5/19/2018 Hepatitis B

1/17

Hepatitis B

5/19/2018 Hepatitis B

2/17

Virology Hepatitis B virus is a DNA virus with small, circular, 3200-bp size

HBVoe o! a !amily o! aimal viruses, hepa"aviruses

#hepatotropic DNA viruses$, a" is classi%e" as hepa"avirus

type &

'eplicate i the liver but e(ist i e(trahepatic sites, cotai their

ow e"ogeous DNA polymerase, have partially "ouble-stra"

a" partially sigle-stra" geomes acute a" chroic

hepatitis a" hepatocellular carcioma

Hepatitis B atiges a" HBV DNA have bee i"eti%e" i

e(trahepatic sites, iclu"ig lymph o"es, boe marrow,

circulatig lymphocytes, splee, a" pacreas

5/19/2018 Hepatitis B

3/17

Virology

HBsAg protei sur!ace

HBcAg core atige

HBeAg a soluble, oparticulate,

ucleocapsi" protei that isimmuologically "istict !rom itact HBcAgbut is a pro"uct o! the same ) gee

HBeAg "urig chroic hepatitis B isassociate" with ogoig viral replicatio,i!ectivity, a" i*ammatory liver i+ury

5/19/2018 Hepatitis B

4/17

cheme o! typical cliical a"laboratory !eatures o! acute hepatitis B

5/19/2018 Hepatitis B

5/17

cheme o! typical laboratory !eatureso! wil"-type chroic hepatitis B

5/19/2018 Hepatitis B

6/17

pi"emiology a" .lobal/eatures

cubatio #"ays$1 30&0, mea 4050

6set1 si"ious or acute

Age pre!erece1 7oug a"ults #se(ual a"percutaeous$, babies, to""lers

8rasmissio1 percutaeous, periatal, se(ual

everity1 6ccasioally severe

/ulmiat1 09&&:

;rogressio to chroicity1 6ccasioal #&&0:$ #50: o!

eoates$ )arier1 09&30:

)acer1

5/19/2018 Hepatitis B

7/17

High-'is> ;opulatios !or =hich HBV-!ectio creeig s 'ecomme"e"

;ersos bor i coutries?regios with a high #@:$ a"iterme"iate #@2:$ prevalece o! HBV i!ectio iclu"igimmigrats a" a"opte" chil"re a" iclu"ig persos bor i theite" tates who were ot vacciate" as i!ats a" whoseparets immigrate" !rom areas o! high HBV e"emicity9

Househol" a" se(ual cotacts o! persos with hepatitis B ;ersos who have use" i+ectio "rugs

;ersos with multiple se(ual cotacts or a history o! se(uallytrasmitte" "isease

e who have se( with me

mates o! correctioal !acilities ;ersos with elevate" alaie or aspartate amiotras!erase levels

;ersos with H)V or HV i!ectio

Hemo"ialysis patiets

;regat wome

;ersos who reCuire immuosuppressive or cytoto(ic therapy

5/19/2018 Hepatitis B

8/17

ymptoms a" igs

prodromal symptoms

)ostitutioal symptoms o! aore(ia, auseaa" vomitig, !atigue, malaise, arthralgias,myalgias, hea"ache, photophobia, pharygitis,cough, a" coryza may prece"e the oset o!

+au"ice by &2 wee>s9

A low-gra"e !ever betwee 3 a" 35)#&00&02/$ is more o!te preset i hepatitisA9

Dar> urie a" clay-colore" stools may beotice" by the patiet !rom &E "ays be!ore theoset o! cliical +au"ice

5/19/2018 Hepatitis B

9/17

ymptoms a" igs

clinical jaundice

;ro"romal symptoms usually"imiish, but i some patiets mil"weight loss #29EE >g$

8he liver becomes elarge" a"te"er right upper Cua"rat paia" "iscom!ort

pleomegaly a" cervicala"eopathy are preset i &020: o!patiets with acute hepatitis

