Etiologic Agent means a disease-causing agent.

Hepatitis A
- Etiologic Agent
o Hepatitis A virus aka infectious hepatitis
- MOT
o acquired primarily by the fecal-oral route by either person-to-person contact or ingestion of
contaminated food
o although HAV may be present in saliva, transmission by saliva has not been demonstrated
- Incubation Period
o 14-28 days
- Signs and Symptoms:
o range from mild to severe, and can include fever, malaise, loss of appetite, diarrhea, nausea,
abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the skin and whites of
the eyes)
o Not everyone who is infected will have all of the symptoms.
o Adults have signs and symptoms of illness more often than children.
o Hepatitis A sometimes relapses. The person who just recovered falls sick again with another
acute episode. This is, however, followed by recovery.
- Complications
o atypical complications may occur, including immunologic, neurologic, hematologic, pancreatic,
and renal extrahepatic manifestations
o Fulminant hepatitis
 most severe rare complication, with mortality estimates up to 80%
 rapidly develop severe, often life-threatening liver failure
- Preventive Measures & Treatment
o Preventive:
 Vaccination against hepatitis A should be part of a comprehensive plan for the
prevention and control of viral hepatitis.
 Improved sanitation, food safety and immunization are the most effective ways to
combat hepatitis A.
 The spread of hepatitis A can be reduced by:
 adequate supplies of safe drinking water
  proper disposal of sewage within communities
 personal hygiene practices such as regular hand-washing before meals and
after going to the bathroom.
o Treatment
 There is no specific treatment for hepatitis A.
 Most important is the avoidance of unnecessary medications.
 Acetaminophen/ Paracetamol and medication against vomiting should not be
given.
 Therapy is aimed at maintaining comfort and adequate nutritional balance, including
replacement of fluids that are lost from vomiting and diarrhea.
- Diagnostic Tests
o not clinically distinguishable from other types of acute viral hepatitis
o Specific diagnosis is made by the detection of HAV-specific Immunoglobulin G (IgM) antibodies in
the blood
o Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the
hepatitis A virus RNA, and may require specialized laboratory facilities.

References:
https://www.sciencedirect.com/topics/immunology-and-microbiology/viral-hepatitis
https://www.who.int/news-room/fact-sheets/detail/hepatitis-a
https://www.cdc.gov/vaccines/pubs/pinkbook/hepa.html#complications
https://www.uofmhealth.org/health-library/hw118500

Hepatitis B
“HBV is 50 to 100 times more infectious than HIV.”
- Etiologic Agent: hepatitis B virus (HBV)
- MOT:
o spread by contact with blood or body fluids of an infected person
o The main ways of getting infected with HBV are:
 from mother to baby at the birth (perinatal)
 from child-to-child
 unsafe injections and transfusions
 unprotected sexual contact
- Incubation Period
o 75 days on average, but can vary from 30 to 180 days
- Signs and Symptoms
o Most people do not experience any symptoms when newly infected. However, some people have
acute illness with symptoms that last several weeks, including:
 yellowing of the skin and eyes (jaundice)
 dark urine
 extreme fatigue
 nausea
 vomiting
 abdominal pain
- Complications
o People with hepatitis B can sometimes develop serious liver problems. These mostly affect
people with an untreated long-term (chronic) infection.
o Some of the main problems associated with hepatitis B include:
 Scarring of the liver (cirrhosis)
 chance of developing liver cancer
 short-term (acute) hepatitis B can lead to a serious problem called fulminant hepatitis B
 - Preventive Measures & Treatment
o Preventive Measures
 HBV vaccine is the mainstay of hepatitis B prevention
 WHO recommends that all infants receive the HBV vaccine as soon as possible after
birth, preferably within 24 hours.
o Treatment
 no specific treatment for acute hepatitis B
 care is aimed at maintaining comfort and adequate nutritional balance, including
replacement of fluids lost from vomiting and diarrhea
 Most important is the avoidance of unnecessary medications
 Acetaminophen/Paracetamol and medication against vomiting should not be
given.
- Diagnostic Tests
o Laboratory diagnosis of hepatitis B infection focuses on the detection of the hepatitis B surface
antigen HBsAg
o Acute HBV infection is characterized by the presence of HBsAg and immunoglobulin M (IgM)
antibody to the core antigen, HBcAg.
o Chronic infection is characterized by the persistence of HBsAg for at least 6 months (with or
without concurrent HBeAg).
References:
https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
https://www.who.int/news-room/q-a-detail/hepatitis-b-how-can-i-protect-myself
https://www.nhs.uk/conditions/hepatitis-b/symptoms/

