ACUTE VIRAL

HEPATITIS

CLINICAL PRESENTATION.
DIGNOSIS.
EPEDEMOLOGY OF VIRAL
HEPATITIS INFECTION A,B,C
MANAGEMENT.
 Viral Hepatitis - Overview
Type of Hepatitis
A B C D E
Source of feces blood/ blood/ blood/ feces
virus blood-derived blood-derived blood-derived
body fluids body fluids body fluids
Route of fecal-oral percutaneous percutaneous percutaneous fecal-oral
transmission permucosal permucosal permucosal

Chronic no yes yes yes no

infection

Prevention pre/post- pre/post- blood donor pre/post- ensure safe

exposure exposure screening; exposure drinking
immunization immunization risk behavior immunization; water
modification risk behavior
modification
 DIAGNOSIS OF HEPATITIS

• Patient history
• Physical examination
• Liver function tests
• Serologic tests
SYMPTOMS AND SIGNS

Pre-icteric phase
1.Anorexia
2.Fatigue
3.Nausea
4.Vomiting
5.Arthralgia
6.Myalgia
7.Headache
8.Photophobia
9.Pharyngitis
 CONT.

• Icteric phase::
1. Enlarged liver
2. Tender upper quadrant
3. Discomfort
4. Splenomegaly (10-20%)
5. General adenopathy

• Post-icteric phase
• 1. cessation of the above symptoms
• Complications: liver cirrhosis, hepatitis
coma and death.
 LAB FINDINGS

1. L FT increase >5-10 times of

normal
2. Markers of hepatitis B or C or A
might be positive
3. RFTs
 PATHOLOGICAL FINDINGS

1. Pan lobular infiltration with mononuclear

cells
2. Hepatic cell necrosis
3. Reticulum framework are intact
 DD:

1. Infectious Mononucleosis
2. Drug Induced Hepatitis
3. Chronic Hepatitis.
4. Alcohol Hepatitis
5. Cholecystitis, Cholelithiasis
6. Bacterial hepatitis etc
 COMPLICATIONS

1.Chronic hepatitis  cirrhosis- HCC

2.Fulmnant hepatitis
 FULMINANT HEPATITIS

• Definition: Hepatic Failure Within 8 Weeks

Of Onset Of Illness.
• Manifestation: Encephalopathy and
Prolonged PT
• Histopathology: Massive Hepatic Necrosis.
 Hepatitis B - Clinical Features
• Incubation period: Average 60-90 days
Range 45-180 days
• Clinical illness (jaundice): <5 yrs, <10%
5 yrs, 30%-50%
• Acute case-fatality rate: 0.5%-1%
• Chronic infection: <5 yrs, 30%-90%
5 yrs, 2%-10%
• Premature mortality from
chronic liver disease: 15%-25%
 HBV INFECTION

Factors affecting transmission ability

1.Replicative status
- HBeAg
- high HBVDNA

2.Route of infection
- percutaneous
- Transmucosal

3. Exposure frequency : Single vs. Multiple

4. Inoculums size : transfusion vs. needle stick

 HEPATITIS B SEROLOGY

• anti-HBc exposure (IgM = acute)

• HBsAg  infection (carrier)
• anti-HBs  immunity
• HBeAg  viral replication
• anti-HBe  seroconversion
• HBV-DNA  viral replication
NATURAL HISTORY

Gow, BMJ 2001

 Hepatitis B Virus
Modes of Transmission

• Sexual
• Parenteral
• Perinatal
 Concentration of Hepatitis B Virus
in Various Body Fluids

Low/Not
High Moderate Detectable

blood semen urine

serum vaginal fluid feces
wound exudates saliva sweat
tears
breastmilk
 POSSIBLE TRANSMISSION
ROUTE OF HBV IN SL

 1-Horisontal transmission (person to person) is the

main transmission route
 2-Perintal transmission (positive HBSAG mothers)
especially if they are HBEAG positive
 3- Heterosexual transmission
 4-Illegal injection drug use
 5- Contaminated equipment used for therapeutic
injections and other health care related procedures
 6- Folk medicine practice
 7-Blood and blood products transfusion without prior
screening
 PREVENTION STRATEGIES OF
MINISTRY OF HEALTH IN SL
Introducing HBV vaccine in EPI
program; and
• Mandatory screening of blood donors and
expatriates.

