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Diagnosis of viral diseases. Diagnosis of viral diseases. Three General Approaches for Laboratory Diagnosis of Viral Infections : Direct detection -Microscopy or staining. Virus Isolation -PCR. Serology -Antibodies. Viral Serology. Detection of SPECIFIC antibodies. - PowerPoint PPT Presentation
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Diagnosis of viral diseasesDiagnosis of viral diseases
Diagnosis of viral diseasesDiagnosis of viral diseases
Three General Approaches for Three General Approaches for Laboratory Diagnosis of Viral Laboratory Diagnosis of Viral Infections Infections
1)1) Direct detectionDirect detection-Microscopy or staining-Microscopy or staining
2)2)Virus IsolationVirus Isolation- - PCRPCR
3)3)SerologySerology- - AntibodiesAntibodies
Viral SerologyViral Serology
Detection of SPECIFIC antibodies Indirect Indirect
Primary and secondary responses to viral Primary and secondary responses to viral infectionsinfections IgM antibody during acute phase (1st exposure)(1st exposure) IgG antibody during convalescence (2nd (2nd
exposure)exposure) IgA mucosal antibody (respiratory infections
GI)
Serology Tests
Serology Tests Commonly Used Haemagglutination
Haemagglutination Inhibition
Complement fixation
Indirect Fluorescent Assay (IFA)
Indirect EIA (ELISA)
Viral Serology
Indirect Fluorescent Assay (IFA) Indirect EIA (ELISA)
Viral SerologyViral Serology
Enzyme-Linked Immunosorbent Assays Enzyme-Linked Immunosorbent Assays (ELISAs) (ELISAs) Enzyme-Linked ImmunoSorbent Assay or ELISA is a
biochemical technique used mainly in immunology to detect the presence of an antibody or an antigen in a sample The ELISA has been used as a diagnostic tool in medicine
Enzyme reacts with substrate to produce colored Enzyme reacts with substrate to produce colored product product
Very sensitive Very sensitive Not expensiveNot expensive
ELISA ProceduresELISA Procedures
Advantages of Viral serology
Determine immune status ndash person or population Verify immune response to vaccination Diagnosis of chronic infection reactivation Diagnosis of recent infection (IgM amp IgA) Wide range of tests available Uses serum ndash easily collected and transported (compared with biopsy tissue or DNA )
1048707
Viral markersViral markers
Some common viral markers Some common viral markers detected by serology detected by serology
1)1) HAVHAV
2)2) HBVHBV
3)3) HCVHCV
4)4) CMVCMV
5)5) OTHERSOTHERS
HEPATITIS A
SerologySerology Acute ndash IgM ndash lasts 3-6 months Acute ndash IgM ndash lasts 3-6 months Chronic ndash IgG ndash lifetime Chronic ndash IgG ndash lifetime bull Liver enzymes ndash increases in ALT Liver enzymes ndash increases in ALT
AST bilirubinAST bilirubin
0 1 2 3 4 5 6 7 8 9 10 11 12 13Week
Re
sp
on
se
Clinical illness
ALT
IgM IgG
HAV in stool
Infection
Viremia
EVENTS IN HEPATITIS A VIRUS INFECTION
HEPATITIS B
Serology - acuteSerology - acute HBsAg+ (HBsAb-) = acute infection or HBsAg+ (HBsAb-) = acute infection or
chronic carrierchronic carrier HBeAg+ = highly infectiousHBeAg+ = highly infectious HBsAb = immune ndash naturally or HBsAb = immune ndash naturally or
vaccinevaccine Window phase = HBsAg- and HBsAb-Window phase = HBsAg- and HBsAb-
will be HBcAb+ (IgM ndash acute)will be HBcAb+ (IgM ndash acute)
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
Diagnosis of viral diseasesDiagnosis of viral diseases
Three General Approaches for Three General Approaches for Laboratory Diagnosis of Viral Laboratory Diagnosis of Viral Infections Infections
1)1) Direct detectionDirect detection-Microscopy or staining-Microscopy or staining
