What is Hepatitis?

General: inflammation of liver parenchyma cells

Worst case: life threatening liver cirrhosis, liver failure and/or liver
cancer

Causes of hepatitis?

Primary: drug induced hepatitis, viral hepatitis

Secondary: syphilis, T.B

Viral hepatitis
Hepatitis A virus (picornovirus)
Hepatitis B virus (hepadnavirus)
Hepatitis C virus (flavivirus)
Hepatitis D, E, F, G viruses and non A-G
Epstien-Barr virus
Cytomegalovirus
Yellow fever virus
Infectious mononucleosis

Hepatitis A Virus -HAVThe Facts

Picornaviridae, SSRNA, non enveloped

Destroyed by autoclaving, boiling, dry heat
Oral-fecal transmission
Occurs as epidemic
i.p 2-7 wks, mild jaundice, hepatospleenomegaly
No carrier state
Recovery within 2 months with solid immunity

Diagnosis and treatment

ELISA for HAV antibodies

Treat complicated case with Ig.

Prevention: decontaminate utensiles, cloths, water
Vaccination to prevent spread of disease

HEPATITIS B
DNA and RNA (Hepadnaviruses)

3 forms of HBV in blood

small 22 nm (spherical
200 nm (filamentous)

Dane particle 42 nm
(spherical) infectious

Viral antigens
HBs Ag
Abs are protective

blood

HBe Ag
Abs are not protective

blood

HBc Ag
Abs not protective

hepatocytes

Infection varies

Sub-clinical
Fulminant (hepatic necrosis)
Chronic carrier (hepatocellular carcinoma)

Transmission
Direct inoculation of blood or plasma (needle, transfusion)
Indirect precutaneous (infected serum) skin cut, abrassion
Adsorption of infected serum (mucosal surface)
Adsorption of potentially infectious secretion (saliva, vaginal,
semen) to mucosal surface
oral-fecal NO
Role of saliva Negative except human bite

Incidence

HBs is predominant in adults

21% oral surgeons
22% general surgeons

13-30 % dentists
significant of HBs is carrier up to 10% in HBs infections

Interpretation of serological markers

+HBs Ag: carrier and infectious
persist for 6 months

acute

persist for year

carrier

Anti HBs : recovery and immunity

vaccination
HBe Ag: Acute disease of high infectivity
if persist

chronic liver damage

Anti HBe: partial recovery from infection

HBc Ag:

present in liver

Anti HBc: Active (recent infection)

Great risk to Dentist

Known and unknown carriers

High risk patients include:

Jaundice (6 months), Blood therapy (hemophilia and thalassemia),
chronic renal failure, multiple blood transfusion, addicts and
homosexual
Prevention: Engerix B vaccine (subunit)
0, 1, 6, booster after one year

HEPATITIS C

RNA

Chiron 1988

Transmition: post-transfusion, associated with hepatocellular

carcinoma
Diagnosis: ELISA for detection of Anti HCV
Dental implication: lichen planus, oral malignancy, saliva contains
HCV, Needle stick is common way of transmission

HEPATITIS D

Defective RNA requires HBs for function

Occurs as coinfection with HBV
Transmitted parenterally
Diagnosis by ELISA
bad prognosis - higher incidence of liver necrosis, mortality

HEPATITIS E
RNA (Calicivirus)
Transmission: fecal/oral

Disease: 3-6 week incubation, abrupt onset, mild except if

pregnant, 20% fatality rate
Jaundice: unknown
Chronic: no

HEPATITIS F: post transfusion

HEPATITIS G:
1996, transmitted through blood
cause mild disease, present in saliva

Transfusion transmitted virus(TTV)

Post transfusional hepatitis, non envelop, ss RNA (parvo virus)