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Wirusowe Zapalenie Wątroby typu B /WZW B/ - etiologia, diagnostyka, profilaktyka.

Wirusowe Zapalenie Wątroby typu B /WZW B/ - etiologia, diagnostyka, profilaktyka. Dr n.med. Witold Wrodycki Klinika Chorób Zakaźnych i Hepatologii UM w Łodzi.

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Wirusowe Zapalenie Wątroby typu B /WZW B/ - etiologia, diagnostyka, profilaktyka.

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  1. Wirusowe Zapalenie Wątroby typu B /WZW B/ - etiologia, diagnostyka, profilaktyka. Dr n.med. Witold Wrodycki Klinika Chorób Zakaźnych i Hepatologii UM w Łodzi

  2. Wirusowe Zapalenia Wątroby – etiologia:A.wirusy pierwotnie hepatotropowe: 1. WZW A (HAV)2. WZW B (HBV)3. WZW C (HCV)4. WZW D (HDV, koinfekcja z HBV)5. WZW E (HEV) B. wirusy o wtórnym hepatotropizmie: EBV, CMV, VZV (HHV3), HSV (HHV-1, HHV-2)

  3. Hepatitis B Virus

  4. Epidemiologia HBV • Ponad 400 mln zakażonych na świecie • 1,25 mln zakażonych w USA • Nosicielstwo HBsAg na świecie od 1-20% • W Polsce nosicielstwo HBsAg - ok. 1-2 % • Spadek liczby zakażonych od 1990r (szczepienia p/wzw B) 1..1....... ...., m m

  5. Geographic Distribution of Chronic HBV Infection HBsAg Prevalence ³8% = High 2%-7% = Intermediate <2% = Low

  6. Wirusowe zapalenie wątroby (hepatitis virusalis) 1961 – 57 088 przyp. zgony 102, 1970 – 70 355 przyp. zgony 369 2000 HAV 262 przyp. (25,5 % w wieku 0-14) zgony 0 HBV 2825 przyp.(10,3% w wieku 0-14) zgony 0 HCV 2086 przyp. (5,7 % w wieku 0-14) zgony 0 2011 WZW B 250 przyp.

  7. Schematyczna budowa HBV

  8. Drogi tranmisji HBV • Seksualna • Parenteralna • Perinatalna • Zarażenie (invasioductio) – pasożyty

  9. Riskw Factors for Acute Hepatitis B Epidemiologia zakażeń HBV-cd. Seksualna Injecting Drug Use (15%) Homosexual Activity (9%) Household Contact (2%) Health Care Employment (1%) Other (1%) * Includes sexual contact with acute cases, carriers, and multiple partners. CxDC Sentinel Counties Study of Viral Hepatitis.

  10. Hepatitis B – Clinical Features • Incubation period: Average 60–90 days Range 45–180 days • Clinical illness (jaundice): <5 yrs, <10% >5 yrs, 30%–50% • Acute case-fatality rate: 0.5%–1% • Chronic infection: <5 yrs, 30%–90% >5 yrs, 2%–10% • Premature mortality fromchronic liver disease: 15%–25%

  11. Hepatitis B – Diagnostic Tools Markers of the virus • HBV DNA • HBeAg • HBsAg Markers of liver damage • ALT • AST • Bilirubin Antibodies to the virus • Anti-HBc • Anti-HBe • Anti-HBs Severity of liver damage • Bilirubin • Albumin • Prothrombin time

  12. No viral markers HBsAg - HBeAg - HBV DNA- Never Been Exposed to Hepatitis B No immune response to the virus • Anti-HBc - • Anti-HBs - • Anti-HBe -

  13. Full complement of viral markers, all present for < 6 months HBsAg + HBeAg + HBV DNA+ Some immune response to the virus Anti-HBs- Anti-Hbe- Anti-HBc+ Acute Hepatitis B Evidence of acute infection • Anti-HBc IgM+

  14. Acute Hepatitis B Virus Infection withRecovery Typical Serologic Course Symptoms anti-HBe HBeAg Total anti-HBc Titer anti-HBs IgM anti-HBc HBsAg 0 4 8 12 16 24 28 32 52 100 20 36 Weeks after exposure

  15. Chronic Hepatitis B with Evidence of Viral Replication Some immune response to the virus • Anti-HBc + • Anti-HBs - • Anti-HBe - Full complement of viral markers, all present for >6 months • HBsAg + • HBeAg + • HBV DNA + No evidence of acute infection • Anti-HBc IgM-

  16. Progression to Chronic Hepatitis B Virus Infection Typical Serologic Course Acute (6 months) Chronic (years) HBeAg anti-HBe HBsAg Total anti-HBc Titer IgM anti-HBc 0 4 8 16 20 24 28 36 12 32 52 Years Weeks after exposure

  17. Koncentracja HBV w różnych płynach w ustrojowych Duża: krew osocze, sączące rany Średnia: nasienie, wydzielina pochowa, sączące rany Mała: mocz, kał, łzy, pot, pokarm

  18. Dziękuje za uwagę

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