2)2)Virus IsolationVirus Isolation- - PCRPCR
3)3)SerologySerology- - AntibodiesAntibodies
Viral SerologyViral Serology
Detection of SPECIFIC antibodies Indirect Indirect
Primary and secondary responses to viral Primary and secondary responses to viral infectionsinfections IgM antibody during acute phase (1st exposure)(1st exposure) IgG antibody during convalescence (2nd (2nd
exposure)exposure) IgA mucosal antibody (respiratory infections
GI)
Serology Tests
Serology Tests Commonly Used Haemagglutination
Haemagglutination Inhibition
Complement fixation
Indirect Fluorescent Assay (IFA)
Indirect EIA (ELISA)
Viral Serology
Indirect Fluorescent Assay (IFA) Indirect EIA (ELISA)
Viral SerologyViral Serology
Enzyme-Linked Immunosorbent Assays Enzyme-Linked Immunosorbent Assays (ELISAs) (ELISAs) Enzyme-Linked ImmunoSorbent Assay or ELISA is a
biochemical technique used mainly in immunology to detect the presence of an antibody or an antigen in a sample The ELISA has been used as a diagnostic tool in medicine
Enzyme reacts with substrate to produce colored Enzyme reacts with substrate to produce colored product product
Very sensitive Very sensitive Not expensiveNot expensive
ELISA ProceduresELISA Procedures
Advantages of Viral serology
Determine immune status ndash person or population Verify immune response to vaccination Diagnosis of chronic infection reactivation Diagnosis of recent infection (IgM amp IgA) Wide range of tests available Uses serum ndash easily collected and transported (compared with biopsy tissue or DNA )
1048707
Viral markersViral markers
Some common viral markers Some common viral markers detected by serology detected by serology
1)1) HAVHAV
2)2) HBVHBV
3)3) HCVHCV
4)4) CMVCMV
5)5) OTHERSOTHERS
HEPATITIS A
SerologySerology Acute ndash IgM ndash lasts 3-6 months Acute ndash IgM ndash lasts 3-6 months Chronic ndash IgG ndash lifetime Chronic ndash IgG ndash lifetime bull Liver enzymes ndash increases in ALT Liver enzymes ndash increases in ALT
AST bilirubinAST bilirubin
0 1 2 3 4 5 6 7 8 9 10 11 12 13Week
Re
sp
on
se
Clinical illness
ALT
IgM IgG
HAV in stool
Infection
Viremia
EVENTS IN HEPATITIS A VIRUS INFECTION
HEPATITIS B
Serology - acuteSerology - acute HBsAg+ (HBsAb-) = acute infection or HBsAg+ (HBsAb-) = acute infection or
chronic carrierchronic carrier HBeAg+ = highly infectiousHBeAg+ = highly infectious HBsAb = immune ndash naturally or HBsAb = immune ndash naturally or
vaccinevaccine Window phase = HBsAg- and HBsAb-Window phase = HBsAg- and HBsAb-
will be HBcAb+ (IgM ndash acute)will be HBcAb+ (IgM ndash acute)
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
Viral SerologyViral Serology
Detection of SPECIFIC antibodies Indirect Indirect
Primary and secondary responses to viral Primary and secondary responses to viral infectionsinfections IgM antibody during acute phase (1st exposure)(1st exposure) IgG antibody during convalescence (2nd (2nd
exposure)exposure) IgA mucosal antibody (respiratory infections
GI)
Serology Tests
Serology Tests Commonly Used Haemagglutination
Haemagglutination Inhibition
Complement fixation
Indirect Fluorescent Assay (IFA)
Indirect EIA (ELISA)
Viral Serology
Indirect Fluorescent Assay (IFA) Indirect EIA (ELISA)
Viral SerologyViral Serology
Enzyme-Linked Immunosorbent Assays Enzyme-Linked Immunosorbent Assays (ELISAs) (ELISAs) Enzyme-Linked ImmunoSorbent Assay or ELISA is a
biochemical technique used mainly in immunology to detect the presence of an antibody or an antigen in a sample The ELISA has been used as a diagnostic tool in medicine
