Transcript Viral Hepatitis

Viral Hepatitis
Australian Family Physician Vol.
30 No.5, May 2001
Presented by 郭詠怡
Date presented:25/8/2003
Causes of hepatitis
HAV: Enteric
HBV: Blood borne
HCV: Blood borne
HDV: Blood borne
HEV: Enteric
HGV: Blood borne
incubation (days):
15-60
45-160
14-120
42-180
15-64
unknown
HAV and HEV: with water/ food outbreaks
( travelling to developing world). No chronic
carriers
HBV and HCV: STD, injecting drug use,
occupational exposure in health care
worker, causing acute and chronic hepatitis,
carriers,, hepatocellular carcinoma
HDV: super infection or coinfection with
HBV
HGV: possibly causes transfusion hepatitis
Other causes of hepatitis
Other viruses:
Herpes viruses
-CMV
-EBV
Yellow fever virus
Other causes: nonviral infections, drugs,
alcohol, anoxic liver injury
Needlestick exposure
Collection nurse (recipient)
Skin unbroken?
Gloves worn?
Had blood been drawn or was sterile needle
involved?
Did injury result in blood being drawn?
Patient (source)
Injection drug use
Sexual preference
Blood ransfusions
Overseas travel
Migration history
Tests to order after needlestick
exposure
On the patient (source)
HIV Ab, HBsAg, HCV Ab
On the nurse (recipient)
HBsAb, storage of serum
Main clinical presentations in viral
hepatitis
HAV:
--acute hepatitis in adults—(75% symptomatic, but
self limiting); children usually asymptomatic
--fulminant hepatitis (rare)
HBV:
--acute hepatitis (mostly self limiting,50%
asymptomatic)
--fulminant hepatitis (specially if coinfected with
HDVor concurrent HCV
--chronic hepatitis leading to carrier state 5-10%
Main clinical presentations in viral
hepatitis
HCV:
--chronic hepatitis leading to carrier state 50-70%
--acute hepatitis (75% asymptomatic)
--fulminant hepatitis (uncommon, seen with concurrent HBV
HDV:
--acute exacerbation in chronic hepatitis B (HDV
superinfection)
--fulminant hepatitis ( if coinfected with HBV)
--chronic hepatitis leading to carrier state (variable 5-70%)
HEV:
--acutehepatitis (usually self limiting)
-- fulminant hepatitis (rare, but seen in pregnant women)
Hepatitis serology
HAV
HBV
HCV
clinical situation
acute hepatitis
see next slide
acute hepatitis
chronic carrier
HDV(only coinfection or
if HbsAg+) superinfection
HEV
acute hepatitis
HGV
tests to order
HAV IgM
HCV Ab,
HCV PCR
HCV Ab
HBsAG, HBcIgM,
HDV Ab
HEV Ab
HGV PCR
HBV serology
Late incubation period: HBsAg
Acute hepatitis: HBsAg, HBcIgM, HBcAb
Total, HBeAb, HBV DNA
Window period: HBcIgM, HBcAb Total,
HBV DNA
Healthy carrier: HBsAg, HBcAb Total,
HBeAb
Chronic carrier/ replicative: HBsAg, HBcAb
total, HBeAg, HBV DNA
Recovery/immunity: HBcAb Total
Recent vaccination: HBsAb
Treatment for viral hepatitis
Virus
A,E,G
B,D
C
Antiviral
not available
interferon+lamivudine
interferon+ribavirin
Prevention of viral hepatitis
Virus
A
B,D
Vaccine
Schedule
Havrix or
2 doses at 0
VAQTA
and 6 months
Engerix B
3 doses at 0,1,6
or HBVax II months
Summary of important points
Most cases of viral hepatitis are self limiting
or asymptomatic
Epidermiological hisory is helpful to
determine which tests to order
There are a number of markers for HBV,
used for different stages of the disease.
Vaccination can prevent infection with
certain hepatitis viruses, eg. HAV and HBV
The role of some new viruses thought to
cause hepatitis is controversial