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Home Books Jawetz, Melnick, & Adelberg's Medical Microbiology, 28e

Chapter 35: Hepatitis Viruses

INTRODUCTION

Viral hepatitis is a systemic disease primarily involving the liver. Most cases of acute viral hepatitis in children and adults are caused by one of the following five agents: hepatitis A virus (HAV), the etiologic agent of viral hepatitis type A (infectious hepatitis); hepatitis B virus (HBV), which is associated with viral hepatitis B (serum hepatitis); hepatitis C virus (HCV), the agent of hepatitis C (common cause of posttransfusion hepatitis); hepatitis D (HDV), a defective virus dependent on coinfection with HBV; or hepatitis E virus (HEV), the agent of enterically transmitted hepatitis. Additional well-characterized viruses that can cause sporadic hepatitis, such as yellow fever virus, cytomegalovirus, Epstein-Barr virus, herpes simplex virus, rubella virus, and the enteroviruses, are discussed in other chapters. Hepatitis viruses produce acute inflammation of the liver, resulting in a clinical illness characterized by fever, gastrointestinal symptoms such as nausea and vomiting, and jaundice. Hepatitis viruses cause similar appearing histopathologic lesions in the liver during acute disease.

PROPERTIES OF HEPATITIS VIRUSES

The characteristics of the five known hepatitis viruses are shown in Table 35-1. Nomenclature of the hepatitis viruses, antigens, and antibodies is presented in Table 35-2.

TABLE 35-1Characteristics of Hepatitis Viruses
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TABLE 35-1 Characteristics of Hepatitis Viruses
Virus Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E
Family Picornaviridae Hepadnaviridae Flaviviridae Unclassified Hepeviridae
Genus Hepatovirus Orthohepadnavirus Hepacivirus Deltavirus Hepevirus
Virion 27 nm, icosahedral 42 nm, spherical 60 nm, spherical 35 nm, spherical 30–32 nm, icosahedral
Envelope No Yes (HBsAg-associated) Yes Yes (HBsAg-associated) No
Genome ssRNA dsDNA ssRNA ssRNA ssRNA
Genome size (kb) 7.5 3.2 9.4 1.7 7.2
Stability Heat and acid stable Acid sensitive Ether sensitive, acid sensitive Acid sensitive Heat stable
Transmission Fecal–oral Parenteral Parenteral Parenteral Fecal–oral
Prevalence High High Moderate Low, regional Regional
Fulminant disease Rare Rare Rare Frequent In pregnancy
Chronic disease Never Often Often Often Never
Oncogenic No Yes Yes Unknown No

ds, double stranded; HBsAg, hepatitis B surface antigen; ss, single stranded.

TABLE 35-2Nomenclature and Definitions of Hepatitis Viruses, Antigens, and Antibodies
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TABLE 35-2 Nomenclature and Definitions of Hepatitis Viruses, Antigens, and Antibodies
Disease Component of System Definition
Hepatitis A HAV Hepatitis A virus. Etiologic agent of infectious hepatitis. A picornavirus, the prototype of genus Hepatovirus
  Anti-HAV Antibody to HAV. Detectable at onset of symptoms; lifetime persistence
  IgM anti-HAV IgM class antibody to HAV. Indicates recent infection with hepatitis A; positive result up to 4–6 months after infection
Hepatitis B HBV Hepatitis B virus. Etiologic agent of serum hepatitis. A hepadnavirus
  HBsAg Hepatitis B surface antigen. Surface antigen(s) of HBV detectable in large quantity in serum; several subtypes identified
  HBeAg Hepatitis B e antigen. Associated with HBV nucleocapsid; indicates viral replication; circulates as soluble antigen in serum
  HBcAg Hepatitis B core ...

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