Hepatitis A, B & C

Dokter pembimbing:dr. H. Iman Firmansyah, Sp.PD, FINASIM

Dian A. Stephanie406148013

Kepaniteraan Ilmu Penyakit DalamRSPI Sulianti Saroso

Virus Hepatitis

RNARNA

Single-strandedSingle-stranded

Positive strandPositive strand

Non-envelopedicosahedral

Non-envelopedicosahedral EnvelopedEnveloped

IcosahedralIcosahedral

Flaviviridae

HEPATITIS C

HEPATITIS E

HEPATITIS A

HEPATITIS D

Picorviridae

Caliciviridae

DNADNA

Double-strandedDouble-stranded

EnvelopedEnveloped

Hepadnaviridae

HEPATITIS B

Double-strandedDouble-stranded

Negative strandNegative strandSingle-strandedSingle-stranded

Non-envelopedNon-enveloped

Classification of major viral agents causing hepatitis

Mode of transmissionMode of transmission

Injection, heterosexual

and homosexual sex

Injection, heterosexual

and homosexual sexFecal/oralFecal/oral

HEVHEVHAVHAV HBVHBV HDVHDVHCVHCV

Acute infections Acute and/or chronic infections

Adapted from Lippincott’s illustrated Review: Microbiology 2nd

TRANSMISSION

Hepatitis

HEPATITIS• (peradangan pada hati) adalah cedera hepatosit yang

menyebabkan influks sel radang akut atau kronis ke hati.

Etiologi :• Virus hepatitis• Overactive sistem imun• Obat-obatan• Toxin : alkohol, zat kimia, dll

Klasifikasi hepatitis• Hepatitis alkohol• Hepatitis obat-obatan • Hepatitis virus

– Hepatitis A– Hepatitis B– Hepatitis C– Hepatitis D– Hepatitis E– Hepatitis G

Hepatitis A

HEPATITIS A

• Merupakan penyakit self limiting dan memberikan kekebalan seumur hidup

• Epidemiologi :– Negara berkembang >>>– Di Indonesia…

• 35%-45% pada usia 5 tahun• 90% pada usia 30 tahun

Important Properties of Hepatitis A Virus (Hepatovirus)

HAV Hepatitis A virus, etiologic agent of infectious hepatitis. A picornavirus, the prototype of a new enus, Hepatovirus.

Anti-HAV Antibody to HAV. Detectable at onset of symptoms; lifetime persistence

IgM anti-HAV IgM class antibody to HAV. Indicates recent infection with hepatitis A; positive up to 4-6 months after infection.

Definition of hepatitis A virus, antigens, and antibody

PATOGENESIS

Makanan + HAV tertelan

masukHati ( hepatosit) REPLIKASI

RNA dependent Polimerase

HAV dieliminasi mel. Sinusoid, kanalikuli

USUS ( sebelum timbul gejala klinis & laboratoris)

masuk

Tubuh eliminasi HAV (IgM &IgG)

MUKOSA GI

HATI (DARAH)

IKAT RESEPTOR HEPATOSIT

PENETRASI SEL KUPFFER

RNA AMBIL ALIH SEL

HOST

SINTESIS KOMPONEN VIRAL BARU

RAKIT MENJADI

VIRUS BARU

DILEPASKAN (VESIKEL)

EMPEDUFESES

REPLIKASI HAV

Air atau makanan yg terkontaminasi feses kerang

(oyster, clam)

5 MACAM GEJALA KLINIS• Hepatitis A klasik…

– Timbul secara mendadak– Gejala prodromal sktr 1 mgg

• Hepatitis A relaps…– Timbul 6-10 mggu setelah

sembuh scra klinis• Hepatitis A kolestatik…

– Pemanjangan gejala hepatitis– Disertai: panas, gatal-gatal, dan

jaundice– AST,ALP,&ALP turun kearah

normal– Kadar bilirubin ↑

• Hepatitis A protracted…– Adanya clearance virus shgga

pulihnya fungsi hati

• Hepatitis A fulminan– Paling berat kematian– Memberatnya ikterus,– ensefalopati, – pemanjangan PT

