1、Viral HepatitisDept.of Infectious Diseases SunYat-sen University Q.F.XIE临床表现课件1Introduction Viral hepatitis are a group of diseases,Caused by A、B、C、D and E 5 hepatitis virus Hepatitis A and E Transmitted by fecal-oral route,present acute and self-limited course Hepatitis B,C and D Spread parenterall
2、y easily lead to chronic hepatitis临床表现课件2 Clinical characters including fatigue,intestinal symptoms tender and enlarged liver abnormal LFTs jaundice in some cases very variable in severity临床表现课件3SignificanceHighly endemicWide clinical spectrumHigh fatality rate in severe casesNo specific pathogenic
3、therapy available nowChronic hepatitis B and C very common,some may develop to cirrhosis even HCCSuccessful vaccination for HBV and HAV临床表现课件4Etiology-HAVHeparnavirusAppeared in bile and feces,spreaded via fecesNo chronic carrier status observedAnti-HAV antibody to HAVAnti-HAV IgM indicative of curr
4、ent or recent infection appeared very early,disappear in about 3months most useful for confirm the diagnosis临床表现课件5Anti HAV IgG current or previous infection a protective antibody,conferring immunity persist for life long time临床表现课件6Etiology-HBV Orthohepadnavirus,Dane particle 4 open reading frame:S
5、,C,P,X 8 genotypes A-H,B and C predominantly in China Strong ability against to environment 3 antigen and antibody system临床表现课件7 HBsAg found in serum and other body fluid not infectious itself suggesting current infection and infectivity Anti-HBs a protective antibody to HBsAg an indicator of past i
6、nfection and immunity to HBV reinfection suggesting non-infectious临床表现课件8 HBeAg suggesting HBV replication and high infectivity negative when pre-C mutation but with high level of replication useful for evaluation of anti-HBV therapyAnti-HBe antibody to HBeAgHBe seroconversion HBeAg(+)(-)and anti-HB
7、e(-)(+)临床表现课件9 HBcAg existing in the core of virion a marker of replication and infectivityAnti-HBc IgM a marker of acute primary HBV infectionAnti-HBc IgG appeared in almost all HBV present and past infection host body临床表现课件10 HBVDNA the genome of HBV suggesting active virus replication and infecti
8、vity useful for diagnosis and evaluation of anti-HBV therapy临床表现课件11Hepatitis B Virus临床表现课件12Etiology-HCV RNA virus,6genotypes,mainly 1b in the country Molecular heterogeneity driven by high mutation rate usually proceed to chronic course Anti-HCV IgM and IgG types antibody to HCV suggesting HCV inf
9、ection临床表现课件13 HCVRNA the genome of HCV suggesting replication and infectivity of HCV useful for the diagnosis and evaluation of antivirus treatment临床表现课件14Etiology-HDV An incomplete RNA virus Causes hepatitis only patients with either acute(coinfection)or chronic(superinfection)hepatitis B HDVAg an
10、d anti-HDV both the markers of HDV infection HDVRNA the genome of HDV a marker of existing HDV infection suggesting virus replication and infectivity临床表现课件15Etiology-HEVNonenveloped RNA virusAppeared in bile and feces,spreaded via fecesNo chronic carrier status observedAnti-HEV IgM and IgG both appe
11、ared in acute infection useful for the diagnosis of HEV infection临床表现课件16 HEVRNA the genome of the virus suggesting existing of HEV infection not available for routine clinical diagnosis临床表现课件17Epidemiology Source of infection Patients with acute or chronic viral hepatitis Carriers of hepatitis viru
12、s,particularly asymptomatic carriers临床表现课件18 Transmission Hepatitis A and E transmitted by the fecal-oral route,water-borne and food-transmitted infection in epidemics临床表现课件19Hepatitis B transmitted parenterally mother-to-infant play a key role in China blood,blood products and body fluid othersHepa
13、titis C and D similar to hepatitis B intravenous drug abusers most common hepatitis C for the time being 临床表现课件20Prevalence rate in China 1992 Hepatitis A anti-HAV+80.90%Hepatitis B HBsAg +9.75%(2006)7.18%Hepatitis C anti-HCV+3.20%Hepatitis D anti-HDV+1.15%Hepatitis E anti-HEV+17.2%临床表现课件21Pathogene
14、sis Hepatocellular damage produced by viral replication directly only in hepatitis D Other types of viral hepatitis induced mainly by immune-mediated attack on the liver临床表现课件22Pathology The varying lesion could be seen in entire liver,but variable in severity and in different stages of the disease
