Hepatitis C



Hepatitis C


Kusa Terianm, MD









Hematoxylin & eosin stain shows dense portal inflammation composed primarily of lymphocytes.






Trichrome stain demonstrates portal fibrous expansion image and periportal fibrous extension image.


TERMINOLOGY


Abbreviations



  • Hepatitis C virus infection (HCV)


Definitions



  • Hepatitis, usually chronic, secondary to hepatitis C virus infection


ETIOLOGY/PATHOGENESIS


Infectious Agents



  • Enveloped, single-stranded RNA virus of Flaviviridae family



    • Positive-sense RNA encodes a single polypeptide


    • Polypeptide post-translationally cleaved to form structural, nonstructural, and envelope proteins


  • Inherent high mutation rate generates viral heterogeneity



    • 6 viral genotypes and over 50 subtypes



      • Vary in geography, mode of transmission, and response to treatment


Modes of Transmission



  • Blood transfusion


  • Needlestick inoculation


  • Perinatal exposure probably occurs with low efficiency


  • Efficiency of sexual transmission is controversial but probably low


Pathogenesis



  • Virus is directly cytopathic and induces immunemediated cellular injury


CLINICAL ISSUES


Epidemiology



  • Incidence



    • Worldwide seroprevalence of HCV antibodies (anti-HCV) estimated at 3%


    • Estimated 3-4 million persons infected in United States


Presentation



  • Fatigue


  • Nausea and anorexia


  • Depression and difficulty concentrating


  • May be asymptomatic


Laboratory Tests



  • Antibodies (anti-HCV) indicate exposure


  • Detection of HCV RNA indicates virus persistence


  • Liver biopsy performed to grade and stage disease and exclude other liver diseases


Natural History



  • Acute infection is often subclinical


  • Fulminant hepatitis is rare


  • Produces persistent (chronic) infection in 85% of infected persons



    • Defined as failure to clear virus in 6 months


    • Remaining 15% have self-limited infection


Treatment



  • Drugs



    • Standard therapy is pegylated interferon-α in combination with ribavirin

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Hepatitis C
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