12 weeks after exposure to the virus.

8. Chronic Hepatitis C Symptoms: Ms.LINITHA.K.B. 8 If hepatitis C infection does not get diagnosed and treated, the disease may continue for years and becomes chronic in nature. It may lead to liver cancer or cirrhosis. In addition to the above conditions, following manifestations may develop: Ascites. Easy bleeding. Easy bruising. Hepatic encephalopathy leading to confusion, drowsiness and slurred speech. Hives or rashes. Itchy skin. Swollen legs. Weight loss. Spider-like blood vessels under the skin (spider angiomas).

9. DIAGNOSTIC EVALUATIONS: Ms.LINITHA.K.B. 9 Detection of antibodies to hepatitis C virus and HCV RNA helps in the diagnosis of hepatitis C infection. Enzyme immunoassays for detection of antibodies are sensitive in high-risk populations but not in the low-risk group. Recombinant immunoblot assay(RIBA) has a higher sensitivity in low-risk patient groups. Anti-hepatitis C virus antibody is not a protective antibody and hence does not confer immunity and is usually present with the virus. Detection of HCV RNA is more sensitive and a viral load > 10 copies/ml of HCV RNA is taken as a cut off for initiating therapy.

10. PREVENTION: Ms.LINITHA.K.B. 10 Screening of donor blood is essential to prevent hepatitis C infection, but is not yet done regularly. Vaccine development has been impeded by the various hepatitis C virus genotypes and presence of quasispecies.