Hepatitis Viruses PDF

### Table 11.2: Important Features of Hepatitis Viruses | VIRUS | TRANSMISSION | COMMENTS...

### Table 11.2: Important Features of Hepatitis Viruses | VIRUS | TRANSMISSION | COMMENTS | | :------------------------------------ | :------------------------------------------------------------------------- | :---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Hepatitis A (HAV) and Hepatitis E (HEV) | Fecal-oral transmission | Acute hepatitis; no chronic state. Anti-virus IgM marks active infection. Anti-virus IgG is protective, and its presence indicates prior infection or immunization (immunization is available for HAV). HEV infection in pregnant women is associated with fulminant hepatitis (liver failure with massive liver necrosis). | | Hepatitis B (HBV) | Parenteral transmission (e.g., childbirth, unprotected intercourse, intravenous drug abuse [IVDA], and needle stick) | Results in acute hepatitis; chronic disease occurs in 20% of cases (Table 11.3). | | Hepatitis C (HCV) | Parenteral transmission (e.g., IVDA, unprotected intercourse); risk from transfusion is almost nonexistent due to screening of the blood supply. | Results in acute hepatitis; chronic disease occurs in most cases. HCV-RNA test confirms infection; decreased RNA levels indicate recovery; persistence indicates chronic disease. | | Hepatitis D (HDV) | - | Dependent on HBV for infection; superinfection upon existing HBV is more severe than coinfection (infection with HBV and HDV at the same time) | ### Table 11.3: Serologic Markers of Hepatitis B Virus | STAGE | HBSAG | HBEAG AND HBV DNA | HBCAB | HBSAB | | :-------- | :----------------------------------------------------------------------------- | :------------------------------------------------ | :--------- | :--------- | | Acute | + (first serologic marker to rise) | + | IgM | - | | Window | - | - | IgM | - | | Resolved | + (presence > 6 months defines chronic state) | +/-; presence of HBeAg or HBV DNA indicates infectivity. | IgG | IgG (protective) | | Chronic | + (presence > 6 months defines chronic state) | +/-; presence of HBeAg or HBV DNA indicates infectivity. | IgG | - | | Immunization | - | - | - | IgG (protective) | ## II. VIRAL HEPATITIS **A.** Inflammation of liver parenchyma, usually due to hepatitis virus (Table 11.2); other causes include EBV and CMV. **B.** Hepatitis virus causes acute hepatitis, which may progress to chronic hepatitis. **C.** Acute hepatitis presents as jaundice (mixed CB and UCB) with dark urine (due to CB), fever, malaise, nausea, and elevated liver enzymes (ALT > AST). 1. Inflammation involves lobules of the liver and portal tracts and is characterized by apoptosis of hepatocytes (Fig. 11.6). 2. Some cases may be asymptomatic with elevated liver enzymes. 3. Symptoms last < 6 months. **D.** Chronic hepatitis is characterized by symptoms that last > 6 months. 1. Inflammation predominantly involves portal tract (Fig. 11.7). 2. Risk of progression to cirrhosis.