Hepatitis viruses - Heptatitis A, B, C, D and E, clinical features, epidemiology and lab diagnosis

This is a series of lectures on microbiology useful for undergraduate medical and paramedical students

1. HEPATITIS VIRUSES
Dr. Ashish V. Jawarkar
M.D. (Pathology)

2. Dr. Ashish JawarkarHepatitis viruses 2
Hepatitis
Infection of liver
Hepatitis viruses – A, B, C, D, E and G
B – DNA virus
All others – RNA viruses
Cause icteric jaundice
Type A and E – food borne, feco oral route
Type B and C – Blood borne, parenteral and
sexual routes

3. Dr. Ashish JawarkarHepatitis viruses 3
Hepatitis A
Epidemiology
Clinical features
Lab diagnosis
Prophylaxis
Treatment

4. Dr. Ashish JawarkarHepatitis viruses 4
Epidemiology
Common in children
Feco oral route – contaminated water
or milk
Over crowding and poor sanitation
Ingested, reaches intestine,
penetrates epithelium, reaches liver
through blood

5. Dr. Ashish JawarkarHepatitis viruses 5
Epidemiology
Clinical features
Lab diagnosis
Prophylaxis
Treatment

6. Dr. Ashish JawarkarHepatitis viruses 6
Clinical features
2-6 weeks incubation period –
asymptomatic
Clinical symptoms – malaise,
anorexia, nausea, vomitting and
abdominal pain
Yellow urine

7. Dr. Ashish JawarkarHepatitis viruses 7

8. Dr. Ashish JawarkarHepatitis viruses 8
Epidemiology
Clinical features
Lab diagnosis
Prophylaxis
Treatment

9. Dr. Ashish JawarkarHepatitis viruses 9
Lab diagnosis
Raised bilirubin in serum
(indirect>direct)
Yellow urine – bilirubin present
Demonstration of antibodies by ELISA
IgM – recent infection
IgG – remote infection

10. Dr. Ashish JawarkarHepatitis viruses 10
Epidemiology
Clinical features
Lab diagnosis
Prophylaxis
Treatment

11. Dr. Ashish JawarkarHepatitis viruses 11
Prophylaxis
Improved sanitation
Vaccine is available
Natural infection leads to life long
immunity

12. Dr. Ashish JawarkarHepatitis viruses 12
Epidemiology
Clinical features
Lab diagnosis
Prophylaxis
Treatment

13. Dr. Ashish JawarkarHepatitis viruses 13
Treatment
No antiviral drug available
Treatment is symptomatic

14. Dr. Ashish JawarkarHepatitis viruses 14
TYPE B HEPATITIS
Over 350 million HBV carriers in the
world
One million die anually

15. Dr. Ashish JawarkarHepatitis viruses 15
Epidemiology
Clinical features
Lab diagnosis
Prophylaxis
Treatment

16. Dr. Ashish JawarkarHepatitis viruses 16
Epidemiology
Hepatitis B virus structure

17. Dr. Ashish JawarkarHepatitis viruses 17
In the serum of Hep B patients we
can see – Australia antigen or

18. Dr. Ashish JawarkarHepatitis viruses 18
Dane particle

19. Dr. Ashish JawarkarHepatitis viruses 19
Developed countries
Adolscents and young adults
Infection occurs through
contaminated syringes and needles
Drug addicts
Homosexuals

20. Dr. Ashish JawarkarHepatitis viruses 20
Developing countries
Children
Vertical transmission from mother to
baby
Horizontal transmission among
infants and neonates

21. Dr. Ashish JawarkarHepatitis viruses 21
Everywhere
Razors, nail clippers, acupuncture,
tatooing, circumscision, ear or nose
piercing
Barbers, dentists and doctors may
get infected

22. Dr. Ashish JawarkarHepatitis viruses 22
Carriers
Those who donot have symptoms but
are HbsAg positive

23. Dr. Ashish JawarkarHepatitis viruses 23
Screening of blood donors
Compulsory

24. Dr. Ashish JawarkarHepatitis viruses 24
Epidemiology
Clinical features
Lab diagnosis
Prophylaxis
Treatment

25. Dr. Ashish JawarkarHepatitis viruses 25
Clinical features
No symptoms in carriers
Similar to HAV in acute phase

26. Dr. Ashish JawarkarHepatitis viruses 26
Epidemiology
Clinical features
Lab diagnosis
Prophylaxis
Treatment

27. Dr. Ashish JawarkarHepatitis viruses 27
Lab diagnosis
Demonstration of viral antibodies and
antigens in serum -

28. Dr. Ashish JawarkarHepatitis viruses 28

29. Dr. Ashish JawarkarHepatitis viruses 29
HBsAg infection
IgM anti HBcAg recent infection
IgG anti HBcAg remote infection
HBeAg infective
Anti HBsAg immunity after
vaccination

30. Dr. Ashish JawarkarHepatitis viruses 30
Epidemiology
Clinical features
Lab diagnosis
Prophylaxis
Treatment

31. Dr. Ashish JawarkarHepatitis viruses 31
Prophylaxis
Avoid multiple partners
Avoid drug abuse
Use of disposable syringes and
needles
Screening of Blood, organ and semen
donors
Universal immunisation (vaccination)

32. Dr. Ashish JawarkarHepatitis viruses 32
Immunisation - Passive
administer HBIG (Hepatitis B
immunoglobulin)
Administer soon after accidental
exposure
Can be administered to baby born to
a carrier mother

33. Dr. Ashish JawarkarHepatitis viruses 33
Active immunisation - vaccine
Consists of HBsAg particles
Given as a routine to all babies

34. Dr. Ashish JawarkarHepatitis viruses 34
Epidemiology
Clinical features
Lab diagnosis
Prophylaxis
Treatment

35. Dr. Ashish JawarkarHepatitis viruses 35
Treatment
Acute phase – no treatment required,
patients recover
Chronic phase – become carriers, can
give antivirals like lamivudine and
adefovir to keep replication in check

36. Dr. Ashish JawarkarHepatitis viruses 36
Hepatitis C Virus
Also blood borne
Most common cause of post
transfusion hepatitis in developed
countries
Most common cause of post hepatitis
– hepatocellular carcinoma

37. Dr. Ashish JawarkarHepatitis viruses 37
Hepatitis E virus
Feco oral route
 Second common cause of hepatitis
after hepatitis A in developing
countries
Generally mild and self limiting illness
Unusually high mortality (20-40 %) in
pregnancy

38. Dr. Ashish JawarkarHepatitis viruses 38