virusul hepatitei a - mgsii.files. · pdf fileac anti vha de tip ig m ... hepatice cronice -...
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VIRUSUL HEPATITEI A
HEPATITA A (“boala mainilor murdare”) enterovirusul 72 procentaj ridicat de forme inaparente (90%) nu se cronicizeaza. la adulti forme severe
PROFILAXIA imunoglobuline standard i.m.
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VIRUSUL HEPATITEI A
• HAV/ VHA Fam. Picornaviridae Heparnavirus– VIRUS CU ARN – NEINVELIT
• Hepatita A endemica la o virsta mai tinara in regiunile cu igiena precara nivel socio-economic scazut
TRANSMITERE fecal-orala
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EPIDEMIOLOGIE HAV/VHA
• Diseminarea epidemica
contactul cu persoanele infectate ingestia apei si a alimentelor contaminate comunitati supraaglomerate
• NU se transmite transplacentar
• Insectele transmit virusul de la fecalele contaminate la alimente
• Teoretic, se poate transmite si prin singe, • rar • durata viremiei scurta <
3 saptamani.
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CLINIC• Incubatia 25 de zile (15- 50 zile).• Simptomatologia
pierderea apetitului greataobosealaicter remite rapid ( in 2-4 saptamini).
• 1 % cazuri hepatite fulminante deteriorarea rapida a starii generalestare comatoasaicter terosdeces in primele 10 zile de la debutautopsie=> necroza hepatocitara extinsa
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DIAGNOSTIC
Ac anti VHA de tip Ig M infectie recenta
• apar la 2-3 saptamini de la infectia alimentara
• persista 1-4 luni
- Ac anti VHA de tip Ig G persista ani de zile.
• Ag VHA (virusul infectant) in scaun• 2 saptamini inainte si• una dupa debutul
simptomelor.
Virusul stabil la caldura
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PROFILAXIE
• igiena personala si alimentara
• consumul molustelor din apele marine, riverane marilor porturi molustele filtreaza mari cantitati de apa pt. hrana si acumuleaza virusuri si bacterii.
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PROFILAXIE• Imnunizarea pasiva
– contactilor din focarele endemice sau – turistilor catre zonele endemice.
• imunoglobuline i.m. • protectie (peste 3 luni)
• Imunizare activa – Vaccinarea protectie pentru 15-25 ani– indicata
• subiectilor ce urmeaza sa lucreze in zone endemice = comunitati cu prevalenta ridicata.
• copii institutionalizati, • hemofilici, • cu boli hepatitice cronice sau care prezinta riscul de a dezvolta boli
hepatice cronice - bolnavi cu hepatita B sau hepatita C.
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Vaccinul HAV/VHA
• Virus A inactivat = structura antigenica• Cultivate pe MRC-5
– Fibroblaste umane– Derivate din tesut pulmonar fetal
• + Virosomi = structuri sintetice• + aluminiu
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H E V/ VHE
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Hepatitis E Virus
• Calicivirus• ARN, neinvelit, 32-34nm • + • Foarte instabil si sensibil in mediu • Relativ recent cultivat
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Incubatia: ~ 40 zile15-60 zile
Mortalitatea: 1%-3%Gravide: 15%-25%
Severitatea: creste cu varsta Cronicizare: Nu
Hepatita E - Clinica
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Simptome
ALT IgG anti-HEV
IgM anti-HEV
Virus in fecale
0 1 2 3 4 5 6 7 8 9 10
11
12
13
Hepatitis E Virus Infection
Titrul
Saptamani post-expunere
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Epidemiile asociate cu apa contaminata fecaloid India, fosta USSR, China, Africa si Mexic. USA si alte zone neendemice prevalenta scazuta AC anti-HEV
(<2%) la populatia sanatoasa. Sursa necunoscuta
Transmitere inter-umana = minima.
Hepatita E - Epidemiologie
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Evitarea folosirii apei cu exceptia celei imbuteliate si controlate Fructe de mare, fructe si legume neprelucrate de
catre calator (curatare, spalare, etc.) Ig E – eficacitate necunoscuta. Vaccin ?
Preventie HEV-
calatorii in zone endemice Regions
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