lp 7 hepatita bd 2013
DESCRIPTION
virusologie bucurestiTRANSCRIPT
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DIAGNOSTIC DE LABORATOR IN HEPATITE DE ETIOLOGIE
VIRALA
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ORIENTAREA DIAGNOSTICA IN HEPATITE
1. Tablou clinic2. Teste biochimice
• Markerii necrozei hepatocitare (transaminaze, LDH)• Markeri colestaza (FAL, GGT, bilirubina)• Markeri ai incapacitatii de sinteza la nivel hepatic (proteine serice,
colesterol, trigliceride)
3. Date epidemiologice: cale transmitere, contact infectant, per. incubatie, vaccinuri
4. Diagnostic etiologic = detectia markerilor virali:
• antigene virale (Ag) • anticorpi antivirali (Ac)• acid nucleic viral
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CLINICA
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AA“Infectioasa”
““Serica”Serica”
HEPATITA VIRALA
TransmitereEnterica
Transmitere Parenterala
EE
““NANB”NANB”
BB DD
CC
EPIDEMIOLOGIE
Virusuri hepatitice F,G…Coxackie, EBV, CMV, arbovirusuri
McCallum-1942
1989-Choo
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Diagnostic V.H.B.
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ANTIGENE VHB
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Sisteme antigenice VHB
• Ag HBs Ac antiHBS
• Ag HBc Ac antiHBc
• Ag HBe Ac antiHBe
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Hepatita B• Hepatita acuta • Hepatita cronica persistenta• Hepatita cronica agresiva
» Ciroza hepatica» Carcinom hepato-celular
ALGORITM
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Simptome
AgHBeADN/VHB
anti-HBe
anti-HBc totali
anti-HBc IgM anti-HBsAgHBs
0 4 8 12 16 20 24 28 32 36 52 100
Infectia acuta cu VHB
evolutie spre vindecare
Saptamini post expunere
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IgM anti-HBc
Total anti-HBc
HBsAg
Acute(6 months)
HBeAg
Chronic(Years)
anti-HBe
0 4 8 12 16 20 24 28 32 36 52 Years
Weeks after Exposure
Infectia cronica cu VHB
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•ELISA de detectie a Ag virale
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Tehnica ELISA “sandwich”
1. Incubare ser pacient 1h la 37ºC2. Spalare3. Incubare CONJUGAT 60min la 37ºC4. Spalare5. Incubare SUBSTRAT 20 min la t.camerei6. Solutie de stopare 7. Citire la spectrofotometru => D.O., MN, MP,
C.O.
ELISA de detectie a Ag virale
Ag HBs
Anti HBs
Anti HBs cuplat cu o enzima = CONJUGAT
SUBSTRAT+
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Diagnostic molecular in infectia VHB
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Mortalitatea datorata bolilor hepatice
0.8%o / an la cei mono-infectati VHB14.2%o / an la cei co-infectati HIV - VHB
(1) Monitorizarea evolutiei naturale /sub tratament a hepatitei virale B
Riscul de ciroza/CHP creste cu nivelul VL, atat pt persoanele AgHBe negative, cat si pt cele AgHBe pozitive
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(2) Initiere tratamentului pt hepatita cronica B
Tratamentul este initiat pe baza » PBH» VL» Transaminaze serice
La persoanele AgHBe negative, iv >10.000 copii/ml indica infectie activa (marker de infectivitate virala).
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(3)Criterii de evaluare a raspunsului la terapie in hepatita cronica VHB
Virusologice
• Mentinerea nedetectabila a ADN-VHB plasmatic
• Seroconversie sustinuta la antiHBe la pacientii AgHBe pozitivi
• Eliminarea AgHBs seroconversie anti HBs
Biochimice:• normalizarea sustinuta a
nivelului transaminazelor
Histologice:• reducerea stadiului de
fibroza sau absenta progresiei
• reducerea activitatii necro-inflamatorii
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Diagnostic V.H.D.
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RNA
Hepatitis D Virus
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anti-HBs
Symptoms
ALT Elevated
Total anti-HDV
IgM anti-HDV + IgM anti HBc
HDV RNA
HBsAg
Coinfectia HBV - HDV
Timp dupa expunere
Titru
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Jaundice
Symptoms
ALTanti-HDV + anti HBc IgG
IgM anti-HDV
HDV RNA
HBsAg
Suprainfectia HBV - HDV
Timp dupa expunere
Titru