GI L17 – Acute Viral Hepatitis

HAV HBV HCV HDV HEV

Signature Acute; dirty food Gives HCC; HK and S China Gives HCC; no vaccine Friend of HBV Acute; dirty
food
RNA/DN ssRNA Part ssDNA Linear ssRNA Circular defective ssRNA ssRNA
A
Virulence Direct cytopathic HBV infects liver cells  T cell attacks - Can transform mild chronic -
effect/T-cell HBV & own liver cells  hepatitis hep B into severe chronic
mediated injury hep B & cirrhosis
(?)
Carrier No Yes Yes Yes Low risk/None
state? Acute, self- (95% full recovery) Wide spectrum of outcomes, Requires HBs-Agaemic to Full recovery
limiting disease May develop chronic hepatitis +/- similar to Hep B be effective expected
(99% full cirrhosis, +/- HCC (100x RR) 50% progress to chronic hepatitis & Co-infection: Simultaneous May cause
recovery), rarely *Infection in infants (~95% chronicity; cirrhosis +/- HCC introduction of HBV & HDV severe disease
fatal associated with poor cell-mediated Causes: Superinfection: HDV into esp. pregnant
immune response to HBV?) 1. Acute/chronic hepatitis HBsAg+ve host women
Broad definition: Presence of HBV 2. Carrier state
regardless of symptoms 3. End-stage liver
Narrow definition: replication of HBV 4. HCC
w/o symptoms
Spread Faecal-oral route Parenteral route Faecal-oral
Ingestion of 1. Transfusion of blood and blood products route
contaminated 2. Contamination of needles
water and foods 3. Medical and dental procedures
e.g. not well 4. Intimate contact esp. sexual
cooked shellfish 5. HBV: Vertical transmission during perinatal period (X pregnancy, V at the time of birth!)
[Food to
subject/subject
to subject]
Transmis Shed in stool 2-3 - - - Caused
sion weeks before massive
and 1 week after outbreaks
onset of jaundice water-borne
hepatitis
Incubatio Short Long Long Long Short
n period 15-40 days (1 1-4 months 7-8 weeks 1-4 months 4-5 weeks
month)
HK % - 1/10 = carrier <1% - -
4/10 = recovered (exclude vaccinated)
Epidemol Occurs Extremely common in HK and S China N Africa - -
ogy throughout the 400 million HBV subjects; 75% Chinese Case: Egypt 1960-70s,
world Incidence varies greatly in different schistosomiasis vaccination; use
Endemic in parts of the world same needle  HCV
countries with 1. Urban > rural
substandard 2. Male > female
hygiene and 3. Certain groups regardless of
sanitation location
4. Poor SES
[HBsAg in 5-20% of apparently healthy
persons in SE Asia and tropical Africa;
0.1-0.6% in W Europe and USA]
Vaccine Yes Yes No No; use HBV vaccine Yes, safe?
Clinical - Acute Hep B tend to be more severe Mild clinically Acute HBV/HDV infection -
features than Hep A/C may be indistinguishable
Subclinical infection frequent esp. in from hep B, but associated
infants and children with relatively high rate of
fulminant hepatitis
Antibody Anti-HAV - Anti-HCV not protective - -
appears during Appears several weeks later than
attack and HCV RNA
persists
Diagnosis Serum IgM HBsAg/Ab to HBcAg 1. +ve anti-HCV Ab; PCR for HCV IgM & IgG PCR for HEV
RNA HDV RNA serum RNA
2. Raised AST, ALT HDAg in liver Serum IgM &
3. Biopsy IgG
a. Portal tract inflammatory
infiltrates rich in
lymphocytes
b. Interface hepatitis
c. Macrovesicular steatosis
(fatty change)
Macro = nucleus distorted
Micro = nucleus X distorted