+Done by: Ahmad Mhd Al-dhlawiyHamad 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 thatattacks the liver . There are various strains of viral hepatitis which cancause lifelong infection, cirrhosis ( scarring) of the liver , liver cancer, liver failure, and death. six medically important viruses are commonly described as “hepatitisviruses”: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, highmortality 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 ofbilirubin in the blood due to liver damage. Hepatocellular carcinoma: is closely associated with hepatitisB, and at least in some regions of the world with hepatitis C virus.
+Modes of Transmission for HBV Parenteral - IV drug abusers, health workers areat increased risk. Sexual - sex workers and homosexuals areparticular at risk. Perinatal - (Vertical) - mother(HBeAg+)→infant.
+risk groups for HBV infection-High People from endemic regions Babies of mothers with chronic HBV Intravenous drug abusers People with multiple sex partners Hemophiliacs and other patients requiting bloodand blood product treatments Health care personnel who have contact with blood
+Concentration of Hepatitis B Virusin Various Body Fluids …High ModerateLow/NotDetectableblood semen urineserum vaginal fluid feceswound exudates saliva sweattearsbreastmilk
+…Pathogenesis & Immunity Virus enters hepatocytes via blood Immune response (cytotoxic T cell) to viral antigens expressed onhepatocyte cell surface responsible for clinical syndrome 5 % become chronic carriers (HBsAg> 6 months) Higher rate of hepatocellular ca in chronic carriers, especially thosewho are “e” antigen positive Hepatitis B surface antibody likely confers lifelong immunity (IgGanti-HBs) Hepatitis B e Ab indicates low transmissibility
+Possible Outcomes of HBV InfectionAcute hepatitis B infectionChronic HBV infection3-5% of adult-acquired infections95% of infant-acquired infectionsCirrhosisChronic hepatitis12-25% in 5 yearsLiver failureHepatocellularcarcinomaLiver transplant6-15% in 5 years 20-23% in 5 yearsDeathDeath
+Treatment …Interferon alfa (Intron A) Response rateis 30 to 40%.Lamivudine (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 HBeAgpositive.Other measures-screening of blood donors, blood and body fluidprecautions.
+Hepatitis B Vaccine Infants: several options that depend on status of themother If mother HBsAg negative: birth, 0-2m,4-6m If mother HBsAg positive: vaccine and Hep B immuneglobulin 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
+Referenceswebsite 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-overviewText 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)