Community Medicine

Huda Hamouda 09090116 3rd year MBBS PBL-4-

Member of the hepadnavirus group Enveloped, double stranded DNA virus It has 3 different types: 42nm spherical particle (Dane particle). The envelope contains a protein called HBs Ag Nucleocapsid Core located in the center: o Core antigen (HbcAg) o e antigen (HBeAg)- an indicator of transmissibility (minor component of the coreantigenically distinct from HBcAg) 22nm spheres and filaments other forms- no DNA in these forms so they are not infectious (composed of surface antigen)- these forms outnumber the actual virions

Hepatitis B: Structure

HEPATITIS B VIRUS : DANE PARTICLE

DNA POLYMERASE DNA LAYER

HBeAg HBsAg

HBcAg

Hepatitis B virus particles

three morphological forms

Large 42 nm spherical Dane particle (infectious) 22 nm tubular particles 22 nm spherical particles

HEPATITIS B
SEROLOGICAL MARKERS FOR HBV INFECTION ANTIGENS
Hepatitis B Surface Antigen (HBsAg) Hepatitis B Core Antigen Hepatitis B e Antigen HBV DNA polymerase HBV DNA (HBcAg) (HBeAg)

ANTIBODIES
Antibody to Hepatitis B Surface Antigen (Anti HBs) Antibody to Hepatitis B Core Antigen (Anti HBc IgM & Anti HBc) Antibody to Hepatitis B e Antigen (Anti HBe)

 In general, the panel of responses can determine whether a patient is o susceptible to infection, o immune as a result of resolved infection, o immune as a result of vaccination, o acutely infected, o or chronically infected

Acute Hepatitis B Virus Infection with Recovery Typical Serologic Course

Symptoms

HBeAg

anti-HBe Total anti-HBc

Titer
HBsAg IgM anti-HBc anti-HBs

12

16

20

24

28

32

36

52

100

Weeks after Exposure

Progression to Chronic Hepatitis B Virus Infection

Typical Serologic Course

Acute (6 months) HBeAg HBsAg Total antiHBc Chronic (Years) anti-HBe

Titer

IgM anti-HBc

0 4 8 12 16 20 24 28 32 36

52

Years

Weeks after Exposure

Acute vs. Chronic HBV Infection

Acute HBsAg+ < 6 mos. IgM anti-HBc + positive Infection will resolve and person will have lifelong immunity HBsAb+ and HBcAb+
Chronic HBsAg + for at least 6 months Also known as a carrier Infection does not resolve and the person remains infectious HBsAb- and HBcAB+

 A battery of serological tests are used for the diagnosis of acute and chronic hepatitis B infection. HBsAg - used as a general marker of infection. HBsAb - used to document recovery and/or immunity to HBV infection. anti-HBc IgM - marker of acute infection. anti-HBcIgG - past or chronic infection. HBeAg - indicates active replication of virus and therefore infectiveness. Anti-Hbe - virus no longer replicating. However, the patient can still be positive for HBsAg which is made by integrated HBV. HBV-DNA - indicates active replication of virus, more accurate than HBeAg especially in cases of escape mutants. Used mainly for monitoring response to therapy.

Diagnosis