Hepatitis C
- Etiologic Agent: Hepatitis C virus (HCV)
- MOT:
o acquired through person-to-person transmission by parenteral routes
o frequently occurs through use of contaminated needles, syringes and other instruments used for
injections and other skin-piercing procedures
o Sexual transmission of hepatitis C occurs rarely
- Incubation Period:
o 2 weeks to 6 months
- Signs and Symptoms:
o Following initial infection, approximately 80% of people do not exhibit any symptoms.
o Those acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting,
abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice (yellowing of skin and
the whites of the eyes)
- Complications
o If left untreated, hepatitis C can sometimes cause scarring of the liver (cirrhosis). This can
develop up to 20 years or more after you first become infected.
o In severe cases of cirrhosis, the liver loses most or all of its functions. This is known as liver failure
or end stage liver disease
o Around 1 in every 20 people with hepatitis-associated cirrhosis will develop liver cancer each
year
- Preventive Measures & Treatment
o Preventive Measures
 Avoid injecting drugs to reduce your risk.
 If you do inject drugs, use sterile injection equipment.
 Avoid reusing or sharing. Avoid sharing personal care items that might have blood on
them (razors, toothbrushes, nail clippers)
o Treatment
  Antiviral medications
 treated with antiviral medications intended to clear the virus from your body
 Liver transplantation
 If you have developed serious complications from chronic hepatitis C infection,
liver transplantation may be an option.
- Diagnostic Tests
o Magnetic resonance elastography (MRE)
 A noninvasive alternative to a liver biopsy
o Transient elastography
 type of ultrasound that transmits vibrations to estimate its stiffness
o Liver biopsy
 involves inserting a thin needle through the abdominal wall to remove a small sample of
liver tissue for laboratory testing
o Blood tests can indicate the extent of fibrosis in the liver
References:
https://www.who.int/ith/diseases/hepatitisC/en/
https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
https://www.mayoclinic.org/diseases-conditions/hepatitis-c/diagnosis-treatment/drc-20354284
https://www.sfcdcp.org/infectious-diseases-a-to-z/hepatitis-c/

Human Immunodeficiency Virus

- Etiologic Agent
o Human immunodeficiency virus (HIV) is the causative agent for AIDS. The most common type is
known as HIV-1 and is the infectious agent that has led to the worldwide AIDS epidemic.
- MOT
You can only get HIV by coming into direct contact with certain body fluids from a person with HIV who has a
detectable viral load. These fluids are:
Blood
Semen (cum) and pre-seminal fluid
Rectal fluids
Vaginal fluids
Breast milk
Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands,
or sharing personal objects, food or water.
- Incubation Period:
o The HIV incubation period (the time between initial infection and appearance of disease) is of
variable duration and can be quite long (on average, 10 years or more).
- Signs and Symptoms
o symptoms vary depending on the stage of infection
o Sweats
o Chills
o Recurring fever
o Chronic diarrhea
o Swollen lymph glands
o Persistent white spots or unusual lesions on your tongue or in your mouth
o Persistent, unexplained fatigue
o Weakness
- Complications
o Infections common to HIV/AIDS
 Pneumocystis pneumonia (PCP)
 Candidiasis (thrush)
  Tuberculosis (TB)
 Cytomegalovirus
 Cryptococcal meningitis
 Toxoplasmosis
o Cancers common to HIV/AIDS
 Lymphoma
 Kaposi's sarcoma
o Other complications
 Wasting syndrome
 Neurological complications
 Kidney disease
 Liver disease
- Preventive Measures & Treatment
o Preventive Measures
o Treatment

- Diagnostic Tests
o Western blot (WB) assay is considered the gold standard test for HIV infection confirmation.
However, it requires technical expertise and is quite time-consuming.

References:
https://webpath.med.utah.edu/TUTORIAL/AIDS/AIDS.html
https://www.who.int/news-room/fact-sheets/detail/hiv-aids
https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036269/
https://visual.ly/community/Infographics/health/how-hiv-transmitted-hiv-transmission-know-facts