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This is a series of lectures on microbiology useful for undergraduate medical and paramedical students
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HEPATITIS VIRUSES
Dr. Ashish V. JawarkarM.D. (Pathology)
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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
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Hepatitis A
Epidemiology Clinical features Lab diagnosis Prophylaxis Treatment
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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
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Epidemiology Clinical features Lab diagnosis Prophylaxis Treatment
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Clinical features
2-6 weeks incubation period – asymptomatic
Clinical symptoms – malaise, anorexia, nausea, vomitting and abdominal pain
Yellow urine
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Epidemiology Clinical features Lab diagnosis Prophylaxis Treatment
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Lab diagnosis
Raised bilirubin in serum (indirect>direct)
Yellow urine – bilirubin present Demonstration of antibodies by ELISA
IgM – recent infection IgG – remote infection
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Epidemiology Clinical features Lab diagnosis Prophylaxis Treatment
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Prophylaxis
Improved sanitation Vaccine is available Natural infection leads to life long
immunity
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Epidemiology Clinical features Lab diagnosis Prophylaxis Treatment
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Treatment
No antiviral drug available Treatment is symptomatic
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TYPE B HEPATITIS
Over 350 million HBV carriers in the world
One million die anually
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Epidemiology Clinical features Lab diagnosis Prophylaxis Treatment
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Epidemiology
Hepatitis B virus structure
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In the serum of Hep B patients we can see – Australia antigen or
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Dane particle
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Developed countries
Adolscents and young adults Infection occurs through
contaminated syringes and needles Drug addicts Homosexuals
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Developing countries
Children Vertical transmission from mother to
baby Horizontal transmission among
infants and neonates
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Everywhere
Razors, nail clippers, acupuncture, tatooing, circumscision, ear or nose piercing
Barbers, dentists and doctors may get infected
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Carriers
Those who donot have symptoms but are HbsAg positive
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Screening of blood donors
Compulsory
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Epidemiology Clinical features Lab diagnosis Prophylaxis Treatment
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Clinical features
No symptoms in carriers Similar to HAV in acute phase
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Epidemiology Clinical features Lab diagnosis Prophylaxis Treatment
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Lab diagnosis
Demonstration of viral antibodies and antigens in serum -
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HBsAg infection IgM anti HBcAg recent
infection IgG anti HBcAg remote
infection HBeAg infective Anti HBsAg immunity after
vaccination
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Epidemiology Clinical features Lab diagnosis Prophylaxis Treatment
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Prophylaxis
Avoid multiple partners Avoid drug abuse Use of disposable syringes and
needles Screening of Blood, organ and semen
donors Universal immunisation (vaccination)
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Immunisation - Passive
administer HBIG (Hepatitis B immunoglobulin)
Administer soon after accidental exposure
Can be administered to baby born to a carrier mother
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Active immunisation - vaccine
Consists of HBsAg particles Given as a routine to all babies
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Epidemiology Clinical features Lab diagnosis Prophylaxis Treatment
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Treatment
Acute phase – no treatment required, patients recover
Chronic phase – become carriers, can give antivirals like lamivudine and adefovir to keep replication in check
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Hepatitis C Virus
Also blood borne Most common cause of post
transfusion hepatitis in developed countries
Most common cause of post hepatitis – hepatocellular carcinoma
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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
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