Arciaga, Frances Geline R.

Obligate intracellular parasites that rely on

host cell for replication and survival.
Can exist as either free infectious virions or
intracellular particles after they have
infected cells.
First line of defense: Innate immunity
IFN-1 = inhibit virus replication
NK cells = release cytotoxic proteins that destroy
virus-infected host cells.
Second line of defense: Adaptive immunity
Abs = prevent spread of virus by neutralization
Cell-mediated = to eliminate intracellular viruses
 Despite the immunologic mechanisms against
viruses, it has developed ways to avoid the
hosts defenses:
Fast replication: evolve and mutate quickly
Alter function of immune system cell by inserting
their genetic material into a host cell.
 Inflammation of the liver
May be caused by viruses, bacteria, fungi,
parasites, drugs, toxins, physical agents (e.g.
heat, hyperthermia, radiation) or excessive
alcohol intake.
Hepatitis Viruses:
Viral hepatitis and acute viral hepatitis are generally
used only to refer cases caused by specific
hepatotropic viruses, namely:
(HAV) hepatitis A virus
(HBV) hepatitis B virus
(NANB) non-A, non-B hepatitis virus/ (HCV) hepatitis C
virus
(HDV) delta virus
 The virus causing hepatitis A is a nonenveloped,
isosahedral, single-stranded RNA particle that belongs to
the family Picornaviridae.
MOT: Fecal-oral
Self-limiting
Antibodies to HAV appear in the plasma. Initially, the
antibody is IgM (anti-HAV IgM), which is subsequently
replaced by IgG that persists for years, probably for life.
Symptoms: fatigue, nausea, vomiting, fever, chills,
jaundice, dark urine, light-colored stool
Laboratory diagnosis: RIA & ELISA to detect presence of
specific HAV Abs.
 HBV is a hepatotropic virus that is microbiologically
unrelated to HAV. It is a double-stranded DNA
particle that exists in three forms:
A. Spherical (disc) particle - 22 nm in diameter
B. Filamentous form - 22 nm wide by 50 to 200 nm long
C. Dane particle, 42 nm in diameter, which represents
the virion, consisting of a 27 nm nucleocapsid DNA-
containing core, surrounded by an outer lipoprotein
coat.
Symptoms
10-16 weeks after exposure
Same as HAV
MOT: Parenteral, perinatal, sexual
 HBsAg
Australian Ag
Indicates acute or chronic HBV infection
(+) --> you are infected
HBcAg
not detected in serum
only found in hepatocytes
marker for past infection
HBeAg
indicates active replication of virus and therefore infectiveness.
Anti-HBc
marker for window period
IgM useful in detecting infection during window period, indicator of
current infection
IgG lifelong marker of Hepatitis B
Anti-Hbe
First serologic evidence of convalescent phase (window period)
Anti-Hbs
Bestows immunity to further HBV infection
Viral clearance of HBV
 HBsAg Anti-HBs Anti-HBc

Early infection; before acute disease + - -

Late acute infection + - +

Recovery - + +

If low level of non-specific rxn immunization w/ - +

HBsAg
Window phase; long after infection - - +

Marker Test Interpretation Vaccine?

HBsAg + Patient is a carrier No

Anti-HBc +
HBsAg - Exposure; developed immunity No
Anti-HBc +
HBsAg - Susceptible to Hepa B Yes
Anti-HBc -
HBsAg + Patient is an infected carrier No
Anti-HBs -
HBsAg - Developed natural immunity; No
Anti-HBs + successful vaccination
HBsAg - Patient is susceptible Yes
Anti-HBs -
 First generation test
Ouchterlony
Second generation test:
Counterelectrophoresis
Rheophoresis
Complement fixation
Third generation test
Reverse passive latex agglutination
ELISA
Reverve passive hemagglutination
Radioimmunoassay
 HCV is an enveloped, single-stranded, positive-sense RNA virus
belonging to the family Flaviviridae and the genus Hepacivirus.
Ability to undergo chronic stage: chronic liver disease
Symptoms: same as other Hepa but they differ only in severity
and state
MOT: Parenteral, sexual contact

Single-stranded RNA virus

MOT: Parenteral
Associated exclusively with HBV infection either as a
coinfection or superinfection
Laboratory diagnosis:
Indirect ELISA
PCR
 Nonenveloped, single-stranded RNA virus that
belongs to genus Hepevirus, in the family
Hepeviridae.
Water-borne hepatitis
MOT: Fecal-oral
Laboratory diagnosis:
Electron microscopy
Indirect ELISA
RT-PCR

