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Hepatitis B is the most dengerous viral hepatitis caused by the hepatitis B virus.This is the only hepanda virus causing infection in humans. And humans are the only basis of infection as yet known.The incubation period is about 4-20 weeks.
Hepatitis B also identified as 'serum hepatitis' or 'long incubation hepatitis. The infective B virus, known as version or dale particle (42 nm) comprises an inner core or nucleocapsid (27 nm) surrounded by an outer  envelope or capsule of surface protein (HBsAG).The core or nucleocapsid is formed of core protein (HBsAG) containing incompletely double-stranded circular DNA and a DNA polymerase.

HBeAG is a protein formed via definite self cleavage of the core gene product, which is secreted individually by the cell.
The virus &the capsular material (HBsAG) circulate in the blood, and individual incubating or suffering from acute hepatities ,is highly infectious as long as the blood. Generally HBsAG appears in the blood in the late phase of the incubation period & before th prodromal phase of infection. In acute hepatitis B, appearance of HBsAG is the first and specific evidence of HB virus infection ,HBsAG may be present in the blood only for a few days, but generally persists for 3-4 weeks or throughout the clinical illness or can persist for up to 5 months. Antibody to HBsAG (anti-HBs) usually appears after 3-6 months that is after clearance of HBsAG &persists for many years to life-long. The persistence of HBsAG after the acute illness indicates chronic hepatities (or carrier state).disappearance of HBsAG and presence of anti-HBs indicates recovery from recurrent infection. Chronic hepatities infection is marked by the presence of HBsAG & anti-HBc in the blood.In this situation patient may be asymptomac, but is highly infectious when markers of continuing viral replication, such HBeAG,HBe is present. In the blood, presence of anti-HBs indicates either a before infection, in which case anti-HBc is usually also present, or previous vaccination if anti-HBc is no present. In the blood HBcAG does not appears, but anti-body to this core antigen(anti-HBc) appears at the earlier stage of the disease and quickly reaches a high tire, which then steadily reduces and persists to a lower level. On the other hand HBeAG appears in the blood only transiently at the outset of the disease and there is also invention of antibody (anti-HBe) indicates active replication of the virus in the liver.    .    

source of hepatitis B

As humans are the major source of hepatitis B infection, so its extend generally occurs through human blood or blood products & use of infected injection materials. Besides the viruses also occur in the human semen, saliva & vaginal secretion, so infection may also spread through close personal contact, such as sexual intercourse (mostly in male homosexuals).  Vertical or direct transmission from mother to child during and after birth is also an important way of hepatitis B virus. 

Investigetion

1. Serum bilirubin is variably reasonably or markedly elevated.
2. Serum AST (SGOT)&ALT (SGPT) are elevated (20-400 U/L),(normal 35 U/L)
3. The prothrombin time is enlarged in severe cases.
4. Serum HBsAG & HBcAG test may be positive (in hepatitis B)
5. Ultrasonogram of hepatobiliary system.
6. Liver biopsy (if needed) is confirmatory-usually not necessary
7. Blood count -lymphocytes         
8. Serological test may be useful

Treatment of Hepatities B

. complete bed rest till serum bilirubin comes down to common level and jaundice subsides.

.2.In case of hepatitis B, the patient should be isolated.
3. Patient with serious illness should be hospitalized.
4.abundance of water and glucose by mouth ,if  the patient vomits, glucose may be given by i. v route,5% dextrose in aqua 500ml & 25% glucose 200-300ml daily.
5. Diet, all diet but excess amount of fatty diet and alcohol. Total calorie intake should be maintained within 2000-3000kcal
6. Bowel should be clear by using laxative, such as milk of magnesia (MGSO4) or lactulose 3-6 tsf daily in the morning in blank stomach.
7. Vitamin supplement e.g. vitamin B complex may be given commonly.
8. Antibiotic-if the patient has got fever or any characteristic of secondary infection, a course of suitable antibiotic (amoxicillin or cephalosporin etc) should be advised.
9. Alcohol should be controlled for 1 year or life-long (for non-habitual)
10. Drugs which are metabolized in the liver should  be restricted such as-
a. Sedatives
b.Antiemetics
c. Analgesic as paracetamol
d.Cotrimoxazole & other sulphonamides
e.Hepatotoxic anti T-B drugs  .

HIV INFECTION & AIDS

                                                        Hiv infection spread
firstly, some cases of severe opportunistic infections e.g. pneumocystis carina pneumonia and abnormal neoplasm, such as Kaposi’s sarcoma, which can only be seen in severely immunocompromised patients i.e. indefective cell mediated immunity-were found in some previously healthy homosexual individuals in the lack of any known cause of underlying immune defects (such as iatrogenic immunosupression e.g. chemotherapy patients, or malignant neoplasm, or severe malnutrition), this situation was then eventually renowned as the acquired immunodeficiency syndrome or AIDS. After finding of HIV virus as the cause of AIDS dissimilar stages of the disease have been described later on, such as a healthy person with seropositive HIV virus at one end of the disease spectrum &severe opportunistic infection or unusual neoplasm like Kaposi’s sarcoma at the other end. In 1987, a meaning of AIDS was described, which included 23 opportunistic infections (such as pneumocystis pneumonia) and unusual neoplasm (like Kaposi’s sarcoma)with loss if weight, diarrhea, dementia and a positive HIV infection, In 1993 CDC (center for disease control and prevention )extended the AIDS definition, and added that, a person with a positive HIV serology and who have ever had a CD4 lymphocyte percentage below 14% is to be considered as a patient of AIDS. 
      




































 

Source of AIDS

AIDS is caused by infection with humane retroviruses recognized as 'human immunodeficiency virus. in addition classic AIDS virus, a group of related viruses designated as HIV - found in some west African patients having same genetic organization as HIV-1,but considerably different glycoprotein contents, manifested AIDS-like illnesses in some patients, but most cases found asymptomatic.

Mode of transmission:

1.Sexual contact is the main mode of transmission of HIV. About 60%are homosexual or bisexual.
2. Intravenous route-about 20%of patients is heterosexual men and women intravenous drug users, and is related to the sharing of needles. About 7% are homosexual or bisexual men, who are also using intravenous drugs.
transfusion of contaminated of blood &blood products, if not screened or treated, may be a significant way of AIDS transmission
3.Infected mothers are efficiently (30-40%)transmit the virus to their infants perinatally during the first and second trimester. Virus can also be transmitted from mother to infant via breast feeding