Viral Hepatitis

Viral Hepatitis
. It caused by five hepatotropic viruses : hepatitis A, B, C, D, and E viruses

HEPATITIS A
.ETIOLOGY
.HAV is an RNA virus

: EPIDEMIOLOGY
Transmission is almost always by person-to-person contact through the fecal- -1
.oral route
Infection has been associated with contact with contaminated food or water and -2
.after travel to endemic areas
. Also contacts with infected persons, child-care centers, and household contacts
HAV excreted in the stool from 2 wk before to 7days after the onset of jaundice. -3
.The patient is therefore contagious during this period

: CLINICAL MANIFESTATIONS
.Incubation period is ≈3 wk
:Systemic symptoms include
.fever, malaise, nausea, emesis, anorexia, and abdominal discomfort
.Diarrhea often occurs in children
Jaundice, dark-colored urine with pale stool occur, and develop after the systemic
.symptoms
.Right upper quadrant pain
.The typical duration of illness is 7–14 days
:Rarely other organ systems can be affected including
.Regional lymph nodes and the spleen may be enlarged-1
.Aplastic anemia-2
Fulminant hepatitis is uncommon in children; co-infection with HCV increases the
risk for fulminant hepatitis. HAV is not associated with chronic liver disease, or an
.intestinal carrier state

: DIAGNOSIS
detection of antibodies to HAV (anti-HAV IgM & IgG) in the serum by -1
.radioimmunoassay
.Pattern of response to hepatitis A virus (HAV) infection •
. Identification of viral particles in stool -2
.Viral polymerase chain reaction (PCR) assay -3
:Liver function test -4
Hyperbilirubinemia (mixed or conjugated (direct)), rise in serum levels of alanine
aminotransferase (ALT) and aspartate aminotransferase (AST) & alkaline
. phosphatase (ALP)

.COMPLICATIONS
.Most patients achieve full recovery
.Acute liver failure (fulminant hepatitis) rare but can occur
.Edema and Ascites due to hypoalbuminemia
: TREATMENT
.No specific treatment for hepatitis A
. Supportive treatment with Intravenous hydration as needed

PREVENTION
Patients should be excluded from school, child care, or work during contagious -1
. period
Careful handwashing, particularly after changing diapers and before preparing -2
.food
..Vaccine : two inactivated, HAV vaccines are approved for children >2 yr of age -3
 HEPATITIS B
: ETIOLOGY
HBV which is double-stranded DNA virus . The surface of the virus includes particles
. designated hepatitis B surface antigen (HBsAg)
The inner portion of the virion contains hepatitis B core antigen (HBcAg), the
nucleocapsid that encodes the viral DNA, called hepatitis B e antigen (HBeAg),
. which serves as a marker of active viral replication

: EPIDEMIOLOGY
Transmission occurs through blood & blood products exposure, sexual contact, -1
.intravenous drugs(addict), tattoos, and intimate contact with carriers

Transplacental transmission from HBsAg-positive mother . The risk of -2

. transmission is greatest if the mother is also HBeAg positive
.HBsAg is recovered in breast milk of infected mothers -3

: CLINICAL MANIFESTATIONS
. Incubation period ranges from 45 to 160 days

.The first clinical evidence is elevation of ALT level*

.Lethargy, anorexia, and malaise*
.Jaundice, usually begins ≈8 wk after exposure and lasts for ≈4 wk*
The illness may be preceded by arthralgia or skin lesions, including urticarial, or*
.Papular acrodermatitis
Extrahepatic conditions include polyarteritis, glomerulonephritis, and aplastic *
.anemia
Chronic carrier state” defined as being positive for HBsAg for >6 mo, complicates“
.up to 10% of cases

: On physical examination
.icteric skin and mucous membranes
.The liver is enlarged and tender
. Splenomegaly and lymphadenopathy
Clinical signs of altered sensorium and hyper-reflexivity indicate encephalopathy
.and ALF

DIAGNOSIS
:A- assay of serologic markers
.HBsAg is the 1st serologic marker of infection to appear-1
Antibody to HBcAg (anti-HBc IgM & IgG AB) -2
Anti-HBs and anti-HBc antibodies are detected in persons with resolved -3
. infection
. While persons immunized with hepatitis B vaccine have only anti-HBs antibodies
.HBeAg -4

. B- HBV DNA can be detected in the serum

. C- Liver function test
 : COMPLICATIONS
.ALF occurs more frequently with HBV than with the other viruses -1
chronic hepatitis, which can lead to cirrhosis, end-stage liver disease, and -2
.primary hepatocellular carcinoma

