Comprehensive Overview of Hepatitis Viruses and Their Detection Methods

hepatitis symptoms

jaundice, elevated bilirubin, elevated ALT

direct hepatitis viruses

hepatitis A-E (F maybe) and (G now changing)

-viruses are from different genome (RNA or DNA) and different families

indirect hepatitis viruses

EBV, CMV also can impact liver function secondary inflammation

acute

rapid onset, short course

chronic

slow process; persisting over long time period

latent

present but not actively reproducing

degenerative

progressive; often irreversible deterioration

reactivated

restored ability to replicate

detection methods

molecular, immunofluorescence, CIEP, ELISA, AG and AB

Hepatitis B

-hepadnaviridae

-partially dsDNA, partially ssDNA, enveloped

-endemic in far east, sub-africa, middle east and south america

transmission HBV

-primarily parenteral and exposure to infected blood or body fluids

-sexual, body fluids, perinatal

-sexual transmission most common

high risk HBV

IV drug users, homosexuals, household contacts, health care personnel, tattoos and body piercings

HBV infections

-virus enters host liver

-2-6 mos incubation -> insidious onset

-fever, anorexia, hepatic tenderness

-50-70% asymptomatic

-20-30% benign resolution

-10% chronic

-15-25% premature death from cirrhosis or heptatocellular carcinoma

acute HBV infection

-anti-HBc IgM = pos

-anti-HBc IgG = neg

-HbsAG = pos

-Anti-HBs = neg

early acute HBV infection

-anti-HBc IgM = neg

-anti-HBc IgG = neg

-HbsAG = pos

-Anti-HBs = neg

resolved acute HBV infectio n

-anti-HBc IgM = neg

-anti-HBc IgG = pos

-HbsAG = neg

-Anti-HBs = pos

not infected prior vaccination for HBV

-anti-HBc IgM = neg

-anti-HBc IgG = neg

-HbsAG = neg

-Anti-HBs = pos

not infected

-anti-HBc IgM = neg

-anti-HBc IgG = neg

-HbsAG = neg

-Anti-HBs = neg

chronic HBV infection

-anti-HBc IgM = neg

-anti-HBc IgG = pos

-HbsAG = pos

-Anti-HBs = neg

spectrum of chronic HBV

-chronic persistent hepatitis = asym

-chronic active hepatitis = sym. exacerbations of hepatitis

-cirrhosis of liver

-hepatocellular carinoma

HBV vaccination

-non infectious HBsAG

-recommended for all infants and high risk adults

-3-4 doses/6 months

-hepatitis B immune globulin recommended after exposure

hepatitis A

-picornaviridae

-ssRNA, non enveloped

HAV transmission

oral-fecal route

-typically from within household especially children from 5-15 years old

-children may be asym.

-possible sexual transmission

HAV incubation and replicates

- 28 days in the liver

-shed in feces 2 weeks before sym. to 1 week after

-non chromic

-self limiting, typically asym. liver tropism

HAV diagnosis

-anti-HAV IgM

-anti-HAV IgG

HAV vaccine

-inactivated HAV

-recommended for children over 12 mo.

-travelers and high risk patients

-2 doses recommended

hepatitis C

-flaviviridae

-ssRNA

-aka NANB = non A and non B hepatitis

-very similiar to HBV demographic

-most sub-clinical cases - asym

-more risk of chronic disease

HCV transmission

primarily parenteral

HCV at risk patients

-health care workers

-IV drug uses

-transfusion patients

-less immunogenic than HBV

lab diagnosis for HCV

-ELISA testing for c100, c33, and c22 proteins and "5-1-1"

-anti-HCV

-RIBA (recombinant immunoblot assay)

-quantitative HCV RBC PCR

hepatitis D

-delta virion

-defective ssRNA virus (incomplete virus)

-requires HBV surface antigen to cause disease

-essentially requires patiennts with chronic HBV

HDV coinfection markers

-anti-HBc IgM

-HBsAg

-Anti-HDV IgM

HDV superinfection markers

HBsAG

anti-HDV

hepatitis E

-hepeviridae

-"enteric" transmitted hepatitis

-ssRNA, small non-enveloped

-acute self limiting similar to HAV, usually not chronic

HEV detection

anti-HEV IgG and IgM

RT-PCR HEV RNA in stool and serum

common in Asia, africa and central america