PEMERIKSAAN SEROLOGIPADA HEPATITIS VIRUSOleh : dr. Diah Hermayanti, SpPK*

*TUJUAN PEMBELAJARANTIUMemahawi pemeriksaan serologi dalam diagnosapenyakit hepatitis virus

TIK1. Mengetahui beberapa jenis hepatitis virus (terutama A, B,C)

2. Memahami respon imunologi pada hepatitis A, B, C tersebut

3. Memahami respon imunologi tersebut dalam diagnosa hepatitis A, B, C

4. Memahami respon imunologi dalam menentukan prognosa

*ANATOMI HEPAR

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*HEPATITISAPA ITU ?

Hepatitis adalah kondisi inflamasi pada hati

EX- Infeksi virus- Infeksi lainnya- Alkohol- zat kimia- penyakit auto-imun, dll

Hepatitis virus yang tersering adalah :

Hepatitis A & B

*HEPATITIS AKUTAktivitas transaminase >>>, meski belum tampak ikterik

tingkat kerusakan sel rendah perluasan kerusakan sel besar

Kenaikan SGPT > SGOTRasio De Ritis SGOT / SGPT < 1

Minggu Itransaminase > sampai SGPT 1200 u/l SGOT 700 u/lMinggu II & IIIbila tidak ada komplikasi transaminaseturun kembali

bila ada kolestasis : GGT, ALP >>>

*PENYEBAB HEPATITIS AKUT

Hepatitis toksik- toksin- obat : Acetaminophen, NSAID, valproic acid, isoniazid

Hepatitis virusHepatitis A, B, C, D, E, GCytomegalovirus, Ebstein Barr virusHerpes simplex virus

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FAKTORABCDEGTYPERNADNARNAPARTIALRNARNAINCUBATION15-50 days30-15015-16030-15020-40?TRANSMISSION:FECAL-ORALyesnominnoyesNoHOUSEHOLDyesminminyesyesNoVERTICALnoyesminyesnoYesBLOODrareyesyesyes?YesSEXUALnoyesminyes? YesDIAGNOSISAnti HAV,IgMHBsAg, PCR, Anti HBc IgMAnti HCV, PCRAnti HDVAnti HEVAnti HGVCARRIER STATENoyesyesyesyesYesCHRONIC Hpttsno10%80%yesnoNoLIVER CaNo yesyesnonoNoPREVENTIONVACCINEyesyesnoYes*noNoIgyesyesnoYes*noNoINTERFERON?50%20-45%yes?yes

*HEPATITIS A

*HEPATITIS A Infectious disease caused by Hepatitis A virus

transmitted by the fecal-oral route via contaminated food or drinking water

the incubation period, is between two and six weeks and the average incubation period is 28 days

Hepatitis A is an acute illness,does not have a chronic stage, is not progressive, and does not cause permanent liver damage

*Virology

The Hepatitis virus (HAV) is a Picornavirus;

it is non-enveloped and contains a single-stranded RNA packaged in a protein shell.[8]

There is only one serotype of the virus, but multiple genotypes exist

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*PADA HEPATITIS AKUT YG DIDUGA KARENA HEPATITIS AMAKA DIPERIKSA :

Ig M antibodi HAV

Mulai terdeteksi pada 1-2 minggu setelah infeksibertahan selama 14 minggu

Bila POSITIF dan diikuti oleh peningkatan SGPT & SGOTMaka diagnosa Hepatitis A dapat ditegakkan

Ig G antibodi HAVBermakna bahwa kondisi akut telah berlaludan orang tersebut telah mempunyai antibodisehingga terlindung dari infeksi selanjutnya

*HEPATITIS B

*HEPATITIS VIRUS BThe infectious virion, otherwise known as the Dane Particle, is about 42nm in diameter.

Contains all the HBV surface proteins as well as the HBV core protein, HBV genome and HBV's DNA polymerase.

*Replication of the HBV genome occurs within the nucleus of an infected cell.

RNA polymerase II transcribes the circular HBV DNA to mRNA.

Once produced, the genomic RNA exits the nucleus and enters the cytoplasm where it is been translated to generate the HBV reverse polymerase, core and e proteins. Life Cycle

*HEPATITIS VIRUS B

Penularan :darah / serumhubungan seksualpemakaian needle bersama,tato, dll

Manifestasi Klinik :

- Hepatitis akut- Hepatitis kronik

*MONTHS012345678Anti-HBcAnti-HBsAnti-HBeHBsAgHBeAgRELATIVE CONCENTRATIONThe most sensitive and specific methods used are RIA and ELISA.

