Hepatic Infections

462 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
462
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
14
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Hepatic Infections

  1. 1. HEPATITIS B, HEPATITIS C AND HIV Jane Minton Consultant in Infectious Diseases & Tropical Medicine Leeds Teaching Hospitals Trust
  2. 2. HEPATITIS B <ul><li>HOW DO YOU GET IT? </li></ul><ul><li>WHAT ARE THE SYMPTOMS? </li></ul><ul><li>HOW DO YOU MAKE THE DIAGNOSIS? </li></ul><ul><li>CAN IT BE TREATED? </li></ul><ul><li>HOW CAN IT BE PREVENTED? </li></ul>
  3. 3. HOW DO YOU GET HEPATITIS B? <ul><li>EXPOSURE TO BODY FLUIDS </li></ul><ul><ul><ul><li>IVDA </li></ul></ul></ul><ul><ul><ul><li>NEEDLESTICKS ETC. </li></ul></ul></ul><ul><ul><ul><li>AMATEUR BODYPIERCING ETC. </li></ul></ul></ul><ul><ul><ul><li>BLOOD TRANSFUSION </li></ul></ul></ul><ul><ul><ul><li>SEX </li></ul></ul></ul><ul><ul><ul><li>PERINATAL </li></ul></ul></ul>
  4. 4. WHAT ARE THE SYMPTOMS OF ACUTE HEPATITIS B? <ul><li>FATIGUE AND MALAISE </li></ul><ul><li>NAUSEA AND VOMITING </li></ul><ul><li>FEVER </li></ul><ul><li>RUQ PAIN AND MYALGIA </li></ul><ul><li>JAUNDICE </li></ul>
  5. 5. HOW DO YOU TEST FOR ACUTE HEPATITIS B? <ul><li>LIVER FUNCTION TESTS </li></ul><ul><ul><li>transaminases in 1000s </li></ul></ul><ul><ul><li>deranged blood coagulation </li></ul></ul><ul><li>SEROLOGY </li></ul><ul><ul><li>HBV Core IgM </li></ul></ul><ul><ul><li>HBV surface antigen </li></ul></ul><ul><ul><li>HBV e antigen </li></ul></ul>
  6. 6. HOW DO YOU TREAT ACUTE HEPATITIS B ? <ul><li>SYMPTOMATIC </li></ul><ul><ul><li>ANALGESIA </li></ul></ul><ul><ul><li>ANTIEMETICS </li></ul></ul><ul><ul><li>ANALGESIA </li></ul></ul><ul><li>SUPPORTIVE </li></ul><ul><ul><li>HYDRATION </li></ul></ul><ul><ul><li>NUTRITION </li></ul></ul><ul><ul><li>COAGULATION </li></ul></ul><ul><ul><li>(TRANSPLANTATION) </li></ul></ul><ul><li>EDUCATION </li></ul><ul><ul><li>TRANSMISSION </li></ul></ul>
  7. 7. WHAT ARE THE COMPLICATIONS OF CHRONIC HEPATITIS B? <ul><li>CHRONIC LIVER DAMAGE </li></ul><ul><li>CIRRHOSIS </li></ul><ul><li>CANCER </li></ul><ul><li>TRANSMISSION TO OTHERS </li></ul>
  8. 8. CAN YOU TREAT CHRONIC HEPATITIS B? <ul><li>INTERFERON </li></ul><ul><li>LAMIVUDINE </li></ul><ul><li>LIVER TRANSPLANT </li></ul>
  9. 9. PREVENTION OF HEPATITIS B <ul><li>EDUCATION </li></ul><ul><ul><li>SAFE SEX, NOT SHARING NEEDLES ETC </li></ul></ul><ul><li>SCREENING </li></ul><ul><ul><li>CASE CONTACTS </li></ul></ul><ul><ul><li>ANTENATAL </li></ul></ul><ul><ul><li>IVUs </li></ul></ul><ul><li>VACCINES </li></ul><ul><ul><li>ACTIVE (HBV sAg) </li></ul></ul><ul><ul><li>PASSIVE (HBIG) </li></ul></ul><ul><li>PROVISION OF CLEAN NEEDLES ETC. </li></ul>