5 MACAM GEJALA KLINIS

Diagnosis secara serologis

Pengobatan

• Infeksi akut dicegah : pemberian Ig / vaksin• Pengobatan meliputi: istirahat• Pencegahan terhadap bahan hepatotoksik (mis:

asetaminofen)• Penderita tipe kolestatik diberikan KS

Medication• Analgesic agents

– Acetaminophen (Tylenol, Tempra, Feverall)• Antiemetics

– Metoclopramide (Reglan)• Vaccines, viral, prevention

– Hepatitis A vaccine, inactivated, and hepatitis B vaccine (Twinrix)

– Hepatitis A vaccine, inactivated (Havrix, Vaqta)• Immune globulins

– Immune globulin, intramuscular (BayGam 15-18%)

http://emedicine.medscape.com/article/177484-treatment

Pencegahan

• Pencegahan umum:– Perbaikan higiene makanan-minuman– Perbaikan sanitasi lingkungan dan pribadi

• Pencegahan khusus (cara imunisasi)- Imunisasi pasif (IG)- Imunisasi aktif (inactivated vaccines ; Havriq, Vaqta, dan Avaxim)

Pencegahan Hepatitis A

Vaksinasi hepatitis A

Hepatitis B

Important Properties of Hepatitis B virus

Classification Classification Hepadnaviridae (hepatotropic DNA viruses)Hepadnaviridae (hepatotropic DNA viruses)

Virus Virus VirionVirion 42 nm in diameter (nucleocapsid 18 nm)42 nm in diameter (nucleocapsid 18 nm)

CompositionComposition DNADNA

GenomeGenome Double-stranded DNA, circular, 3.2 kb in size, Double-stranded DNA, circular, 3.2 kb in size, infectious, negative sense is full length and positive infectious, negative sense is full length and positive sense is partially complete. The gap must be sense is partially complete. The gap must be complete at beginning of replication cycle complete at beginning of replication cycle

ProteinsProteins Two major polypeptides are present in HBsAg; one Two major polypeptides are present in HBsAg; one polypeptide is present in HBcAgpolypeptide is present in HBcAg

EnvelopeEnvelope Contain HBsAg and lipid Contain HBsAg and lipid

ReplicationReplication In vivo replication: liver, lymphocytes, pancreas, In vivo replication: liver, lymphocytes, pancreas, other organs. other organs.

HBcAg in nucleus; HBsAg in cytoplasm; both mature HBcAg in nucleus; HBsAg in cytoplasm; both mature virus and 22 spherical particles consist of HBsAg virus and 22 spherical particles consist of HBsAg secreted from the cell surfacesecreted from the cell surface

HBV Hepatitis B virus, etiologic agent of serum hepatitis. A hepadnavirus

HBsAg Hepatitis B surface antigen. Surface antigen of HBV detectable in large quantity in serum ; several subtype identified

HBeAg Hepatitis B enveloped antigen. Soluble antigen. A part of the core; related to the potential for infectivity and HBV replication with high titer of HBV in serum

HBcAg Hepatitis B core antigen

Anti-HBsAg Antibody to hepatitis B surface antigen. Indicates past infection with and immunity to HBV, presence of passive antibody from HBIg, or immune response from HBV vaccine

Anti-HBeAg Antibody to hepatitis B enveloped antigen. Presence in serum of HBsAg carrier suggests lower titer of HBV

Anti-HBcAg Total antibody to hepatitis core antigen. Indicates infection with HBV at some undefined time in the past

IgM anti-HBcAg IgM class antibody to HBcAg. Indicates recent infection with HBV; positive for 4-6 months after infection

Definition of hepatitis B virus, antigens, and antibody

Cara Transmisi HBV• Melalui darah:

– Penerima produk darah– IVDU– Pasien hemodialisis– Pekerja kesehatan– Pekerja yg terpapar darah

• Transmisi seksual• Penetrasi jaringan (perkutan)

atau permukosa:– Tertusuk jarum– Penggunaan alat medis

berulang yg terkontaminasi

– Penggunaan bersama alat cukur dan silet

– Tato– Akupuntur– Tindik– Penggunaan sikat gigi

bersama• Transmisi maternal-neonatal

atau maternal-infant• Tidak ada bukti penyebaran

fecal-oral.