• Vaccination of risk groups.

• Health education especially among medical

personnel .
 THE CURRENT EPI IN THE SL

1. At birth BCG + HB1

2. At 6 weeks DPT1 + OPV1 Hb2
3. At 3 months DPT2 + OPV2
4. At 5 months DPT3 + OPV3
6. At 5months Measles HB3
7. At 12 months MMR
8. At 18 months (DPT + OPV) Booster 1
9. At 4-6 years (DPT + OPV) Booster 2
HCV INFECTION
 Transmission of HCV
 Percutaneous
– Injecting drug use
– Clotting factors before viral inactivation
– Transfusion, transplant from infected donor
– Therapeutic (contaminated equipment, unsafe
injection practices)
– Occupational (needlestick)
 Permucosal
– Perinatal
– Sexual
 Features of Hepatitis C Virus Infection
Incubation period Average 6-7 weeks
Range 2-26 weeks
Acute illness (jaundice) Mild (<20%)
Case fatality rate Low
Chronic infection 75%-85%
Chronic hepatitis 70% (most asx)
Cirrhosis 10%-20%
Mortality from CLD 1%-5%
 Household Transmission of HCV
 Rare but not absent
 Could occur through percutaneous/mucosal
exposures to blood
– Theoretically through sharing of contaminated
personal articles (razors, toothbrushes)
– Contaminated equipment used for home therapies
• Injections*
• Folk remedies

*Reported in U.S.
 Sexual Transmission of HCV
 Occurs, but efficiency is low
– Rare between long-term steady partners
– Factors that facilitate transmission between
partners unknown (e.g., viral titer)
 Accounts for 15-20% of acute and chronic
infections in the United States
– Sex is a common behavior
– Large chronic reservoir provides multiple
opportunities for exposure to potentially infectious
partners
 Nosocomial Transmission of HCV

 Recognized primarily in context of outbreaks

 Contaminated equipment
– hemodialysis*
– endoscopy
 Unsafe injection practices
– plasmapheresis,* phlebotomy
– multiple dose medication vials
– therapeutic injections
* Reported in U.S.
NATURAL HISTORY

Marcellin, J Hepat 1999

PREVENTION OF HCV
TRANSMISSION
 Avoiding shared use of Razors or brushes
and any item that pierces the skin.
 Strict adherence of the universal
precautions in health facilities.
 Educating and training of HCW’s to the
proper use of standard precautions
 Folk medicine/ herbal ?!
HAV INFECTION
 Perinatal Transmission of HCV
 Transmission only from women HCV-RNA
positive at delivery
– Average rate of infection 6%
– Higher (17%) if woman co-infected with HIV
– Role of viral titer unclear
 No association with
– Delivery method
– Breastfeeding
 Infected infants do well
– Severe hepatitis is rare
 Occupational Transmission of HCV
 Inefficiently transmitted by occupational exposures
 Average incidence 1.8% following needle stick from
HCV-positive source
– Associated with hollow-bore needles
 Case reports of transmission from blood splash to eye
– No reports of transmission from skin exposures to blood
 Prevalence 1-2% among health care workers
– Lower than adults in the general population
– 10 times lower than for HBV infection
 Presence of recognized risk factor does not
necessarily equate with “increased risk”
 Occupational Transmission of HCV
 Inefficiently transmitted by occupational exposures
 Average incidence 1.8% following needle stick from
HCV-positive source
– Associated with hollow-bore needles
 Case reports of transmission from blood splash to eye
– No reports of transmission from skin exposures to blood
 Prevalence 1-2% among health care workers
– Lower than adults in the general population
– 10 times lower than for HBV infection
 Presence of recognized risk factor does not
necessarily equate with “increased risk”
 Perinatal Transmission of HCV
 Transmission only from women HCV-RNA
positive at delivery
– Average rate of infection 6%
– Higher (17%) if woman co-infected with HIV
– Role of viral titer unclear
 No association with
– Delivery method
– Breastfeeding
 Infected infants do well
– Severe hepatitis is rare
THANK YOU