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Publicada porPedro Tenorio Modificado hace 6 años
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1 1/24/2019 Viral Hepatitis Hugh B. Fackrell Filename: Hepatite.ppt
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2 1/24/2019 Hepatitis Virus Outline Definitions Classification Structure Multiplication Clinical manifestations Epidemiology Diagnosis Control Baron’s Web Site Baron’s Web Site
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3 1/24/2019 Hepatitis an ancient disease, the etiology has only recently (50 yrs.) been revealed.
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4 1/24/2019 Hepatitis An inflammatory disease - necrosis of hepatocytes - mononuclear response destroys liver architecture Liver excretion of bile pigments such as bilirubin into the intestine is interrupted
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5 1/24/2019 Bilirubin Bilirubin: greenish-yellow pigment accumulates in the blood and tissues Jaundice - - yellow tinge in the skin and eyes - caused by bilirubin
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6 1/24/2019 Types of Jaundice Pre hepatic: Hemolytic Jaundice - normal feces, anemia, reticulocytes Hepatic: Hepatocellular Jaundice - fecal fat, bilirubinuria, Alkaline phosphatase high, gamma globulins high Post Hepatic: Obstructive Jaundice - fecal fat, bilirubinuria, alkaline phosphatase high
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7 1/24/2019 Jaundice of the Newborn Premature infants bilirubin increases from birth peaks at one week caused by - 1:excessive hemolysis - 2:immature liver function
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8 1/24/2019 Hepatitis symptoms Swelling and tenderness of liver Jaundice -yellow tinge in the skin and eyes dark urine transaminase, alkaline phosphatase levels increased
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9 1/24/2019 Viral Hepatitis Liver infection caused by several UNRELATED VIRUSES Inflammation and necrosis of the liver 50% of HAV & HBV are subclincal
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10 1/24/2019 Hepatitis types Hepatitis A - HAV "infectious hepatitis" Hepatitis B - HBV "serum hepatitis" Hepatitis C - HCV non A, non B Hepatitis D - HDV Delta virus Hepatitis E - HEV similar to type “A”
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11 1/24/2019 Hepatitis A “Infectious hepatitis” “Epidemic hepatitis” HAV
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12 1/24/2019 Hepatitis A Clinical manifestations asymptotic or anicteric in children 3-5 week incubation period liver inflammation malaise - flu like symptoms self limiting low mortality
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13 1/24/2019 Hepatitis A Structure Picornavirus Only one serotype Enterovirus type 72 27-29 nm icosahedral ssRNA
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14 1/24/2019 Hepatitis A Host Defenses antibodies develop late in incubation period IgM - within a week of dark urine - peaks a week later - lasts 40-60 days IgG - after IgM - peaks 60-80 days - lasts many years
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15 1/24/2019 Hepatitis A Epidemiology Global distribution- underreported Fecal-oral route, - person to person - water Overcrowding & poor sanitation Infected food handlers common vector
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16 1/24/2019 Annual Incidence Viral food borne diseases Norwalk-like viruses - 23,000,000 Rotavirus - 3,900,000 Astrovirus - 3,900,000 Hepatitis A - 83,391 Total Viral food borne 30,883,391 Total Microbial food borne incidence - 38,629,64 CDC
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17 1/24/2019 Hepatitis A Diagnosis Clinical manifestions Viral antigens - Immunoelectron microscopy - RIA - ELISA - Immune Adherence hemagglutination (old method) Viral antibodies
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18 1/24/2019 Hepatitis A Control No specific control Improve hygiene and sanitation Human immunoglobulin - 2 IU anti Hepatitis A /kg body weight HAV vaccines in clinical field trials
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19 1/24/2019 Hepatitis B “Serum hepatitis” HBV
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20 1/24/2019 Hepatitis B Clinical Manifestations typical viral hepatitis symptoms 4-26 week incubation period more severe than HAV CHRONIC PERSISTENT HEPATITIS CHRONIC ACTIVE HEPATITIS
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21 1/24/2019 Hepatitis B Structure Hepadnavirus dsDNA, circular, 3200 nucleotides enveloped icosahedral virus 42 nm
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22 1/24/2019 Australia antigen “Dane particle” small pelomorphic particles 20-22nm tubular forms excess viral capsids released into blood stream
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23 1/24/2019 3 forms of HBV
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24 1/24/2019 Dane Particles
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25 1/24/2019 Hepatitis B Host Defenses Cell mediated Immunity - important for recover in acute phase - autoimmune liver damage in chronic infections Humoral Immunity - not always protective - HBsAg for Vaccines Interferon - not detected during infection - exogenous application effective