Enzyme reacts with substrate to produce colored Enzyme reacts with substrate to produce colored product product
Very sensitive Very sensitive Not expensiveNot expensive
ELISA ProceduresELISA Procedures
Advantages of Viral serology
Determine immune status ndash person or population Verify immune response to vaccination Diagnosis of chronic infection reactivation Diagnosis of recent infection (IgM amp IgA) Wide range of tests available Uses serum ndash easily collected and transported (compared with biopsy tissue or DNA )
1048707
Viral markersViral markers
Some common viral markers Some common viral markers detected by serology detected by serology
1)1) HAVHAV
2)2) HBVHBV
3)3) HCVHCV
4)4) CMVCMV
5)5) OTHERSOTHERS
HEPATITIS A
SerologySerology Acute ndash IgM ndash lasts 3-6 months Acute ndash IgM ndash lasts 3-6 months Chronic ndash IgG ndash lifetime Chronic ndash IgG ndash lifetime bull Liver enzymes ndash increases in ALT Liver enzymes ndash increases in ALT
AST bilirubinAST bilirubin
0 1 2 3 4 5 6 7 8 9 10 11 12 13Week
Re
sp
on
se
Clinical illness
ALT
IgM IgG
HAV in stool
Infection
Viremia
EVENTS IN HEPATITIS A VIRUS INFECTION
HEPATITIS B
Serology - acuteSerology - acute HBsAg+ (HBsAb-) = acute infection or HBsAg+ (HBsAb-) = acute infection or
chronic carrierchronic carrier HBeAg+ = highly infectiousHBeAg+ = highly infectious HBsAb = immune ndash naturally or HBsAb = immune ndash naturally or
vaccinevaccine Window phase = HBsAg- and HBsAb-Window phase = HBsAg- and HBsAb-
will be HBcAb+ (IgM ndash acute)will be HBcAb+ (IgM ndash acute)
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
Serology Tests
Serology Tests Commonly Used Haemagglutination
Haemagglutination Inhibition
Complement fixation
Indirect Fluorescent Assay (IFA)
Indirect EIA (ELISA)
Viral Serology
Indirect Fluorescent Assay (IFA) Indirect EIA (ELISA)
Viral SerologyViral Serology
Enzyme-Linked Immunosorbent Assays Enzyme-Linked Immunosorbent Assays (ELISAs) (ELISAs) Enzyme-Linked ImmunoSorbent Assay or ELISA is a
biochemical technique used mainly in immunology to detect the presence of an antibody or an antigen in a sample The ELISA has been used as a diagnostic tool in medicine
Enzyme reacts with substrate to produce colored Enzyme reacts with substrate to produce colored product product
Very sensitive Very sensitive Not expensiveNot expensive
ELISA ProceduresELISA Procedures
Advantages of Viral serology
Determine immune status ndash person or population Verify immune response to vaccination Diagnosis of chronic infection reactivation Diagnosis of recent infection (IgM amp IgA) Wide range of tests available Uses serum ndash easily collected and transported (compared with biopsy tissue or DNA )
1048707
Viral markersViral markers
Some common viral markers Some common viral markers detected by serology detected by serology
1)1) HAVHAV
2)2) HBVHBV
3)3) HCVHCV
4)4) CMVCMV
5)5) OTHERSOTHERS
HEPATITIS A
SerologySerology Acute ndash IgM ndash lasts 3-6 months Acute ndash IgM ndash lasts 3-6 months Chronic ndash IgG ndash lifetime Chronic ndash IgG ndash lifetime bull Liver enzymes ndash increases in ALT Liver enzymes ndash increases in ALT
AST bilirubinAST bilirubin
0 1 2 3 4 5 6 7 8 9 10 11 12 13Week
Re
sp
on
se
Clinical illness
ALT
IgM IgG
HAV in stool
Infection
Viremia
EVENTS IN HEPATITIS A VIRUS INFECTION
HEPATITIS B
Serology - acuteSerology - acute HBsAg+ (HBsAb-) = acute infection or HBsAg+ (HBsAb-) = acute infection or
chronic carrierchronic carrier HBeAg+ = highly infectiousHBeAg+ = highly infectious HBsAb = immune ndash naturally or HBsAb = immune ndash naturally or
vaccinevaccine Window phase = HBsAg- and HBsAb-Window phase = HBsAg- and HBsAb-
