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Hepatitis C

Hepatitis C. Lana Abdul Sater MD3 July 1 st , 2014. Table of Contents. Introduction Replicative Cycle Transmission and Epidemiology Pathogenesis and Immunity Clinical Findings Lab Diagnosis Treatment and Prevention References. Introduction.

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Hepatitis C

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  1. Hepatitis C Lana Abdul Sater MD3 July 1st, 2014

  2. Table of Contents • Introduction • Replicative Cycle • Transmission and Epidemiology • Pathogenesis and Immunity • Clinical Findings • Lab Diagnosis • Treatment and Prevention • References

  3. Introduction • Hepatitis is the medical term for inflammation of the liver. • The Hepatitis C virus is one of the many causes of liver inflammation • HCV belongs to the Flaviviridae family, specifically to the hepacivirus genus • Hepatitis C has a core protein genetic material (RNA) surrounded by a protective shell of protein and further encased in a lipid envelope of cellular material.

  4. Life Cycle of Hepatitis C • Hepatitis C uses particular proteins present on its protective lipid coat to attach to a receptor site. • Virus’s protein core penetrates the plasma membrane and enters the cell. • Protein coat dissolves to release the viral RNA in the cell. • Cell’s ribosomes begin the production of materials necessary for viral reproduction  viral RNA synthesizes the RNA transcriptase it will need for reproduction • Production of protein based capsomeres. Ribosomes create the proteins and release them for use • Capsomeres self-assemble to form a spherical shell, called capsid that full encapsulates the virus’s RNA. • Newly formed viruses travel to the inside portion of the plasma membrane and attach to it, creating a bud. The plasma membrane encircles the virus and then releases it, providing the virus its protective lipid coat which will later be used to attach to another liver cell.

  5. Life Cycle Continued

  6. Transmission & Epidemiology • Transmitted by any source of blood or blood products (ex. Used razor) • Maternal-infant transmission has also been documented as a mode of spread • Tattooing as well as many body piercing practices • Needle-stick injuries, contaminated medical equipment, and blood spills in health care settings • IV Drug users as well as Cocaine users have also shown to transmit the virus by sharing snorting straws • Heterosexual or homosexual activity with multiple sexual partners

  7. Pathogenesis & Immunity • The hepatitis C virus is a single stranded RNA virus. It is able to escape innate and adaptive immune surveillance  agent of chronic hepatitis. • Cytotoxic lymphocytes then contribute to liver injury in an attempt to eradicate the virus. • On the other hand strong multispecific T-lymphocyte reaction against HCV proteins is associated with viral clearance. Both CD4+ and CD8+ lymphocyte functions are important to effect this outcome. • In chronic infection, genetic and environmental factors determine the progression of inflammation and fibrosis in individual patients. • Development of hepatocellular carcinoma is mainly restricted to patients with cirrhosis.

  8. Pathogenesis • Acute hepatitis C is a short-term infection with the hepatitis C virus. Symptoms can last up to 6 months. The infection sometimes clears up because your body is able to fight off the infection and get rid of the virus. • Chronic hepatitis C is most often treated with a medicine combination that attacks the hepatitis C virus. Treatment may last from 24 to 48 weeks.

  9. Schematic of the potential outcomes of hepatitis C infection in adults, with their approximate frequencies in the United States.

  10. Diagrammatic representation of the genomic structure and transcribed components of the hepatitis C virion. The hepatitis C virion is transcribed in one single transcript, as depicted in the top line; 340 nucleotides at the 5' end and 128 nucleotides at the 3' end are not translated into protein

  11. Sequence of serologic markers for hepatitis C viral hepatitis demonstrating (A) acute infection with resolution and (B) progression to chronic relapsing infection.

  12. Chronic viral hepatitis due to hepatitis C virus, showing portal tract expansion with inflammatory cells and fibrous tissue and interface hepatitis with spillover of inflammation into the adjacent parenchyma. A lymphoid aggregate is present Cirrhosis resulting from chronic viral hepatitis. Note the broad scar and coarse nodular surface.

  13. Clinical Findings • Most people do not have any symptoms until the hepatitis C virus causes liver damage, which can take 10 or more years to happen. • Others may have one or more of the following symptoms: • Feeling tired • Muscle soreness • Upset stomach • Stomach pain • Fever • Loss of appetite • Diarrhea • Dark-yellow urine • Light-colored stools • Jaundice • When symptoms of hepatitis C occur, they can begin 1 to 3 months after coming into contact with the virus.

  14. Lab Diagnosis • A blood test will show if you have hepatitis C (anti-HCV test) • A liver biopsy if chronic hepatitis C is suspected. A liver biopsy is a test to take a small piece of your liver to look for liver damage.

  15. Treatments • Hepatitis C is usually not treated unless it becomes chronic. • Chronic hepatitis C is treated with medicines that slow or stop the virus from damaging the liver.  • Boceprevir • Peginterferonalfa • Ribavirin • Telaprevi • Chronic hepatitis C is also treated with liver transplant in case of severely damaged liver.

  16. Preventions • At present, no vaccine exists to prevent infection with HCV • You can protect yourself and others from getting hepatitis C if you • Do not share drug needles and other drug materials • Wear gloves if you have to touch another person’s blood or open sores • Do not share or borrow a toothbrush, razor, or nail clippers • Make sure any tattoos or body piercings you get are done with sterile tools • Tell your doctor and your dentist if you have hepatitis C • Practice safe sex (ex. condoms)

  17. Thank You!! • Any Questions??

  18. References • Ryan KJ, Ray CG (editors), ed. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 551–2. ISBN 0838585299. • Rosen, HR (2011-06-23). "Clinical practice. Chronic hepatitis C infection". The New England Journal of Medicine364 (25): 2429–38.doi:10.1056/NEJMcp1006613. PMID 21696309. • Carreño, V; Bartolomé, J; Castillo, I; Quiroga, JA (May–June 2008). "Occult hepatitis B virus and hepatitis C virus infections.". Reviews in medical virology18 (3): 139–57.doi:10.1002/rmv.569. PMID 18265423. •  Mueller, S; Millonig G; Seitz HK (2009-07-28). "Alcoholic liver disease and hepatitis C: a frequently underestimated combination" (PDF). World journal of gastroenterology : WJG15 (28): 3462–71. doi:10.3748/wjg.15.3462. PMC 2715970. PMID 19630099. • Ozaras, R; Tahan, V (April 2009). "Acute hepatitis C: prevention and treatment". Expert review of anti-infective therapy7 (3): 351–61. doi:10.1586/eri.09.8.PMID 19344247.

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