  10. 10. Case History: Mr HB age 42 <ul><li>Unwell for 10 days: malaise, nausea, vomiting, abdo pain, dark urine & jaundice </li></ul><ul><li>Previously fit, no medication </li></ul><ul><li>Recently separated, has 2 sons age 8 &10 </li></ul><ul><li>Girl friend for 4 months, pregnant </li></ul><ul><li>Fireman </li></ul><ul><li>Travel to Majorca last year </li></ul><ul><li>Alcohol 10U/week, non smoker & no other recreational drug use </li></ul>
  11. 11. Mr HB <ul><li>Examination: deeply jaundiced, enlarged tender liver </li></ul><ul><li>Investigations: </li></ul><ul><ul><li>LFTs - acute hepatitis </li></ul></ul><ul><ul><li>Serology - acute hepatitis B </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>symptomatic </li></ul></ul><ul><ul><li>follow-up </li></ul></ul><ul><li>Public health issues </li></ul><ul><ul><li>notifiable </li></ul></ul><ul><ul><li>screening +/- investigation of contacts </li></ul></ul><ul><ul><li>vaccination of non-immune contacts </li></ul></ul>
  12. 12. HEPATITIS C <ul><li>HOW DO YOU GET IT? </li></ul><ul><li>WHAT ARE THE SYMPTOMS? </li></ul><ul><li>HOW DO YOU MAKE THE DIAGNOSIS? </li></ul><ul><li>CAN IT BE TREATED? </li></ul><ul><li>HOW CAN IT BE PREVENTED? </li></ul>
  13. 13. HOW DO YOU GET HEPATITIS C? <ul><li>BLOOB-BORNE </li></ul><ul><ul><ul><li>IVDA </li></ul></ul></ul><ul><ul><ul><li>NEEDLESTICKS ETC. </li></ul></ul></ul><ul><ul><ul><li>AMATEUR BODYPIERCING ETC. </li></ul></ul></ul><ul><ul><ul><li>BLOOD TRANSFUSION </li></ul></ul></ul><ul><li>[SEX] </li></ul><ul><li>[VERTICAL] </li></ul>
  14. 14. WHAT HAPPENS WHEN YOU GET HEPATITIS C? <ul><li>OFTEN ASYMPTOMATIC TO START WITH </li></ul><ul><li>MOST PEOPLE REMAIN INFECTED </li></ul><ul><li>[CHRONIC HEPATITIS C] </li></ul>
  15. 15. WHAT ARE THE SYMPTOMS OF CHRONIC HEPATITIS C? <ul><li>NOTHING </li></ul><ul><li>MALAISE AND FATIGUE </li></ul><ul><li>LIVER FAILURE </li></ul><ul><ul><li>CIRRHOSIS </li></ul></ul><ul><ul><ul><li>ASCITES </li></ul></ul></ul><ul><ul><ul><li>JAUNDICE </li></ul></ul></ul><ul><ul><ul><li>BLEEDING </li></ul></ul></ul><ul><ul><ul><li>ENCEPHALOPATHY </li></ul></ul></ul>
  16. 16. WHAT ARE THE COMPLICATIONS OF CHRONIC HEPATITIS C? <ul><li>CHRONIC LIVER DAMAGE </li></ul><ul><li>CIRRHOSIS </li></ul><ul><li>CANCER </li></ul><ul><li>TRANSMISSION TO OTHERS </li></ul>
  17. 17. HOW DO YOU TEST FOR CHRONIC HEPATITIS C? <ul><li>SEROLOGY [HCV ANTIBODIES] </li></ul><ul><li>LIVER FUNCTION TESTS </li></ul><ul><li>HCV PCR </li></ul><ul><li>ULTRASOUND OF LIVER </li></ul><ul><li>LIVER BIOPSY </li></ul>
