Viral hepatitis. Dr Mahmood Nabavi Iranian CDC
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1 Viral hepatitis Dr Mahmood Nabavi Iranian CDC
2 Viral hepatitis - Five virus species are the cause of most of human viral hepatitis cases, and due to the time of their recognition named : A-B-C-D-E. - B & C & Delta viruses are blood borne viruses that transmit via blood rout and rarely sexual. - A&E viruses transmit fecal-orally by contaminated food and water. - B&C viruses have the potential for triggering chronic hepatitis that may end in cirrhosis and liver cancer (hepatoma ).
3 Vial hepatitis-2 Borden of viral hepatitis in I. R. Iran : it is estimated due to data's that gathered in the last DHS studies in 2009, that 1.7% of Iran population are HBSA carriers, and below 1% are HCV+. In high risk groups like IDUs, HCV prevalence is between 30 to 50% and HBV prevalence is 7 to 10%. In different provinces of the country it differs from 1% to 5% due to tattooing and drug abuse are more frequent in that high endemic areas
4 Viral hepatitis -3 In surveys from 2010 till 2012 in10000 pregnant women in labor facilities of 14 provinces of the country rate of HBs Ag carriers was 1.2 % and HCV Ab positive about 0.1%. Also at the same time in 12 prisons in 2000 prisoners rate of HCV Ab positivity was 12% due to concentrated epidemic of disease in IDUs.
5 Coverage of third time vaccination against hepatitis B in below one year old Iranian children Series
6 نمودار بروز ھپاتیتھاي منتقلھ از راه خون در صدھزار نفر جمعیت طي سالھاي HBV HCV
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11 جدول مقایسھ تعداد موارد گزارش شده ھپاتیتھاي منتقلھ از راه خون از دانشگاھھاي سراسر كشور بھ مركز مدیریت بیماریھاي واگیر تعداد موارد گزارش شده در سال 1390 بروز در سال 1390 در صدھزار نفر جمعیت تعداد موارد گزارش شده در سال 1391 بروز در سال 1391 در صدھزار نفر جمعیت HBV HCV HBV&HCV Total
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16 مورد اول 1- جوانی در اھدای خون متوجھ HBs Ag مثبت بودن خودش می شود سابقھ بیماری خاصی نداشتھ است. چھ کارھایی درخواست می کنید
17 1 HBs Ag & HBC Ab in patient mother SGOT- SGPT- Alk ph- Bil( D- Ind)- Pt-Ptt HBs Ag IgM HBC Ab Hbe Ag Hbe Ab Alfa feto protein Serum albumin -4 If possible HBV viral load Liver sonography each six month Liver biopsy or fibrscan if HBC Ab + & HBC Ab IgM
18 مورد دوم دختر 19 سالھ ای دچار 2 روز تب و علایم کوریزا شده سپس ایکتر و تھوع پیدا کرده و تب قطع می شود در بررسی ھا IgM anti HAV مثبت و تشخیص ھپاتیت A داده می شود پس از سھ ھفتھ ایکتر و علایم بالینی بھبود می یابد ولی SGOT & SGPT با وجود کاھش بھ نرمال نمی رسد و در کنترل ھای ماھیانھ تا شش ماه بعد بین دوتاسھ برابر نرمال نوسان می کند چھ بررسی ھایی را توصیھ می کنید
19 -2 1- AMA titration 2- SGOT- SGPT- Alk ph- Pt- Ptt- Bil ( D &T) Serum albumin. 3- HBs Ag HBC Ab HCV Ab HIV Ab- CMV IgM. 4- Anti ds DNA ANA. 5- Liver sonography. 6 Fibrscan or liver biopsy.
