Clinical outcomes of HBV infection
• Subclinical disease• Acute hepatitis, Fulminant hepatitis• Asymptomatic carrier • Chronic hepatitis >6 months necrosis and
inflammation of the liver , actively replicating virus—source of infection
• Cirrhosis, HCC
Chronic hepatitis• Inflammation of the liver >6 mo (not alcoholic)• Mild-(chronic persistent hepatitis)• Inflammation confined to portal tract • Limiting plate preserved• Severe (chronic active hepatitis)• Inflammation spills into periportal liver• Interface hepatitis• Bridging necrosis Fatty change, lymphocytes (C)
Periportal fibrosis Ground glass (B)
Carrier state
• Presence of HBsAg in serum >6 months• May be symptomatic /asymptomatic• More common following vertical transmission
& immunocompromised
Biochemical abnormalities in chronic hepatitis
• Elevation of AST,ALT• S. Bilirubin elevated at times
HCV
• Hepacivirus• Enveloped single stranded RNA virus• Unstable virus with multiple genotypes and
subtypes. (no vaccine)• Anti HCV IgG does not confer effective
immunity• High risk of chronicity (80%),cirrhosis &HCC
(10%)
Pathogenesis of HCV infection
• Cytotoxic T cells response to virally infected hepatocytes
• Not directly cytopathic• Defects in HCV specific cellular immunity
Clinical features of HCVdisease
• Mild disease• Fulminant disease rare• Chronic disease is common (80% )• 20% develop cirrhosis• 5% of cirrhosis develop HCC • Extrahepatic manifestation-membranoproliferative
glomerulonephritis,prophyria cutanea tarda, sicca syndrome
HDV
• RNA virus• Conifection HBV and HDV simultaneously• Superinfection: HBV followed by HDV• Serologic diagnosis: anti HDV IgM.
HEV
• Oro-fecal transmission• Asia,india,subsaharan africa, mexico• High mortality in pregnant women• Self limiting• No chronic phase,no viremia.
Clinical manifestations of hepatitis
• Preicteric or palindromic phase• Precedes jaundice • 1-21 days • Phase of maximum infectivity in HAV infection• Nausea, fever, anorexia, malaise• Serum sickness-like syndrome (B)
Hepatitis-clinical manifestations...
Icteric phase Jaundice• Pruritis• Pale coloured stool,dark urine• Tender hepatomegaly
Clinical features of Chronic hepatitis
• Variable• Not predictive of outcome• Fatigue,malaise .mild haundice’spider
angiomas,mild tender hepatomegaly, • Occasionly, immune complex mediated
disease (C&D)