Membranous glomerulonephritis due to circulating immune complexes is a rare -3

. complication

.TREATMENT
.Treatment of the acute infection is supportive
. Chronic hepatitis B treated with Interferon-α
.Lamivudine use in children older than age 2
PREVENTION
.Hepatitis B vaccine -1
Infants born to HBsAg-positive women should receive vaccine at birth-2
accompanied by administration of Hepatitis B Immunoglobulin(HBIG) as soon after
. delivery as possible (within 12 hr)

postexposure prophylaxis : Hepatitis B vaccine and HBIG given for household, -3

sexual, and needle-sharing contacts, those with blood exposure &
.Immunocompromised patients
 HEPATITIS C
. previously known as “transfusion-related non-A, non-B hepatitis

ETIOLOGY
. HCV is a single- stranded RNA virus

.EPIDEMIOLOGY
:Risk factors for transmission include
blood transfusion*
. Illegal drug use with exposure to blood from HCV-infected individual*
. Sexual transmission*
. occupational exposure*
. perinatal transmission from mother to her infant*
: CLINICAL MANIFESTATIONS
. The incubation period is 7–9 wk
Acute liver failure rarely occurs. HCV is the most likely hepatotropic virus to cause
.chronic infection
Chronic HCV infection is defined by persistently elevated levels of ALT in the
.presence of hepatic fibrosis and by the presence of HCV RNA in blood

.DIAGNOSIS
.serologic test to detect the antibodies to HCV antigens (anti-HCV AB) -1
.PCR assay for detection of small amounts of HCV RNA -2
 Liver function test -3
.liver biopsy to assess the presence and extent of hepatic fibrosis -4

.COMPLICATIONS
.chronic hepatitis(60-80%) -1
cirrhosis or HCC -2
.acute liver failure (rarely) -3

TREATMENT
.Interferon-α and ribavirin use for children >3 yr of age

.PREVENTION
.No vaccine is available to prevent HCV
Thank you
Choice the most appropriate single answer:
1. A 2-month-old infant brought to the clinic because his mother
was recently diagnosed with hepatitis B infection. Of the following,
the test that is MOST helpful in establishing whether this infant is
infected with hepatitis B virus is:
A. Anti-HBc antibody
B. Anti-HBe antibody
C. HBeAg
D. Anti-HBs antibody
E. HBsAg
2. Regarding hepatitis C all the following statements are true
except:
A. Hepatitis C virus is the most likely hepatotropic virus to cause
chronic infection.
B. Blood transfusion is the main rout of transmission.
C. The incubation period is 7–9 wk.
D. Acute liver failure is a common complication.
E. Interferon-α and ribavirin use for children >3 yr of age with HCV
infection.
3. Hepatitis A:
A. Infectivity from faecal shedding begins at the onset of symptoms.
B. Is associated with intestinal carrier state.
C. Has a 10% chance of subsequent hepatocellular carcinoma in the
30 years following infection.
D. Can cause edema and ascites due to decrease synthetic activity
of liver.
E. Treated with Interferon-α.
4. In a mother who is HBsAg positive, which of the following
combinations is the most appropriate for her newborn baby?
A. Hepatitis B vaccine and hepatitis B immunoglobulin.
B. Hepatitis B vaccine and Interferon-α.
C. Hepatitis B and hepatitis C vaccines combined.
D. Hepatitis B vaccine.
E. Hepatitis B immunoglobulin.
5. Regarding Active acute hepatitis B infection, select the
appropriate serologic markers:
A. HBeAg and HBsAg
B. Anti-HBs and anti-HBc antibodies
C. Positive HBsAg for > 6 mo
D. Anti-HAV antibodies
E. Anti-HBs antibodies
6. Regarding hepatitis B, which serologic marker indicate active
viral replication?
A. HBeAg
B. HBcAg
C. Anti-HBc antibodies
D. Anti-HBs antibodies
E. HBsAg
7. Which is associated with an increased risk of hepatitis A
infection?
A. Contaminated food and water.
B. Attendance at daycare centers.
C. Travel to endemic areas.
D. Household contacts of children in daycare.
E. All of the above.
 True/False
1-The serologic markers detect in a patient with previous resolved
hepatitis B infection are HBsAg and anti-HBc antibodies. False
2-Hepatitis A may present with edema and ascites due to decrease
synthetic activity of liver and hypoalbuminemia. True
3-Chronic hepatitis B infection defined as being positive for HBsAg
for >6 months. True
4-HB vaccine is contraindicated in HIV infected children. False
5-Newborn who is mother HBsAg positive should receive hepatitis B
vaccine. True