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Hepatitis ( A B C D E ) - Pathology Lectures for FMGE and NEET PG
The main RNA viruses that cause hepatitis include:
• Hepatitis A (HAV)
• Hepatitis C (HCV)
• Hepatitis D (HDV)
• Hepatitis E (HEV)
HAV is a picornavirus that is transmitted fecal-oral and causes acute hepatitis(no chronic carrier state) that may be anicteric. HAV is commonly acquired by travelers.
HCV is a flavivirus that is transmitted parenterally (IV drug abuse, blood transfusions) and causes acute hepatitis or more commonly, a chronic carrier state. HCV infection can eventually lead to cirrhosis and hepatocellular carcinoma.
HDV is a delta virus that is transmitted parenterally and requires HBV for replication. Superinfection occurs upon an existing HBV infection and is more severe than co-infection (an infection with HBV and HDV at the same time).
HEV is a herpesvirus that is transmitted fecal-oral and causes acute hepatitis. HEV infection in pregnant women is associated with fulminant hepatitis and is commonly acquired from contaminated water or undercooked seafood.
The only DNA hepatitis virus is Hepatitis B (HBV). HBV is a hepadnavirus that is transmitted parenterally (childbirth, unprotected intercourse, and IV drug abuse) and causes acute hepatitis. Only a fraction of cases (~20%) leads to chronic disease. Perinatal infections have a higher likelihood of cirrhosis and hepatocellular carcinoma.
Acute viral hepatitis presents:
• Flu-like systemic symptoms
• Jaundice
• Elevated ALT more than AST
• Moderately increased GGT
• Increased alkaline phosphatase
Chronic viral hepatitis is defined as an active disease that persists for more than 6 months without recovery or an asymptomatic carrier which "carries" the virus and doesn't develop a substantial injury. Asymptomatic carriers may have slightly elevated AST and ALT and possible hepatomegaly.
In viral hepatitis, eosinophilic globules surrounded by normal parenchyma known as Councilman bodies may be seen on liver biopsy.
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