will be HBcAb+ (IgM ndash acute)will be HBcAb+ (IgM ndash acute)
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
Viral Serology
Indirect Fluorescent Assay (IFA) Indirect EIA (ELISA)
Viral SerologyViral Serology
Enzyme-Linked Immunosorbent Assays Enzyme-Linked Immunosorbent Assays (ELISAs) (ELISAs) Enzyme-Linked ImmunoSorbent Assay or ELISA is a
biochemical technique used mainly in immunology to detect the presence of an antibody or an antigen in a sample The ELISA has been used as a diagnostic tool in medicine
Enzyme reacts with substrate to produce colored Enzyme reacts with substrate to produce colored product product
Very sensitive Very sensitive Not expensiveNot expensive
ELISA ProceduresELISA Procedures
Advantages of Viral serology
Determine immune status ndash person or population Verify immune response to vaccination Diagnosis of chronic infection reactivation Diagnosis of recent infection (IgM amp IgA) Wide range of tests available Uses serum ndash easily collected and transported (compared with biopsy tissue or DNA )
1048707
Viral markersViral markers
Some common viral markers Some common viral markers detected by serology detected by serology
1)1) HAVHAV
2)2) HBVHBV
3)3) HCVHCV
4)4) CMVCMV
5)5) OTHERSOTHERS
HEPATITIS A
SerologySerology Acute ndash IgM ndash lasts 3-6 months Acute ndash IgM ndash lasts 3-6 months Chronic ndash IgG ndash lifetime Chronic ndash IgG ndash lifetime bull Liver enzymes ndash increases in ALT Liver enzymes ndash increases in ALT
AST bilirubinAST bilirubin
0 1 2 3 4 5 6 7 8 9 10 11 12 13Week
Re
sp
on
se
Clinical illness
ALT
IgM IgG
HAV in stool
Infection
Viremia
EVENTS IN HEPATITIS A VIRUS INFECTION
HEPATITIS B
Serology - acuteSerology - acute HBsAg+ (HBsAb-) = acute infection or HBsAg+ (HBsAb-) = acute infection or
chronic carrierchronic carrier HBeAg+ = highly infectiousHBeAg+ = highly infectious HBsAb = immune ndash naturally or HBsAb = immune ndash naturally or
vaccinevaccine Window phase = HBsAg- and HBsAb-Window phase = HBsAg- and HBsAb-
will be HBcAb+ (IgM ndash acute)will be HBcAb+ (IgM ndash acute)
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
Viral SerologyViral Serology
Enzyme-Linked Immunosorbent Assays Enzyme-Linked Immunosorbent Assays (ELISAs) (ELISAs) Enzyme-Linked ImmunoSorbent Assay or ELISA is a
biochemical technique used mainly in immunology to detect the presence of an antibody or an antigen in a sample The ELISA has been used as a diagnostic tool in medicine
Enzyme reacts with substrate to produce colored Enzyme reacts with substrate to produce colored product product
Very sensitive Very sensitive Not expensiveNot expensive
ELISA ProceduresELISA Procedures
Advantages of Viral serology
Determine immune status ndash person or population Verify immune response to vaccination Diagnosis of chronic infection reactivation Diagnosis of recent infection (IgM amp IgA) Wide range of tests available Uses serum ndash easily collected and transported (compared with biopsy tissue or DNA )
1048707
Viral markersViral markers
Some common viral markers Some common viral markers detected by serology detected by serology
1)1) HAVHAV
2)2) HBVHBV
3)3) HCVHCV
4)4) CMVCMV
5)5) OTHERSOTHERS
HEPATITIS A
SerologySerology Acute ndash IgM ndash lasts 3-6 months Acute ndash IgM ndash lasts 3-6 months Chronic ndash IgG ndash lifetime Chronic ndash IgG ndash lifetime bull Liver enzymes ndash increases in ALT Liver enzymes ndash increases in ALT
AST bilirubinAST bilirubin
0 1 2 3 4 5 6 7 8 9 10 11 12 13Week
Re
sp
on
se
Clinical illness
ALT
IgM IgG
HAV in stool
Infection
Viremia
EVENTS IN HEPATITIS A VIRUS INFECTION
HEPATITIS B
