AZERBAIJAN

MEDICAL
UNIVERSITY
 Name: Zakarya kamal Sattouf
 Group: 180B
 Subject: Hepatitis A
 Date: 11/13/2019
What Is Hepatitis A?
• Hepatitis A is a liver disease caused by the hepatitis A virus
(HAV). The virus is primarily spread when an uninfected
(and unvaccinated) person ingests food or water that is
contaminated with the faces of an infected person. The
disease is closely associated with unsafe water or food,
inadequate sanitation, poor personal hygiene and oral-anal

Definition
sex.

• Unlike hepatitis B and C, hepatitis A does not cause chronic

liver disease and is rarely fatal,

• Incubation period . 2-6 weeks

• ALT and Igm from 2 to 7
• IgG start after 7 weeks
Microbiology

RNA picornavirus; Hepatovirus genus. Nonenveloped virus

(a lack of a lipid envelope confers resistance to bile lysis in the small
intestine and
liver). Four genotypes and one serotype.

The coding region of the genome codes for 4 structural proteins and 7

Etiology
nonstructural proteins.

The virus replicates through a RNA-dependent polymerase in hepatocytes

and gastrointestinal epithelial cells

Lifecycle of HAV
1. Oral inoculation of fecally excreted virus.
2. Transportation across gastrointestinal epithelium to mesenteric veins of
liver (viremia).
3. Taken up by hepatocytes, replicates, and shed into the bile canal.
4. Transported to the intestine and excreted into the feces
EPIDEMIOLOGY

1. Most common cause of acute viral hepatitis.

2. More likely to occur in patients age 5 to 14 years.
3. More likely to occur in Central and South America, Africa, India, the
Middle East, and parts of Asia (lowest in the United States and Japan).

EPIDEMIOLOGY
Hepatitis A Transmission
People who are infected can start spreading the infection (shedding virus)
about 1 week after their own exposure. People who do not have symptoms
can still spread the virus. Infection with HAV occurs throughout the world.

The risk of infection is greatest in developing countries with poor sanitation

or poor personal hygiene standards.
Infection rates are also higher in areas where direct fecal-oral transmission

Transmission
is likely to occur, such as daycare centers, prisons, and mental institutions.
People at increased risk for hepatitis A infection include:

1. Household contacts of people infected with HAV

2. Sexual partners of people infected with HAV
3. International travelers, especially to developing countries
4. Military personnel stationed abroad, especially in developing countries
5. Men who have sex with other men
6. People who use illegal drugs (injected or non-injected)
7. People who may come into close contact with HAV infected people at
work
Risk Factors.

Most commonly transmitted by oral-fecal route; however, no

identified source occurs in approximately 50% of cases.
1. Household or sexual contact (especially men who have sex with men).
2. Foreign travelers (particularly those to developing nations).
3. Contaminated food or water (particularly associated with green onions
and strawberries).

Risk Factors.
4. Consumption of shellfish from contaminated water.
5. Daycare children and daycare workers.
6. Blood transfusion or blood products are very rarely associated with
HAV.
7. Injection and no injection drug use.
What Are the Symptoms of Hepatitis A?

If you have this infection, you have inflammation in your 

liver that's caused by a virus. You don't always get
symptoms, but when you do, you might have:
1. Jaundice (yellow eyes and skin, dark urine)
2. Pain in your belly
3. Loss of appetite

symptoms
4. Nausea
5. Fever
6. Diarrhea
7. Fatigue
Children often have the disease with few symptoms.
You can spread the hepatitis A virus about 2 weeks before
your symptoms appear and during the first week they
show up, or even if you don't have.
Complications of Hepatitis A
Hepatitis A can cause more serious health problems. Keep in mind all
that these are rare and more likely to happen in people who are over 50.
Liver failure . This usually affects people who are:
Older
Already have another type of liver disease
Have a weakened immune system

Complications
Guillain-Barre syndrome. With this disorder, your immune system
attacks your nervous system. It causes muscle weakness and even
paralysis. You’ll need to be treated in a hospital to ease your symptoms
and make you heal faster. You’ll get high-dose immunoglobulin therapy.
This mix of proteins delivered through an IV will boost your immune
system.

Pancreatitis . This is when your pancreas, a gland that helps digest food

and control blood sugar, gets inflamed. You may need to stop eating for a
few days to give it a rest. If you’re at risk of getting dehydrated, you may
need to go into the hospital to get fluids through an IV.
If your doctor feels your liver isn’t working well, she may admit you to
the hospital to keep an eye on how well your liver is working. In severe
 Diagnose Hepatitis A?
Laboratory studies. 3. PT/PTT (Partial Thromboplastin
Time). A prolonged PTT may reflect
1. Serum anti-HAV IgM and IgG. The extensive liver necrosis and/or need for
preferred confirmatory test for HAV. liver transplantations (especially if PTT is
greater than or equal to 25 seconds)
- Anti-HAV IgM. Detected 1 to 2 weeks
after HAV exposure and remains
elevated for 3 to 6 months.
- Anti-HAV IgG. Detected 5 to 6 weeks
after HAV exposure, remains Radiographic Studies. A trans

Diagnose
elevated lifelong, and confers protective
abdominal US or CT scan may be
immunity against HAV.
helpful to
demonstrate hepatomegaly and
2. CBC (Complete blood count).
Routinely ordered on hospitalized
splenomegaly in association with
patients
HAV infection
but nonspecific.
(common in icteric phase of HAV)
but usually reserved to evaluate
cases with
concerns for cholelithiasis and
choledocholithiasis
Treatment.
Virus-specific therapy is not available for HAV; therefore,
treatment is mainly supportive measures, avoidance of hepatic
toxins (less than 2
g/day acetaminophen), and alcohol, vaccination, and prevention.
Indication for
evaluation for liver transplantation includes:

Treatment
1. Fulminant HAV.
2. Jaundice lasting more than 7 days before encephalopathy
(indicating
extensive liver necrosis). 3. Serum bilirubin greater than or equal to
17 mg/dL
Prevention.
 Vaccination of high-risk patients, and post exposure
prophylaxis.

 Hand hygiene is most important for preventing transmission.

Since the virus
can survive as fomites and resist freezing, detergents, and

Prevention
acids. Environmental
control of surfaces should include inactivation of HAV by
formalin and/or
chlorine.
 Passive Immunization: immune globulin.
 Active Immunization: vaccination.
Source :
https://hepatitiseducation.med.ubc.ca/types-of-viral-hepatiti
s/
https://www.emedicinehealth.com/hepatitis_a/article_em.ht
m
https://www.webmd.com/g00/hepatitis/treatments-for-hepat
itis-a?i10c.ua=1&i10c.encReferrer=&i10c.dv=25
https://www.who.int/news-room/fact-sheets/detail/hepatitis-
a

Source:
https://www.webmd.com/hepatitis/digestive-diseases-hepati
tis-a#2
Wright, WF. Essentials of clinical infectious diseases.
Demos Medical Pub, 2013. 367 p.