15、No specific lesion suggesting etiologic type of hepatitis virus临床表现课件23Clinical manifestations Wide clinical spectrum from asymptomatic form to fatal outcome such as liver failure Similar clinical course in different etiological type of viral hepatitis 临床表现课件24The clinical types viral hepatitisAcute
16、 hepatitisChronic hepatitisLiver failure(severe hepatitis)Cholestatic viral hepatitisHepatitis cirrhosisAsymptomatic virus carrier status(usually only in HBV)临床表现课件25Incubation period Hepatitis A 2-6w 4w Hepatitis E 2-9w 6w Hepatitis B 1-6m 3m Hepatitis C 2w-6m 6w Hepatitis D 4-20w临床表现课件26Acute hepa
17、titis 3 phases of the icteric hepatitis Prodromal phase sudden or insidious onset,lasting 3-7d constitutional symptom:malaise,fatigue,mild fever some time,dark urine gastrointestinal symptoms:anorexia,nausea,vomiting serum ALT level rise deeply临床表现课件27Jaundice phase jaundice appeared and peak level
18、often in 2 weeks after the onset other symptoms subside after jaundice tender liver palpable serum bilirubin elevated lasting for 26 weeks临床表现课件28Convalescent phase symptoms and jaundice gradual resolution liver return to normal size serum ALT and bilirubin decreased 1 to 2 months neededAnicteric ac
19、ute viral hepatitis more common,mild manifastation临床表现课件29Chronic hepatitis Seen only in hepatitis B,C and D,virus infection over 6 months Severity variable,3 subtypes:mild,typical and advanced Common manifestations:malaise,fatigue,poor appetite,nausea,distension of abdomen 临床表现课件30 Jaundice seen in
20、 some cases Enlargement of liver and/or spleen Spider naevi,hepatic palms in cases with long history Abnormal LFTs:transaminase,bilirubin A/GPrognosis different:stable,breakthrough or flare,develop to Cir or Ca临床表现课件31Liver failure(severe hepatitis)Bad prognosis Pathological basis:extensive necrosis
21、 of hepatic cells 4 subtypes:acute liver failure,subacute,acute-on-chronic,chronic Clinical syndrome including:jaundice deepen rapidly临床表现课件32 liver size become smaller bleeding,prolonged prothrombin time,PTA less than 40%cerebral edema,high intracranial pressure complicated infection:SBP hepatic en
22、cephalopathy toxic abdominal distension and ascites hepatic-renal syndrome 临床表现课件33Cholestatic viral hepatitis acute and chronic mild manifestation but deepen jaundiceHepatitis cirrhosis hepatic fibrosis compensated cirrhosis decompensated cirrhosis临床表现课件34Asymptomatic HBV carrier HBV infection more
23、 than 6 months have no symptoms and signs normal LFTs 70%-80%have no pathologic change in liver biopsy临床表现课件35DiagnosisClinical DataEpidemiological evidencesLaboratory investigationsUltrasoundBiopsy临床表现课件36Differential diagnosisJaundice caused by other etiological agentsHepatitis caused by other eti
24、ological agents临床表现课件37TreatmentBasic principles of management guideline for daily living,physical activity,food and drink intake of the patients supportive and symptomatic treatment 临床表现课件38Hepatic function protective agentsAnti-virus therapy most important treatment for chronic hepatitis B、acute a
25、nd chronic hepatitis C hepatitis B indication:HBVDNA 105copies/ml for HBeAg,临床表现课件39 HBVDNA 104copies/ml for HBeAg+;ALT 2ULN,or biopsy G2S2 Drugs:interferon-(typical or pegylated)or,nucleotide analogues:3TC,adfovir,entecavir,Ldt Hepatitis C indication:HCVRNA+drugs:interferon-(typical or pegylated)+r
26、ibavirin临床表现课件40 Traditional Chinese medicineManagement for liver failure basic supportive therapy treatment of complications bleeding infection complications encephalopathy renal failure临床表现课件41Hepatic transplantationManagement of asymptomatic HBV carrier medical check up periodically no any alcoho
27、l intake liver biopsy when patients age more than 40 years and HBV replication in high level临床表现课件42PreventionImprovement of sanitationBlood screening of donorsAnti-virus treatment for hepatitis B and hepatitis C临床表现课件43Immunoprophylaxis active immunization vaccines for hepatitis A and B are available around world,very successful for pre-exposure prevention passive immunization IG for hepatitis A,HBIG for hepatitis B;post-exposure临床表现课件44 Thanks!临床表现课件45
