ACUTE VIRAL HEPATITIS

HEPATITIS A -single stranded RNA virus -one serotype -genus->hepatovirus -excreted into stool & bile HEPATITIS B -HBV DNA 1. S gene & Pre-S region HBsAG 2. C gene HBcAG & HBeAG 3. P gene DNA polymerase 4. X gene HBxAG Viral markers HbsAG - HBsAB HBeAG - HBeAB HBcAG - Anti-HBC-IgM & IgG HBV DNA HEPATITIS C -lipid enveloped,single stranded RNA -single open reading frame -genus flavivirus & pestivirus -several genotypes & subtypes -mutation -Transfusion of blood & blood products -iv drug abuse -heterosexual & household contact -occupational exposure -no risk factor -immune mediated hepatocellular damage -Cytotoxic T-cell IP - 2-26w Jaundice <25 % Fatigue, headache, malaise, anorexia, nausea & abd.pain

Viral Description

Epidemiology MOT Period Infectivity Sources Outbreak Pathogenesis CP Symptoms

Feco-oral route 2-3w before & 2w after Water & food contamination Immune & non immune IP - 30days Acute self limiting disease Prodromal period: Anorexia, malaise, fever, headache, diarrhea, dehydration Jaundice, abd.pain, nausea, vomiting pruritis resolve 4w HSM

Signs

IP - 30-180days Prodromal period: Low grade fever,headache,malaise,anorexia&nausea Serum sickness like illness: (arthralgia, arthritis, urticaria, maculopapulo rash) Hematuria & proteinuria (rare) Popular dermatitis & lymphadenopathy Icteric phase 1-2w, pruritus, nausea, vomiting, jaundice Hepatomegaly: mild & tender, Splenomegaly: mild

Diagnosis & Lab

Complications

1. HAV-IgM 2. HAV-IgG 3. Aminotransferases 1. Fulminant hepatitis rare (0.1%) 2. No chronic hepatitis 3. No carrier state 4. No vertical transmission 5. No cancer predisposition
1. Cholestatic hepatitis 2. Relapsing hepatitis 3. Immune complex disorders 4. Autoimmune hepatitis

1. Fulminant hepatitis rare 2. Chronicity is common 25% 3. Carrier 4. Vertical transmission 5. Cancer predisposition (most common)

1. ELISA 2. PCR 3. Aminotransferase 1. Fulminant hepatitis very rare 2. Chronic hepatitis 50-70% acute cases 3. Carrier 4. Vertical transmission < HBV 5. Cancer predisposition

Atypical Clinical Manifestations