Both assays make use of specific antibodies against various HBV proteins and can detect HBsAg as low as 0.5 ng/mL and anti-HBs antibodies at a level of 1mU/mL.Diagnosis

*PEMERIKSAAN SEROLOGI UNTUK DIAGNOSA HEPATITIS VIRUS B AKUT

HBsAg

Pada kondisi WINDOW PERIODE (HBs Ag sudah menghilang, namun belum terbentuk HBs Ab)

HBcAb

Untuk melihat potensi infreksius :

HbeAb

*Diagnosis

Presence of HBsAg

Presence of Anti-HBs

Presence of Anti-HBc

Interpretation

(

(

(

Acute Infection

(

(or (

(

Acute or Chronic infection can differentiate by testing for IgM anti-HBc

(

(

(

Previous HBV infection

(

(

(

Could be results of vaccination.

Validate by retesting anti-HBs and anti-HBc reactivity

(

(

(

Liver toxicity is due to some other agent other than HBV

*04812162024283236HBsAgTotal anti-HBcanti-HBsIgM anti-HBc52100TiterWeeks after ExposureSymptomsHBeAganti-HBeInfection with Recovery

*0481216202428323652TiterWeeks after ExposureHBs AgTotal anti-HBcIgM anti-HBcanti-HBeHBeAgAcute (6 months)Chronic (Years)Progression to Chronic InfectionYears

*Pada pasien dg kronik HBsAgPeriksa :

HBe Ag & Hbe Ab(menentukan status infeksi)

HBV-DNA

HBe Ag (+) arti : virus aktif bereplikasi (infeksius) HBV-DNA aktif diproduksi

HBe Ag (+) kemudian tjd serokonversi Hbe Ab (+) arti : HBV-DNA tidak aktif diproduksi

*Common features are anxiety, fatigue, failure to regain weight, anorexia, alcohol intolerance and right upper abdominal discomfort. The edges of the liver may be tender

Serum transaminase levels may be up to three times that of normal.

Hepatic histology reveals only mild, residual portal zone cellularity and fibrosis, sometimes fatty changes in the liver cells. Post Hepatic Syndrome

*Hepatocellular carcinoma is the liver cancer. This form of the disease may develop after a long time in individuals suffering from chronic hepatitis B infection.

The events will trigger the development of this disease form are unknown.Hepatocellular Carcinoma

*HEPATITIS C

*APA ITU ?

Infeksi hati oleh virus Hepatitis C

85% penderita akut hepatitis C gagal mengeliminasi virus iniSehingga menjadi kondisi KRONIK

Penularan :

terutama lewat darah yg terkontaminasiterbanyak karena IV drug userslebih sedikit lewat hubungan seksual

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*HEPATITIS VIRUS Chypervariableregioncapsidenvelopeproteinprotease/helicaseRNA-dependentRNA polymerasec225coreE1E2NS2NS333cNS4c-100NS53S t r u c t u r e

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*SymptomsTime after ExposureTiteranti-HCVALTNormal01234561234YearsMonthsSerological Course-HCV

*Pemeriksaan Serologi untuk diagnosa

HCVAntibodi

Bila positifDitindaklanjuti dengan pemeriksaan

HCV RNA (dengan tehnik PCR untuk menghitung Viral load)

*HEPATITIS KRONIKInflamasi kronik dari hati yang menetap sekurangnya6 bulan

Pola ensim :

Parameter Hepatitis kronikSirosis SGOT75 (90) U/L49 (64) U/LSGPT59 (118) U/L22 (45) U/LGLDH5,8 (10,8) U/L1,5 (3,5) U/LGGT256 U/L102 U/LCHE1843 U/L1085 U/LRasio De RitisSGOT/SGPTSekitar 0,8 Sekitas 2,3

*PENYEBAB HEPATITIS KRONIK & STRATEGI DIAGNOSISPCR :polymerase chain reaction; ANA ; antinuclear antibody;ASTHMA : anti smooth muscle antibody; LKM1 : anti Liver kidney Microsomal antibody-1; AT : antytripsisn

PENYEBABDIAGNOSISHepatitis BRiwayat, HBsAg, anti HBs, anti HBc, HBV-DNAHepatitis CAnti HCV, HCV RNA dg PCRAutoimmune type 1ANA, ASTHMAAutoimmune type 2SLA, Anti LKM1Wilsons diseaseCeruloplasminObat Riwayat -1 antitrypsin deficiency-1 AT phenotypeidiopatikBopsi hati, petanda-petanda negatif

*HEPATOCELLULAR CARCINOMA (HCC)Penyebab kematian terbanyak oleh kanker

Terbanyak didahului oleh sirosis

Gejala klinik :sirosis kemudian berkembang adanya right upper quadrant painfever, malaise, anorexia, anemia,jaundismasa di right upper quadrant ascites

Laboratorium :ALP >>>AFP (-feto protein) >>>

*SEMOGA

BERMANFAAT