Hepatitis serology

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Hepatitis serology

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Hepatitis serology

  1. 1. Dr. RABIE IBRAHIMSUPERVISED BY Dr.ABDALLA AL-SHAHRANI
  2. 2. Hepatitis A B C D EVirus HAV HBV HCV HDV HEVFamily Picornavirus Hepadnavirus Flavivirus Satellite Calicivirus cGenome ssRNA dsDNA ssRNA ssRNA ssRNA parenteral, parenteral, parenteral,Spread Fecal-oral sexual,perinat Fecal-oral ?sexual ?sexual al HbsAg,HBcAg,Antigens HAV-Ag HCV-Ag HDV-Ag HEV-Ag HBeAg Anti-HBs,Anti-Antibodies Anti_HAV Anti-HCV Anti-HDV Anti-HEV HBc,Anti-HBe HBV DNA, viruslikeVirus markers HAV RNA DNA HCV RNa HDV RNa partiacles polymerase
  3. 3. serology• HBsAg: surface antigen• HBeAg: e antigen (a component of HBV core); marker ofviral replication• HBcAg: core antigen (cannot be measured in serum)• both HBsAg and HBeAg are present during acute hepatitis B• anti-HBs follows HBsAg clearance and confers long-termimmunity• anti-HBe and anti-HBc appear during the acute and chronicphases of the illness but do notprovide immunity• anti-Hbe indicates low infectivity
  4. 4. Possible Outcomes of HBV Infection Acute hepatitis B infection 3-5% of adult- 95% of infant- acquired infections acquired infections Chronic HBV infection Chronic hepatitis 12-25% in 5 years Cirrhosis 6-15% in 5 years 20-23% in 5 years Hepatocellular Liver failure carcinomaDeath Liver transplant Death
  5. 5. Acute Hepatitis B Virus Infection with Recovery Typical Serologic Course Symptoms HBeAg anti-HBe Total anti-HBcTitre HBsAg IgM anti-HBc anti-HBs 0 4 8 12 16 20 24 28 32 36 52 100 Weeks after Exposure
  6. 6. Acute HBV Infection with Progression toChronic Infection: Typical Serologic Course Acute Chronic (6 months) (Years) HBeAg Anti-HBe HBsAg Total anti-HBc IgM anti-HBc 0 4 8 12 16 20 24 28 32 36 52 Years Weeks after Exposure
  7. 7. 、Laboratory Diagnosis
  8. 8. Hepatitis B virus HBV belongs to the Hepadnaviridae family of viruses. Diagram of hepatitis B virus. Hepatitis B surface Ag. Hepatitis core Ag. Hepatitis e Ag. HBV-DNA. HBV-DNA polymerase.
  9. 9. Laboratory Markers for HBV Infection Hepatitis B surface antigen (HBsAg): present in acute or chronic infection. It appears 4-12 week after infection Hepatitis B surface antibody (anti-HBs):marker of immunity acquired through natural HBV infection, vaccination, or passive antibody (immune globulin) , It appears 4-10 month after infection
  10. 10. Laboratory Markers for HBV Infection Hepatitis B core antibody (anti-H Bc): Ig M--indicative of infection in the previous six months, It appears 6-14 week after infection Ig G--indicative of more distant HBV infection that may have been cleared by the immune system or that may persist. positive HBsAg and anti-HB c Ig G--indicative of persistent chronic HBV infection
  11. 11. Laboratory Markers for HBV Infection Hepatitis B e antigen (HBeAg) :correlates with a high level of viral replication; often called a "marker of infectivity" Hepatitis B e antibody (anti-HBe):correlates with low rates of viral replication.It appears 8-16 week after infection HBV DNA:correlates with active replication; useful in monitoring response to treatment of HBV infection, especially in HBeAg-negative mutants
  12. 12. Interpretation of HBV Tests Test Result Interpretation
  13. 13. Test Result InterpretationHBsAg Negative Susceptible (not immune) toAnti-HBc Negative HBVAnti-HBs Negative infectionHBsAg Negative Immune because of naturalAnti-HBc Positive infectionAnti-HBs PositiveHBsAg Negative Immune because of hepatitisAnti-HBc Negative B vaccinationAnti-HBs PositiveHBsAg Positive Acute HBV infectionAnti-HBc PositiveIgM anti-HBc PositiveAnti-HBs NegativeHBsAg Positive Chronic HBV infectionAnti-HBc PositiveIgM anti-HBc NegativeAnti-HBs NegativeHBsAg NegativeAnti-HBc PositiveAnti-HBs Negative
  14. 14. Possible Interpretations:(1) patient may be recovering from acute infection;(2) patient may be distantly immune--testing does not detect very low level of anti-HBs;(3) patient may be susceptible, with a false- positive anti-HBc; or(4) there may be an undetectable level of HBsAg in the serum, and the patient is actually a carrier
  15. 15. Diagnostic criteria for HBV infection Acute Infection Acute HBV infection is subclinical in 70 percent of adults and 90 percent of children younger than five years. The incubation period after infection lasts one to four months. Symptoms of acute HBV infection include nausea, anorexia, fatigue, low-grade fever, and right upper quadrant or epigastric pain. Clinical jaundice appears as constitutional symptoms are resolving
  16. 16.  Hepatic transaminase levels [ALT] and [AST]) reflect hepatocellular injury and range from several hundred to 20,000 IU per L. Serum bilirubin values are usually less than 20 mg per dL (342 µmol per L). Mild anemia is common, as is relative lymphocytosis. More severe disease results in an elevation in the prothrombin time and a decrease in the serum albumin level. HBV is not cytopathic, and liver injury is caused by the hosts immune response against infected hepatocytes
