KINGBMT

3.  Prodromal symptoms
constitutional symptoms:
› -anorexia -athralgias
› - nausea and vomiting -myalgias
› -fatigue -headache
› -malaise -pharyngitis
› -cough
› Low grade fever (38-39 C)- HAV and HEV
› Dark urine and clay-colored stools- 1-5 days
before the onset of clinical jaundice.

4.  Onset of jaundice
› Constitutional symptoms diminish
› -in some patients, mild weight loss (2.5-5 kg)
› -liver is enlarged and tender
› -Right upper quadrant pain and discomfort
Recovery/post-icteric phase
-constitutionalsymptoms disappear
-2-12 weeks (more prolonged in HBV and HCV)
-some liver enlargement and biochemical test
abnormalities are still evident
-complete clinical and biochemical recovery:
1-2 months

5.  A number of clinical syndromes
may develop after exposure to
hepatitis viruses:
› Acute hepatitis
› Fulminant hepatitis
› Chronic hepatitis
› Chronic carrier state

6.  The typical morphologic lesions of all
types of viral hepatitis are similar :
› Panlobular infiltration with mononuclear cells
› Hepatic cell necrosis
› Hyperplasia of Kupffer cells
› Variable degrees of cholestasis

7. SGOT
SGPT
BILIRUBIN
PT

9.  Enterovirus 72
 Family: Picornavirus
 Genus: Hepatovirus
 nonenveloped 27 –nm, heat, acid, and
ether resistant RNA virus
Inactivation by:
a. boiling for 1 min
b. contact with
formaldehyde
c. Chlorine
d. ultraviolet radiation

10.  Incubation period:
4 weeks/ 15-45
days
 Replication:
limited in the liver
 Late incubation
period: virus is
present in the liver,
bile, stools and
blood.
 Period of
communicability:
before to after
symptoms appear

11.  Fecal-oral route

13. Serology
• IgM anti-HAV : acute HAV infection
• IgG anti-HAV : resolution or previous infection

14.  Prophylaxis with immune serum globulin
given before or early in the incubation
period ( 80% to 90% effective in preventing
clinical illness
 Post-exposure: administration of 0.02 mL/kg
 • Active immunization recommended for:
 • Travellers to developing countries:
 <3 months travel : 0.02 mL/kg
longer travels: 0.06 mL/kg every 4-6 months
 • Children 2 – 18 years old

15.  Formalin-inactivated vaccines
 -made from strains of HAV attenuated
 in tissue culture have been shown to be
safe, immunogenic, and effective in
preventing hepatitis A.
 -Hepatitis A vaccination provides long-
lasting protection (protective levels of
anti -HA V should last 20 years after
vaccination)

27.  Major cause of liver disease worldwide
 Most common chronic blood-borne
infection
 Most common cause of chronic liver
disease.

28. PARENTERAL

29. According to the 2008 data from the USA
Centers for Disease Control, the most
common risk factors for HCV are:
 Intravenous drug abuse (54%)
 Multiple sex partners (36%)
 Having had surgery within the past 6
months (16%)
 Needle stick injury (10%)
 Multiple contacts with an HCV-infected
person (10%)
 Employment in medical and dental
fields (1.5%)
 Unknown (32%)

30.  HVC
 Single-stranded positive sense RNA Virus
• Belongs to the FLAVIRIDAE FAMILY
• Sole member of the genus Hepacivirus
 The genome of HCV contains
approximately 9600 nucleotides with
open reading frame (ORF) that encodes
one large viral polypeptide precursor of
3008 to 3033 amino acids

31. HEPATOCYTE- Major site of viral replication
 In the cytosol,the 5’ UTR directs the RNA to its
docking site on the endoplasmic reticulum and
directs cap-independent internal initiation of
HCV polyprotein translation by recruiting both
cellular proteins, including eukaryotic initiation
factors (eIF) 2 and 3, and viral proteins.
 HCV- small enveloped, single-stranded RNA
virus with 9.6-kilobase that codes for a single
polyprotein with one open reading frame,
which is processed into functional proteins

33.  The 5’ untranslated region and the C
region are highly conserved among
isolates, while envelope domain E2
contains hypervariable region.
 P7 – Adjacent to the structural proteins, a
membrane protein that functions as ion
channel.

34.  3’ end are six nonstructural (NS) regions,
 NS2, which code for cyteinprotease
 NS3, which code for serine protease and
an RNA helicase
 NS4 and NS4B, NSA5A and NSA5B, which
code for RNA dependent RNA
polymerase

35.  Viral Genotype
 first division used to describe genetic
heterogeneity of HCV
 Refers to genetically distinct groups of HCV
isolates that have arisen during the evolution of
the virus
 The sequence cluster into 6 major
genotypes (designed by numbers), and
more than 70 subtypes (desined by lower
case letter) within these major genotypes

36. The incubation period for HCV ranges
from 6 to 26 days. HCV RNA is detectable in
the blood for 1-3 weeks, with elevation in
serum transaminases.

