PresentationOnHEPATITIS-VIRUSES_SabnamKayastha.pptx

Introduction, types, clinical significance of Hepatitis viruses

1. HEPATITIS VIRUSES SUBMITTED BY: Sabnam Kayastha 5 th semester BSc MM SUBMITTED TO: Amrita Wagle Lect. PHM

2. Hepatitis Hepatitis is the inflammation of the liver. It is the major cause of morbidity. There is number of unrelated viruses that can cause hepatitis. It also caused by drugs(alcohol), chemicals, autoimmune disease and metabolic abnormalities.

3. ETIOLOGY OF HEPATITS

4. INTRODUCTION Five types of hepatitis have been identified: Hepatitis A, B, C, D, E. Hepatitis A is always an acute, short-term disease, while hepatitis B, C and D are most likely to become ongoing an chronic. Hepatitis E is usually acute but can be particularly in pregnant woman. The hepatitis A and E viruses typically cause only acute, or short-term infections. Other viruses that cause liver disease id Cytomegalovirus(CMV), Herpes virus, Rubella virus, Epstein- barr virus(EPV).

5. INCIDENCE Millions of viral hepatitis cases occur worldwide. Hepatitis(especially B and C) was responsible for 1.4 millions deaths in 2015.(according to WHO) Nepal is classified as low endemic region for hepatitis B infection(HBV) with overall seroprevalance of 1.1%. Some ethnic groups and geographical areas have high prevalence rate.

6. Hepatitis B virus Hepadnaviridie Enveloped, DNA virus Also called a ‘serum hepatitis’(due to the relation with blood transfusion) Can cause acute and chronic infection. Acute infection may last upto 6 months and infected person are also able to transmit during this time. Chronic hepatitis is defined as persistence of Hbsag for 6 months or more after acute infection of HBV.

7. S tructure Size 42nm in diameter. Genome: circular, small and partially double stranded, Enveloped: 7nm thick lipid layer, contains HBsAg Inner protein core: surrounds viral genome, HBcAg Contains HBeAg, associated with HBcAg. Incubation period is 2-5 months.

8. Sources of infection are : Mainly by sexual contact .(STD) Further mode of transmission are paremtral or permucosal exposure to blood, perinatal transmission . Contaminated needles, syringes, blood products. Tattoo or body piercings with contaminated needles .

9. Mechanism The virus interferes with the function of liver while replicating in hepatocytes. The immune system then activated to produce a specific reaction to combat and possibly eradicate the infectious agents. As a consequence of pathological damage, the liver gets damaged. HBV may be the cause of 80% of all cases of hepatocellular carcinoma world wide.

10. Si gn and symptoms Jaundice Abdominal pain Fatigue Dark urine Fever Joint pain Loss of apatite Nausea and vomiting

11. Diagnosis Blood testes : ALT, AST, ALP, serum proteins, PT, urinary bilirubin, urinary urobilinogen, total serum bilirubin. Serological tests: HbsAg, Ant-HBs, HbeAg, Anti-Hbe, Anti Hbe Igg, HBV genotyping. Liver ultrasound: transient electrography can show the amount of liver damage. Liver biopsy Fibrin tests

12. Treatment Acute infection Short lived and will g aways on its own. May not need a treatment. Instead proper nutrition, rest, and fluids helps body to fight the infection. Chronic intection Chronic infectiction need treatment for rest of life. Reduce the risk of liver disease and prevents from passing the infection. Treat for chronic hepatitis B may include:

13. Continue.. Antiviral medication : entecavir ( Baraclude ), tenofovir ( viread ), lamivudine( Epivir ), adefovir ( Hepsera ) and telbivudine ( Tyzeka ). Interferone injections : interferone alfa-2b( interone A) is a man made version of a substance produced by the body to fight the infection. Mainly used for young people. Liver transplant : incase of severly damaged liver.

14. Prevention and control Best way to prevent hepatitis is to get vaccinated soon after coming to contact with virus. Avoid having unprotected sex. Cover all open cuts and wounds. Make certain that any needles for drugs , ear pirecings , or tattoos or tools for  manicures   and pedicures are properly sterilized. Don’t share razors , toothbrushes, nail care tools, or pierced earrings with anyone.

15. Hepatitis C virus Flaviviridie Enveloped, RNA virus. In most cases it is transmitted though blood or blood products. It is also transmitted through unprotected sex and contaminated or unsterile nedles . Also found in I.V drugs users and renal dialysis patirnts . It can result in both acute and chronic illness.

16. S tructure Flaviviridea Small 55-65 nm sin size Enveloped Positive sence single stranded RNA Two viral glycoprotein E1 and E2 are embedded in lipid envelope.

17. Source of infection Mother-infant transmission Shareing needle or syringe Shareing razor or toothbrush Kissing , hugging or sharing eating utensils Sexual conctact with HCV infected person

18. Mechanism HCV presumably  binds to specific receptor(s) and enters cells through endocytosis , as do other members of Flaviviridea. The viral genome is translated into a precursor polyprotein after uncoating, and viral RNA is synthesized by a virus-encoded polymerase complex.

19. Sign and symptoms Fatigue Nausea and vomiting Jaundice Lack of apatite Dark urine Diagnosis Hepatitis C antibody HCV genotyping

20. Treatment Patient with acute HCV infection, treatment with pegylad interferon within the 12-24 weeks of infection reduce the development of chronic hepatitis C Incase of chronic HCV pregylated interferon, ribavirin rebatol, protease inhibitors such as incivek and beceprevir.

21. Prevention and control There is no effective vaccine against hepatitis C so prevention depends on reducing the risk of exposure to the virus in health care settings and in higher risk populations . Primary prevention interventions recommended by WHO include: safe and appropriate use of health care injections; safe handling and disposal of sharps and waste; provision of comprehensive harm-reduction services to people who inject drugs; testing of donated blood for HBV and HCV (as well as HIV and syphilis); training of health personnel; and prevention of exposure to blood during sex.

22. Hepatitis A virus (HAV) A highly contagious liver infection. It can cause acute hepatitis with jaundice also acute live failure. It does not cause long term infection. Transmitted through fecal-oral route. Source of infection is poor personal hygiene, contaminated food and water, person with subclinical infections. More prevalent in underdeveloped countries. Diagnosis include antibody detection. (IgG, IgM) There are no drug therapy for HAV infection. Key preventive measure for HAV infection is to get vaccinated. Maintain good personal hygiene and sanitation.

23. Hepatitis D virus (HDV) It is also known as Delta hepatitis. It cannot cause infection on its own, requires HBV to replicate. Source of infection is same as HBV. (though not sexually transmitted) T wo types of infections: Co-infection: person infected with HBV and HDV at the same time, leads to severe acute hepatitis. Recovery is usual. Super infection: in this case person infected with delta virus who are already infected with chronic HBV leads to severe chronic hepatitis. Diagnosis include Anti-HDV tests( IgG,IgM ) and HDV antigen detection. HDV can be prevented by vacctinating HBV susceptible person with hepatitis B vaccine.( But it doesnot protect HBv carriers superinfection by HDV)

24. Hepatitis E virus (HEV) HEV is an RNA virus. Transmission is through fecal-oral route. Source of infection is through contaminated food water, poor sanitation. It is more common in adults and severe in pregnant women. Diagnosis include detection of Anti-HEV IgG and IgM, HEV RNA quatification . HEV usually revolves on its own with in 4-6 weeks. Treatment focuses on rehydration and rest.

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