تشخیص هپاتیت Hepatitis Diagnosis

صفحه 1:


صفحه 2:
مت ۳۵9۳ اتید 99 ar vee stage stranded, ter ‏حور‎ صصب مهس postive ‏وه‎ stage pirated, bora 

صفحه 3:
Hepatitis A and E Type Sourc Transmissi Chronic Prevention e on Immunizatio A Feces Fecal-oral No 2 Ensure safe E Feces Fecal-oral No drinking water 

صفحه 4:
Hepatitis B, C and D Source Transmiss Chron Prevention ion ic Blood/ Percutane body See Yes Immunization 0 permucos fluids al Percutane Blood/ ous screening, risk 0 ۱ behavior fluids al modification Blood/ Percutane Immunization, risk eo ous i sis Sees ieee eas 

صفحه 5:


صفحه 6:
Hepatitis B Virus 

صفحه 7:
Hepatitis B Virus ٠ ‏و(‎ ‎hepatotropic ‎virus ٠١ * Virions called Dane particles 

صفحه 8:
Subviral Particles epost ۵ ‏ضوقت ماب‎ NA polymere NA (most double onde, 3200 bp * subviral ‏عد‎ ‎particles: - ¢ Filamentous or rods bodies * Spherical bodies Done parle 

صفحه 9:
‎eee ee‏ ا تسس ‎HBV ‎3213 ‎15> ‎* Partially Double stranded DNA ‎٠ DNA polymerase with RT activity ‎¢ four known genes encoded by the genome called C, X, P, and S. ‎ 

صفحه 10:
Gene Products and Functions Polymerase Terminal protein (priming) Reverse transcriptase, RNAse H Surface Envelope proteins ۳۳6 - 1 Receptor binding, Regulation of cccDNA, viral assembly Pre - S2 Viral assembly, fusion sequence 5 Primary structural component, major antigenic determinants Core HBeAg Secreted, immunomodulatory function Core Nucleocapsid component 

صفحه 11:
serotypes & Genotypes Four major serotypes based on antigenic epitopes presented on its envelope proteins - adr, adw, ayr, ayw, * Eight genotypes (A-H) according to overall nucleotide sequence variation of the genome. 

صفحه 12:
Natural History of 

صفحه 13:
Clinical outcomes OF Hepatitis b Hepatic cell carcinoma infections Acute hepatitis B Fulminant hepatitis HBsAg* for >6 months Resolution| 50% J 1 1 1 Asymptomatic | |Chronic persistent! | Chronic active carrier state hepatitis hepatitis Extrahepatic disease: | | ‏مب‎ ‎Polyarteritis nodosum Sito cee Resolution اس( رانا ‎GODS, Cheyer OF, pital‏ مت ان راب60 سب وی مسق 

صفحه 14:


صفحه 15:
Expected and usual association between HBVgenotypes and subtypes as reported worldwide. ۲20 ۸ که ۸02 04د كن اه له له ۵02 ‎Subtype‏ ‏4 كلك ‎—ayw2‏ له اه ۸۲ ۰.8 ۸۲ ۸01 ۰.4 ۸012 اج ‎awl‏ ‏قله ذه .©0:/80-0, 0000106 5د جدرا” .007 طساوا 

صفحه 16:
HBV Genotypes A-H A 

صفحه 17:
five parts on the basis of geographical location. Numbers and percentages of patients in each part A > / caspian sea} 51 (20%) Persian’ Gull 

صفحه 18:
Biochemical Effe S Alanine inotransferase (ALT) & Acut 1 spartate Amino- Hepatocellul transferase (AST) ar Necrosis SS 1 erum Albumin Prothrombin Time 

صفحه 19:
immunological events or acute vs. chronic HBV infection ©) One ®) Oko [ina ro ray at ch, Deed erdbey nba, CDS, ‏مود‎ 8, bleh y Don Phe, 

صفحه 20:
Clinical Significance of Serological Markers for HBV Serological wn on Clinical Significance 120۹ ‏1ن‎ hRevios 0۵ cute kevin WOrBy ‏سوه سا‎ ‎bow Pec‏ رای هی هروه ی مطامحنل سا ...رکه له رام 

