2. Objectives
● Define Viral Hepatitis
● Causes of Viral Hepatitis
● Classify Different Types of Viral Hepatitis (Acute vs Chronic)
● Differentiate between types of Acute Viral Hepatitis (A & E)
● Differentiate between types of Chronic Viral Hepatitis (B, C, & D)
8. Organism: The hepatitis A virus (HAV) belongs to the
picornavirus group of enteroviruses.
Incubation Period: 2- 4 weeks
Mode of Transmission: faecal-oral route
Population at Risk:
Children
Low-socio economic area (poor sanitation and over crowding)
Prisoners
HEPATITIS A
9. Infectivity Period: Infected individuals,
who may be asymptomatic, excrete the virus in faeces for
about 2–3 weeks before the onset of symptoms and then
for a further 2 weeks or so.
Investigations:
Serology:
Active Infection: Anti-HAV IgM
Recovery/Vaccination: Anti-HAV IgG (protective antibody)
HEPATITIS A
10.
11. Silent/Subclinical: Asymptomatic
Classic Presentation: Occurs in 3 phases:
Prodromal phase:
● Headache
● Myalgia
● Arthralgia
● nausea and anorexia
Icteric phase:
● Jaundice
● Dark urine
● Pale stool
● Abdominal pain
Recovery phase
HEPATITIS A
14. HEPATITIS E
Organism: Hepatitis E is caused by an RNA virus.
Incubation Period: 3-8 weeks
Mode of Transmission: faecal-oral route
Clinical Features:
• Mild fever
• reduced appetite, nausea and vomiting lasting for a few days
• abdominal pain
• itching jaundice
• dark urine and pale stools
• Painful hepatomegaly
15. HEPATITIS E
Investigations:
Serology:
Active Infection: Anti-HEV IgM
Hepatitis E differs from hepatitis A in that infection during pregnancy is
associated with the development of acute liver failure, which has a high
mortality.
Treatment:
Self-limiting infection
Supportive treatment
18. HEPATITIS B
Organism: The hepatitis B virus (HBV) is a DNA virus that
belongs to the Hepadna group.
Incubation Period: 4- 20 weeks
Mode of Transmission:
19. HEPATITIS B
Clinical Features:
Acute Infection:
• Fever
• jaundice .
• Painful hepatomegaly.
• Elevated serum transaminases (ALT>>AST).
• Followed by recovery.
• Can progress to fulminant hepatitis in <1% cases
20. HEPATITIS B
Clinical Features:
Chronic Infection:
Usually asymptomatic.
90% of the infected babies and infants will develop a
chronic hepatitis B infection.
Complications:
Hepatocellular carcinoma
Cirrhosis
Hepatitis is one of the most common causes of
chronic liver disease and hepatocellular carcinoma
world-wide.
22. HEPATITIS B
Treatment:
The goals of treatment are HBeAg seroconversion, reduction in HBV-DNA and
normalisation of the LFTs.
Acute Infection:
Treatment is supportive with monitoring for acute liver failure, which occurs in less than
1% of cases.
Full recovery occurs in 90–95% of adults following acute HBV infection.
The remaining 5–10% develop a chronic infection which usually continues for life,
23. HEPATITIS B
Chronic Infection:
Medical Treatment:
Nucleoside-nucleotide antiviral agents Entecavir or Lamivudine (1st line agents
Pegylated interferon Alpha (PEG INF-alpha)
Surgical Treatment:
Liver transplant
Prevention:
• Active: Recombinant vaccine (at birth, 1-month, after 6 months).
• Passive: Immune globulins.
• Use of sterilized needles
• Proper screening of blood before transfusion.
• Avoid unprotected sexual contact.
24. HEPATITIS D
Organism: The hepatitis D virus (HDV) is an RNA-defective
virus.
Incubation Period: 6-9 weeks
Mode of Transmission: Parenteral
Infection with HDV arises in following setting:
● Co-infection by HDV & HBV
● Super-infection of chronic HBV carriers by HDV
Management:
Effective management of hepatitis B effectively prevents
hepatitis D.
25. HEPATITIS C
Organism: This is caused by an RNA flavivirus.
Incubation Period: 2 - 26 weeks
Mode of Transmission: Parenteral
26. HEPATITIS C
Clinical Features:
Acute Infection:
80% is subclinical, only 10-20% is symptomatic any may cause:
• Fatigue
• Muscle pain
• Joint pain
Jaundice and complications of portal hypertension typically occur
only when the disease progresses to cirrhosis.
Chronic Infection:
Chronic hepatitis occurs in 80% of patients
Cirrhosis occurs in 20% of chronic infection within 20 years.
Hepatocellular carcinoma develops in 2-5% of patients with
cirrhosis.
29. HEPATITIS C
Treatment:
The aim of treatment is to eradicate infection.
Treatment of choice: The treatment of choice is pegylated α-interferon given
weekly subcutaneously, together with oral ribavirin.
Liver transplantation should be considered when complications of cirrhosis
occur, such as diuretic-resistant ascites.
Cure is defined as loss of virus from serum 6 months after completing therapy.
Prevention:
There is no active or passive protection against HCV.
