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Hepatitis virus
1. Fe A. Bartolome, MD, FPASMAP Department of Microbiology Our Lady of Fatima University
2. CASE 1: A 55-year old man was admitted to the hospital with fatigue, nausea, and abdominal discomfort. He had a slight fever, his urine was dark yellow, and his abdomen was distended and tender. He had returned from a trip to Thailand within the previous month.
11. Approach to Diagnosis Hepatitis A (HAV) IgM anti-HAV Negative Positive Assay “total” anti-HAV as clinically indicated (-) Not immune to HAV Acute HAV infection (+) Immune to HAV
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15. CASE 2: A 28-year-old woman was admitted to the hospital complaining of vomiting, abdominal discomfort, nausea, anorexia, dark urine, and jaundice. She admitted that she was a former heroin addict and that she had shared needles . She was also three months pregnant.
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25. Spread of virus: HEPATITIS B (Serum Hepatitis) Source Infection Blood Ab Prevent spread and disease Liver Viremia CMI Symptoms, Resolution HBsAg Ab Immune complexes Immune complex disease Mother’s milk Vaginal secretions Blood Semen Saliva Rash, polyarthritis, fever, GN
26. Symptoms of typical acute HBV infection: Fever, rash, arthritis (15%) Jaundice Dark urine Malaise (95%) Anorexia (90%) Nausea (80%) RUQ pain (60%) Itching (10%) EXPOSURE Incubation Period Pre-icteric Icteric Convalescent period
29. Approach to Diagnosis of HBV infection Hepatitis B (HBV) HBsAg Negative Positive Assay anti-HBs (total) (-) Consider immunization for appropriate populations Assay IgM anti-HBc (+) Recovered or immunized (-) Chronic HBV infection (+) Acute or reactivated HBV infection
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32. Serologic test results in four stages of HBV infection 1 IgM is found in the acute stage; IgG is found in subsequent stages.
33. How will you know if you are protected from HBV? Quick Test Results Results Interpretation HBsAg (+) Anti-HBs (-) Chronic HBV infection if HBsAg remains (+) for six months HBsAg (-) Anti-HBs (+) Immune to HBV HBsAg (-) Anti-HBs (-) Unprotected; need vaccination HBsAg (+) Anti-HBs (+) (rare) Chronic HBV infection
34. Simplified Diagnostic Approach in Patients Presenting with Acute Hepatitis Serologic Tests of Patient’s Serum Diagnostic Interpretation HBsAg IgM Anti-HAV IgM anti-HBc + + + + -- -- -- -- -- -- + + + + -- -- + -- -- + -- + + -- Acute hepatitis B Chronic hepatitis B Acute hep A superimposed on chronic HBV Acute hepatitis A and B Acute hepatitis A Acute hep A and hep B (HBsAg below detection level) Acute hepatitis B (HBsAg below detection level) Test for acute hepatitis C (anti-HCV)
35. Hepatitis B: Serologic Tests of Candidate for HBV Vaccine
36. CASE 3: A 65-year-old man was admitted with jaundice, nausea, and vomiting 6 months after undergoing coronary artery bypass grafting.