صفحه 21:
0 8 Diagnosi A battery of serological tests are used for the diagnosis of acute and chronic hepatitis B infection. = used as a general marker of infection. ____= used to document recovery and/or immunity to HBV infection. ss marker of acute infection. ‎past or chronic infection.‏ « ان ‎=~ indicates active replication of virus and therefore infectiveness. ‎no longer replicating. However, the‏ فلت ‎patient can still be positive for HBsAg which is made by‏ ‎integrated HBV.‏ ‎= indicates active replication of virus, more accurate than HBeAg especially in cases of escape mutants. Used mainly for monitoring response to therapy. ‎ 

صفحه 22:
Clinical Features or Hepatitis B 1/1 ‏وجد حاو‎ Ord Oot likely Cenmninems Orwwou Grard ‏و‎ ‏ابو‎ Cowwou ID - 1% Preiss 

صفحه 23:
Clinical Features of Hepatitis B Jaundice S-CO% Fulminant, > Diaegnastic feats rue tPeviod WOsOy, KO ‏)سل‎ ‎Ohrow ‏موه‎ WOsBy, TS wai-WOr immunity ۰15 ‏)هت ,راکمه‎ Case-fatality raie 0-906 Chronic: infection >90% taPacts <O% uhile 

صفحه 24:
Hepatitis B Blood Tests Definition/Diagnostic Use General marker of infection Persistence for > 6 months = chronic infection Indicates active replication of virus Indicates actual level of virus in the blood Markers HBsAg: Hepatitis B surface antigen HBeAg: Hepatitis Be antigen HBV DNA 

صفحه 25:
Hepatitis B Blood Tests: Antihodiac SESELSIIUULUSDS Definition/Diagnostic Use Documents recovery and/or immunity to HBV Detectable after successful hepatitis B vaccination Documents past or present infection with HBV Indicates lower level of viral replication Markers Anti-HBs: Antibody to hepatitis B s antigen Anti-HBc: Antibody to hepatitis B core antigen Anti-HBe: Antibody to hepatitis B e antigen 

صفحه 26:
Hepatitis B Disease States Nowe oy bep لؤ)دل)راا” و ee ‏اران وه مامدلل‎ Vora OUI ‏رز )را‎ = 4UQO UO = I aw (© SU,UOU WWheb, ‏بیدا کل > رنب راب رن عم‎ ) 

صفحه 27:
۱61۵1۷۵ ۱۰111016110۷ 01 ۶۸۵ ۷ ‏ر‎ ‎HCV, HIV Transmission by Type of Exposure Type of exposure Efficiency of transmission to infected source HBV HCV HIV Transfusion tttt +444 Injecting druguse ++++ = = ++++ Unsafe injections +++ + Perinatal arora +4+4+ Needle stick +++ + 

صفحه 28:
(ک۳) معط زرا (۳)) مرب له را 

صفحه 29:
Guidelines on Chronic HBV: Whom to Treat with Antiviral Therapy ٠ Clevated WOO OOO levels < CO,OOO 10/ab vr = (0° copies! ‏تیه‎ ‎۰ Persistedty elevated BLT levels 2S x OLD (wren CLP: SO IW Por wea, 1 Okob Por woven) (ice ۰ ‏هرا حول ولو(‎ disease vo biopsy ‏عنس۲ 6 ۶ 9 ,9 موه‎ 

صفحه 30:
Goals for Treatment- Naive Chronic HBV Patients Qveedzdion OP ‏یط ور‎ tests Ondeteorble MOO OOO WOr®q serverwersion (PF orkid WOr@Oqt) = WOcOy wy & WOrOb pes Reduce ‏حول‎ ۳۳۳۶930 & visk EP WCC 

صفحه 31:
Pharmacologic Treatment Options for Chronic Hepatitis B یت مره من ‎Crsthoe‏ © ‎tay‏ وج ()) (#مسحومصياا") عضحخاط©) - اما وج ل 0.6 (عدماومهةا)) هموي ه9) - ‎aqeds‏ ری امس موی ‎٠‏ ‎(Opa-VOO®) (OO wy tay‏ رورا - ‎Debus (Nyzeba") OOO wa daly‏ - 

صفحه 32:
Pharmacologic Treatment Options for Chronic Hepatitis B © ActerPevoce based preporuivd in selevt potects (injevtuble) - ‏(©ورومية)) محمداه موموناءجورتة)‎ (OO wey OQ quweck ‏ع‎ PO weebs 

صفحه 33:
Algorithm in Treatment-Naive Chranic.HBy | 

صفحه 34:
lgorithm in Treatment-Naive Chronic HBV 1/۵۵ Poster or Orne ۱ ١ ۱ ۰ ‘LOO OOO LOO OOO 200,000 kd, |~ (oR) | 200° o/h 1 , ۹ et P Orwd |— | 7 _Oorwd | ia there ‏مب ی‎ CPratte pte: OxbPour, Bctevar or ‏مسب‎ ‏اه یمتا سا ا تسسات ا د‎ 

صفحه 35:
Cases for Interpretation? 