  18. 18. CAN YOU TREAT CHRONIC HEPATITIS C? <ul><li>INTERFERON WITH RIBAVIRIN </li></ul><ul><li>LIVER TRANSPLANT </li></ul>
  19. 19. THE PROBLEMS WITH INTERFERON <ul><li>LOW SUCCESS RATE </li></ul><ul><li>SUBCUTANEOUS INJECTION </li></ul><ul><li>LONG COURSE OF TREATMENT </li></ul><ul><li>LOTS OF SIDE EFFECTS </li></ul><ul><ul><li>‘FLU-LIKE </li></ul></ul><ul><ul><li>BONE MARROW </li></ul></ul><ul><ul><li>DEPRESSION </li></ul></ul><ul><li>THE COST </li></ul>
  20. 20. PREVENTION OF HEPATITIS C <ul><li>EDUCATION </li></ul><ul><ul><li>NOT SHARING NEEDLES ETC, SAFE SEX </li></ul></ul><ul><li>SCREENING </li></ul><ul><ul><li>CASE CONTACTS </li></ul></ul><ul><ul><li>IVUs </li></ul></ul><ul><li>VACCINES </li></ul><ul><ul><li>NONE </li></ul></ul><ul><li>PROVISION OF CLEAN NEEDLES ETC. </li></ul>
  21. 21. CASE HISTORY: MR HC AGE 33 <ul><li>Registers with GP asking for detox. </li></ul><ul><li>Complains of tiredness first thing in morning </li></ul><ul><li>PMH: jaundice age 26 </li></ul><ul><li>10 year history IVU, has shared equipment in the past </li></ul><ul><li>Lives with partner (also IVU) who is pregnant </li></ul><ul><li>Alcohol rarely, smokes 15/day </li></ul><ul><li>No foreign travel </li></ul>
  22. 22. MR HC <ul><li>Examination normal except needle tracks </li></ul><ul><li>Investigations </li></ul><ul><ul><li>HCV Ab positive [HBV past infection, HIV negative] </li></ul></ul><ul><ul><li>LFTs: ALT 121 </li></ul></ul><ul><ul><li>HCV PCR positive </li></ul></ul><ul><ul><li>ultrasound of liver normal </li></ul></ul><ul><ul><li>liver biopsy: moderate hepatitis </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>candidate for interferon plus ribavirin (NB drug use) </li></ul></ul><ul><li>Public health issues </li></ul><ul><ul><li>notifiable </li></ul></ul><ul><ul><li>screening +/- investigation of contacts </li></ul></ul>
  23. 23. HIV <ul><li>HOW DO YOU GET IT? </li></ul><ul><li>WHAT ARE THE SYMPTOMS? </li></ul><ul><li>HOW DO YOU MAKE THE DIAGNOSIS? </li></ul><ul><li>HOW DO YOU TREAT IT? </li></ul><ul><li>HOW CAN IT BE PREVENTED? </li></ul>
  24. 24. HOW DO YOU GET HIV? <ul><li>EXPOSURE TO BODY FLUIDS </li></ul><ul><ul><ul><li>IVDA </li></ul></ul></ul><ul><ul><ul><li>NEEDLESTICKS ETC. </li></ul></ul></ul><ul><ul><ul><li>AMATEUR BODYPIERCING ETC. </li></ul></ul></ul><ul><ul><ul><li>BLOOD TRANSFUSION </li></ul></ul></ul><ul><ul><ul><li>SEX </li></ul></ul></ul><ul><ul><ul><li>PERINATAL </li></ul></ul></ul>
