HEPATITIS VIRUS

Viral hepatitis infection of liver by hepatitis virus type A or

type B or non A, non B hepatitis virus.
Based on epidemiological & clinical criteria
1.Sporadic/Epidemic - Type A hepatitis
In children & young adults,
transmitted by faecal oral route Infective/Infectious hepatitis
2.Serum Inoculation/blood transfusion Type B hepatitis
Transmitted by serum inoculation/ blood transfusion
Homologous serum jaundice/ serum hepatitis
3. Non A and Non B hepatitis
Some no evidence with Type A and Type B
Clinical syndrome of type A or B produced, but
uncharacterized viral agent
Hepatitis A Virus (HAV):
Picorna family
27 mm, non enveloped RNA virus
Enterovirus 72
Inactivated - heat at 60C for 1 hour, acid at PH -3, formaldehyde at
37C for 72 hrs, chlorine at 1 ppm for 30 min.
Type A Hepatitis (infectious hepatitis)
Virus enters the body by ingestion
Multiplies in the intestinal epithelium, before it reaches liver by
haematogenous spread
Incubation period 2-6 weeks
Disease 2 stage preicteric/prodormal stage & icteric stage.
Shed in faeces late incubation period (prodormal phase)
Virus in blood short period (pre icteric stage)
Disappears jaundice sets in
Occasionally present in saliva & urine
Clinical feature
Onset acute or insidious with fever, malaise, anorexia, nausea,
vomiting & liver tenderness.
Recovery slow, overa period of 4-6 weeks
Mortality-low, most in case of adults.
Epidemiology
World wide in distribution
Temperate countries autumn-winter dilation
Tropic region no seasonal distribution
India heavy rainfall, Faecal oral transfer, food borne
Viraemic phase patient blood infectious, transmission - rare
Lab diagnosis
Demonstration of virus/ antibody immune electron microscopy,
complement fixation, haemagglutination, RIA, ELISA
Virus present in faecal extract
Antibodies in course of disease
Ig M antibody in serum recent infection
Ig G recent or remote infection
Prophylaxis
Improved sanitation, prevention of contamination of food & water
Passive immunization with gamma immunoglobulin effective
Pooled human Ig prevent clinical illness
Immunity conferred against type A infection
Hepatitis B Virus (HBV):
Family Hepadna virus
Icosahedral symmetry
DS DNA virus
Antigenic structures
Surface component of hepatitis B virus (HBs ag/australia ag) 3
components group specific a, type specific d-y,w-r
HBc core antigen
Hbe hidden ag
Ds DNA & DNA polymerase
Hepatitis B carriers- based on serological markers
Super carrier : early stage HBe ag, highly infectious, in blood DNA
polymerase & raised serum transaminase. Transmit from mother to child.
Simple carrier: later stage of carrier state.no Hbe ag, low level of HBs ag
in blood DNA polymerase absent. Transmitted only if large volume of
blood transferred.
Type B Hepatitis (serum hepatitis)
Transmitted by parenteral route
Clinical feature
Incubation period 2-6 months
Clinical disease similar to type A, more severe
Extra hepatic lesions rash, arthralgia, polyarteritis nodosa &
glomerulonephritis
Some chronic active hepatitis & cirrhosis
Late consequence primary hepatocellular carcinoma, viral DNA
integrated into genome of malignant hepatocytes.
Epidemiology
Throughout world, no seasonal distribution
Chronic/persistent carriers persons with HBs ag in blood for more
than 6 months.
Transmission percutaneous route tattoing, acupuncture, sharing
of razor, sexual intercourse, blood sucking insect.
Virus body fluids & excretions, urine, saliva, milk, semen, bile &
feces.
Immune response
3 ags (HBs, HBc, Hbe) evoke cellular & humoral immune response
Surface ag - Cell mediated Immunity
T cell self limited course of hepatitis, its absence result in chronic
liver damage.
Laboratory method
Diagnose acute and chronic infection
HBs ag disappears with recover from disease
HBc ag non detectable in serum, liver cells detected by
immunofluorescence
Hbe ag hidden ag, detected by immunodiffusion
Viral DNA polymerase- detected during pre icteric stage
Delta agent liver & blood of some HBs ag carrier
Prophylaxis
Health education, personal hygiene
Preventive measure screening of HBs ag & Hbe ag in blood donors
Passive immunization Human serum immuneglobulin, antihepatitis
immune globulin
Active immunisation heat activated human carrier plasma- source of
HBs ag
Non A Non B Hepatitis (NANB Hepatitis)
Viral hepatitis resembling Type a or type B clinically &
epidemiologically
Not caused by either of these of these virus.
Epidemiologically 3 types
Post transfusion hepatitis
Repeated administration of blood & blood products
Faecal oral route
Other Hepatitis viruses
Hep C virus (a flavivirus)
Transmission primarily through blood products
Sexual transmission can occur
Hepatitis type D virus (viroid, unclassified)
Hep B coinfection
Substantially contributes to Hep B pathogenesis
Hepatitis type E virus (unclassified)
Oral-fecal transmission
Hepatitis type G virus (Flaviviridae)
Transmission through blood products
No known disease