5/19/2018 Hepatitis B

10/17

ymptoms a" igs

recovery phase

)ostitutioal symptoms "isappear, but usually someliver elargemet a" abormalities i liver biochemicaltests are still evi"et

8he "uratio o! the posticteric phase is variable, ragig

2&2 wee>s, a" is usually more prologe" i acutehepatitis B a" )

)omplete cliical a" biochemical recovery is to bee(pecte" &2 moths a!ter all cases o! hepatitis A a" a" 3F moths a!ter the oset o! +au"ice i three-

Cuarters o! ucomplicate" el!-limite" cases o! hepatitis B a" ) #amog healthy

a"ults, acute hepatitis B is sel!-limite" i 5E55: whilehepatitis ) is sel!-limite" i oly &E:$

5/19/2018 Hepatitis B

11/17

Gaboratory /eatures

A8 a" AG8variable icrease "urig the pro"romalphase o! acute viral hepatitis a" prece"e the rise ibilirubi level

;ea> levels vary !rom F00F000 or more

au"ice sclera or s>i whe the serum bilirubivalue is @F3 mol?G #29E mg?"G$

Neutropeia a" lymphopeia are trasiet a" are!ollowe" by a relative lymphocytosis

easuremet o! the prothrombi time #;8$ Hypoglycemia

erum albumi

erologic mar>er

5/19/2018 Hepatitis B

12/17

)ommoly coutere" erologic;atters o! Hepatitis B !ectio

5/19/2018 Hepatitis B

13/17

)omplicatio

Relapsing hepatitiswee>s to moths a!terapparet recovery !rom acute hepatitis recurreceo! symptoms, amiotras!erase elevatios,occasioally +au"ice, a" !ecal e(cretio o! HAV

Cholestatic hepatitis uusual Fulminant hepatitis#massive hepatic ecrosis$

8he combiatio o! rapi"ly shri>ig liver size,rapi"ly risig bilirubi level, a" mar>e" prologatio

o! the ;8, eve as amiotras!erase levels !all,together with cliical sigs o! co!usio,"isorietatio, somolece, ascites, a" e"emahepatic !ailure with ecephalopathy

5/19/2018 Hepatitis B

14/17

)hroic hepatitis

#&$lac> o! complete resolutio o! cliical symptomso! aore(ia, weight loss, !atigue, a" thepersistece o! hepatomegalyI

#2$8he presece o! bri"gig?iter!ace ormultilobular hepatic ecrosis o liver biopsy"urig protracte", severe acute viral hepatitisI

#3$/ailure o! the serum amiotras!erase, bilirubi,a" globuli levels to retur to ormal withi 4&2 moths a!ter the acute illess

#F$8he persistece o! HBeAg !or @3 moths orHBsAg !or @4 moths a!ter acute hepatitis

5/19/2018 Hepatitis B

15/17

8reatmet

A ucleosi"e aalogue !or severe,but ot mil"mo"erate, acutehepatitis B

Gamivu"ie, etecavir, telbivu"ie

5/19/2018 Hepatitis B

16/17

;ree(posure prophyla(is

5/19/2018 Hepatitis B

17/17

;ree(posure prophyla(is

Perinatale(posure o! i!ats bor to HBsAg-positive mothers a sigle

"ose o! HB., 09E mG #$ i the thigh immediately after birth, three

i+ectios o! recombiat hepatitis B vaccie to be starte" withi the %rst

&2 hours o! li!e9

Direct percutaeous ioculatio or trasmucosal e(posure to HBsAg-

positive bloo" or bo"y *ui"s -a sigle "ose o! HB., 0904 mG?>g,

a"miistere" as soo a!ter e(posure as possible, is !ollowe" by a

complete course o! hepatitis B vaccie to begi withi the %rst wee>

Sexualcotact to a patiet with acute hepatitis B, a sigle "ose o!

HB., 0904 mG?>g, shoul" be give withi &F "ays o! e(posure

Booster "oses are recomme"e" whe ati-HBs levels !all to J&0 m?mG