Serology - acuteSerology - acute HBsAg+ (HBsAb-) = acute infection or HBsAg+ (HBsAb-) = acute infection or
chronic carrierchronic carrier HBeAg+ = highly infectiousHBeAg+ = highly infectious HBsAb = immune ndash naturally or HBsAb = immune ndash naturally or
vaccinevaccine Window phase = HBsAg- and HBsAb-Window phase = HBsAg- and HBsAb-
will be HBcAb+ (IgM ndash acute)will be HBcAb+ (IgM ndash acute)
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
ELISA ProceduresELISA Procedures
Advantages of Viral serology
Determine immune status ndash person or population Verify immune response to vaccination Diagnosis of chronic infection reactivation Diagnosis of recent infection (IgM amp IgA) Wide range of tests available Uses serum ndash easily collected and transported (compared with biopsy tissue or DNA )
1048707
Viral markersViral markers
Some common viral markers Some common viral markers detected by serology detected by serology
1)1) HAVHAV
2)2) HBVHBV
3)3) HCVHCV
4)4) CMVCMV
5)5) OTHERSOTHERS
HEPATITIS A
SerologySerology Acute ndash IgM ndash lasts 3-6 months Acute ndash IgM ndash lasts 3-6 months Chronic ndash IgG ndash lifetime Chronic ndash IgG ndash lifetime bull Liver enzymes ndash increases in ALT Liver enzymes ndash increases in ALT
AST bilirubinAST bilirubin
0 1 2 3 4 5 6 7 8 9 10 11 12 13Week
Re
sp
on
se
Clinical illness
ALT
IgM IgG
HAV in stool
Infection
Viremia
EVENTS IN HEPATITIS A VIRUS INFECTION
HEPATITIS B
Serology - acuteSerology - acute HBsAg+ (HBsAb-) = acute infection or HBsAg+ (HBsAb-) = acute infection or
chronic carrierchronic carrier HBeAg+ = highly infectiousHBeAg+ = highly infectious HBsAb = immune ndash naturally or HBsAb = immune ndash naturally or
vaccinevaccine Window phase = HBsAg- and HBsAb-Window phase = HBsAg- and HBsAb-
will be HBcAb+ (IgM ndash acute)will be HBcAb+ (IgM ndash acute)
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
Advantages of Viral serology
Determine immune status ndash person or population Verify immune response to vaccination Diagnosis of chronic infection reactivation Diagnosis of recent infection (IgM amp IgA) Wide range of tests available Uses serum ndash easily collected and transported (compared with biopsy tissue or DNA )
1048707
Viral markersViral markers
Some common viral markers Some common viral markers detected by serology detected by serology
1)1) HAVHAV
2)2) HBVHBV
3)3) HCVHCV
4)4) CMVCMV
5)5) OTHERSOTHERS
HEPATITIS A
SerologySerology Acute ndash IgM ndash lasts 3-6 months Acute ndash IgM ndash lasts 3-6 months Chronic ndash IgG ndash lifetime Chronic ndash IgG ndash lifetime bull Liver enzymes ndash increases in ALT Liver enzymes ndash increases in ALT
AST bilirubinAST bilirubin
0 1 2 3 4 5 6 7 8 9 10 11 12 13Week
Re
sp
on
se
Clinical illness
ALT
IgM IgG
HAV in stool
Infection
Viremia
EVENTS IN HEPATITIS A VIRUS INFECTION
HEPATITIS B
Serology - acuteSerology - acute HBsAg+ (HBsAb-) = acute infection or HBsAg+ (HBsAb-) = acute infection or
chronic carrierchronic carrier HBeAg+ = highly infectiousHBeAg+ = highly infectious HBsAb = immune ndash naturally or HBsAb = immune ndash naturally or
vaccinevaccine Window phase = HBsAg- and HBsAb-Window phase = HBsAg- and HBsAb-
will be HBcAb+ (IgM ndash acute)will be HBcAb+ (IgM ndash acute)
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
Viral markersViral markers
Some common viral markers Some common viral markers detected by serology detected by serology
1)1) HAVHAV
2)2) HBVHBV
3)3) HCVHCV
4)4) CMVCMV
5)5) OTHERSOTHERS
HEPATITIS A
