Hepatiis TD
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Transcript of Hepatiis TD
PendahuluanInfeksi beberapa virus dapat menyebabkan
peradangan pada hati, yang ditandai dengan gejala klinis (Mims et al., 2004):
Asimptomatis Simtomatis: badan terasa lelah, demam, nyeri
persendian, anoreksia, sakit kepala, gejala gastrointestinal seperti mual (nausea) dan muntah (vomiting), rasa tidak enak dan nyeri pada perut, diare dan bisa diikuti jaundice yaitu fase kuning (ikterik) pada kulit, sclera, membran mukosa.
Jika 6 bulan setelah infeksi tidak sembuh total penyakit hepatitis beralih menjadi fase kronis (hepatitis kronis)
AA“ Infectious”
“ Serum”
Viral hepatitis
Entericallytransmitted
ParenterallytransmittedF, G, TTV
? other
EE
NANBNANB
BB DD CC
Viral Hepatitis - Historical Perspectives
Source ofvirus
feces blood/blood-derived
body fluids
blood/blood-derived
body fluids
blood/blood-derived
body fluids
feces
Route oftransmission
fecal-oral percutaneouspermucosal
percutaneouspermucosal
percutaneouspermucosal
fecal-oral
Chronicinfection
no yes yes yes no
Prevention pre/post-exposure
immunization
pre/post-exposure
immunization
blood donorscreening;
risk behaviormodification
pre/post-exposure
immunization;risk behaviormodification
ensure safedrinking
water
Type of HepatitisA B C D E
Hepatitis A Virus Naked RNA virus Related to enteroviruses, formerly known as
enterovirus 72, now put in its own family: hepatovirus
One stable serotype only Difficult to grow in cell culture: primary
marmoset cell culture and also in vivo in chimpanzees and marmosets
4 genotypes exist, but in practice most of them are group 1
Morfologi dan Komponen virus Merupakan virus RNA, single stranded, polaritas positif berat molekul 2,25-2,28x 106 dalton. Simetri ikosahedral, diameter 27-32 nm dan tidak
mempunyai selubung. Mempunyai protein terminal VPg pada ujung 5’nya dan
poli (A) pada ujung 3’. Panjang genom HAV : 7500-8000 pasang basa. Protein struktural yang dibentuk oleh virus ini adalah:
VP1 (30-33 kilodalton), VP2 (24-27 kilodalton), VP3 (21-23 kilodalton), VP4 (7-14 kilodalton).
Atas dasar sifat fisik dan kimianya, virus ini digolongkan sebagai enterovirus 72, urutan nukleotida dan asam amino HAV cukup jelas untuk memasukkan virus ini menjadi genus pikornavirus yang baru yaitu Heparnavirus.
Lemak bersifat stabil jika diberi perlakuan dengan eter, asam dan panas (60oC selama 1 jam). Infektivitasnya dapat bertahan paling sedikit 1 bulan setelah dikeringkan dan disimpan pada suhu 25oC dengan kelembaban relatif 42% atau selama bertahun-tahun pada suhu -20oC.
Virus HAV dapat diinaktivasi dengan : 1. Otoklaf (121oC selama 20 menit) 2. Sinar ultraviolet (1 menit pada 1,1 watt) 3. Formalin (1:4000 wt/vol selama 3 hari pada 37oC). 4. Klorine (10-15 ppm selama 30 menit) 5. Sodium hipoklorit 0,5% selama 15 menit 6. Pemanasan kering (180oC selama 1 jam) 7. Pendidihan dalam air selama 5 menit
Incubation period: Average 30 days
Range 15-50 days Jaundice by <6 yrs, <10%
age group: 6-14 yrs, 40%-50%>14 yrs, 70%-80%
Complications: Fulminant hepatitisCholestatic hepatitisRelapsing hepatitis
Chronic sequelae: None
Hepatitis A - Clinical Features
FecalHAV
Symptoms
0 1 2 3 4 5 6 12 24
Hepatitis A Infection
Total anti-HAV
Titre ALT
IgM anti-HAV
Months after exposure
Typical Serological Course
Close personal contact
(e.g., household contact, sex contact, child day care centers)
Contaminated food, water(e.g., infected food handlers, raw shellfish)
Blood exposure (rare)(e.g., injecting drug use, transfusion)
Hepatitis A Virus Transmission
EndemicityDisease
RatePeak Age
of Infection Transmission Patterns
High Low to High
Early childhood
Person to person;outbreaks uncommon
Moderate High Late childhood/
young adults
Person to person;food and waterborne outbreaks
Low Low Young adults Person to person;food and waterborne outbreaks
Very low Very low Adults Travelers; outbreaks uncommon
Global Patterns of Hepatitis A Virus Transmission
Laboratory Diagnosis Acute infection is diagnosed by the detection of HAV-IgM
in serum by EIA. Past Infection i.e. immunity is determined by the detection
of HAV-IgG by EIA. Cell culture – difficult and take up to 4 weeks, not
routinely performed
Direct Detection – EM, RT-PCR of faeces. Can detect illness earlier than serology but rarely performed.
Multiplikasi virus menginokulasikannya pada biakan sel monyet Afrika atau jenis rhesus, sel Vero, sel paru fetus manusia dan sel kanker hati manusia
Metode pilihan untuk mengukur antibodi HAV radioimunoasai, ELISA dan hemaglutinasi pelekatan imun
Dengan metode radioimunoasai, antigen HAV telah ditemukan di dalam hati, tinja, empedu dan darah orang yang terkena infeksi secara alami serta simpanse dan marmoset yang terkena infeksi dalam percobaan laboratorium
Titer HAV tertinggi ditemukan pada tinja kira-kira 1-2 minggu sebelum ditemukannya kelainan enzim hati
Many cases occur in community-wide outbreaks no risk factor identified for most cases highest attack rates in 5-14 year olds children serve as reservoir of infection
Persons at increased risk of infection travelers homosexual men injecting drug users
Hepatitis A Vaccination Strategies
Epidemiologic Considerations
Pre-exposure travelers to intermediate and high
HAV-endemic regions Post-exposure (within 14 days)
Routine household and other intimate contactsSelected situations institutions (e.g., day care centers) common source exposure (e.g., food prepared by
infected food handler)
Hepatitis A Prevention - Immune Globulin