PEMERIKSAAN

SEROLOGI
PADA HEPATITIS VIRUS

Oleh : dr. Diah Hermayanti, SpPK

TUJUAN PEMBELAJARAN

TIU

Memahawi pemeriksaan serologi dalam diagnosa

penyakit hepatitis virus

TIK

1. Mengetahui beberapa jenis hepatitis virus (terutama A, B,C)

2. Memahami respon imunologi pada hepatitis A, B, C tersebut
3. Memahami respon imunologi tersebut dalam diagnosa
hepatitis A, B, C
4. Memahami respon imunologi dalam menentukan prognosa

ANATOMI
HEPAR

HEPATITIS

APA ITU ?

Hepatitis adalah kondisi inflamasi pada hati

EX
- Infeksi virus
- Infeksi lainnya
- Alkohol
- zat kimia
- penyakit auto-imun, dll
Hepatitis virus yang tersering adalah :
Hepatitis A & B

HEPATITIS AKUT
Aktivitas transaminase >>>, meski belum tampak ikterik

tingkat kerusakan sel rendah

perluasan kerusakan sel besar

Kenaikan SGPT > SGOT

Rasio De Ritis SGOT / SGPT < 1
Minggu I

transaminase > sampai SGPT 1200 u/l

SGOT 700 u/l
Minggu II & III bila tidak ada komplikasi transaminase
turun kembali
bila ada kolestasis : GGT, ALP >>>

PENYEBAB HEPATITIS AKUT

Hepatitis toksik
- toksin
- obat : Acetaminophen, NSAID,
valproic acid, isoniazid
Hepatitis virus
Hepatitis A, B, C, D, E, G
Cytomegalovirus,
Ebstein Barr virus
Herpes simplex virus

FAKTOR

RNA

DNA

RNA

PARTIAL

RNA

RNA

15-50
days

30-150

15-160

30-150

20-40

FECALORAL

yes

no

min

no

yes

No

HOUSEHOL
D

yes

min

min

yes

yes

No

VERTICAL

no

yes

min

yes

no

Yes

BLOOD

rare

yes

yes

yes

Yes

SEXUAL

no

yes

min

yes

Yes

Anti
HAV,IgM

HBsAg,
PCR, Anti
HBc IgM

Anti HCV,
PCR

Anti HDV

Anti HEV

Anti HGV

CARRIER
STATE

No

yes

yes

yes

yes

Yes

CHRONIC
Hptts

no

10%

80%

yes

no

No

LIVER Ca

No

yes

yes

no

no

No

VACCINE

yes

yes

no

Yes*

no

No

Ig

yes

yes

no

Yes*

no

No

50%

20-45%

yes

yes

TYPE
INCUBATIO
N
TRANSMISS
ION:

DIAGNOSIS

PREVENTIO
N

INTERFERO
N

HEPATITIS A

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HEPATITIS A
Infectious disease caused by Hepatitis A virus
transmitted by the fecal-oral route
via contaminated food or drinking water
the incubation period,
is between two and six weeks
and the average incubation period is 28 days
Hepatitis A is an acute illness,
does not have a chronic stage,
is not progressive,
and does not cause permanent liver damage

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Virology
The Hepatitis virus (HAV) is a Picornavirus;
it is non-enveloped and contains a single-stranded RNA
packaged in a protein shell.[8]
There is only one serotype of the virus, but multiple
genotypes exist

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13

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PADA HEPATITIS AKUT YG DIDUGA KARENA HEPATITIS A

MAKA DIPERIKSA :
Ig M antibodi HAV
Mulai terdeteksi pada 1-2 minggu setelah infeksi
bertahan selama 14 minggu
Bila POSITIF
dan diikuti oleh peningkatan SGPT & SGOT
Maka diagnosa Hepatitis A dapat ditegakkan
Ig G antibodi HAV
Bermakna bahwa kondisi akut telah berlalu
dan orang tersebut telah mempunyai antibodi
sehingga terlindung dari infeksi selanjutnya
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HEPATITIS B

16

HEPATITIS VIRUS B
Core Protein
(HBc)

The infectious virion,

otherwise known as the
Dane Particle, is about
42nm in diameter.
DNA

Contains all the HBV

surface proteins as well as
the HBV core protein, HBV
genome and HBV's DNA
polymerase.

Surface Protein
(HBs)
DNA Polymerase
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Life Cycle

mRNA

Assemble
y
Assemble
y

NUCLEUS

Replication of the HBV

genome occurs within the
nucleus of an infected cell.

mRNA

RNA polymerase II
transcribes the circular
HBV DNA to mRNA.
Once produced, the
genomic RNA exits the
nucleus and enters the
cytoplasm where it is been
translated to generate the
HBV reverse polymerase,
core and e proteins.

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HEPATITIS VIRUS B
Penularan :
darah / serum
hubungan seksual
pemakaian needle bersama,
tato, dll
Manifestasi Klinik :
- Hepatitis akut
- Hepatitis kronik

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Diagnosis

RELATIVE CONCENTRATION

The most sensitive and

specific methods used
are RIA and ELISA.

Anti-HBc
HBsAg

Anti-HBs
Anti-HBe

HBeA
g
0

Both assays make use

of specific antibodies
against various HBV
proteins and can detect
HBsAg as low as 0.5
ng/mL and anti-HBs
antibodies at a level of
1mU/mL.