PATOGENESIS

Virus masuk ke dalam sel hati melalui aliran darah

Hepatitis kronis

Kerusakan sel hati yang terinfeksi

DNA HBV,HBsAg,HBeAg, anti HBc (terdeteksi dalam serum)

REPLIKASI ( tanpa adanya kerusakan jaringan hati & tanpa gejala klinis)

Penderita dapat sembuh

Gejala Klinis

• Hepatitis Akut– Gejala: flu, anoreksia,

mual muntah, ikterus dan pembesaran hati

• Hepatitis kronis– Peningkatan kadar

aminotransferase atau HBsAg slm 6 bln

• Gagal hati fulminan– Ditandai: timbulnya

ensefalopati hepatikum, ikterus

• Pengidap Sehat– Sering terjadi: pada

bayi di daerah yang endemik secara vertikal dari ibunya

Scheme of typical clinical and laboratory features of acute hepatitis B

Scheme of typical laboratory features of wild-type chronic hepatitis B

HBVHasil test :

Vaksin HBV dengan pemberian Ig

PENCEGAHAN SECARA UMUM :KIE tentang hubungan seks bebas dan pemakaian alat secara bersamaan

Pencegahan HBV u/ Tim medis1) Vaksinasi 2) Protective dressing (sarung tangan, kacamata pelindung, dll)3) Eliminasi bebas risiko limbah yang berpotensi

terkontaminasi 4) Menggunakan peralatan yang runcing dengan hati2

Rekomendasi profilaksis HBV post-exposureDonor Resipien

Hepatitis C

Hepatitis C • Penyakit Hepatitis C adalah penyakit hati yang disebabkan

oleh virus Hepatitis C (HCV)

• Transmisi– Melalui darah– Transmisi seksual– Maternal-neonatal– Tindakan operasi

Important properties of Hepatitis C virus (Hepacivirus) Classification Classification FlaviviridaeFlaviviridae

Virus Virus VirionVirion 30-60 nm in diameter30-60 nm in diameter

CompositionComposition RNARNA

GenomeGenome Single-stranded DNA, linier, 9.4 kb in size, infectious, Single-stranded DNA, linier, 9.4 kb in size, infectious, positive sensepositive sense

Replication and Replication and ProteinsProteins

Genomic length transcript produce a precusor Genomic length transcript produce a precusor polyprotein encoding nonstructural protein (replicase, polyprotein encoding nonstructural protein (replicase, transcriptase)transcriptase)

Subgenomic mRNA encodes struktural proteinSubgenomic mRNA encodes struktural protein

EnvelopeEnvelope Two glycoproteinsTwo glycoproteins

Variation Variation 6 different genotype, > 90 subtype6 different genotype, > 90 subtype

Pemeriksaan • Tes serologis

– Anti-HCV• HCV RNA• Enzyme Immuno Assay (EIA)• PCR

Penatalaksanaan• Interferon alfa• Pegylated interferon alfa• Ribavirin

Pencegahan• Saat ini, tidak ada vaksin untuk mencegah penularan HCV.• Cara terbaik untuk mencegah penularan HCV adalah:

– Mencegah kontak dengan darah yang terinfeksi dan organ-organ

– Menghindari perilaku seksual berisiko tinggi seperti banyak pasangan dan hubungan seksual oral-anal.

– Menghindari alkohol dan obat-obatan yang dapat merusak hati yang dapat membantu memperlambat laju perkembangan penyakit.