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Viral Hepatitis Tutorial

The document discusses viral hepatitis types A through E and G. It provides information on key aspects of each virus such as genome type, typical onset of symptoms, severity, chronicity, carrier state, detection methods, and transmission routes. Treatment options are also summarized for some hepatitis types. Serological testing patterns and interpretations are outlined for hepatitis A, B, C, D, and E to aid in diagnosis.

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110 views

Viral Hepatitis Tutorial

The document discusses viral hepatitis types A through E and G. It provides information on key aspects of each virus such as genome type, typical onset of symptoms, severity, chronicity, carrier state, detection methods, and transmission routes. Treatment options are also summarized for some hepatitis types. Serological testing patterns and interpretations are outlined for hepatitis A, B, C, D, and E to aid in diagnosis.

Uploaded by

annie1970
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Viral Hepatitis

Tutorial

Hepatitis Viruses
FEATURE Family A
Piconavi ridae ssRNA+ Hepato virus

B
Hepadna viridae dsDNA Orthohe padnavirus

C
Flaviviri dae ssRNA+ Hepaci virus

D
Unclssifi ed ssRNA-

E
Hepeviri dae ssRNA+

G
Flaviviri dae ssRNA+

TTV
?Circovi ridae ssDNAAnello virus

Genus

Deltavirus Hepevirus Tentative Hepaci virus

Mean IP (days) Typical onset Age preference

20-30 Sudden
Child young adult

60-90 Slow All

60-90 Slow All

60-90
Variable

20-30 Sudden All

? ? ?

? ? ?

All

Severity

Usually mild <0.5%

Modera te <1-2%

Can be severe 0.5-1%

Severe in HBV+ high

Usually mild 1-2%

Acute Fulminat hepatitis

Hepatitis Viruses (Cont)


FEATURE Chronicity Carrier state Serologic detection Transmission A None None Yes Faecooral B Low-Mod Yes Yes C High yes Yes D Mod-high Yes Yes E None None ? Faecooral G Likely Likely No TTV Likely Likely No

Blood Blood Blood Sexual Sexual Sexual Perinatal Perinatal Yes + ? Yes (B) (B) -

Blood Blood ?Sex ?Faecooral ?Vertical ?Vertical ? ? -

Hyper Ig protection Vaccine Antiviral Treatment

Yes + -

None -

IFN IFN 3TC Ribavirin Adefovir

Hepatitis A Virus Infection


Typical Serologic Course
Symptoms

Total anti-HAV

Titer

ALT

Fecal HAV

IgM anti-HAV

Months after Exposure

12

24

HBV
HBs Ag Hbe Ag Anti-HBc IgM IgG Anti HBe Anti HBs

Interpretation
Incubation period Acute hepatitis B infection Carrier state Carrier state Convalescence Recovery HBV Infection without detectable HBsAg Possibilities: (1) HBV infection in remote pass, (2) low level HBV carrier (3) window bet disappearance of HBsAg and appearance of HBsAb, (4) False positive or non specific reaction Vaccine type response

+ + + + -

+ + + -

+ +/+/+

+ + + + + -

+ + -

+ + -

Common HBV Serology Patterns


Interpretation No evidence of HBV infection Acute HBV infection Chronic HBV (if HBsAg + for >6mths) (1)Window period (2) HBV infection in remote pass, (3) low level HBV carrier (4) False positive Previous HBV infection HBV vaccine response HBsAg + + AntiHBcIgM + Total AntiHBc + + AntiHBS -

+ -

+ +

HDV
HBs Anti HBc Ag Total IgM HBe Ag Anti HBe Anti HBs Anti-Delta Total IgM Interpretation Acute coinfection with HBV and Delta Acute Delta superinfection (anti-Delta low), or chronic Delta superinfection (anti-Delta low) Recovery from acute Delta superinfection (anti-Delta low), or, rarely, chronic Delta superinfection (anti-Delta level high), usually without symptoms Previous HBV and Delta infection with probable recovery Recovery from HBV and Delta infection

+/-

+/-

+/-

+/-

+ +

+ +/-

+ +

INNO-LIA
Streptavidin Level 3+ anti-human IgG, strong positive Level 1+ human IgG, moderate positive Level + human IgG, weak positive C1 C2 E2 NS3 NS4 NS5

HCV Antigens

INNO-LIA
Negative For HCV Ab
-all HCV Ag lines negative -only one HCV Ag lines + (except NS3)

Positive For HCV Ab


-at least 2 HCV Ag lines + or >

Indeterminate for HCV Ab


-one HCV Ag line 1+ or > -NS3 + or >

Interpreting Anti-HCV Test Results


Anti HCV Positive (1) Anti-HCV screening test positive and RIBA/NAT positive; or (2) Anti-HCV screening test positive, NAT negative, RIBApositive Anti-HCV Negative (1) Anti-HCV screening test negative; or (2) Anti-HCV screening test positive, RIBA negative (3) Anti-HCV screening test positive, NAT negative, RIBA negative Anti-HCV Indeterminate An indeterminate anti-HCV result is defined as anti HCV screening test positive, RIBA indeterminate

Algorithm For The Serologic Diagnosis Of HAV, HBV, HCV, HDV & HEV

Request anti-HAV IgG to exclude previous infection*

Negative Anti-HAV Positive IgM

Recent HAV infection

Request anti-HEV IgG to exclude previous infection*

Negative Anti-HEV Positive IgM

Recent HEV infection

*Exclude recent transfusions, Ig, or maternal Ab

Algorithm For The Serologic Diagnosis Of HAV, HBV, HCV, HDV & HEV

HCV infection unlikely Request HCV RNA if indicated

Negative Anti- HCV

Positive

Active or previous HCV infection

HCV RNA assay Negative Positive

Previous HCV suspected

Active HCV

Algorithm For The Serologic Diagnosis Of HAV, HBV, HCV, HDV & HEV Anti-HBc Total Negative No active HBV infection Negative HBsAg Positive

Positive Indicates either active or previous HBV infection

Request anti-HBs test Negative No previous HBV infection Positive Vaccine type response*

Request anti-HBs test Negative Active HBV cannot be excluded Positive Previous HBV infection; immunity confirmed*

*Exclude recent transfusions, Ig, or maternal Ab

Positive +anti-HBc positive HBsAg Anti-HDV IgG Positive Negative No active HDV infection HDV HBeAg Anti-HBe

Negative

Active HBV infection either acute or chronic

Anti-HBc IgM Negative Chronic HBV infection Positive Recent / Ac HBV infection

Anti-HDV Negative IgM/ HDVRNA

Positive

HBeAg positive

Neither positive

Anti-HBe positive

HDV infection acute or chronic

HBV infectivity is relatively high

HBV infectivity is relatively low

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