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Hepatitis B
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Hepatitis B

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  • 1. + Done by: Ahmad Mhd Al-dhlawiy Hamad Emad Dhuhayr
  • 2. + Contents … General concepts for hepatitis.  Types of hepatitis.  HBV Structure & Antigens.  Transmission Epidemiology.  Pathogenesis & Immunity.  Clinical pictures.  Laboratory Diagnosis.  Treatment Prevention.  References. 
  • 3. + General Concepts …  VIRAL HEPATITIS :- is a serious disease caused by virus that attacks the liver . There are various strains of viral hepatitis which can cause lifelong infection, cirrhosis ( scarring) of the liver , liver cancer , liver failure, and death.  six medically important viruses are commonly described as “hepatitis viruses”: HAV,HBV,HCV,HDV,HEV,HGV
  • 4. + Terms for Hepatitis ….  Acute: Short term and/or severe.  Chronic: Lingering or lasting - may or may not be severe  Fulminant: Developing quickly and lasting a short time, high mortality rate.  Cirrhosis: Hardening: may be the result of infection or toxins (e.g. alcohol)  Jaundice: Yellowing of the skin, eyes, etc due to raised levels of bilirubin in the blood due to liver damage.  Hepatocellular carcinoma: is closely associated with hepatitis B, and at least in some regions of the world with hepatitis C virus.
  • 5. + Viral hepatitis …
  • 6. + Viral hepatitis …
  • 7. + HBV Structure & Antigens … HBsAg = surface (coat) protein ( 4 phenotypes : adw, adr, ayw and ayr) HBcAg = inner core protein (a single serotype) HBeAg = secreted protein; function unknown
  • 8. + Replication …
  • 9. + Modes of Transmission for HBV  Parenteral - IV drug abusers, health workers are at increased risk.  Sexual - sex workers and homosexuals are particular at risk.  Perinatal →infant. - (Vertical) - mother(HBeAg+)
  • 10. +
  • 11. +
  • 12. + Incidence of Hepatitis in KSA
  • 13. + High-risk groups for HBV infection  People from endemic regions  Babies of mothers with chronic HBV  Intravenous drug abusers  People with multiple sex partners  Hemophiliacs and other patients requiting blood and blood product treatments  Health care personnel who have contact with blood
  • 14. + Concentration of Hepatitis B Virus in Various Body Fluids … High blood serum wound exudates Moderate semen vaginal fluid saliva Low/Not Detectable urine feces sweat tears breastmilk
  • 15. + Pathogenesis & Immunity …  Virus enters hepatocytes via blood  Immune response (cytotoxic T cell) to viral antigens expressed on hepatocyte cell surface responsible for clinical syndrome  5 % become chronic carriers (HBsAg> 6 months)  Higher rate of hepatocellular ca in chronic carriers, especially those who are “e” antigen positive  Hepatitis B surface antibody likely confers lifelong immunity (IgG anti-HBs)  Hepatitis B e Ab indicates low transmissibility
  • 16. + Clinical pictures …
  • 17. + Possible Outcomes of HBV Infection Acute hepatitis B infection 3-5% of adultacquired infections 95% of infantacquired infections Chronic HBV infection Chronic hepatitis 12-25% in 5 years 6-15% in 5 years Cirrhosis Hepatocellular carcinoma Death 20-23% in 5 years Liver failure Liver transplant Death
  • 18. + Acute Hepatitis B Infection
  • 19. + Laboratory Diagnosis …
  • 20. + Treatment … Interferon alfa (Intron A) is 30 to 40%. Lamivudine Response rate (Epivir HBV) (relapse ,drug resistance) Adefovir dipivoxil (Hepsera)
  • 21. + Prevention …  Vaccination - highly effective recombinant vaccines.  Hepatitis B Immunoglobulin (HBIG) -exposed within 48 hours of the incident/ neonates whose mothers are HBsAg and HBeAg positive.  Other measures -screening of blood donors, blood and body fluid precautions.
  • 22. + Hepatitis B Vaccine  Infants: several options that depend on status of the mother  If mother HBsAg negative: birth, 0-2m,4-6m  If mother HBsAg positive: vaccine and Hep B immune globulin within 12 hours of birth, 1-2m, <6m  Adults  * 0,1, 6 months Routine booster doses are NOT routinely recommended for any group  Vaccine recommended in  All those aged 0-18  Those at high risk
  • 23. + References website  http://www.hepatitis-central.com/hbv/hepbfaq/viroligy.html  http://en.wikipedia.org/wiki/Hepatitis_B  http://www.who.int/mediacentre/factsheets/fs204/en/index.html  http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-hep-b.pdf  http://www.worldhepatitisalliance.org/AboutViralHepatitis/Prevention_Diagnosis_Treatment.aspx  http://emedicine.medscape.com/article/177632-overview Text books  Richard A, HARVEY, Pamela C,Champe, Bruce D, Fisher. Microbiology 2nd edition. Lippicott Williams & wilkins. Chapter 26. PP(273-282)  Raphael Rubin, David S. Strayer. Rubin’s pathology 5th edition. Lippicott Williams & wilkins. Chapter 14. PP(637-640)
  • 24. +  AHMED AL DAHLAWY  HAMAD EMAD THUHAYR

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