  17. 17. Diagnostic criteria for HBV infectionChronic disease  HBsAg positive for longer than six months.  Serum HBV DNA > 100,000 copies per mL.  Persistent or intermittent elevation of alanine transaminase and aspartate transaminase levels  Liver biopsy showing chronic hepatitis
  18. 18. Inactive HBsAg carrier state  HBsAg positive for longer than six months.  HB e Ag negative, anti-HB e positive  Serum HBV DNA < 100,000 copies per mL  Persistently normal alanine transaminase or aspartate transaminase levels  Liver biopsy to confirm absence of significant hepatitis
  19. 19. Resolved disease  History of acute or chronic hepatitis B.  Presence of anti-HBc, with or without anti-HBs  HBsAg negative  Normal alanine transaminase level
  20. 20. CASE 1A 25-yr-old male patient presented to your clinic for pre-employment evaluation and his lab results show the following :HBsAg Negative, Anti-HBc Negative,Anti-HBs Positive.What is your interpretation of his lab results?
  21. 21. Immune because of previous hepatitis B vaccination.
  22. 22.  Case 2: A 35 years old man presented with complain of fever, abdominal pain associated with nausea. Investigations showed : CBC : HB 10.5 g%, WBC 8.5, ESR 100, CRP 20 mg/dl . LFT : bilirubin 14 mg/dl , AST (SGOT) 900 u/L, ALT (SGPT) 1500 u/l. Hepatitis profile: HBsAg –ve, Anti HBc IgM –ve, HBeAg +ve, Anti HBs –ve. VDRL +ve.QUESTION:1. What is your interpretation?2. Explain your findings.
  23. 23.  Answer : Acute recent hepatitis infection, HBsAg should be positive but in occasional cases it appears later than the HBe Ag. You should repeat the test to detect the HBsAg . VDRL is false positive. Hepatitis is one of the causes of false positive VDRL.
  24. 24.  Case 3: A 30 years old healthy hospital worker reported to check the results of his hepatitis screening test: HBsAg –ve. Anti HBs +ve. Anti HBc +ve. HBe Ag -ve. Anti HBe -ve. Anti HCV -ve QUESTION: Interpret this test.
  25. 25.  Answer: Past hepatitis infection. Immune and not infective
  26. 26.  Case 4: A 20 years old reported for pre-employment examination and investigations, all his systems were free apart from 2cm BCM hepatomeglay and he reported a painless lesion on his penis since 2 weeks. Investigations: CBC HB 12.5mg%, WBC 12.5. LFT : ALT 120 u/l, AST 100 u/l, Alk Phos 300 u/l. Hepatitis profile: HBsAg +ve, Anti HBc IgG +ve, HBe Ag +ve , Anti HBs –ve. HBDNA >100.000 copies. VDRL –ve. Question: How would you interprete this tests. What is the diagnosis?
  27. 27.  Answer : Chronic persistent hepatitis, did not develop immunity yet still infective. ? First stage Syphlitic lesion with –ve VDRL in early phase . Needs : Repeat LFT and hepatitis profile regularly. Liver US and liver biobsy. Repeat VDRL after 1 week, if +ve, perform the TP specific tests. Do HIV screening and screen for other STD
  28. 28.  Case 5: A 25 years old female who had an attack of fever and epigastric pain 3 months ago, her husband was found to be hepatitis positive. She presented to check her investigations she did last week. CBC HB 10.5 g%, WBC 7.8, ESR 30 LFT ALT 70 U/l , AST 85 U/l, alk phosp 120 U/l Hepatitis profile: HBsAg –ve ,anti HBc+ve , HBeAg –ve , anti HBs –ve. Question:1. How would you interpret her findings?2. What is your next step?
  29. 29.  Answer: Window stage. Repeat after 1month
  30. 30. Case 6 A 26 years old woman seen by her GP because she was jaundiced and feeling unwell. She had a history of drug addiction.A hepatitis screen was done, the results are: Anti-HAV NEGATIVE. Anti HBs POSITIVE. Anti-HbsAg NEGATIVE. HbsAg NEGATIVE. Hbe Ag NEGATIVE Anti-HCV NEGATIVE. Anti-HBc POSITIVE.
  31. 31. Questions Which of the following is the most likely cause of her jaundice.A. Acute hepatitis C.B. Chronic hepatitis B and acute hepatitis C.C. Hepatitis ED. Chronic Hepatitis EE. Acute hepatitis B
  32. 32. Answer 6 The picture suggests previous exposure TO hepatitis B but this would not give a clinical picture of jaundice, so another cause needs to be considered. History of drug addiction suggest hepatitis C. Antibody against hepatitis C takes about 3 months, the PCR testing is test used to reach the diagnosis in the acute phase.
  33. 33. Question 7During pre-employment screening. A 26 year old male has the followinghepatitis serology HBs Ag negative HBs Ab positive Hbe Ag negative Hbe Ab positive HBc Ab positive A.What is your interpretation ?
  34. 34. Answer 7Immune by past infection
  35. 35. Case 8 :Highly infective chronic hepatitis B is suggested by:1. normal liver enzymes, HBeAg+, anti-HBc IgG+2. elevated liver enzymes, HBeAg+, anti-HBc IgM+3. normal liver enzymes, HBeAg-, anti-HBc IgG+4. elevated liver enzymes, HBeAg+, anti-HBc IgG+
  36. 36. Highly infective chronic hepatitis B is suggested by:•1 normal liver enzymes, HBeAg+, anti-HBc IgG+ F•2 elevated liver enzymes, HBeAg+, anti-HBc IgM+ F•3 normal liver enzymes, HBeAg-, anti-HBc IgG+ F•4 elevated liver enzymes, HBeAg+, anti-HBc IgG+ T

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