Hepatitis B - University of North Carolina at Chapel Hill：乙型肝炎-北卡罗来纳大学教堂山分校.pptVIP

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Hepatitis B - University of North Carolina at Chapel Hill：乙型肝炎-北卡罗来纳大学教堂山分校.ppt

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Hepatitis B - University of North Carolina at Chapel Hill：乙型肝炎-北卡罗来纳大学教堂山分校

Hepatitis B Patricia D. Jones, M.D. November 13, 2009 Hepatitis B Prototype member of the Hepadnaviridae family DNA virus Outer lipoprotein envelope with 3 glycoproteins – Hep B surface antigens (HBsAg) Viral nucleocapsid protein - Hep B core antigen (HBcAg) Soluble nucleocapsid protein-Hepatitis B e antigen (HBeAg) /virol/hep-b5.jpg Epidemiology Worldwide: Affects 350-400 million persons Endemic areas: Asia, Africa 1 million worldwide deaths per year Acquired perinatally and in childhood United States: Affects 1.25 million persons 4000-5000 deaths per year Acquired via sexual activity, then IVDU and occupational exposure /images/education/world_incidence.jpg Primary Infection Incubation Period 4-10 weeks During the prodromal period, patient may have a serum sickness-like syndrome. Constitutional symptoms, anorexia, nausea, RUQ discomfort and jaundice. 30 % develop icteric hepatitis. 70% develop anicteric or subclinical hepatitis. 0.5-1% develop fulminant liver failure. Symptoms and jaundice disappear in 1-3 months, though fatigue may persist. Infection in Children vs. Adults Children In neonates, the immature immune system does not recognize a difference between the virus and the host. Cellular immune responses to hepatocyte-membrane HBV proteins do not occur. Risk of developing chronic HBV infection is 90% in infants born to HBeAg positive mothers. In children under 5, risk is 25-30%. Adults: Tend to have a more vigorous immune response. Less than 5% of those infected develop continual viremia and persistent infection. Serologic Diagnosis HBsAg HBeAg Anti-HBc IgM Anti-HBc IgG Anti-HBe HBsAb HBV DNA ACUTE Early + + + +++ Window + + Recovery + + + +/- CHRONIC Replicative + + + +++ Nonreplicative + + + +/- Flare + +/- + + + Precore/core promoter mutants + + + ++ .au/userData/img//hepB1.jpg Chronic Hepatitis B Infection Early Replicative Phase: Immune Tolerance Perinatally acquired infection High levels of HBV DNA, HBeAg present No liver disease—norma