HEPATITIS

M.ANKURBMB MSc FIRST YEARPONDICHERRY CENTRAL UNIVERSITY

►HepatitisHepatitis is inflammation of the liver, is inflammation of the liver, which can be caused by viruses, which can be caused by viruses, medications, or toxic agents. medications, or toxic agents.

►Viral or non-viral hepatitis.Viral or non-viral hepatitis.

►Viral hepatitis-Acute or chronicViral hepatitis-Acute or chronic

►Currently 11 viruses are recognised as Currently 11 viruses are recognised as causing hepatitis .causing hepatitis .

►Two are herpersviruses Two are herpersviruses (cytomegalovirus, CMV) and Epstein-(cytomegalovirus, CMV) and Epstein-barr viruses (EBV) and 9 are barr viruses (EBV) and 9 are heterotropic viruses.heterotropic viruses.

►Most common Most common ► Infection with the hepatitis A virus Infection with the hepatitis A virus

leads to inflammation of the liver.leads to inflammation of the liver.

ROUTROUTE OF TRANSMISSIONE OF TRANSMISSION

►Mostly transmitted by oral-fecal Mostly transmitted by oral-fecal route via eating food and drinking route via eating food and drinking water infected with a virus called water infected with a virus called HAV.HAV.

►Hepatitis A can affect all age groups. Hepatitis A can affect all age groups. Once a person is exposed to the Once a person is exposed to the virus it takes between 2 and 6 weeks virus it takes between 2 and 6 weeks to produce symptomsto produce symptoms

FEATURESFEATURES

►The Hepatitis The Hepatitis virusvirus (HAV) is a (HAV) is a PicornavirusPicornavirus; ;

► It is It is non-envelopednon-enveloped and contains a and contains a single-stranded RNAsingle-stranded RNA packaged in a packaged in a protein protein shellshell. .

►A virus is icosahedral. There is only A virus is icosahedral. There is only one one typetype of the virus. of the virus.

SYMPTOMSSYMPTOMS

►a short, mild, flu-like illness. a short, mild, flu-like illness. ►nausea, vomiting and diarrhoea. nausea, vomiting and diarrhoea. ► loss of appetite. loss of appetite. ►weight loss. weight loss. ► jaundice (yellow skin and whites of jaundice (yellow skin and whites of

eyes, darker yellow urine and pale eyes, darker yellow urine and pale faeces). faeces).

► itchy skin. itchy skin. ►abdominal pain. abdominal pain.

TREATMENTTREATMENT

►Avoiding alcohol and fatty foods.Avoiding alcohol and fatty foods.►Should get plenty of rest and eat a Should get plenty of rest and eat a

nutritious diet. nutritious diet. ►Also ensure not to spread HAV by Also ensure not to spread HAV by

washing their hands after using the washing their hands after using the toilet and before preparing food. toilet and before preparing food.

IMMUNIZATIONIMMUNIZATION

►The first single injection in the arm gives The first single injection in the arm gives protection for a year. protection for a year.

►The second booster injection at 6 to 12 The second booster injection at 6 to 12 months extends protection for up to 10 months extends protection for up to 10 years. years.

►Routinely recommended for young children Routinely recommended for young children living in areas with high incidence of living in areas with high incidence of hepatitis A, and anyone travelling to hepatitis A, and anyone travelling to countries where hepatitis A is endemic.countries where hepatitis A is endemic.

PREVENTIVE MEASURESPREVENTIVE MEASURES

To prevent hepatitis A, remember to: To prevent hepatitis A, remember to: ►Wash hands well after using any Wash hands well after using any

washroom. washroom. ►Eat only freshly cooked foods. Eat only freshly cooked foods. ►Drink only commercially bottled water or Drink only commercially bottled water or

boiled water in places where sanitation boiled water in places where sanitation and the water supply are questionable and the water supply are questionable and do not eat non-peelable raw fruits or and do not eat non-peelable raw fruits or vegetables unless cleaned thoroughly. vegetables unless cleaned thoroughly.

►Likely to cause chronic long-term Likely to cause chronic long-term illness and permanent damage to the illness and permanent damage to the liver if not treated.liver if not treated.

►Most frequently passed on through the Most frequently passed on through the exchange of bodily fluids with an exchange of bodily fluids with an infected person. infected person.

FEATFEATURESURES

►A member of the A member of the HepadnavirusHepadnavirus family family..

