Hepatitis

Finish Hepatitis B & C!

Flavi

Epidemiology

Transmission

Parenteral

esp. Tattoos

Incubation period

Long

1-4 mo.

Prevalence

3-10%

25% for high risk groups

F

Misnomer

See HBV

Picorna

Clinical

No chronic cases

Diagnosis

Anti-HAV (total)

Exposed

Vaccinated

Anti-HAV IgM

Recently vaccinated

Epidemiology

Transmission

Fecal-oral

Incubation period

Short

2-3 wks

Mortality rate

0.1%

Very low

No carrier state

Prevention

Vaccine

Lifelong immunity

Recommendations

Who should get the vaccine?

Homosexual / Bisexual men

Drug users

w/ Chronic liver disease

Children in high HAV areas

Travelers to high HAV countries

Treatment

No Treatment

Hepadna

Clinical

Chronic hepatitis

< 5 y.o.

Rate?

60%

> 5 y.o.

Rate?

Hepatocellular carcinoma

Diagnosis

Refer to lecture notes and syllabus and study the "window"

HBsAg

Infected

Carrier

Anti-HBs

Immunity

Vaccinated

Anti-HBc

Infected

Anti-HBc IgM

Recent Infection

Think Immunology (IgM)

HBeAg

Highly infectious

HBV e antigen (DNA polymerase): indicates that infection is active (virus is replicating)

HBV viral DNA

Infected

Chronic disease activity

Epidemiology

Person

Transmission

Parenteral

Carriers

How many?

300 million

Mortality Rate

0.8% in acute illness

Very low

Vertical transmission

What percentage of infants born to infected mothers will be infected?

80%

Time

Incubation period

Long

6 wk - 6 mo

Place

75-90%

Asia

Pacific Islands

Mid East

How many?

1.2 mil

Prevention

Vaccine

Treatment

No specifics

Flavi

Characteristics

Kupffer cell hyperplasia

Cholestasis

Total or partial suppression of the flow of bile.

Patchy lobar steatosis

Clinical

Mild

Cryoglobulinemia

Porphyria cutanea tarda

Aplasic anemia

80% chronic

20% cirrhosis

Diagnosis

Epidemiology

Pareneteral

Low risk of death

Prevention

Treatment

Ribavirin + interferon alpha for 24 weeks

Unassigned

Characteristics

Enteric

Clinical

similar to HAV

High mortality pregnant women

15-25% for pregnant women1-3% overall

Diagnosis

IgM anti-HEV

IgG anti-HEV

Epidemiology

Transmission

Exposure to fecally contaminated water

P2P minimal

Incubation period

Short

2-8 weeksShort similar to HAV

Place

Low in U.S.: Usually includes history of travel to HEV-endemic areas

Africa

Asia

India

Mexico

Prevention

Avoid questionable water sources

Avoid uncooked

shellfish

fruits

veggies

Ig Preps ineffective

Vaccine

Treatment

Unassigned

Characteristics

Circular (-)ssRNA

Deltavirus

Defective

Replication

Requires HBV

Forms ribozyme intermediate

Antigens

delta Ag

HBsAg

Clinical

Worsens HBV symptoms

Leads to..

Cirrhosis

Coinfection

Infected at same time

Severe acute

Low risk of chronic

Superinfection

Infected one after another

Usu. develop chronic HDV infection

High risk severe CLD

CLD = Chronic liver disease

Diagnosis

Nothing about lab tests, but here's what was in the diagram:IgM anti-HDVanti-HBs

Epidemiology

Transmission

Percutaneous

IV drug users

Permucosal

Sexual contact

Incubation period

Long

6 wk - 6 mo

Prevention

HBV vaccine

Pre/Post-exposure prophylaxis

HBV-HDV Coinfection

Education for those w/ chronic HBV

HBV-HDV Superinfection