Hepatitis A, B & C
Dokter pembimbing:
dr. H. Iman Firmansyah, Sp.PD, FINASIM
Dian A. Stephanie
406148013
Kepaniteraan Ilmu Penyakit Dalam
RSPI Sulianti Saroso
RNA RNA Single-stranded Single-stranded Positive strand Positive strand Non-enveloped icosahedral Non-enveloped
icosahedral EnvelopedEnveloped
Icosahedral Icosahedral Flaviviridae HEPATITIS C HEPATITIS E HEPATITIS A HEPATITIS D Picorviridae Caliciviridae DNA DNA Double-stranded Double-stranded Enveloped Enveloped Hepadnaviridae HEPATITIS B Double-stranded Double-stranded Negative strand Negative strand Single-stranded Single-stranded Non-enveloped Non-enveloped
Mode of transmission
Mode of transmission
Injection, heterosexual and homosexual sex
Injection, heterosexual and homosexual sex
Fecal/oral Fecal/oral HEV HEV HAV HAV HBVHBV HCVHCV HDVHDV
Acute infections Acute and/or chronic infections
Adapted from Lippincott’s illustrated Review: Microbiology 2nd
HEPATITIS
• (peradangan pada hati) adalah cedera hepatosit
yang menyebabkan influks sel radang akut atau kronis ke hati.
Etiologi :
• Virus hepatitis
• Overactive sistem imun • Obat-obatan
Klasifikasi hepatitis
• Hepatitis alkohol • Hepatitis obat-obatan • Hepatitis virus – Hepatitis A – Hepatitis B – Hepatitis C – Hepatitis D – Hepatitis E – Hepatitis GHEPATITIS A
• Merupakan penyakit self limiting dan memberikan
kekebalan seumur hidup
• Epidemiologi :
– Negara berkembang >>> – Di Indonesia…
• 35%-45% pada usia 5 tahun • 90% pada usia 30 tahun
HAV Hepatitis A virus, etiologic agent of infectious hepatitis. A picornavirus, the prototype of a new enus, Hepatovirus.
Anti-HAV Antibody to HAV. Detectable at onset of symptoms; lifetime persistence
IgM anti-HAV IgM class antibody to HAV. Indicates recent infection with hepatitis A; positive up to 4-6 months after infection.
PATOGENESIS
Makanan + HAV tertelan masuk Hati ( hepatosit) REPLIKASI RNA dependent Polimerase HAV dieliminasi mel. Sinusoid, kanalikuli USUS ( sebelum timbul gejala klinis & laboratoris) masuk Tubuh eliminasi HAV (IgM &IgG)MUKOSA GI HATI (DARAH) IKAT RESEPTOR HEPATOSIT PENETRASI SEL KUPFFER RNA AMBIL ALIH SEL HOST SINTESIS KOMPONEN VIRAL BARU RAKIT MENJADI VIRUS BARU DILEPASKAN (VESIKEL) EMPEDU FESES
REPLIKASI
HAV
Air atau makanan yg
terkontaminasi feses kerang (oyster, clam)
5 MACAM GEJALA KLINIS
• Hepatitis A klasik…
– Timbul secara mendadak
– Gejala prodromal sktr 1 mgg
• Hepatitis A relaps…
– Timbul 6-10 mggu setelah sembuh scra klinis
• Hepatitis A kolestatik…
– Pemanjangan gejala hepatitis
– Disertai: panas, gatal-gatal, dan jaundice
– AST,ALP,&ALP turun kearah normal
– Kadar bilirubin ↑
• Hepatitis A protracted…
– Adanya clearance virus
shgga pulihnya fungsi hati
• Hepatitis A fulminan
– Paling berat kematian
– Memberatnya ikterus, – ensefalopati,
– pemanjangan PT
Pengobatan
• Infeksi akut dicegah : pemberian Ig / vaksin • Pengobatan meliputi: istirahat
• Pencegahan terhadap bahan hepatotoksik (mis:
asetaminofen)
Medication
• Analgesic agents
– Acetaminophen (Tylenol, Tempra, Feverall) • Antiemetics
– Metoclopramide (Reglan) • Vaccines, viral, prevention
– Hepatitis A vaccine, inactivated, and hepatitis
B vaccine (Twinrix)
– Hepatitis A vaccine, inactivated (Havrix, Vaqta) • Immune globulins
– Immune globulin, intramuscular (BayGam
15-18%)
Pencegahan
• Pencegahan umum:
– Perbaikan higiene makanan-minuman
– Perbaikan sanitasi lingkungan dan pribadi • Pencegahan khusus (cara imunisasi)
- Imunisasi pasif (IG)
- Imunisasi aktif (inactivated vaccines ; Havriq, Vaqta, dan Avaxim)
Important Properties of Hepatitis B virus
Classification
Classification Hepadnaviridae (hepatotropic DNA viruses)Hepadnaviridae (hepatotropic DNA viruses) Virus
Virus VirionVirion 42 nm in diameter (nucleocapsid 18 nm)42 nm in diameter (nucleocapsid 18 nm) Composition
Composition DNADNA Genome
Genome Double-stranded DNA, circular, 3.2 kb in size, Double-stranded DNA, circular, 3.2 kb in size,
infectious, negative sense is full length and positive
infectious, negative sense is full length and positive
sense is partially complete. The gap must be
sense is partially complete. The gap must be
complete at beginning of replication cycle
complete at beginning of replication cycle
Proteins
Proteins Two major polypeptides are present in HBsAg; one Two major polypeptides are present in HBsAg; one polypeptide is present in HBcAg
polypeptide is present in HBcAg
Envelope
Envelope Contain HBsAg and lipid Contain HBsAg and lipid Replication
Replication In vivo replication: liver, lymphocytes, pancreas, In vivo replication: liver, lymphocytes, pancreas, other organs.
other organs.