MONTH
S

20

PEMERIKSAAN SEROLOGI UNTUK DIAGNOSA

HEPATITIS VIRUS B AKUT
HBs

Ag

Pada kondisi WINDOW PERIODE

(HBs Ag sudah menghilang, namun belum terbentuk HBs Ab)
HBc

Ab

Untuk melihat potensi infreksius :

Hbe

Ab

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Diagnosis
Presence Presence of
of HBsAg Anti-HBs

Presence of
Anti-HBc

or

Interpretation
Acute Infection
Acute or Chronic
infection can
differentiate by
testing for IgM antiHBc
Previous HBV
infection
Could be results of
vaccination.
Validate by retesting
anti-HBs and antiHBc reactivity
Liver toxicity is due
to some other agent
other than HBV

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Infection with Recovery

Symptoms
HBeAg

anti-HBe

Titer

Total anti-HBc

IgM
anti-HBc

HBsAg

12

16

20

24

28

32

anti-HBs

36

52

100

Weeks after Exposure

23

Progression to Chronic Infection

Chronic
(Years)
HBeAg

Acute (6
months)

anti-HBe

Titer

HBs Ag

Total anti-HBc

IgM anti-HBc

12
16
Weeks after Exposure

20

24

28

32

36

52

Years
24

Pada pasien dg kronik HBsAg

Periksa :
HBe Ag & Hbe Ab
(menentukan status infeksi)
HBV-DNA
HBe Ag (+) arti : virus aktif bereplikasi (infeksius)
HBV-DNA aktif diproduksi
HBe Ag (+) kemudian tjd serokonversi Hbe Ab (+)
arti : HBV-DNA tidak aktif diproduksi

25

Post Hepatic Syndrome

Common features are anxiety, fatigue, failure to regain weight,

anorexia, alcohol intolerance and right upper abdominal
discomfort. The edges of the liver may be tender

Serum transaminase levels may be up to three times that of

normal.

Hepatic histology reveals only mild, residual portal zone

cellularity and fibrosis, sometimes fatty changes in the liver
cells.

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Hepatocellular Carcinoma

Hepatocellular carcinoma is the liver cancer.

This form of the disease may develop after a long time in

individuals suffering from chronic hepatitis B infection.

The events will trigger the development of this disease form are
unknown.

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HEPATITIS C

28

APA ITU ?
Infeksi hati oleh virus Hepatitis C
85% penderita akut hepatitis C gagal mengeliminasi virus ini
Sehingga menjadi kondisi KRONIK
Penularan :
terutama lewat darah yg terkontaminasi
terbanyak karena IV drug users
lebih sedikit lewat hubungan seksual

29

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HEPATITIS VIRUS C
Structure

capsid envelop
e
protein
c22

protease/helica
se
33c

RNAdependent

RNA polymerase

c-100
3

5
cor E1
e

E2

NS2

NS3

NS4

NS5

hypervariable
region
31

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Serological Course-HCV

antiHCV

Titer

Symptoms

ALT

Normal
0
Time after
Exposure

3
Months

Years
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Pemeriksaan Serologi untuk diagnosa

HCV

Antibodi

Bila positif
Ditindaklanjuti dengan pemeriksaan
HCV RNA
(dengan tehnik PCR untuk menghitung Viral load)

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HEPATITIS KRONIK
Inflamasi kronik dari hati yang menetap sekurangnya
6 bulan
Pola ensim :
Parameter
SGOT

Hepatitis kronik

Sirosis

75 (90) U/L

49 (64) U/L

SGPT

59 (118) U/L

22 (45) U/L

GLDH

5,8 (10,8) U/L

1,5 (3,5) U/L

GGT

256 U/L

102 U/L

CHE

1843 U/L

1085 U/L

Rasio De Ritis
SGOT/SGPT

Sekitar 0,8

Sekitas 2,3

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PENYEBAB HEPATITIS KRONIK & STRATEGI DIAGNOSIS

PENYEBAB

DIAGNOSIS

Hepatitis B

Riwayat, HBsAg, anti HBs,

anti HBc, HBV-DNA

Hepatitis C

Anti HCV, HCV RNA dg PCR

Autoimmune type 1

ANA, ASTHMA

Autoimmune type 2

SLA, Anti LKM1

Wilsons disease

Ceruloplasmin

Obat

Riwayat

-1 antitrypsin
deficiency

-1 AT phenotype

idiopatik

Bopsi hati, petandaPCR :polymerase chain reaction; ANApetanda

; antinuclearnegatif
antibody;
ASTHMA : anti smooth muscle antibody; LKM1 : anti Liver kidney
Microsomal antibody-1; AT : antytripsisn

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HEPATOCELLULAR CARCINOMA (HCC)

Penyebab kematian terbanyak oleh kanker
Terbanyak didahului oleh sirosis
Gejala klinik :
sirosis kemudian berkembang adanya
right upper quadrant pain
fever, malaise, anorexia, anemia,
jaundis
masa di right upper quadrant
ascites
Laboratorium :
ALP >>>
AFP (-feto protein) >>>
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SEMOGA
BERMANFAAT

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