►Consists of an outer Consists of an outer lipidlipid envelope envelope and an and an icosahedralicosahedral nucleocapsidnucleocapsid core composed of core composed of proteinprotein. .

►The nucleocapsid encloses the viral The nucleocapsid encloses the viral DNA and a DNA polymerase that DNA and a DNA polymerase that has has reverse transcriptasereverse transcriptase activity. activity.

LIFE CYCLE

MODE OF TRANSMISSIONMODE OF TRANSMISSION

► Having unprotected sex with an infected person. Having unprotected sex with an infected person. ► Sharing drug needles . Sharing drug needles . ► Getting a tattoo or body piercing with dirty Getting a tattoo or body piercing with dirty

(unsterile) needles and tools that were used on (unsterile) needles and tools that were used on someone else. someone else.

► Getting pricked with a needle that has infected Getting pricked with a needle that has infected blood on it . blood on it .

► Sharing a toothbrush, razor, or other personal Sharing a toothbrush, razor, or other personal items with an infected person. items with an infected person.

► An infected woman can give hepatitis B to her An infected woman can give hepatitis B to her baby at birth or through her breast milk. baby at birth or through her breast milk.

► Through a bite from another person. Through a bite from another person.

SYMPTOMSSYMPTOMS

►A short, mild, flu-like illness. A short, mild, flu-like illness. ►Nausea, vomiting and diarrhoea. Nausea, vomiting and diarrhoea. ►Loss of appetite. Loss of appetite. ►Weight loss. Weight loss. ► Jaundice (yellow skin and whites of Jaundice (yellow skin and whites of

eyes, darker yellow urine and pale eyes, darker yellow urine and pale faeces). faeces).

► Itchy skin. Itchy skin.

TREATMENTREATMENTT

►Antiviral medication is given as Antiviral medication is given as treatment to those with chronic treatment to those with chronic symptoms to help prevent further liver symptoms to help prevent further liver damage. damage.

►These medications may be injected or These medications may be injected or given in pill form. given in pill form.

►Examples are Interferon Alpha, Examples are Interferon Alpha, Lamivudine and Baraclude. Lamivudine and Baraclude.

►Three immunisation injections are Three immunisation injections are given over a period of 3-6 months.given over a period of 3-6 months.

► A blood test is taken once the course A blood test is taken once the course of injections is completed to check of injections is completed to check that they have worked. that they have worked.

► Immunity should last for at least 5 Immunity should last for at least 5 years. years.

IMMUNISATION

► It is caused by the virus HCV. It is caused by the virus HCV.

► It is spread the same way as hepatitis It is spread the same way as hepatitis B, through contact with an infected B, through contact with an infected person's blood, semen, or body fluid . person's blood, semen, or body fluid . Like hepatitis B, hepatitis C causes Like hepatitis B, hepatitis C causes swelling of the liver and can cause swelling of the liver and can cause liver damage that can lead to cancer. liver damage that can lead to cancer.

►The Hepatitis C virus (HCV) is a small , The Hepatitis C virus (HCV) is a small , enveloped, single-stranded, positive sense enveloped, single-stranded, positive sense RNA virusRNA virus. .

► It is the only known member of the It is the only known member of the hepacivirushepacivirus genus in the family genus in the family FlaviviridaeFlaviviridae. .

►There are six major genotypes of the There are six major genotypes of the hepatitis C virus, which are indicated hepatitis C virus, which are indicated numerically (e.g., genotype 1, genotype 2, numerically (e.g., genotype 1, genotype 2, etcetc

CHARACTERIC FEATURES

MODE OF TRANSMISSIONMODE OF TRANSMISSION

►By sharing drug-injecting equipment By sharing drug-injecting equipment (needles, heating spoons, etc).(needles, heating spoons, etc).

►By using non-sterilised equipment for By using non-sterilised equipment for tattooing, acupuncture or body piercing. tattooing, acupuncture or body piercing.

►Through exposure to blood during Through exposure to blood during unprotected sex with an infected person. unprotected sex with an infected person.

►Through blood transfusion. Through blood transfusion.

SSYMPTOMSYMPTOMS

►a short, mild, flu-like illness. a short, mild, flu-like illness. ►nausea and vomiting. nausea and vomiting. ►diarrhoea. diarrhoea. ► loss of appetite. loss of appetite. ►weight loss. weight loss. ► jaundice (yellow skin and whites of eyes, jaundice (yellow skin and whites of eyes,

darker yellow urine and pale faeces). darker yellow urine and pale faeces). ► itchy skin. itchy skin.

