Paediatric

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Ms.LINITHA.K.B.

2. DEFINITION:
Ms.LINITHA.K.B.
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Hepatitis C infection is a liver disease caused by the
hepatitis C virus (HCV).
HCV accounts for approximately 15-20% cases of
acute hepatitis.
The virus can cause both acute and chronic hepatitis,
ranging in severity from a mild illness lasting a few
week to a serious and lifelong illness.
Hepatitis C is a major cause of liver cancer.

3. ETIOLOGY:
Ms.LINITHA.K.B.
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Hepatitis C virus is a blood borne virus.
 It is an important cause of post- transfusion
hepatitis.
HCV is a small-enveloped RNA virus belonging to
the family Flaviviridae and genus Hepacivirus.
It is an enveloped, linear, and single-strand RNA
Flavivirus with six genotypes and several subtypes
based on genomic differences.

4. EPIDEMIOLOGY:
Ms.LINITHA.K.B.
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 Hepatitis C infection is transmitted more often by blood
and blood products as compared to body secretions.
 It is therefore not as infective as hepatitis B but results in
more morbidity.
 Hepatitis C virus is less common in children as compared to
adults, with a prevalence of 0.2% in children younger than
11 years of age and 0.4% in children more than 11 years of
age.
 The risk factor for hepatitis C transmission in children
includes repeated blood transfusion or illegal drug usage by
adolescents.
 Perinatal transmission of hepatitis C virus is much less as
compared to hepatitis B virus infection and depends on the
maternal hepatitis C viral load and HIV status.

5. MODES OF TRANSMISSION:
Ms.LINITHA.K.B.
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The hepatitis C virus is a blood-borne virus.
It is most commonly transmitted to children through: the
reuse or inadequate sterilization of medical equipment,
especially syringes and needles in healthcare settings.
The transfusion of unscreened blood and blood products.
Injecting drugs through the sharing of injections and
needles (in case of adolescents).
From am infected mother to her baby; is less common.
Hepatitis C does not spread through breast milk, food,
water or casual contact such as hugging, kissing and
sharing food or drinks with an infected person.

6. PATHOGENESIS:
Ms.LINITHA.K.B.
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 Chronic hepatitis C infection is not a consequence of direct
cytopathic effect but rather an intermediate immune response
that is sufficient to induce hepatic cell destruction and fibrosis
but not sufficient enough to clear the virus.
 Natural targets of hepatitis C virus are hepatocytes and
possibly B lymphocytes.
 Viral clearance is associated with the development and
persistence of strong virus specific responses by cytotoxic T
lymphocytes and helper T cells.
 In most infected people, viremia persists and is accompanied
by variable degrees of hepatic inflammation and fibrosis.
Findings from studies suggest that at least 50% of hepatocytes
may be infected with hepatitis C virus in patients with chronic
hepatitis C.

7. CLINICAL FEATURES:
Ms.LINITHA.K.B.
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 Incubation Period of hepatitis C virus infection 7-9 weeks.
 Early signs and symptoms of Acute Hepatitis C:
 Abdominal pain.
 Clay-colored stool.
 Dark urine.
 Fatigue.
 Fever.
 Jaundice.
 Arthralgia (Joint pain).
 anorexia,.
 Nausea.
 Vomiting.
 Symptoms usually show up between 2 and 12 weeks after
exposure to the virus.

8. Chronic Hepatitis C Symptoms:
Ms.LINITHA.K.B.
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 If hepatitis C infection does not get diagnosed and treated, the
disease may continue for years and becomes chronic in nature. It
may lead to liver cancer or cirrhosis.
 In addition to the above conditions, following manifestations
may develop:
 Ascites.
 Easy bleeding.
 Easy bruising.
 Hepatic encephalopathy leading to confusion, drowsiness and
slurred speech.
 Hives or rashes.
 Itchy skin.
 Swollen legs.
 Weight loss.
 Spider-like blood vessels under the skin (spider angiomas).

9. DIAGNOSTIC EVALUATIONS:
Ms.LINITHA.K.B.
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Detection of antibodies to hepatitis C virus and HCV
RNA helps in the diagnosis of hepatitis C infection.
Enzyme immunoassays for detection of antibodies are
sensitive in high-risk populations but not in the low-risk
group.
Recombinant immunoblot assay(RIBA) has a higher
sensitivity in low-risk patient groups.
Anti-hepatitis C virus antibody is not a protective
antibody and hence does not confer immunity and is
usually present with the virus.
Detection of HCV RNA is more sensitive and a viral load
>10 copies/ml of HCV RNA is taken as a cut off for
initiating therapy.

10. PREVENTION:
Ms.LINITHA.K.B.
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Screening of donor blood is essential to prevent
hepatitis C infection, but is not yet done regularly.
Vaccine development has been impeded by the
various hepatitis C virus genotypes and presence of
quasispecies.