9. Symptoms
• The clinical presentation of infectious hepatitis varies with the
individual, as well as with the specific causative virus.
• The classic presentation of acute infectious hepatitis involves 4
phases.
10. 1. Phase 1 (viral replication phase) – Patients are asymptomatic
during this phase; laboratory studies demonstrate serologic
and enzyme markers of hepatitis
2. Phase 2 (prodromal phase)-
– Anorexia
– Ausea
– Vomiting
– alterations in taste
– arthralgias,
– malaise, fatigue
– urticaria
11. 3. Phase 3 (icteric phase)-
• Yellowish discoloration of eyes
• Dark urine
• RHC pain
4. Phase 4 (convalescent phase) – Symptoms and icterus
resolve, and liver enzymes return to normal
12. Signs
• Physical findings in patients with hepatitis vary with
the type of hepatitis and the time of presentation.
• General Ex-
– Ill looking
– Febrile to touch
– Signs of dehydration
– Icterus
– Cervical lymphadenopathy
– urticarial rashes
15. Source of
virus
feces blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
feces
Route of
transmission
fecal-oral percutaneous
permucosal
percutaneous
permucosal
percutaneous
permucosal
fecal-oral
Chronic
infection
no yes yes yes no
Prevention pre/post-exposure
immunization
pre/post-exposure
immunization
blood donor
screening;
risk behavior
modification
pre/post-exposure
immunization;
risk behavior
modification
ensure safe
drinking
water
Type of Hepatitis
A B C D E
16. Hepatitis A
Incubation period: Average 30 days
Range 15-50 days
Complications: Fulminant hepatitis
Cholestatic hepatitis
Relapsing hepatitis
Post hepatic syndrome
Chronic sequelae: None
17. Laboratory Diagnosis
Acute infection is diagnosed by the detection of
HAV-IgM in serum.
Past Infection i.e. immunity is determined by the
detection of HAV-IgG.
Cell culture – difficult and take up to 4 weeks, not
routinely performed
Direct Detection – EM, RT-PCR of faeces. Can detect
illness earlier than serology but rarely performed
18. Treatment
No specific Tx.
-Bed rest
-Symptomatic Rx
Fever-Antipyretics
Vomiting-Antiemetics
Pruritus-colestyramine
19. Prevention
Pre-exposure
travelers to intermediate and high HAV-endemic
regions
Post-exposure (within 14 days)
• Routine
-household and other intimate contacts
• Selected situations
-institutions (e.g., day care centers)
-common source exposure (e.g., food prepared by
infected food handler)
20. Hepatitis B
Incubation period: Average 60-90 days
Range 45-180 days
Spectrum
– Chronic Persistent Hepatitis - asymptomatic
– Chronic Active Hepatitis - symptomatic exacerbations of
hepatitis
– Cirrhosis of Liver
– Hepatocellular Carcinoma
21. Laboratory Diagnosis
• HBsAg - used as a general marker of infection.
• HBsAb - used to document recovery and/or immunity to
HBV infection.
• anti-HBc IgM - marker of acute infection.
• anti-HBc IgG - past or chronic infection.
• HBeAg - indicates active replication of virus and
therefore infectiveness.
• Anti-Hbe - virus no longer replicating. However, the
patient can still be positive for HBsAg which is made by
integrated HBV.
• HBV-DNA - indicates active replication of virus, more
accurate than HBeAg especially in cases of escape
mutants. Used mainly for monitoring response to therapy
22. Treatment
• 1. Symptomatic
• 2. Antivirals
– Indications
• HBeAg +ve carriers with chronic active hepatitis
• Decompensated cirhosis
• Detection of HBV DNA by PCR
– Drugs
• alpha-interferon
• Lamivudine
• Adefovir
• Entecavir
23. Prevention
• Active immunization
– Recombinant HbsAg vaccine
– For individuals at risk and for neonates
• Passive immunization
– Hep B immunoglogulines
– Following acute post exposure and neonates who
born to hep B + mothers.
• Other measures
– - screening of blood donors, blood and body fluid
precautions.
24. Hepatitis C
Incubation period: Average 6-7
wks
Range 2-26 wks
Spectrum
Chronic hepatitis-80%
Cirrhosis-20-30%
25. Laboratory Diagnosis
1. HCV antibody - generally used to
diagnose hepatitis C infection. Not
useful in the acute phase.
2. HCV RNA-by PCR
3. HCV-antigen
26. Treatment
• Acute- No specific Tx, Supportive Mx
• Chronic-
– Interferon
– Ribavirin
27. Prevention
• Screening of blood, organ, tissue donors
• High-risk behavior modification
• Blood and body fluid precautions
• No vaccine available.
28. Hepatitis D
• A defective virus, may only co-infect with HBV or
superinfect person with hep B.
29. Hepatitis E
Incubation period: Average 40 days
Range 15-60 days
Spectrum
Fulminant hepatitis-1-2%
No chronic form