VIRAL HEPATITIS

HEPATITIS
Hepatitis is a medical condition

defined by the Inflammation of the

liver.
This is usually characterized by the
presence of inflammatory cells in the
tissue of the organ.
The name is from the Greek Hepar
the root being hepat meaning liver &
suffix itis meaning inflammation.

Introduction
This is basically refers to the primary

infection of the liver by any one of a

heterogeneous group of hepatitis
viruses which currently consists of
types A,B,C,D,E and G.
Hepatitis viruses are taxonomically
unrelated .Except for type B which is
a DNA virus,all the others are RNA
viruses

Type A Hepatitis
This type occurred sporadically or

as epidemics,affecting mainly
children and young adults,and
transmitted by the fecal-oral route.
This was called Infective or

Infectious Hepatitis ,later termed

Type A Hepatitis.

Clinical features
Large majority of infections are asymtomatic.
The incubation period is 2-6 weeks .
Onset may be acute or insidious .

Fever
Malaise
Anorexia
Nausea
Vomiting
Liver tenderness
These usually subside with onset of Jaundice
Recovery is slow ,over a period of 4-6 weeks

Hepatitis A virus
In 1973,Feinstone and

coworkers,using
Immunoelectron
microscopy( IEM)
HAV is a 27 nm,
noneveloped RNA virus
belonging to the
Picornavirus family.
It was originally
designated as
enterovirus 72
HAV is now recognised
as the prototype of a
new genus
Hepatovirus

Hepatitis A virus
HAV can be grown in

some human and

simian cell cultures
and is the only human
hepatitis virus which
can be cultivated in
vitro.
HAV is resistant to
inactivation by the
heat at 60 degree
celsius for 1 hour but
it is inactivated by
boiling for 1 minute

Hepatitis A virus

Prevention

TYPE B HEPATITIS
Type B hepatitis is the most widespread

and the most important type of viral

hepatitis.
More than a third of the worlds
population is estimated to be have been
infected by the Hepatitis B
virus(HBV).
These develop serious liver disease
,including chronic hepatitis ,cirrhosis
and primary Hepatic cancer.

Type B Hepatitis
As there is an effective vaccine against

HBV,Hepatocellular carcinoma
becomes the only human cancer which
is vaccine preventable
This type of viral hepatitis ,transmitted
mainly by inoculation,was originally
observed in persons receiving serum
inoculation or blood transfusion.
This had been given various names such
as homologous Serum jaundice ,Serum
hepatitis and Transfusion Hepatitis.
It was later called Type B hepatitis.

Clinical features
This incubation period is long,about 1-6

months.
The onset is insidious and fever is not
prominent.
Extrahepatic complications like
Arthralgia,Urtcaria and rarely
Polyarteritis or Glomerulonephritis may
occur
These are ascribed to circulating to
immune complexes containing the viral
surface antigen.

Hepatitis B virus
HBV is a 42 nm DNA virus with an

outer envelope and an inner core,27

nm in diameter ,enclosing the viral
genome and a DNA polymerase.
HBV is assigned to a separate family
Hepadnaviridae(hepatotropic DNA
viruses),which consist of two
genera.,Orthohepadnavirus and
Avihepadnavirus

Hepatitis B virus

Hepatitis B virus

Causes of
Transmission
HBV is a bloodborne

virus and the

infection is
transmitted by
parenteral,sexual,an
d perinatal modes
Virus may also be
present in other
body fluids and
Excreations,such as
saliva ,Breast
Milk,Semen ,Vaginal
Secreations,Urine,bil
e and feces.

Prophylaxis
General prophylaxis consists in avoiding
risky practices like .
Promiscuos sex.
Injectable drug abuse .
And direct or indirect contact with blood .
Semen or other body fluids of patients
and carriers.
Health Education,use of disposable
syringes and needles,screening of
blood,semen and organ donors,have all
helped to an extent,but these alone
cannot eliminate the risk altogether.

Prophylaxis
Both passive and active methods of

Immunisation are available.

Hyperimmune Hepatitis B immune
globulin(HBIG) prepared from human
volunteers with high titre antiHBs,administered IM in a dose of 300-500
i.u.soon after exposure to infection
constitutes passive Immunisation.
The first vaccine introduced in 1982,was
prepared from pooled plasma of Healthy
Human carriers with high level Antigenemia.

Prophylaxis
The 22nm HBsAg particles separated

by Ultracentrifugation were treated

with Proteinase,urea and formaldehyde
and uses as the vaccine.
The currently preferred vaccine is
genetically engineered by cloning the
S gene of HBV in bakers yeast .
It consists of Unglycosylated HBsAg
alone.It is given with alum adjuvant.

Treatment
No specific antiviral

treatment is available
for acute HBV
infection.
Interferon Alpha,alone
or in combination with
other antiviral agents
such as lamivudine
and famcyclovir,has
been beneficial in
some cases of chronic
Hepatitis.