20 مورد 3 زنی 40 سالھ و روستایی از گیلان بدنبال 2 ھفتھ ایکتر پیشرونده و عدم بھبود از بیمارستانی در رشت بھ تھران منتقل می شود. در بررسی ھا SGPTوSGOT بین دو تا سھ ھزار واحد Alk ph حد اکثر نرمال بیلیروبین توتالmg/dl 40 با تساوی دایرکت و نرمال وبررسی برای ویروس ھای ھپاتو تروپ A ایندایرکت و Pt CPK & LDH و BUN & Cr منفی بود و پلاکت نرمال و B-C-E نیز در حد نرمال بود چھ راه ھای تشخیصی توصیھ می کنید
21 3 1- بررسی لوپوس و بیماری ھای اتو ایمون بخصوص AMA و. Anti ds DNA 2- درخواست سرولوژی لپتوسپیروز. و شکم کبد CT- scan و اگر لازم بود 3- سونوگرافی
22 مورد -4 خانمی 55 سالھ بھ علت عدم بھبود و تشدید بیماری ایکتریک پس از یک ماه بستری در بخش عفونی بیمارستان قاي م شھر مازندران بھ تھران انتقال یافت بررسی مکرر مارکر ھای ویروسی و اتو ایمون منفی ومصرف دارویی را ذکر نمی کردند و در معاینھ کبد کوچک آزمایش ھا طولانی شده ایکتر در Pt و آسیت پیدا کرده بود و شده عمیق و بیلیروبین توتال 44 mg/dl داشت و SGOT= 900 و SGPT= 450 داشت بیمار گیج و خواب آلود بود و چھار روز بعد از پذیرش در بخش تھران بھ اغما رفت در ھمان روز خواھر بیمار دو قرص داروی ضد فشار خون متیل دوپا را نشان داد کھ بیمار بھ علت اغما نخورده بود وذکر کرد از 20 سال قبل این دارو ره مصرف میکرده است.
23 Hepatitis A Virus 27 nm Transmission route: fecal-oral Clinical presentation - Jaundice: Adults- 30%, Children- <5% - Fulminant: <1% Diagnostic tests - Acute infection: IgM anti-hav - Chronic infection: Not applicable Immunity: IgG anti-hav Case-fatality rate: % None Chronic infection: Nucleic Acid: 7.5 kb ssrna
24 Global Prevalence of Hepatitis A Infection HAV Prevalence High Intermediate Low Very Low
25 Hepatitis E Virus 32 nm Fecal-oral transmission (human to human) Contaminated water supplies in tropical or subtropical developing countries Mainly young adults Can infect primates, swine, sheep, rats Swine may be reservoir of infection in North America Maternal-infant transmission occurs and is often fatal Nucleic Acid: 7.5 kb ssrna
26 Hepatitis B Virus HBsAg 42 nm HBcA g HBV DNA Hepadnaviridae member that primarily infects liver cells 50 to 100 times more infective than HIV Multiple genotypes exist (A-H) DNA virus found in blood and body fluids Able to survive in dried blood for longer than 1 week
27 > 350 million carriers (HBsAg + > 6 months) Geographic Distribution of Chronic HBV Infection 10th cause of death (1 million / year) Cirrhosis in 20% ( million) HCC in 5-10% (20-40 million) HBsAg Prevalence 8% - High 2-7% - Intermediate <2% - Low
28 Hepatitis D Virus: Morphology and Characteristics Nucleic Acid: 1.7 kb ssrna Classification: unclassified, related to viroids; deltavirus Transmission: sex, IVDA 35-37nm Clinical features - Fulminant: 2 7.5% - Chronic infection Superinfection: 80% Coinfection: < 5% + Diagnostic tests -Acute infection: IgM anti-hdv -Chronic infection:igg anti-hdv, HBsAg
29 Modes of HDV infection Coinfection B D Superinfection D B
تازه ھاي تشخیص ودرمان ھپاتیت برنامھ روز جھاني ھپاتیت شبكھ بھداشت و درمان شھریار 12/5/1393
تازه ھاي تشخیص ودرمان ھپاتیت برنامھ روز جھاني ھپاتیت شبكھ بھداشت و درمان شھریار 12/5/1393 تشخیص بالیني ھپاتیت ھاي ویرال در دو گروه افتراق علل یرقان ) علامت دار) و بررسي اپیدمیولوژیك ) بدون علامت) در گروه
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