Hepatitis Virus

Dr. Md. Abdullah Yusuf

Assistant Professor, Dept. of Microbiology
National Institute of Neurosciences & Hospital
Dhaka, Bangladesh
Email: ayusuf75@yahoo.com

Objectives

Definition & Classification

Basic Structure
Mode of Transmission
Important events in Pathogenesis
Clinical Features
Laboratory Tests & their interpretation
Treatment & Prevention

Definition
Hepatitis viruses
group of virus those can infect liver tissue
Only infect hepatocyte
Hepatotropic Viruses
Infect both hepatocytes and other tissues
infect liver as well as other organs of the body

Classification
Six viruses
Classical Hepatitis Viruses
Hepatitis A (Infectious viruses)
Hepatitis B (Serum hepatitis virus)
Hepatitis C (Non-A, non-B post transfusion)
Hepatitis D (Delta agent)
Hepatitis E (Enteric non-A, non-B)
Hepatitis F
Hepatitis G

Hepatotropic virus
Examples
Epstein-Barr virus
Cytomegalo virus
Yellow fever virus
Dengue virus

Basic Structure
Hepatitis Genome
Family
Coverings
Viruses
HAV
ssRNA
Picornavirus Non-enveloped
HBV
Partly ds DNA Hepadnavirus Enveloped
HCV
ssRNA
Flavivirus
Enveloped
HDV
ssRNA
Deltavirus/ Enveloped
Viroid like
HEV
ssRNA
Norovirus Non-enveloped
HGV
ssRNA
Flavivirus
Non-enveloped

Different components of HAV

Disease

Compone
Definition
nt of
System
Hepatitis A HAV
Hepatitis A virus
Etiologic agent of infectious hepatitis
IgM anti- IgM antibody to HAV
HAV
Indicates recent infection with
hepatitis A
positive up to 46 months after
infection
best test to detect acute hepatitis A

Antigens of Hepatitis B Virus

Hepatitis HBV Hepatitis B virus, agent of serum hepatitis
B Virus
also known as Dane particle
HBsAg Hepatitis B surface antigen
Non-infectious particles in patient's blood
positive during acute disease
continued presence indicates carrier state
HBeAgHepatitis B e antigen
Associated with HBV nucleocapsid
indicates viral replication
circulates as soluble antigen in serum
antigenic determinant in the HBV core
Important indicator of transmissibility
HBcAg Hepatitis B core antigen

Antibodies against HBV

Anti-HBs Ab Antibody to HBsAg
Indicates past infection & immunity to HBV
presence of passive antibody from HBIG or
immune response from HBV vaccine
Anti-Hbe Ab Antibody to HBeAg
indicates low transmissibility
Anti-HBc Ab Antibody to HBcAg
Indicates infection with HBV at some
undefined time in the past
positive during window phase
IgM anti-HBc IgM class antibody to HBcAg
Indicates recent infection with HBV
positive for 46 months after infection

 Hepatitis C virus
agent of posttransfusion hepatitis
Anti-HCV Antibody to HCV
Hepatitis D HDV
Hepatitis D virus
agent of delta hepatitis
causes infection only in presence of
HBV
HDAg
Delta antigen (delta-Ag)
Detectable in early acute HDV
infection
Anti-HDV Antibody to delta-Ag (anti-delta)
Indicates past or present infection
with HDV
Hepatitis E HEV
Hepatitis E virus
Transmission by fecal-oral
Hepatitis C HCV

Mode of Transmission
HAV & HEV & also HFV- by fecal-oral route
Contaminated food & water
Shellfish from sewage-contaminated water
Food handlers
Daycare workers
Children

Mode of Transmission
HBV, HCV, HDV
by Parenteral
sexual
Also Vertical

Mode of Transmission
HAV is rarely transmitted via the blood, because
level of viremia is low
chronic infection does not occur

Important events in Pathogenesis

Hepatitis Onset
viruses

IP
Severity
(days)

HAV

Abrupt

15-50

HBV

Insidious

45-160 Occasionally severe

HCV

Insidious

14-180 Usually subclinical

HDV

Abrupt

15-64

HEV

Abrupt

15-50

Mild

Co-infection with HBV occa. severe;

Super infection with HBV often
severe
Normal Patients-Mild
Pregnant Women-Severe

HAV
Disease: hepatitis A
Important Properties
typical enterovirus
single-stranded RNA genome
Non-enveloped
icosahedral nucleocapsid
replicates in the cytoplasm of the cell
also known as enterovirus 72
has one serotype

Age Group
Children are the most frequently infected group
Outbreaks in summer camps and boarding schools

Pathogenesis
HAV infection of cultured cells
produces no cytopathic effect
attack by cytotoxic T cells
causes the damage to the hepatocytes
Infection is cleared
the damage is repaired
no chronic infection ensues

Clinical Features
HAV
Fever, Fatigue
Anorexia, Nausea, Vomiting
abdominal Pain
jaundice (70-80% adults; 10% children)
Dark urine, pale feces
elevated transaminase levels (SGPT/ ALT)
viral shedding in stool during Sign/Symptoms

HAV
99% complete recovery spontaneously in 24 weeks

Lab Diagnosis of HAV

detection of IgM antibody
most important test
Fourfold rise in IgG antibody titer

Treatment
No antiviral therapy is available

Prevention
Active immunization by inactivated HAV
Two doses
initial dose followed by
booster 6 to 12 months later
Indications
travelers to developing countries
children ages 218 years
Homosexual men

C/F of HBV
acute infection
Chronic infection
Primary Hepatocellular carcinoma

Acute hepatitis B

90%

1%

Resolution

9%
Fulminate hepatitis

HBsAg +ve
HBsAg+ve
for>6
>6months
months
50%

Resolution

Asymtomatic Carrier State

Chro. Persistent
hepatitis

Extrahepatic Dis.: PAN, GN

Cirrhosis

Chro Active
Hepatitis

HCC

Clinical Features (cont.)

HCV- 3 types of diseases
1. Acute hepatitis with resolution of infection
2. Chronic Persistent Infection with possible
progression to disease
3. severe rapid progression to cirrhosis

HCV Acute Infection

15%

15%

Recovery &
clearence

70%

Cirrhosis rapid Onset

Persistent Infection
40%
Asymptomatic
Chronic Hepatitis

6%
20%
Liver Failure

Cirrhosis

4%
HCC

Laboratory Tests & Their interpretation

Serology
RT-PCR

Treatment
Antiviral Drugs
Interferon gamma
Active & Passive Immunization
HVB vaccine
HBV IG

Prevention
Vaccine Available
HAV
HBV
HCV Vaccine Not possible
Due to rapid mutation

Dosage
0, 1, 6 months, 1yr, 5 yr
0,1,1, 9 months, 5 yrs

Epidemiological Measures

Avoid unprotected penetrative sexual intercourse

Transfuse Safe blood
Avoid contaminated water
Take vaccine in Health care workers

Thank You