HEPATITIS

Gatot Sugiharto, MD, Internist

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Faculty of Medicine, UWKS

Lecture - 2014

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Hepatitis, introduction(1)

Generic term for inflammations of the liver

Caused by a number of viruses, other infectious
agents, ethanol and toxins
There are 5 hepatitis viruses of A, B, C, D, E (+ F,
G)
The means of transmission and long-term effects
vary, depending on which virus causes the
disease
A major concern for the traveler
Many cases can be prevented by immunization.

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Viral Hepatitis

Hepatitis A and E are transmitted primarily by

contaminated food and water.
High-risk areas are poor sanitation results in
contamination of groundwater, tap water, and well
water.
Hepatitis B and C are spread by sexual contact,
exchange of body fluids, injections from
contaminated needles and syringes, and unscreened
blood transfusions.
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Symptoms

The symptoms can vary, some of them unnoticed.

Because the liver has so many metabolic functions tend to have
generalized symptoms
Fever, fatigue, loss of appetite, jaundice (yellow skin), dark urine,
abdominal pain, and aching joints are the most common
Symptoms of acute hepatitis may occur weeks to months after exposure
and typically last from 2 to 6 weeks.
Complete recovery occurs in most cases of types A and E hepatitis, but
5% to 80% of types B and C may progress, causing chronic, sometimes
fatal, liver disease.
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Laboratory test

A definite diagnosis : Viral-specific hepatitis test (serologic

markers)
Viral hepatitis assays detect the presence of specific Vi antigens
and/or antibodies in serum.
The purposes of serologic marker test are :
Diagnose, differentiate between virus hepatitis, stage of
infection, knowing the resolution of the infection
Screening to prevent spreading of the virus, identify infected
individual, to test sex partner etc
Monitor and evaluate seroconversion, success of
prophylaxis
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Hepatitis A

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Hepatitis A

Accounts for 20-40% of all viral hepatitis

Spread fecal-oral route; maternal-fetal transmission not
reported
Usually results in acute, self-limited illness or
asymptomatic infection (majority of cases)
Fulminant disease more common when co-infected with HBV or HCV,
especially when older

Labs
ALT > AST usually >1000 IU/dl
Bilirubin >10 mg/dl is common
IgM anti-HAV : gold standard for diagnosis

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Epidemiology

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Hepatitis A (Contd)

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Postexposure prophylaxis

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Immune globulin and HAV vaccination usually

administrated together
Immune globulin effective within 2 weeks of
exposure
Vaccine recommended for higher risk groups
(chronic liver disease, occupational risk, children
in states with higher risk (>2x national average))

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Hepatitis B

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Partially double-stranded circular DNA virus

A member of the Hepa-dna-viridae family
Virus consists of a central core nucleocapsid
containing viral DNA and a surrounding envelope
containing the surface protein of surface antigen
Global public health problem
300 million HBV carriers
250,000 deaths yearly
In USA 0.1%-2% prevalence of HBV carriers
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Viral hepatitis B

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Routes of Transmission(1)

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Percutaneous
Contaminated needle stick (injecting drug use and occupational
exposure) Nosocomial
Most commonly transmitted blood-borne virus; more common
from patient to health care provider
Percutaneous exposure and risk of infection : HBV 6-30%, HCV
0-7%, HIV 0.3%
Hemodialysis
Human bite
Transplant or transfusion of unscreened blood or blood products
Sharing razors
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Routes of Transmission(2)

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Individual at Risk

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Individual at Risk (cont)

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Clinical Course

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Clinical Course (cont)

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Jaundice develops in 25-35 % of patients with

symptoms
Most of HBV-infected adults will recover within
six months and develop immunity
Of those infected with HBV, 30-90 % of chlidren
less than 5 years of age and 2-10 % of the
population over 5 years of age will progress to
chronic infection
Among all age groups, 15-25 % of those who
become chronically infected with HBV die
prematurely as a result of chronic liver disease
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Diagnostic panels

Consists of 5 hepatitis B
markers: HBsAg, HBeAg,
anti-HBe anti-HBc and antiHBs

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If HBsAg and anti-HBc IgM is

positive Acute Hepatitis B
is established serial
testing with the monitoring
panel is indicated

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Hepatitis B monitoring
panels

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To determine the patients potential for developing chronic

HBV infection due to the persistence of the surface antigen
(HBsAg)

To determine relative infectivity (HBeAg)

To monitor seroconversion from HBeAg to anti-Hbeusually
indicates progression toward a resolution of the disease
To monitor seroconversion from HBsAg to anti HBs positivity, which
indicates resolution of the disease and establishment of immunity
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ent teach us more than books

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Chronic HBV Infection

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Testing to Determine Immunity: Anti-HBs

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Treatment for chronic HBV infections

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Considered when HBsAg >6 months, evidence of active

virus replication (HBeAg and HBV DNA positive) and active
liver disease (chronic hepatitis on biopsy, elevated ALT)
Interferon Therapy
12-24 weeks in doses of 5 Million Units (MU)/daily or 10 Million
Units (MU) 3x/week
Pegylated interferon may be superior
Target :
Supresses HBV replication ( HBV-DNA, HBeAg)
Improvement in liver disease (normal ALT)
Prevention of cirrhosis, hepatocellular carcinoma
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Prevention/Prophylaxis

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Worldwide screening of blood and blood products

Destruction of disposable needles, and adequate
sterilization of reusable materials such as surgical or
dental instruments
Effective use of universal precautions and barrier
techniques (such as use of sterile equipment, the
wearing of gloves, and wearing of eye/face protection)
Education about the risks of using inadequately
sterilized or unsterilized equipment
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Hepatitis Vaccination in Adult

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Available for HAV & HBV

HAV :
Two dose (i.m.) 1 ml + booster 6-12 month later
Protection : 2-3 years

HBV :
Three doses each 1 ml (i.m.) at 0, 1, 6 month at
0,1,2 + booster at 12 month
Protection : 15-20 years
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Complication : Hepatitis

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palmar erythema

Spider angiomas

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