Hepatitis A: Ditangani

atau tidak?

dr.P.Kusnanto,SpPD-KGEH, FINASIM
Staf Ilmu Penyakit Dalam
Divisi Gastroentero Hepatologi
FK UNS / RS dr.Moewardi
Surakarta
 Serum Transaminase sebagai
Prediktor Kerusakan Hati

Giannini EG, Testa R, and Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ. 2005; 172(3): 367–379.
 Etiologi Penyakit Hepatitis

Autoimmune disease

Viral

Hepatitis

Drugs Alcohol

Fatty Liver
Anonim. Situasi dan Analisis Hepatitis. Infodatin 2014. (cited 2016 Nov 30). Available from: URL:
http://www.depkes.go.id/resources/download/pusdatin/infodatin/infodatin-hepatitis.pdf
Prevalensi Hepatitis Viral di Indonesia

(Sumber: Riskesdas, 2013)

Prevalensi hepatitis yang disebabkan oleh virus pada tahun 2013

sebesar 1,2%, dimana hal tsb dua kali lebih besar dibandingkan
prevalensi tahun 2007.
Prevalensi Infeksi Hepatitis A di Indonesia

Kasus Prevalensi
Hepatitis B 21,8%
Hepatitis A 19,3% Di Indonesia, Hepatitis A merupakan kejadian
Hepatitis C 2,5% hepatitis yang paling sering kedua terjadi.
Hepatitis
lainnya 1,8%
(Source: riskesdas, 2013)
No Provinsi Kabupaten/Kota Jumlah Kasus

Kabupaten Bintan
1 Kepulauan Riau 87
(Kec. Bintan Timur)
Outbreak
2 Lampung
Kabupaten Lampung Timur
11
hepatitis A
(Kec. Bumi Agung)
terjadi
3 Sumatera Barat
Kota Padang (Kec. Kuranji) 15 pada
Kabupaten Darmasraya (Kec. Koto Baru) 45
provinsi
4 Jambi Kota Jambi 26 yang
5 Jawa Tengah
Kabupaten Sukoharjo
26
berbeda-
(Kec. Kartosuro)
beda di
Kabupaten Pasuruan 110 tahun
Kabupaten Ponorogo 25
6 Jawa Timur Kabupaten Lamongan 72 2013 &
Kabupaten Jombang 14
Kabupaten Pacitan (Kec. Ngadirojo) 66 2014.

Total KLB Hepatitis A tahun 2013 (kematian dan Case Fatality Rate : 0) 495

No Provinsi Kabupaten/Kota Jumlah Kasus

Anonim. Situasi dan
Analisis Hepatitis. Infodatin
1 Bengkulu Kota Bengkulu (Kec. Teluk Sagara) 19
2014. (cited 2016 Nov 30).
Available from: URL:
Kabupaten Sijunjung (Kec. Kamang) http://www.depkes.go.id/re
2 Sumatera Barat 159 sources/download/pusdati
Kabupaten Pesisir Selatan (Kec. Balai Selasa)
n/infodatin/infodatin-
hepatitis.pdf
3 Kalimantan Timur Kabupaten Paser (Kec. Batu) 104

Total KLB Hepatitis A tahun 2014 (kematian dan Case Fatality Rate : 0) 282
 Natural history of viral hepatitis

Feature HAV HBV HCV HDV HEV

Parenteral,
Route(s) of
transmission
Fecal-oral vertical, Parenteral Parenteral Fecal-oral
sexual
Incubation period
(mean)
30 days 60-90 days 50 days 60-90 days 40 days
Onset Acute Insidious Acute Insidious Acute
Severity Mild Occ severe Moderate Occ severe Mild
Fulminant / Acute
Liver Failure
0,1% 0,1-1% 0,1% 5-20% 1-2%

Ministry of Health & Family Welfare Government of India. Viral hepatitis – The silent disease facts and treatment guidelines. NCDC 2013. (cited 2016 Nov 30).
Available from: URL: http://www.ncdc.gov.in/writereaddata/linkimages/guideline_hep20158117187417.pdf
 Time course of Hepatitis A virus infection
(Copyright: Kent County Health Department, Grand Rapids, Michigan USA)
 Progressivity Hepatitis to Acute Liver Failure