TREATMENTTREATMENT

►Combination the antiviral drugs Combination the antiviral drugs interferon and ribavirin. interferon and ribavirin.

►The antiviral drugs may cause The antiviral drugs may cause significant side effects headaches significant side effects headaches which include-which include-

flu-like symptoms, nausea ,tiredness, flu-like symptoms, nausea ,tiredness, body aches ,Depression ,skin rashesbody aches ,Depression ,skin rashes

PREVENTIVE PREVENTIVE MEASURESMEASURES

►Cover open wounds, don't share razors or Cover open wounds, don't share razors or manicure tools. manicure tools.

►Practice safe sex. Practice safe sex. ►Don't share needles, razors, toothbrushes, Don't share needles, razors, toothbrushes,

manicure tools or other items that could manicure tools or other items that could bear contaminated blood. bear contaminated blood.

►Don't allow yourself to be pierced with Don't allow yourself to be pierced with non-sterile equipment. non-sterile equipment.

►Limit alcohol intake.Limit alcohol intake.

► It is caused by the virus HDV.It is caused by the virus HDV.► It is spread through contact with It is spread through contact with

infected blood, dirty needles that have infected blood, dirty needles that have HDV on them, and unprotected sex HDV on them, and unprotected sex with a person infected with HDV. with a person infected with HDV.

►Hepatitis D causes swelling of the liver. Hepatitis D causes swelling of the liver.

GENOMEGENOME

► The HDV genome exists as a negative The HDV genome exists as a negative

sense, single-stranded, closed circular sense, single-stranded, closed circular RNA. RNA.

► With a genome of approximately 1700 With a genome of approximately 1700 nucleotides, HDV is the smallest "virus" nucleotides, HDV is the smallest "virus" known to infect animals.known to infect animals.

PREVENPREVENTIVE MEASURESTIVE MEASURES

►Since the hepatitis D virus cannot Since the hepatitis D virus cannot infect on its own without hepatitis B, infect on its own without hepatitis B, use the preventive measures outlined use the preventive measures outlined in hepatitis B. in hepatitis B.

► It is caused by the virus HEV. It is caused by the virus HEV. ►Hepatitis E spread by drinking water Hepatitis E spread by drinking water

infected with the virus. infected with the virus. ► It causes swelling of the liver, but no It causes swelling of the liver, but no

long-term damage.long-term damage.

► It was originally classified in the It was originally classified in the CaliciviridaeCaliciviridae family, the virus has since family, the virus has since been classified into the genus been classified into the genus HepevirusHepevirus of the family of the family HepeviridaeHepeviridae. .

►The virus itself is a small non-The virus itself is a small non-enveloped particle.enveloped particle.

FEATURES

PREVENTIVE MEASURESPREVENTIVE MEASURES

►Wash hands well after using any Wash hands well after using any washroom. washroom.

►Eat only well and freshly cooked foods. Eat only well and freshly cooked foods. ►Drink only commercially bottled water Drink only commercially bottled water

or boiled water in places where or boiled water in places where sanitation and the water supply are sanitation and the water supply are questionable, and questionable, and

►Don't eat non-peelable raw fruits or Don't eat non-peelable raw fruits or vegetables unless cleaned thoroughly.vegetables unless cleaned thoroughly.

►Alcoholic hepatitis Alcoholic hepatitis is the most is the most common precursor of cirrhosis common precursor of cirrhosis

►To prevent alcoholic hepatitis, - Limit To prevent alcoholic hepatitis, - Limit the amount of alcohol consumption. the amount of alcohol consumption.

►Toxic/drug-induced hepatitisToxic/drug-induced hepatitis is is caused after inhalation or ingestion caused after inhalation or ingestion of a toxin, or the use of certain of a toxin, or the use of certain medications. contraceptives and medications. contraceptives and anabolic steroids. anabolic steroids.

►To prevent toxic/drug-induced To prevent toxic/drug-induced hepatitis, remember to: hepatitis, remember to:

-Be aware of the lethal contents of -Be aware of the lethal contents of all chemicals. all chemicals.

-Face the spray away from the -Face the spray away from the body. body.

►Autoimmune hepatitis Autoimmune hepatitis is a is a condition in which the liver is condition in which the liver is attacked by the body's immune attacked by the body's immune system. system.

►Granulomatous hepatitis Granulomatous hepatitis is a is a condition in which abnormal condition in which abnormal collections of white blood cells collections of white blood cells collect in the liver. collect in the liver.

THANK YOU