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Serologic diagnosis of HBVinfection

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.

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Serologic diagnosis of HBVinfection

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  1. Serologic diagnosis of HBVinfection

  2. 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

  3. Outcome of hepatitis B infection

  4. 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)

  5. Chronic hepatitis

  6. Hepatitis B infection

  7. Carrier state • Presence of HBsAg in serum >6 months • May be symptomatic /asymptomatic • More common following vertical transmission & immunocompromised

  8. Biochemical abnormalities in chronic hepatitis • Elevation of AST,ALT • S. Bilirubin elevated at times

  9. 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%)

  10. Pathogenesis of HCV infection • Cytotoxic T cells response to virally infected hepatocytes • Not directly cytopathic • Defects in HCV specific cellular immunity

  11. 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

  12. Serologic diagnosis of HCVinfection

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

  14. Clinical outcomes of HDV infection

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

  16. Comparison of hepatitis viruses

  17. 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)

  18. Hepatitis-clinical manifestations... Icteric phase Jaundice • Pruritis • Pale coloured stool,dark urine • Tender hepatomegaly

  19. 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)

  20. Summary • Definition of hepatitis • Hepatitis viruses, serologic diagnosis • Clinical manifestations • Acute hepatitis,fulminant hepatitis,chronic hepatitis, carrier state. • Cirrhosis, HCC ……

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