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26 1/24/2019 Hepatitis B Epidemiology Parenterally ie via blood, saliva, menstrual and vaginal discharges, semen and breast milk infected blood and blood products sexual contact perinatally from mother to child
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27 1/24/2019 Hepatitis B Prevalence AREA HBsAg anti HBsAg AREA HBsAg anti HBsAg Western Europe 0.2-0.5% 4-6% USA Eastern Europe 2-7 % 20-55% USSR Eastern Europe 2-7 % 20-55% USSR China 8-20 % 70-95% Asia
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28 1/24/2019 Hepatitis B Diagnosis Electron microscopy Viral DNA polymerase Viral DNA probes Serology
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29 1/24/2019 Hepatitis B Serology Hepatitis B surface antigen- HBsAg - 10 subtypes Hepatitis B core antigen- HBsCAg Soluble core associated antigen HBeAg Corresponding antibodies to each antigen occur
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30 1/24/2019 Hepatitis B Control No specific control Passive Immunization - HBV immunoglobulin - 250-500 IU within 48 hours - neonates of infected mothers -immediately after birth Active Immunization - HBsAg - recombinant DNA in yeast
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31 1/24/2019 1. Transformation of the cell by virus 2. Helper virus if the transforming virus is defective 3. Co-carcinogen, chemical, cigarette smoke HBV & Cancer
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32 1/24/2019 Transformed cells lose contact inhibition continue to divide form random aggregations can become invasive Not warts: Papovavirus
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33 1/24/2019 Primary Hepatocellular Carcinoma Highest incidence: - Central Africa - Southeast China - Pacific Islands, Borneo, Sarawak, Taiwan Icteric symptoms: - jaundice, dark urine, pale stools Global 250,000- 1,000,000 deaths /year U.S.A. 5000 deaths / year
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34 1/24/2019 Acute Hepatitis B 90%1% Resolution Fulminant Hepatitis 90%1% Resolution Fulminant Hepatitis 50% 50% Resolution Asymptomatic Carrier Chronic Chronic Active Cirrhosis Hepatic Cell Carcinoma Extrahepatic Disease Hepatitis Acute HBV & Cancer
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35 1/24/2019 Hepatitis C HCV Non -A Non-B
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36 1/24/2019 Hepatitis C Clinical Manifestations resembles HBV persistent carrier state 50% of patients have chronic liver damage associated with hepatocellular carcinoma
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37 1/24/2019 Hepatitis C is probably caused by several different viruses
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38 1/24/2019 Hepatitis C Epidemiology in USA causes 90% of post transfusion hepatitis Mother to infant transmission
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39 1/24/2019 Hepatitis C Diagnosis C100-3 recombinant viral antigen anti c100-3 marker of chronic infection
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40 1/24/2019 Structure Cultured in cells Epidemiology Transmission Incubation period Symptoms Jaundice Onset Vaccine Diagnostic tests RNA yes endemic & epidemic oral/fecal, water & food 2-7 weeks fever, G-I tract disorder 1 case in 10 acute/short not available yes DNA no endemic blood/serum, close contact 1-6 months fever, rash, arthritis common gradual/chronic yes HBV no endemic blood/serum, intimate contact 2-8 weeks similar to HBV common acute/chronic not available yes Hepatitis A HAV Hepatitis B HBV Hepatitis C HCV
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41 1/24/2019 Hepatitis D HDV
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42 1/24/2019 Dependovirus, it is defective and cannot produce infection unless the cell is also infected with HBV. Viroid - a naked strand of RNA that enters the cell in piggy-back fashion.
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43 1/24/2019 Hepatitis D Clinical Manifestations Dual infection is more severe than HBV fulminating hepatitis severe rapidly progressive hepatitis severe exacerbations
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44 1/24/2019 Hepatitis D Structure 35-37 nm virus particle shares coat protein of HBV small RNA genome one serotype
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45 1/24/2019 Hepatitis D Epidemiology hemophiliacs and IV drug users Contaminated blood and blood products
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46 1/24/2019 Geographic distribution of HDV
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47 1/24/2019 Hepatitis D Diagnosis Clinical manifestations Delta antigen - Immunofluorescence - RIA - ELISA Anti delta antigen - same as above
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48 1/24/2019 Hepatitis E Virus
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49 1/24/2019 Hepatitis E fecal/oral route predominantly found in developing countries but is world wide. symptoms similar to HAV but mortality 1- 2% (ten times that of Hepatitis A). epidemics - India, Pakistan, Nepal, Burma, North Africa and Mexico.
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