HBcAg in nucleus; HBsAg in cytoplasm; both mature
HBcAg in nucleus; HBsAg in cytoplasm; both mature
virus and 22 spherical particles consist of HBsAg
virus and 22 spherical particles consist of HBsAg
secreted from the cell surface
HBV Hepatitis B virus, etiologic agent of serum hepatitis. A hepadnavirus
HBsAg Hepatitis B surface antigen. Surface antigen of HBV detectable in large quantity in serum ; several subtype identified
HBeAg Hepatitis B enveloped antigen. Soluble antigen. A part of the core; related to the potential for infectivity and HBV replication with high titer of HBV in serum HBcAg Hepatitis B core antigen
Anti-HBsAg Antibody to hepatitis B surface antigen. Indicates past infection with and immunity to HBV, presence of passive antibody from HBIg, or immune response from HBV vaccine
Anti-HBeAg Antibody to hepatitis B enveloped antigen. Presence in serum of HBsAg carrier suggests lower titer of HBV
Anti-HBcAg Total antibody to hepatitis core antigen. Indicates infection with HBV at some undefined time in the past
IgM anti-HBcAg IgM class antibody to HBcAg. Indicates recent infection with HBV; positive for 4-6 months after infection
Cara Transmisi HBV
• Melalui darah:– Penerima produk darah – IVDU – Pasien hemodialisis – Pekerja kesehatan – Pekerja yg terpapar darah • Transmisi seksual • Penetrasi jaringan (perkutan) atau permukosa: – Tertusuk jarum
– Penggunaan alat medis
berulang yg terkontaminasi
– Penggunaan bersama
alat cukur dan silet
– Tato
– Akupuntur – Tindik
– Penggunaan sikat gigi
bersama
• Transmisi maternal-neonatal
atau maternal-infant
• Tidak ada bukti penyebaran fecal-oral.
PATOGENESIS
Virus masuk ke dalam sel hati melalui aliran darah Hepatitis kronis Kerusakan sel hati yang terinfeksi DNA HBV,HBsAg,HBe Ag, anti HBc (terdeteksi dalam serum) REPLIKASI ( tanpa adanya kerusakan jaringan hati &tanpa gejala klinis)
Penderita dapat sembuh
Gejala Klinis
• Hepatitis Akut
– Gejala: flu, anoreksia, mual muntah, ikterus dan pembesaran hati • Hepatitis kronis
– Peningkatan kadar
aminotransferase atau HBsAg slm 6 bln
• Gagal hati fulminan
– Ditandai: timbulnya ensefalopati
hepatikum, ikterus • Pengidap Sehat
– Sering terjadi: pada bayi di daerah yang endemik secara
Scheme of typical clinical and
laboratory features of acute
Scheme of typical laboratory
features of wild-type chronic
HBV
Hasil test :Vaksin HBV dengan pemberian
Ig
PENCEGAHAN SECARA UMUM :
KIE tentang hubungan seks bebas dan pemakaian alat secara bersamaan
Pencegahan HBV u/ Tim medis
1) Vaksinasi
2) Protective dressing (sarung tangan, kacamata pelindung, dll)
3) Eliminasi bebas risiko limbah yang berpotensi terkontaminasi
4) Menggunakan peralatan yang runcing dengan hati2
Rekomendasi profilaksis HBV
post-exposure
Hepatitis C
• Penyakit Hepatitis C adalah penyakit hati yang
disebabkan oleh virus Hepatitis C (HCV)
• Transmisi
– Melalui darah
– Transmisi seksual – Maternal-neonatal – Tindakan operasi
Important properties of Hepatitis C virus (Hepacivirus)
Classification
Classification FlaviviridaeFlaviviridae Virus
Virus VirionVirion 30-60 nm in diameter30-60 nm in diameter Composition
Composition RNARNA Genome
Genome Single-stranded DNA, linier, 9.4 kb in size, infectious, Single-stranded DNA, linier, 9.4 kb in size, infectious, positive sense
positive sense
Replication and
Replication and
Proteins
Proteins Genomic length transcript produce a precusor polyprotein encoding nonstructural protein (replicase, Genomic length transcript produce a precusor polyprotein encoding nonstructural protein (replicase, transcriptase)
transcriptase)
Subgenomic mRNA encodes struktural protein
Subgenomic mRNA encodes struktural protein
Envelope
Envelope Two glycoproteinsTwo glycoproteins Variation
Pemeriksaan • Tes serologis – Anti-HCV • HCV RNA • Enzyme Immuno Assay (EIA) • PCR Penatalaksanaan • Interferon alfa • Pegylated interferon alfa • Ribavirin
Pencegahan
• Saat ini, tidak ada vaksin untuk mencegah
penularan HCV.
• Cara terbaik untuk mencegah penularan HCV
adalah:
– Mencegah kontak dengan darah yang
terinfeksi dan organ-organ
– Menghindari perilaku seksual berisiko tinggi
seperti banyak pasangan dan hubungan seksual oral-anal.
– Menghindari alkohol dan obat-obatan yang
dapat merusak hati yang dapat membantu memperlambat laju perkembangan penyakit.
