Microbiology
Pathogens
About what percentage of patients with hepatitis B develop chronic hepatitis:
Answer:
In about 90% of people, lifelong immunity is achieved after clearing the infection. About 10% of patients overall develop chronic hepatitis which may be complicated by cirrhosis or hepatocellular carcinoma. Congenital infection carries a very high risk of chronic infection and hepatocellular carcinoma, whereas only about 5% of people infected as healthy adults develop chronic infection.Hepatitis B
Microbiology / Pathogens / Hepatitis
Last Updated: 16th April 2022
Transmission
Hepatitis B virus (HBV) is transmitted sexually, vertically from mother to child or through blood (e.g. needlestick injuries, IV drug users, blood products).
Clinical Features
HBV has a long incubation period (2 - 6 months).
Initial infection may be asymptomatic, particularly in children or may be associated with a prodromal phase characterised by malaise, anorexia, myalgia, nausea and weakness.
Acute hepatitis of variable severity develops insidiously signalled by the appearance of jaundice and right upper quadrant abdominal pain; hepatocellular damage is detectable biochemically with elevated transaminase levels before the onset of clinical jaundice. Fulminant disease with acute liver failure carries a 1 - 2% mortality.
In about 90% of people, lifelong immunity is achieved after clearing the infection. About 10% of patients develop chronic hepatitis which may be complicated by cirrhosis or hepatocellular carcinoma. Congenital infection carries a very high risk of chronic infection and hepatocellular carcinoma, whereas only about 5% of people infected as healthy adults develop chronic infection.
Diagnosis
Serology:
- Antigens
- Hepatitis B surface antigen (HBsAg)
- acute infection (present in blood 6 weeks to 3 months after acute infection)
- presence for greater than 6 months signifies chronic hepatitis B infection
- Hepatitis B envelope antigen (HBeAg)
- high level of viral replication and high infectivity
- Hepatitis B surface antigen (HBsAg)
- Antibodies
- Anti-hepatitis B core antibody (anti-HBc)
- IgM: acute viral replication and diagnostic
- IgG: previous exposure (chronic state or cleared infection)
- Anti-hepatitis B surface antibody (anti-HBs)
- hepatitis B immunity (cleared infection or vaccination)
- Anti-hepatitis B envelope antibody (anti-HBe)
- decreased infectivity (absence = high infectivity)
- Anti-hepatitis B core antibody (anti-HBc)
| Disease State | Serology |
|---|---|
| Acute hepatitis B | HBsAg, HBeAg, anti-HBc IgM |
| Chronic hepatitis B (inactive) | HBsAg (>6/12), anti HBe, anti-HBc IgG |
| Chronic hepatitis B (active) | HBsAg (>6/12), HBeAg, anti-HBc IgG |
| Immunity following infection | Anti-HBs, anti-HBe, anti-HBc IgG |
| Immunity due to vaccination | Anti-HBs |
Treatment
Treatment is supportive for acute infection; acute hepatitis B is a notifiable disease. Treatment with antivirals should be considered in chronic infection as responders have a reduced risk of liver damage and liver cancer in the long term. HBeAg seroconversion is often taken as a mark of treatment success.
Prevention
In August 2017 the UK introduced the hexavalent (DTaP/IPV/Hib/HepB) combination vaccine into the routine childhood immunisation.
Individuals at high risk should be immunised with HBV vaccine (inactivated HBsAg). High risk groups include healthcare workers, IV drug users, babies born to HBV-infected mothers, individuals with chronic liver or renal disease, or those receiving regular blood transfusions.
Hepatitis B immunoglobulin is available to be given at the same time as vaccination for non-immune people who have been exposed to potentially infected blood or body fluid.
Hepatitis D
Hepatitis D virus is transmitted in the same way as HBV and either with HBV or as a superinfection in an individual infected with HBV. HDV is associated with severe hepatitis and an accelerated progression to liver failure, cirrhosis and hepatocellular carcinoma.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