SerologySerology Acute ndash IgM ndash lasts 3-6 months Acute ndash IgM ndash lasts 3-6 months Chronic ndash IgG ndash lifetime Chronic ndash IgG ndash lifetime bull Liver enzymes ndash increases in ALT Liver enzymes ndash increases in ALT
AST bilirubinAST bilirubin
0 1 2 3 4 5 6 7 8 9 10 11 12 13Week
Re
sp
on
se
Clinical illness
ALT
IgM IgG
HAV in stool
Infection
Viremia
EVENTS IN HEPATITIS A VIRUS INFECTION
HEPATITIS B
Serology - acuteSerology - acute HBsAg+ (HBsAb-) = acute infection or HBsAg+ (HBsAb-) = acute infection or
chronic carrierchronic carrier HBeAg+ = highly infectiousHBeAg+ = highly infectious HBsAb = immune ndash naturally or HBsAb = immune ndash naturally or
vaccinevaccine Window phase = HBsAg- and HBsAb-Window phase = HBsAg- and HBsAb-
will be HBcAb+ (IgM ndash acute)will be HBcAb+ (IgM ndash acute)
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
HEPATITIS A
SerologySerology Acute ndash IgM ndash lasts 3-6 months Acute ndash IgM ndash lasts 3-6 months Chronic ndash IgG ndash lifetime Chronic ndash IgG ndash lifetime bull Liver enzymes ndash increases in ALT Liver enzymes ndash increases in ALT
AST bilirubinAST bilirubin
0 1 2 3 4 5 6 7 8 9 10 11 12 13Week
Re
sp
on
se
Clinical illness
ALT
IgM IgG
HAV in stool
Infection
Viremia
EVENTS IN HEPATITIS A VIRUS INFECTION
HEPATITIS B
Serology - acuteSerology - acute HBsAg+ (HBsAb-) = acute infection or HBsAg+ (HBsAb-) = acute infection or
chronic carrierchronic carrier HBeAg+ = highly infectiousHBeAg+ = highly infectious HBsAb = immune ndash naturally or HBsAb = immune ndash naturally or
vaccinevaccine Window phase = HBsAg- and HBsAb-Window phase = HBsAg- and HBsAb-
will be HBcAb+ (IgM ndash acute)will be HBcAb+ (IgM ndash acute)
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
0 1 2 3 4 5 6 7 8 9 10 11 12 13Week
Re
sp
on
se
Clinical illness
ALT
IgM IgG
HAV in stool
Infection
Viremia
EVENTS IN HEPATITIS A VIRUS INFECTION
HEPATITIS B
Serology - acuteSerology - acute HBsAg+ (HBsAb-) = acute infection or HBsAg+ (HBsAb-) = acute infection or
chronic carrierchronic carrier HBeAg+ = highly infectiousHBeAg+ = highly infectious HBsAb = immune ndash naturally or HBsAb = immune ndash naturally or
vaccinevaccine Window phase = HBsAg- and HBsAb-Window phase = HBsAg- and HBsAb-
will be HBcAb+ (IgM ndash acute)will be HBcAb+ (IgM ndash acute)
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
HEPATITIS B
Serology - acuteSerology - acute HBsAg+ (HBsAb-) = acute infection or HBsAg+ (HBsAb-) = acute infection or
chronic carrierchronic carrier HBeAg+ = highly infectiousHBeAg+ = highly infectious HBsAb = immune ndash naturally or HBsAb = immune ndash naturally or
vaccinevaccine Window phase = HBsAg- and HBsAb-Window phase = HBsAg- and HBsAb-
will be HBcAb+ (IgM ndash acute)will be HBcAb+ (IgM ndash acute)
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
HEPATITIS C ss +RNA Flavivirus (former non-A non-B)ss +RNA Flavivirus (former non-A non-B) Marked genetic heterogeneity due to hypervariable Marked genetic heterogeneity due to hypervariable
regionregion Mutates under immunologic pressure and becomes Mutates under immunologic pressure and becomes
chronicchronic
Vaccines are difficult to developVaccines are difficult to develop
Immunoglobulin not effectiveImmunoglobulin not effective
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
Serologic Pattern of Acute HCV Infection with Recovery
Symptoms +-
Time after Exposure
Tit
eranti-HCV
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4YearsMonths
HCV RNA
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
EBV Serology
EBV VCA IgG Positive EBV VCA IgM Positive EBNA IgG Negative EBV AI lt60 Acute EBV
10487071048707
THANK YOUTHANK YOU
THANK YOUTHANK YOU