Blood borne hepatitis

Flavivirus
No available serologic test
 Cirrhosis
One of the most common complications of chronic
hepatitis that results to scarring of the liver which can
be found by biopsy.
Can lead to liver failure, a life-threatening condition.
Symptoms: fatigue, nausea, weight loss, and swelling in
the belly and legs.
In severe cases, patients may experience jaundice and
confusion.
Liver Cancer
Viral hepatitis is the top cause of liver cancer, so people
with chronic hepatitis B or C need monitoring even if
they feel healthy.
Blood tests can detect proteins that suggest the
presence of liver cancer.
Ultrasounds, CT scans, and MRIs can reveal abnormal
lesions in the liver.
Tumors found early may be surgically removed but most
are difficult to treat.
 There are vaccines to protect against
hepatitis A and B. The CDC recommends
hepatitis A vaccination for all children ages
12 to 23 months and for adults who plan to
travel or work in areas with hepatitis A
outbreaks or who have other risk factors.
People with chronic hepatitis B or C should
also get the hepatitis A vaccine if they don't
already have immunity to the disease. The
hepatitis B vaccine is recommended for all
infants at birth and for adults.
There is no vaccine for hepatitis C.
 Hepatitis A
Immunization of children (1-18 years of age) consists of two or
three doses of the vaccine. Adults need a booster dose six to 12
months following the initial dose of vaccine. The vaccine is
thought to be effective for 1520 years or more.
Hepatitis B
Safe and effective vaccines provide protection against hepatitis B
for 15 years and possibly much longer. Currently, the Center for
Disease Control and Prevention recommends that all newborns and
individuals up to 18 years of age and adult participating at risk of
infection be vaccinated. Three injections over a six to 12 month
period are required to provide full protection.
In General:
Wash your hands after going to the bathroom and before fixing
food or eating.
Use latex condoms, which may lower the risk of transmission.
Avoid tap water when traveling to certain countries or regions. Ask
your doctor about risks before you travel or call the Centers for
Disease Control and Prevention at 877-FYI-TRIP.
Don't share drug needles.
Don't share personal itemssuch as toothbrushes, razors and nail
clipperswith an infected person.
 First generation test: Ouchterlony
Least sensitive
Second generation test:
Counterelectrophoresis
Rheophoresis
Complement fixation
Third generation test: Most sensitive
Reverse passive latex agglutination
ELISA
Reverve passive hemagglutination
Radioimmunoassay
 Fairlylarge, enveloped DNA viruses that
undergo a replicative cycle involving DNA
expression and nucleocapsid assembly within
the nucleus.
Herpes Simplex Virus (HSV)
Herpes Simplex Type 1 (HSV-1)
Herpes Simplex Type 2 (HSV-2)
Cytomegalovirus
Varicella-Zoster Virus
Human Herpesvirus-6
 Is a lentivirus (a subgroup of retrovirus) that
causes the acquired immunodeficiency
syndrome (AIDS)
The HIV infected person may, or may not have
AIDS.
They may, or may not, have signs or symptoms
of illness but are still infectious to others.
 Semen Pus
Blood & Blood Saliva
components Tears
Menstrual Flow Urine
Vaginal Secretions Feces
Pre-Ejaculatory Fluid Vomit
Breast Milk Nasal Mucous
Cerebral Spinal Fluid
 Time between when a person is first infected with
HIV and when early symptoms develop may be a
few days to several weeks. It can take as 2 weeks
or as long as 6 months from the time you become
infected with HIV for the antibodies to be detected
in your blood.

Usually none
Early warning signs might include fever, skin
rash, diarrhea, swollen glands, night sweats,
fatigue, cough, oral problems, repeated vaginal
infections, and/or weight loss.
 HIV-1 is more virulent, more infective,and is
the cause of the majority of HIV infections
globally.
HIV-2 has lower infectivity, because of its
relatively poor capacity for transmission, HIV-2
is largely confined to West Africa.

It is roughly spherical with a
diameter of about 120 nm
The outer shell of the
virus is known as the Viral
envelope. Embedded in the
viral envelope is a complex
protein known as env
which consists of an outer
protruding cap
glycoprotein 120, and a
stem glycoprotein14.
Within the viral envelope
is an HIV protein called
p17, and within this is the
viral core or capsid, which
is made of another viral
protein p24(core antigen).
 The viral envelope, consists of two layers of lipids; different
proteins are embedded in the viral envelope, forming "spikes"
consisting of the outer glycoprotein (gp) 120 and the
transmembrane gp41. The lipid membrane is borrowed from the
host cell during the budding process (formation of new
particles). gp120 is needed to attach to the host cell, and gp41
is critical for the cell fusion process.