صفحه 36:
Case 1: ۰ ٩۶ Orxnive ٠ Cat LOcr DOryquive ۰ Oaot-LOs Oerquive Interpretation? 

صفحه 37:
Case 2: ۰ 2 Ornive * Oat-LOr Positive ۰ Oa-L®Os Positive Interpretation? 

صفحه 38:
Case 3: * WOs®Oy ‏شم‎ ‎۰ ‏شبح( کي‎ * @atWOs Positive Interpretation? 

صفحه 39:
Case 4: ۰ 1۶۹ Positive * Owt-LOr Posture ۰ 10 ‏یراکش‎ Positive ۰ ‏۶و‎ Orvuive *Interpretation? 

صفحه 40:
Case 5: ۰ 2/۹ @ovstive ۰ ‏۶و‎ Positive 21D wtLOr 3 Dexnive ۰ ‏او‎ Orxvuive Interpretation? 

صفحه 41:
Case 6: * WOsOy Ornive * Oat-LOc Positive ۰ Oat-LOs Oecuive Interpretation? 

صفحه 42:
Interpretation of the Hepatitis B Panel Tests Results Interpretation HBsAg Tegatve 0 negative ‘susceptible anti-HBs rogatve HBsAg negative ‎positive ‘immune due to natural infection‏ نا ‎anti-HBs positive ‎HBsAg 7 ‎anti-HBs negative immune due to hepaisB vaccination ‎anti-HBs positive ‎‘HBsAg positive ‎aniitBe postive ‏نود‎ ‎positive infected‏ و ‎ants regatve ‎HBsAg positive ‎anti-H postive chroricaly ‎negative infected‏ 200186 لوا ‎ani-8s negative ‎HBSAg negative four ‎postive interpretations‏ وت ‎ent-HBS negative possible * ‏دا ‎‘May be recovering from acute HBV infection,‏ ۳1 ‎2. May ‏معط‎ immune ad test not sensitive enough to o detect very low level of ant-HB in serum. 3. May be susceptible with a false positive anti-HBc. 4, May be undetectable level of HBsAg present in the serum and the person is actually @ carrier. ‎ ‎Seal aac ‏اه هه‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ 

صفحه 43:
Hepatitis D Epona’, 

صفحه 44:
Hepatitis D Virus ’Nucleic Acid: 1.7 kb ssRNA Classification: unclassified, related to viroids; deltavirus “HBV envelope One serotype, three genotypes 

صفحه 45:
Hepatitis D (Delta) Virus ‎th UBO-LDO creo any hae tore smvere tants deme orn u hear rok oP Karen karat (2% CD%)‏ مسجو چا مس و راو ‎errand ud home fected ude LOO char heuumvmr, charms “UDO rE eva oppure to poo ben‏ ‎ba‏ وید 1/060 بو معط رقعی ‎(UDO mngeri‏ موه سای ‎UBO-U00 wore ecto. Ohms ABO carrer‏ ‎UDO cerviers ude LODO mipernb ect, 0% 010% bra hemp even of cher keer‏ موه اه شوه یمسا ‎ear‏ مهم ( 1,6۵6 سم ‎seme tudvcrrhower ean ue 66 OKD% of pret a‏ 

صفحه 46:
Modes of HDV infection Ler al © => انا 6 

صفحه 47:
HDV -Coinfection 

صفحه 48:
HDV - Superinfection 

صفحه 49:
Clinical Sequelae ا ذلك ‎Coinfecti‏ 

صفحه 50:
a 3 5 ۲ 

صفحه 51:
Outcome Following Hepatitis C Infection eer ‏زر‎ eth _, a Aes - Os ۰ eo 50 

صفحه 52:
Clinical course of hepatitis C infection Acute hepatitis C infection (mostly asymptomatic) للخ تتم Chronic infection Cleared infection (70-80%) (20-30%) لس Cirrhosis Chronic persistent (20-30%) hepatitis | A proportion will develop hepatocellular carcinoma 