  25. 25. WHAT ARE THE SYMPTOMS OF HIV? <ul><li>NON-SPECIFIC ILLNESS (SEROCONVERSION) </li></ul><ul><li>NOTHING </li></ul><ul><li>OPPORTUNISTIC INFECTIONS EG: </li></ul><ul><ul><li>ORAL THRUSH </li></ul></ul><ul><ul><li>RECURRENT SHINGLES </li></ul></ul><ul><ul><li>PNEUMONIA (PNEUMOCYSTIS) </li></ul></ul><ul><ul><li>HEADACHES (MENINGITIS) </li></ul></ul><ul><ul><li>DIARRHOEA (CRYPTOSPORIDIUM) </li></ul></ul>
  26. 26. WHAT DOES HIV DO? <ul><li>INFECTS AND DESTROYS KEY CELLS IN IMMUNE SYSTEM </li></ul><ul><li>ESPECIALLY CD4+ OR HELPER T CELLS </li></ul><ul><li>MAY INFECT OTHER TISSUES EG NERVE CELLS </li></ul><ul><li>MAKES PATIENTS MORE SUSCEPTIBLE TO INFECTIONS </li></ul><ul><ul><li>COMMON INFECTIONS </li></ul></ul><ul><ul><li>OPPORTUNISTIC INFECTIONS </li></ul></ul>
  27. 27. HOW DO YOU TEST FOR HIV? <ul><li>SEROLOGY [HIV ANTIBODIES] </li></ul><ul><li>CD4 COUNT [HELPER T CELLS] </li></ul><ul><li>HIV PCR [VIRAL LOAD] </li></ul>
  28. 28. HOW DO YOU TREAT HIV? <ul><li>COMBINATION ANTIRETROVIRAL DRUGS </li></ul><ul><ul><li>AT LEAST 3 </li></ul></ul><ul><ul><li>MAJOR CLASSES </li></ul></ul><ul><ul><ul><li>REVERSE TRANSCRIPTASE INHIBITORS </li></ul></ul></ul><ul><ul><ul><li>NON-NUCLEOTIDE RTIs </li></ul></ul></ul><ul><ul><ul><li>PROTEASE INHIBITORS </li></ul></ul></ul><ul><li>PROPHYLACTIC DRUGS EG FOR PCP </li></ul><ul><li>EDUCATION </li></ul><ul><li>NUTRITION </li></ul><ul><li>SUPPORT </li></ul>
  29. 29. PREVENTION OF HIV <ul><li>EDUCATION </li></ul><ul><ul><li>SAFE SEX, NOT SHARING NEEDLES ETC </li></ul></ul><ul><li>SCREENING </li></ul><ul><ul><li>CASE CONTACTS, ANTENATAL, IVUs </li></ul></ul><ul><li>PROVISION OF CLEAN NEEDLES ETC </li></ul><ul><li>POST-EXPOSURE PROPHYLAXIS </li></ul><ul><li>NO VACCINES </li></ul>
  30. 30. CASE HISTORY: MS HI AGE 26 <ul><li>Premature delivery at 28 weeks </li></ul><ul><li>PMH: anaemia & UTIs in pregnancy </li></ul><ul><li>Drugs: iron </li></ul><ul><li>Student from Zimbabwe in UK for 6 months </li></ul><ul><li>1 child from previous marriage </li></ul><ul><li>Current partner well </li></ul><ul><li>Alcohol 2u/week, non-smoker, no recreational drug use </li></ul><ul><li>Baby HIV antibody positive </li></ul>
  31. 31. MS HI <ul><li>Examination: oral thrush </li></ul><ul><li>Investigations </li></ul><ul><ul><ul><li>HIV antibody positive </li></ul></ul></ul><ul><ul><ul><li>CD4+ count 21 (normal 500+) </li></ul></ul></ul><ul><ul><ul><li>HIV viral load > 100,000 virus per ml blood </li></ul></ul></ul><ul><li>Treatment </li></ul><ul><ul><ul><li>3 antiviral drugs & septrin </li></ul></ul></ul><ul><ul><ul><li>Support </li></ul></ul></ul><ul><li>Counselling/testing for partner </li></ul>

×