The HIV matrix proteins (consisting of the p17 protein), lie

between the envelope and core.

The viral core, contains the viral capsule protein p24 which
surrounds two single strands of HIV RNA and the enzymes
needed for HIV replication, such as reverse transcriptase,
protease, ribonuclease, and integrase; out of the nine virus
genes, there are three, namely gag, pol and env, that contain
the information needed to make structural proteins for new
virus particles.
 HIV crosses into the T-4 white cell.
Virus uses the genetic mechanisms of the cell to
produce millions of new viruses.
The cell dies and the new viruses are released into
the blood to infect new un-infected cells.
T-4 cells are killed and the patient becomes
immunodeficient
The person becomes susceptible to opportunistic
infections or AIDS related cancers
 Abstinence
sexual intercourse
reusing of IV needles
Tattoo/body piercing

There's no cure for HIV/AIDS, but there are

medications that can help slow disease
progression.
 Screening tests
ELISA (enzyme-linked immunosorbent assay)
Most common
RIA
Agglutination tests

Confirmatory test
Western blot
This test is more difficult than the ELISA to perform, but it is
done to confirm the results of two positive ELISA tests.
 Toknow if you have been infected or not
Where?
Hospitals
Health clinics
Special HIV/AIDS voluntary counseling and
testing (VCT) sites
If positive:
Take antiretroviral treatment to slow down the virus and maintain a
healthy immune system.
If a person is aware of their HIV status they can take steps to prevent
HIV transmission to other people
For those thinking of starting a family, they can learn about ways to
prevent their child from becoming infected with HIV through mother-
to-child transmission.
 What do they test What is the How long for the
HIV tests Reliability
for? window period? results?

Between a few days

Antibody tests HIV antibodies Three months High
and a few weeks

High for primary

infection,
11 days to one A few days to a
Antigen (p24) test p24 viral proteins increasingly
month week
unreliable
afterwards

Fourth generation HIV antibodies & 11 days to one

2-14 days High
tests p24 viral proteins month

Genetic material
PCR / NAT test 12 days Up to a week High
belonging to HIV

Satisfactory for
Rapid test HIV antibodies Three months within 20 minutes uncomplicated HIV
infection
 TheDane particle is the most common form
of HBV seen in patients with Hepatitis B.
True or False?

Afterinfection with HIV, antibodies can

usually be detected within?
A. 6 months
B. 6 days to 2 months
C. 2 weeks to 3 months
D. 1 year
 Theprimary target/s of infection of human
herpesvirus-6 are:
A. T cells
B. B cells
C. both B and T cells
D. platelets

Serum tested positive for HbsAg and anti-HBc

IgM. The patient most likely has which of the
following?
A. Acute hepatitis C
B. Chronic hepatitis B
C. Acute hepatitis B
D. Acute hepatitis A
 Whichof the following tests can detect the
presence of HIV antibodies in the blood
within a few days to a few weeks?
A. Rapid tests
B. Antibody tests
C. Fourth generation tests
D. all of the above
 A young woman recently discovered that her
boyfriend tested HIV-positive. She was
concerned that she may have also contracted the
infection, because she had experienced flulike
symptoms a month ago. She decided to visit her
physician for a medical evaluation.
What initial laboratory tests should be performed on
the young woman to determine if she has been
exposed to HIV?
If the woman tests positive in the initial evaluation,
how can it be determined whether her test results
are truly positive because of HIV infection or if they
represent a false-positive result?
If the womans test results are truly positive, what
tests can be done to monitor her over time?
 Bryant, Neville. Laboratory Immunology and Serology. 3rd
ed. USA: W.B. Saunders Co.
Epidemiology and Prevention of Viral Hepatitis A to E:
http://www.pptdirectory.com/07/Epidemiology-and-
Prevention-of-Viral-Hepatitis-A-to-E.html
Hepatitis: Symptoms, Diagnosis, Treatment & Prevention:
https://medlineplus.gov/magazine/issues/spring09/article
s/spring09pg25.html
Hubbard, J. D., & Hubbard, J. D. (2010). A concise review
of clinical laboratory science (2nd ed.). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.
Stevens, Christine Dorresteyn. (2010) Clinical Immunology
& Serology: A Laboratory Perspective Philadelphia, PA. :
F.A. Davis,
Interpretation of Hepatitis B Serologic Test Results
https://www.cdc.gov/hepatitis/hbv/pdfs/serologicchartv8
.pdf