Introduction The hepatitis viruses primarily infect hepatocytes Taxonomy there are 4 important RNA hepatitis viruses hepatitis A (HAV) hepatitis C (HCV) hepatitis D (HDV) hepatitis E (HEV) there is 1 important DNA hepatitis virus hepatitis B (HBV) Symptoms patients infected with hepatitis suffer from fever jaundice elevated ALT and AST ALT > AST in viral hepatitis AST > ALT in alcoholic hepatitis - "a Scotch and Tonic" Chronic vs. acute disease HBV and HCV can cause long-term chronic disease chronic active hepatitis cirrhosis hepatocellular carcinoma Transmission HAV and HEV transmitted fecal-oral "vowels from your bowels" these viruses are naked and are not destroyed in the gut Comparison chart HAV HBV HCV HDV HEV Family Picornavirus Hepadnavirus Flavivirus Defective Hepevirus Characteristics Naked RNA Enveloped DNA Enveloped RNA Enveloped RNA (circular) Naked RNA Disease Mild acute No chronic Acute Chronic (~20%) Cirrhosis Carcinoma Acute Chronic (70%) Cirrhosis Carcinoma Co-infection or superinfection (worse) with HBV Mild acute No chronic Transmission Fecal-oral Parenteral or sex Parenteral or sex Parenteral or sex Fecal-oral Mortality <0.5% 1-2% 0.5-1% High 1-2% or 25% if pregnant 3rd trimester Incubation period Short (3 wks) Long (3 mo) Short (6-12 wks) - - Carriers No Yes Yes Yes No Vaccine available Yes Yes No (in clinical trials) No No (in clinical trials) Remember! A is Acute only B is Bad (many diseases, high mortality), Big like a "great dane" C is Chronic (leading cause for liver transplant) D is Dependent (needs HBV to infect -- HBsAg must coat HDAg) E is Enteric in the far East (seen in Asia, not U.S.)