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Done by: Ahmad Mhd Al-dhlawiy
Hamad Emad Dhuhayr
+

Contents …

General concepts for hepatitis.
 Types of hepatitis.
 HBV Structure & Antigens.
 Transmission Epidemiology.
 Pathogenesis & Immunity.
 Clinical pictures.
 Laboratory Diagnosis.
 Treatment Prevention.
 References.

+

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
+

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.
+

Viral hepatitis …
+

Viral hepatitis …
+

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
+

Replication …
+

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+)
+
+
+

Incidence of Hepatitis in KSA
+
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
+

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
+

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
+

Clinical pictures …
+

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
+

Acute Hepatitis B Infection
+

Laboratory Diagnosis …
+

Treatment …
Interferon

alfa (Intron A)
is 30 to 40%.

Lamivudine

Response rate

(Epivir HBV)

(relapse ,drug resistance)
Adefovir

dipivoxil (Hepsera)
+

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.
+

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
+

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)
+



AHMED AL DAHLAWY



HAMAD EMAD THUHAYR

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