HEPATITIS VIRUS

To Screen, Diagnose, and Follow-Up

Bagus Setyoboedi, Sjamsul Arief

Department of Child Health Medical School, Airlangga University
Dr. Soetomo Hospital Surabaya - Indonesia
Hepatitis
 Hepatitis Virus

Sacher RA, Peters SM, Bryan JA. Testing for viral hepatitis: a practice parameter. Am J Clin Pathol 2000;113:12–7
Worldwide prevalence of HAV, 2006 Worldwide prevalence of HCV, 2007

Worldwide prevalence of HBV, 2006

WHO. International travel and health. Maps. http://www.who.int/ith/maps/hepatitis

Hepatitis Symptoms (if present)
 Clinical Spectrum of Viral Hepatitis
Association
Incubation Likelihood of
Hepatitis Mortality Likelihood of with
Transmission Period Chronic
Virus (%) Carrier State Hepatocellular
(weeks) Disease
Carcinoma
A Fecal-oral 2-6 1 None None No

B Parenteral,  4-26 1-2 10% (adults) 1-10% Yes

perinatal, 90% (infants)
sexual
C Parenteral,  2-23 1-5 50%-80% 80%-90% Yes
perinatal and
possibly
sexual
D Parenteral, 6-26 2-20 Variable 80% in Yesa
sexual, superinfectiona
perinatal
E Fecal-oral 2-9 1-2b None None No
a
 Requires co-infection with HBV. Simultaneous infection with HBV is associated with severe acute disease and low likelihood of
chronic infection (<5%); superinfection of HBV carries high likelihood of fulminant disease (2%-20%), chronic HDV infection (up to
80%), and cirrhosis (60%-70%), and may progress to hepatocellular carcinoma.
b
 15%-20% in pregnant women. (Bendinelli et al., 2002)
 Acute Hepatitis

• Injury to liver cells rather than bile ducts

• Predominantly elevations of ALT / AST
• Sudden onset or gradual onset
• Over short duration (< 6 months)
• Variety of causes
 Chronic Hepatitis

• Chronic or ongoing injury to liver cell

• Elevations of ALT / AST
• Longer duration (> 6 months)
• Number of causes
 Diagnostic work-up for Hepatitis

• Diagnostic work-up to identify

abnormalities
– Hepatocellular injury
– Bile ductal injury (obstructive features)
• Evaluate the etiology of liver disease
• Assessing severity of liver disease
• Follow up the course of liver disease
Viral Hepatitis Markers and Their Significance

www.health.state.nd.us/disease/Hepatitis
Viral Hepatitis Markers and Their Significance

www.health.state.nd.us/disease/Hepatitis
Viral Hepatitis Markers and Their Significance

www.health.state.nd.us/disease/Hepatitis
Diagnostic work-up for Hepatitis

www.health.state.nd.us/disease/Hepatitis
Diagnostic Algorithm for Serologic
Testing in Suspected Acute Viral
Hepatitis

Sacher RA, Peters SM, Bryan JA. Testing for viral hepatitis: a practice parameter. Am J Clin Pathol 2000;113:12–7
 Diagnostic Algorithm for Serologic
Testing in Suspected Chronic Viral Hepatitis

Sacher RA, Peters SM, Bryan JA. Testing for viral hepatitis: a practice parameter. Am J Clin Pathol 2000;113:12–7
 Interpretation of HAV and HCVs Serology Test

http://www.ashm.org.au/images/publications/monographs/HIV_viral_hepatitis_and_STIs_a_guide_for_primary_care
 Interpretation of HBV Serology Test

http://www.ashm.org.au/images/publications/monographs/HIV_viral_hepatitis_and_STIs_a_guide_for_primary_care
 Simplified Diagnostic Approach to Possible Acute Viral Hepatitis

http://www.merckmanuals.com/professional/sec03/ch027/ch027b.html
http://img.medscape.com/fullsize/migrated/editorial/clinupdates/2008/17159/tan.fig1.gif
Algorythm in approach regarding
treatment of HCV
 Diagnostic steps in delta hepatitis

Wedemeyer H., Yurdaydin C. Delta Hepatitis. In: Tillman HL, editor. Handbuch Hepatitis B: Diagnostik, Verlauf, Therapie.
Bremen: Uni-Med, 2007: 96-103
 Diagnostic algorithm for autoimmune hepatitis

http://img.medscape.com/fullsize/migrated/524/097/mgm524097.fig5.gif
 save our children…

Act to Fight Hepatitis

Terima Kasih
 Hepatitis Screening

http://www.arupconsult.com/Algorithms/HepatitisScreening.pdf
http://www.ashm.org.au/images/publications/monographs/HIV_viral_hepatitis_and_STIs_a_guide_for_primary_care
http://liver.stanford.edu/Education/hepbpatients.html
 Results (1)
• HAV Ab IgM negative
• HBsAg positive
• HBcAb IgM positive
• HCV Ab negative

Acute hepatitis B
 Results (2)
• HAV Ab IgM: positive
• HBsAg: negative
• HBcAb IgM: negative
• HCV Ab: negative

Acute hepatitis A
 Results (3)
• HAV Ab IgM positive
• HBsAg positive
• HBcAb IgM negative
• HCV Ab negative

Acute hepatitis A on
chronic HB infection
 Results (4)
• HAV Ab negative
• HBsAg negative
• HBcAb IgM positive
• HCV Ab negative

Acute hepatitis B
“Window”
 Results (5)
• HAV Ab IgM negative
• HBsAg negative
• HBcAb IgM negative
• HCV Ab positive

Acute hepatitis C
 A CASE
• 10 yrs old presented to your clinic
– Malaise, fatigue, myalgia, arthralgia and low grade
fever
• No history: IV drug/fluid, blood transfusion,
injection
• Physical Examination:
– Jaundice
– Mild hepatomegally
– No chronic stigmata of liver disease
 What is your working Diagnosis ?

WHAT DO YOU WANT TO

DO NEXT ?
 a case…..

Liver Chemistry: Viral Serologies:

• AST- 112 0 IU • HAV-IgM –ve
• ALT- 2300 IU • HAV-IgG + ve
• AP - 234 IU • HBsAg + ve
• TB - 5 mg/dl • HBs Ab –ve
• Albumin – 3.8 g /dl • HBc Ab (IgM)+ve
• PT – 12.3 • HBc Ab (IgG) +ve
How do you interpret laboratory test results?

What is your Differential Diagnosis?

What is your Diagnosis?

What do you want to do next?

http://depts.washington.edu/hepstudy/images/hepB/HBVRxd03.pn
g
http://depts.washington.edu/hepstudy/images/hepB/HBVRxd02.png