SEROLOGIC INVESTIGATIONS IN

VIRAL HEPATITIS
DR EJEMAI EBOREIME
INTRODUCTION
• Viral Hepatitis is a systemic disease primarily
affecting the liver.
• Hepatotropicviruses are the culprits in about
99% of cases
HEPATOTROPIC VIRUSES
• Hepatitis A virus (HAV):
▫ Picornavirus
▫ Transmitted feco-orally
▫ Causes acute but no chronic infection
• Hepatitis B virus (HBV):
▫ Hepadna virus
▫ Aka Dane particle
▫ Transmitted via body fluids
▫ Causes both acute and chronic infections
 STRUCTURE OF HBV
HBsAg HBV-DNA
Polymeras
e

HBV- HBcAg
DNA HBeAg
(blood)
• Hepatitis C virus (HCV):
▫ RNA-containing flavivirus
▫ Causes chronic hepatitis
▫ Commonest mode of transmission is blood and
blood products
▫ Sexual and vertical transmissions are not very
common
• Hepatitis D virus (HDV):
▫ RNA-defective virus
▫ Incapable of independent replication
▫ Requires HBV

• Hepatitis E virus (HEV):

▫ RNA virus
▫ Feco-oral transmission
▫ Chronic infection does not occur
NON HEPATOTROPIC VIRUSES
(aka non A-E viral hepatitis)
• CMV
• EBV
• HSV
• Yellow fever virus
Role of serology in hepatitis
management
• Serology involves the study of seroactive
substances for the purpose of diagnosis and
management of diseases
• Such substances may include antigens and
antibodies.
• The presence and time of detection of these
substances are essential in hepatological
infectology
Hepatitis A
• Anti HAV:
▫ Detectable at onset of symptoms (IgM)
▫ Persists for lifetime hence not very useful clinically
(IgG)
• IgManti HAV indicates recent infection. Could
remain +ve 4-6months post infection
Hepatitis B
• Serologic markers include:
▫ Hep B surface antigen (HBsAg)
Detectable in large quantities in serum
Indicates acute infection and high infectivity
Appears in blood late incubation period and disappears
within 3-4 wks but may persist up to 6mths
▫ Anti HBs
Indicates past infection with and immunity to HBV (if
assoc. with anti HBc), presence of passive antibody from
HBIG,or immune response from HBV vaccine
• Hep B core antigen (HBcAg)
• Anti HBc: of 2 types
▫ IgM
Appears after about 2 mths and may persist till 7th mth.
Indicates acute infection
▫ IgG
Indicates chronic infection
• HBe Ag
▫ Circulating form of HBcAg
▫ A marker of viral replication and infectivity
▫ Appears transiently at onset of infection and lasts 1-3mths
▫ Associated with HBV replication and indicates high titre and
infectivity of serum
• Anti-HBe
▫ Appears from 10th wek
▫ Presence in serum of HBsAgcarrier suggests lower titre of HBV
• Most sensitive test is detection of HBV DNA in serum
though not generally required for routine diagnosis
• HCV:
▫ Anti-HCV, for chronic infections
▫ Serum PCR
• HDV:
▫ Anti HDV (IgG & IgM)
• HEV:
▫ Anti HEV
CONCLUSION
• Viral hepatitis is a common cause of CLD in this
environment.
• Healthworkers are particularly at risk of infection
• Understanding the basis for serological
investigations of viral hepatitis improves
diagnosis, management, prognostication as well
as prevention of the disease and its complications.
THANK YOU
 High risk stage for
Chronic Hepatitis B
progression
Symptom flares may occur if
immunocompromised
Conversion to Stage 3
Occurs in most adults
rapidly
Others convert 5-15%
per year
Early Acute
HBsAg Positive
HBeAg Positive
Acute (2-12 weeks)
HBsAg Positive
HBeAg Positive
xHBc IgM Antibody Positive
xHBc IgG Antibody Positive
Acute and Seroconversion
(transitions into Stage 3)
HBsAg Positive
xHBc IgM Antibody Positive
xHBc IgG Antibody Positive
xHBe IgG Antibody Positive
Stage 3: Inactive carrier state (3-6