Type C Hepatitis
Attempts to identify the group of

non A-non B viruses by

experimental infection in
chimpanzees led to the discovery of
Hepatitis C virus (HCV).
It is now most common cause of post

transfusion Hepatitis in the

developed countries.

Clinical features
The incubation period is long..15 to 150

days
The acute illness is usually mild or anicteric.
Overt jaundice is seen in about 5% of
patients only
The important part in hepatitis C is the
chronic illness
About 50% to 80% of patients progress to
chronic Hepatitis,with some developing
cirrhosis and Hepatocellular Carcinoma

Epidemiology
The HCV infection is seen only
in humans
The source of infection is the
large number of
carriers,estimated to be
about 200 million
worldwide .
Infection is mainly by blood
transfusion and other modes
of contact with infected
blood or blood products
Injectable drug
abusers,transplant recipients
and immnunocompromoised
persons are at higher risk
Sexual transmission is probably
less important.

Hepatitis C virus

Hepatitis C
Diagnosis is usually done by the ELISA

method.
Identification of HCV RNA in blood
provides more sensitive results within
few days of exposure to HCV
Only general prophylaxis ,such as blood
screening is possible.
No possible active or Immunising agent
is available
Prolonged treatment with Interferon
alpha either alone or in combination
with antiviral agents like Ribavirin.

Type D Hepatitis
In 1977,Rizzeto and colleagues in Italy

identified a new viral antigen in the liver

cell nuclei of patients infected with
Hepatitis B virus
This has been shown to be due to the
Hepatotropic virus delta or Hepatitis D
virus(HDV).
Delta is a defective RNA virus dependent
on the helper function of HBV for its
replication and expression
Therefore it has no independent existence
and can survive and replicate only as long
as HBV infection persist

Hepatitis D virus

Hepatitis D
HDV is a spherical,36 nm particle with an outer

coat composed of the Hepatitis B surface

antigen surrounding the circular single
stranded RNA genome.
It has been proposed to be classified in a new
genus Delta virus.And also called as Delta
agent.
Its mode of infection is the same as for HBV.
Two types of infection are
recognised,Coinfection and Superinfection.
In Coinfection,Delta and HBV are transmitted
together at the same time.
In Superinfection,Delta Infetcion occurs in a
person already harbouring HBV.

Type E Hepatitis
Popularly termed as the NON-A or NON-

B Hepatitis
Mainly transmitted through fecal
polllution of drinking water .
Often appears as epidemics( hence also
called epidemic NON-B).
The largest such epidemic occurred
inDelhi during the winter of 195556,affecting over 30,000 persons within
six weeks.

Type E virus
HEV is a spherical non

enveloped virus 32-34nm

in diameter
It is a single stranded RNA
genome.
The surface of the virion
shows indentation and
spikes
HEV can be demonstrated
by IEM in the bile and
feces of patients in the
incubation period.
The virus is labile,in
morphology and physical
characteristics,it
resembles Calciviruses

Hepatitis G virus
Two flavivirus-like isolates were obtained in

1955 from Tamarain monkeys inoculated

with blood from a young surgeon (GB) with
Hepatitis.A similar virus was isolated from
another human specimen the same
year.These isolates were called GB viruses
A,B and C respectively.
IN 1966 an isolate closely resembling GBVC was obtained from a patient with chronic
Hepatitis.This has been called Hepatitis G
virus(HGV).

Hepatitis G virus
It has not been grown,but its RNA

genome has been cloned.

HGV RNA has been found in patients
with acute,chronic and fulminant
Hepatitis.Hemophiliacs,patients with
multiple transfusions and
Hemodialysis,intravenous drug addicts
and blood donors
HGV appears to be a blood borne virus
resembling HCV
Its role in Hepatitis is yet to be clarified

Type A

Type B

Type C

Type D

Type E

Virus

HAV,27
nm
RNA,Picor
navirus(H
epatoviru
s)

HBV,47
nm
DNA( Hep
adnavirus
)

HCV,3060nm
RNA,Flavi
virus(Hep
acivirus)

HDV,3537 nm
Defective
RNA
virus,Delt
a virus

HEV,32-34
nm RNA
Herpesvirus

Modes of
infection

Fecal-Oral Percutane
ous,Vertic
al,Sexual

Percuatan
eous

Percutane
ous

Fecal-Oral

Age
Infected

Children

Any age

Adults

Any age

Young
adults

Incubatio
n Period

15-43

30-180

15-160

30-180

15-60

Onset

Acute

Insidious

Insidious

Insidious

Insidious

Illness

Mild

Ocassion
aly
severe

Moderate Ocassion
aly
severe

Mild
except in
Pregnanc
y

Carrier
state

Nil

Common

Present

Nil(only
with HBV)

Nil

Oncogenic
ity

Nil

Present
specially
after
neonatal

Present

Nil

Nil

Prevalence Worldwide

Worldwide

Probably
Worldwide

Endemic
areas

Only
developing
countries

Specific
prophylaxi
s

Ig and
Vaccine

Nil

HBV
vaccine

Nil

Ig and
Vaccine