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Done by: Ahmad Mhd Al-dhlawiy
Hamad Emad Dhuhayr

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Contents …
 General concepts for hepatitis.
 Types of hepatitis.
 HBV Structure & Antigens.
 Transmission Epidemiology.
 Pathogenesis & Immunity.
 Clinical pictures.
 Laboratory Diagnosis.
 Treatment Prevention.
 References.

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General Concepts …
 VIRAL HEPATITIS :- is a serious disease caused by virus that
attacks the liver . There are various strains of viral hepatitis which can
cause lifelong infection, cirrhosis ( scarring) of the liver , liver cancer
, liver failure, and death.
 six medically important viruses are commonly described as “hepatitis
viruses”:
HAV,HBV,HCV,HDV,HEV,HGV

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Terms for Hepatitis ….
 Acute: Short term and/or severe.
 Chronic: Lingering or lasting - may or may not be severe
 Fulminant: Developing quickly and lasting a short time, high
mortality rate.
 Cirrhosis: Hardening: may be the result of infection or toxins (e.g.
alcohol)
 Jaundice: Yellowing of the skin, eyes, etc due to raised levels of
bilirubin in the blood due to liver damage.
 Hepatocellular carcinoma: is closely associated with hepatitis
B, and at least in some regions of the world with hepatitis C virus.

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…Viral hepatitis

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…Viral hepatitis

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HBV Structure & Antigens …
HBsAg = surface (coat) protein ( 4 phenotypes : adw, adr, ayw and ayr)
HBcAg = inner core protein (a single serotype)
HBeAg = secreted protein; function unknown

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…Replication

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Modes of Transmission for HBV
 Parenteral - IV drug abusers, health workers are
at increased risk.
 Sexual - sex workers and homosexuals are
particular at risk.
 Perinatal - (Vertical) - mother(HBeAg+)
→infant.

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Incidence of Hepatitis in KSA

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risk groups for HBV infection-High
 People from endemic regions
 Babies of mothers with chronic HBV
 Intravenous drug abusers
 People with multiple sex partners
 Hemophiliacs and other patients requiting blood
and blood product treatments
 Health care personnel who have contact with blood

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Concentration of Hepatitis B Virus
in Various Body Fluids …
High Moderate
Low/Not
Detectable
blood semen urine
serum vaginal fluid feces
wound exudates saliva sweat
tears
breastmilk

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…Pathogenesis & Immunity
 Virus enters hepatocytes via blood
 Immune response (cytotoxic T cell) to viral antigens expressed on
hepatocyte cell surface responsible for clinical syndrome
 5 % become chronic carriers (HBsAg> 6 months)
 Higher rate of hepatocellular ca in chronic carriers, especially those
who are “e” antigen positive
 Hepatitis B surface antibody likely confers lifelong immunity (IgG
anti-HBs)
 Hepatitis B e Ab indicates low transmissibility

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Clinical pictures …

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Possible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5% of adult-
acquired infections
95% of infant-
acquired infections
Cirrhosis
Chronic hepatitis
12-25% in 5 years
Liver failureHepatocellular
carcinoma
Liver transplant
6-15% in 5 years 20-23% in 5 years
DeathDeath

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Acute Hepatitis B Infection

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…Laboratory Diagnosis

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Treatment …
Interferon alfa (Intron A) Response rate
is 30 to 40%.
Lamivudine (Epivir HBV)
(relapse ,drug resistance)
Adefovir dipivoxil (Hepsera)

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Prevention …
Vaccination
- highly effective recombinant vaccines.
Hepatitis B Immunoglobulin (HBIG)
-exposed within 48 hours of the incident/
neonates whose mothers are HBsAg and HBeAg
positive.
Other measures
-screening of blood donors, blood and body fluid
precautions.

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Hepatitis B Vaccine
 Infants: several options that depend on status of the
mother
 If mother HBsAg negative: birth, 0-2m,4-6m
 If mother HBsAg positive: vaccine and Hep B immune
globulin within 12 hours of birth, 1-2m, <6m
 Adults * 0,1, 6 months
 Routine booster doses are NOT routinely recommended for any group
 Vaccine recommended in
 All those aged 0-18
 Those at high risk

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References
website
 http://www.hepatitis-central.com/hbv/hepbfaq/viroligy.html
 http://en.wikipedia.org/wiki/Hepatitis_B
 http://www.who.int/mediacentre/factsheets/fs204/en/index.html
 http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-hep-b.pdf
 http://www.worldhepatitisalliance.org/AboutViralHepatitis/Prevention_Diagnosis_Treatment.aspx
 http://emedicine.medscape.com/article/177632-overview
Text books
 Richard A, HARVEY, Pamela C,Champe, Bruce D, Fisher. Microbiology 2nd edition. Lippicott Williams &
wilkins. Chapter 26. PP(273-282)
 Raphael Rubin, David S. Strayer. Rubin’s pathology 5th edition. Lippicott Williams & wilkins. Chapter 14.
PP(637-640)

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 AHMED AL DAHLAWY
 HAMAD EMAD THUHAYR