صفحه 53:
Diagnostic Tests * Wepuitis C waibody tests * Quolitaive MCO ROO tests * Quancitaive ICO ROO tests ٠ Cewtppicy 

صفحه 54:
Acute hepatitis C infection ‎or‏ بك > © © © © © 4 9۶ 66 40۵ © © © © © ‎Dente‏ و0 ‎Tree OPter Grpzoure‏ واه 5 ‎ 

صفحه 55:
Antibody tests for hepatitis C ۰ Vadicutes pust or preseu Period 

صفحه 56:
Qualitative HCV RNA ۰ ‏اند رکه هون‎ © Ose ia the eur) dagquosis oP acute hepuititis O ۰ Oewoustirutes the presewe oP wie iuPevion عم حول عرو "لماك لكان3)" 5 ۳۹ 1۳ ۲۳۳۲۲۵۶ 

صفحه 57:
Clinical Features of Hepatitis C Transmixsion Ord Ov Cenninens Cowwou ‏یموق‎ ‘Yes, rae @ertcatat ‘Yes, ‏نط‎ Prequeuy Incubation period 06 - 00 (da) Clinical Uiness at 9 - 0 presentation 

صفحه 58:
Clinical Features of Hepatitis C 6 © سول ‎Rae‏ #ججشرطل ‎Discrete theme Acute infection HCV RNA (anti- HCV) Chronic infection HCV RNA (anti-HCV), >6 months ‎Ovkwwa‏ و۹ ‏04-06 ابر تلبت( 06 - 60 محمطوي او 1 

صفحه 59:
Treatment of chronic HCV infection with oral ribavirin and intramuscular pegylated interferon: treatment duration and response. Chronic HCV infection HCV genotype 1, 4, 5, 6 HCV genotype 2, 3 +Recommended treatment Recommended treatment duration 48 weeks duration 24 weeks 50% with SVR’ 80% with SVR" + Patients infected with HCV genotype 1, 4, 5, 6 should have their viral load measured at week 12 of treatment. Treatment should be is continued in those who do not show a significant fall in HCV viral load as these patients are not likely to respond. * SVR — sustained viral response (suppression). 

صفحه 60:


صفحه 61:
Hepatitis A Virus ۰0 ۲۲ ۰.9 :24 یاس( 

صفحه 62:
Typical Serologic Course of Acute Hepatitis A Virus Infection Op 

صفحه 63:
Cimical Features Or Hepatitis A Transmission Oral Common Percutaneous Rare Sexual No Perinatal No incuhation perisd 15 - 49 days (average 25) 8% Children presentation 70-80% Adults 

صفحه 64:
Clinical Features of Hepatitis A 0۳40 Chittex-<S% Pulser >09 ۱ ‏ححص‎ ‎8 ‏مصادص أو عندح‎ IO 0 Chrous kPevica Ont ‏ریت‎ ‎‘epee IW ot LOO Totes Od O.P% Denis ‏مويحة عا‎ Ovw 

صفحه 65:


صفحه 66:
Hepatitis E Virus * Owes Bord: (۳.9 ۲۲ 0 

صفحه 67:
Clinical Characteristics ’ Gixoilar to Keputitis (D Cun pose severe unuite hepatic Gubclaicd icPectivg is cowed Oo chrowc iPection - Op tt CO% wortaliy avoay preyerat 

صفحه 68:


صفحه 69:
Clinical reatures or Hepatitis E ‘Transmission Oral Common Percutaneous Unknown Sexual No Perinatal Yes, unknown frequency Incubation peried 15 - 60 (days) 70 = 80% in adults presentation —,- Common 

صفحه 70:
Clinical Features OF Hepatitis E Fulminant <1%, in pregnancy up to 30% Diaguastic texts Acute infection IgG anti-HEV (seroconversion) Chronic infection Not applicable ‏و‎ 11 Not applicable Case-fataliiy rate 0.5 - 4% 1.5 - 21% in pregnant women Chronic infection None 

صفحه 71:
Additional Hepatitis Agents 4990 ‏عم‎ post ‏أصدة‎ صاصم‎ heputits ‏ون تسس‎ 2 (0% vP wu ‏ای له‎ « 0-0 Op t FO% vP Pukorocrat heputits ‏جا بوكصاصاع جه‎ preset Curses oP wre keputtts Polo wed by upkistic wewn