Serologic diagnosis of HBVinfection

Clinical outcomes of HBV infection

• Subclinical disease• Acute hepatitis, Fulminant hepatitis• Asymptomatic carrier • Chronic hepatitis >6 months necrosis and

inflammation of the liver , actively replicating virus—source of infection

• Cirrhosis, HCC

Outcome of hepatitis B infection

Chronic hepatitis• Inflammation of the liver >6 mo (not alcoholic)• Mild-(chronic persistent hepatitis)• Inflammation confined to portal tract • Limiting plate preserved• Severe (chronic active hepatitis)• Inflammation spills into periportal liver• Interface hepatitis• Bridging necrosis Fatty change, lymphocytes (C)

Periportal fibrosis Ground glass (B)

Chronic hepatitis

Hepatitis B infection

Carrier state

• Presence of HBsAg in serum >6 months• May be symptomatic /asymptomatic• More common following vertical transmission

& immunocompromised

Biochemical abnormalities in chronic hepatitis

• Elevation of AST,ALT• S. Bilirubin elevated at times

HCV

• Hepacivirus• Enveloped single stranded RNA virus• Unstable virus with multiple genotypes and

subtypes. (no vaccine)• Anti HCV IgG does not confer effective

immunity• High risk of chronicity (80%),cirrhosis &HCC

(10%)

Pathogenesis of HCV infection

• Cytotoxic T cells response to virally infected hepatocytes

• Not directly cytopathic• Defects in HCV specific cellular immunity

Clinical features of HCVdisease

• Mild disease• Fulminant disease rare• Chronic disease is common (80% )• 20% develop cirrhosis• 5% of cirrhosis develop HCC • Extrahepatic manifestation-membranoproliferative

glomerulonephritis,prophyria cutanea tarda, sicca syndrome

Serologic diagnosis of HCVinfection

HDV

• RNA virus• Conifection HBV and HDV simultaneously• Superinfection: HBV followed by HDV• Serologic diagnosis: anti HDV IgM.

Clinical outcomes of HDV infection

HEV

• Oro-fecal transmission• Asia,india,subsaharan africa, mexico• High mortality in pregnant women• Self limiting• No chronic phase,no viremia.

Comparison of hepatitis viruses

Clinical manifestations of hepatitis

• Preicteric or palindromic phase• Precedes jaundice • 1-21 days • Phase of maximum infectivity in HAV infection• Nausea, fever, anorexia, malaise• Serum sickness-like syndrome (B)

Hepatitis-clinical manifestations...

Icteric phase Jaundice• Pruritis• Pale coloured stool,dark urine• Tender hepatomegaly

Clinical features of Chronic hepatitis

• Variable• Not predictive of outcome• Fatigue,malaise .mild haundice’spider

angiomas,mild tender hepatomegaly, • Occasionly, immune complex mediated

disease (C&D)

Summary

• Definition of hepatitis• Hepatitis viruses, serologic diagnosis• Clinical manifestations• Acute hepatitis,fulminant hepatitis,chronic

hepatitis, carrier state.• Cirrhosis, HCC ……