41.  Presence of anti-HCV in high titer in
serum (generally an enzyme immuno
assay greater than 9)
 Indicates exposure to virus
 Serologic Assays
 Used for diagnosis
 Virologic Assays
 For confirming infection, monitoring
response to treatment, and evalauting
immunocompromised patients.

42.  EIAs detect antibodies against HCV
antigens
 Three generations of EIAs are developed:
Third Generation –latest generation, EIAs
detect antibodies against HCV core, NS3,
NS4, NS5 antigens as early as 7-8 weeks after
infection, with sensitivity and specificity rates
of 99%

43.  Qualitative HCV RNA
nucleic acid test
(NAT)
 Only report whether
HCV is found in serum
 not and do not
quantitate the
amount of HCV RNA
 Used only for
screening purposes
now (eg. Screening
of blood donated to
the blood bank)
 Quantitative HCV
RNA test
 Essential for
monitoring the
response to antiviral
therapy

44.  Disposable equipment, and rigorous
sterilization of reusable medical and
surgical equipment have reduced
nosocomial HCV infection
 Avoidance of having sexual intercourse
to multiple partners.

45.  Exclusion of commercial blood donors and reliance
on volunteer blood supply
 Screening donor blood with surrogate markers such
as ALT and Anti-HBc,
-markers that identify segments of blood donor
population with an increased risk of blood borne
infection
 Exclusion of blood donors in high risk groups for
AIDS and the introduction of anti-HIV screening test
 Progressively sensitive serologic and virologic
screening test for HCV infection.

46.  Eradication of the Virus
**Primary goal of therapy for HCV
infections
 Sustained Virologic Response (SVR)
**Absence of detectable virus in blood
24 hrs after completion of therapy –
excellent marker for the resolution of
HCV infection.

48. HEPATITIS D VIRUS
-Discovered in 1977
-Only member of Deltavirus
-HDV is a defective RNA
virus that co-infects with
and requires the helper
function of HBV for its
replication and expression.

49. LARGE DELTA ANTIGEN
-214-amino-acid species
-It suppress replication but
its required for assembly of
the antigen into virions
SMALL DELTA ANTIGEN
-195-amino-acid species
-It plays a role in facilitating
HDV RNA replication

51. •HDV will bind
to RNA
polymerase II
REPLICATION
•Hepatocytes
via RNA-
directed RNA
synthesis
TRANSCRIPTION
• Genomic RNA to
complementary
antigenomic RNA
HDsAg

53. CO-INFECTION
-HDV can either
infect a person
simultaneously with
HBV
SUPERINFECTION
-Superinfect a
person already
infected with HBV

54.  It is clinically
indistinguishable from
other forms of viral
hepatitis
 90% of patients are
asymptomatic
 Incubation period is 21-45
days but maybe shorter in
cases of superinfection

55.  Vaccinating susceptible
person with hepatitis B
vaccine
 No products available for
immunoprophylaxis to prevent
HBsAg carriers
 Avoidance of percutaneous
exposure and limitation of
intimate contact with person
who have HDV infection

57.  Enterically transmitted virus that occurs
primarily in India, Asia, Africa and Central
America
 In these places, Hepatitis E virus (HEV) is the
most common cause of acute hepatitis
 It has 3 open reading frames (ORF) genes;
ORF1, ORF2 and ORF3

58.  ORF1 – encodes non-structural protein
involved in virus replication; Largest
among the three
 ORF2 – middle-sized; encodes the
nucleocapsid protein
 ORF3 – smallest; encodes stuctural
protein with function undetermined
 All HEV isolates belongs to a single
serotype and five genotypes
 HEV is detected in stool, bile and liver
 IgM and IgG anti-HEV are both detected
but rapidly fall after acute infection

59.  Resembles Hepatitis A virus (HAV) in its
primarily enteric mode of spread.
 Commonly on contaminated water
 Rare person-to-person spread
 Infections arise in those population that
are immune in HAV and mostly young
adults

61.  Philippine Cancer Society – Manila
Cancer Registry
 Department of Health
 World Health Organization
 Sleisenger and Fordtran’s Gastrointestinal
and Liver Disease, 9th edition
 Robbin’s and Cotran Pathologic Basis of
Disease, 8th edition
 Harrison’s Principle of Internal Medicine,
18th edition