Definition: Etiology:
“Potentially reversible condition, Drug Induce Liver
the consequence of severe liver 58% Injury
(n = 665)
injury, with the occurrence of
encephalopathy within 8 weeks of 3% Hepatitis A
(n = 31)
the onset of acute hepatic
illness and in the absence of
Hepatitis B Acute Liver Failure
pre-existing liver disease” 7%
(n = 83) (ALF)

Outcome rates are far better than Indeterminate

14%
(n = 161)
in the era before transplants when
mortality rates were 80% or All others
18%
higher. (n = 207)

Lee WM, et al. Acute Liver Failure: Summary of a Workshop. Hepatology 2008;47(4):1401-15.
Clinical manifestation

• Prodromal Illness : several days to a week or more which is

characterized by increasing fatigue (Gust and Feinstone, 2008),
malaise, loss of appetite, nausea, and vomiting. In hepatitis A, fever
is a common occurrence
– Abdominal discomfort, nausea, arthralgia, constipation, cough,
dark colored urine, drowsiness, irritability, itching,jaundice,
anorexia, malaise

• Icteric phase : The icteric phase begins within 10 days of the initial
symptoms in more than 85% of HAV cases (Hollinger and
Emerson,2001)
• Acute HAV superinfection causes more severe
disease, acute hepatic failure, and higher fatality
rates in patients with underlying chronic liver
disease, specifically chronic HBV infection and
chronic HCV infection
Diagnosis

• IgM anti-HAV (not Anti HAV total !!)

• Liver Biochemical Test and other hepatitis
viruses seromarkers
• Abdominal ultrasound
 Treatment Acute Hepatitis
Recommendations treatment in Hepatitis A1
• The treatment should be conservative and supportive. There is no specific
medication for HAV infection. Hygiene is very important — hands should
always be washed after bathroom use. The management should focus on
treating the symptoms and identifying the small proportion of patients
with a particular risk of developing fulminant hepatic failure. Patients
over the age of 40 and those with underlying chronic liver disease are most
at risk.

• Postexposure prophylaxis with immunoglobulin is more than 85% effective

in preventing hepatitis A if administered within 2 weeks after exposure to
HAV, but the efficacy is highest when administered early in the incubation
period

1. World Gastroenterology Organisation. World Gastroenterology Organisation Practice Guidelines: Management of Acute Viral Hepatitis. WGO 2007. (cited 2016 December 2). Available from: URL:
http://www.worldgastroenterology.org/guidelines/global-guidelines/management-of-acute-viral-hepatitis/acute-viral-hepatitis-english
 Evaluation of Stronger Neo Minophagen-C (SNMC) in patients with acute
hepatitis
Kiran Reddyvari, Avinash Balekuduru, Umesh Jalihal, Satyaprakash Bonthala
M.S Ramaiah medical college and hospital, Bangalore, India
Objectives:
To evaluate the efficacy of SNMC in patients with hepatitis of all etiologies without underlying
chronic liver disease.
Methods:
In this study conducted at a tertiary care centre, 11 consecutive patients with deranged liver
function test, unresponsive to conventional treatment with ursodeoxycholic acid for 5 days, were
selected and their response to SNMC was evaluated based on the improvement in the LFT values.
60 ml SNMC in 500 ml normal saline was administered as an intravenous infusion over 2 h once a
day for 3 days and the LFT values were assessed on day 4.
Results:
ALT (x + SD) AST (x + SD) PT (x + SD) INR (x + SD)

Before 1132 (128 – 1367) 1040 (145 – 2084) 14,1 (13 – 18,1) 1,2 (1,2 – 1,58)

After 160 (75 – 499) 507 (49,3 – 810) 13,2 (12,1 – 17,7) 1,1 (1,0 – 1,48)

(n=11)
Conclusion:
Administration of SNMC is useful in the improvement of ALT, AST, PT, and INR levels in
patients with acute hepatitis. Larger studies are needed to confirm this pilot study results.
Journal of Clinical and Experimental Hepatology | June/July 2015 | Vol. 5 | No. S2 | S69-S81
Summary
• Acute hepatitis A has good prognosis
• Acute hepatitis A infection in patient with chronic liver
disease (alcohol, HBV,HCV) may worsen the patient
clinical condition
• Treat or not To Treat ?
– Based on symptoms severity (Quality of Life)
– Co-infection with HBV, HCV
– Concomitant with chronic liver diseases (alcohol,
HBV,HCV)
TERIMA KASIH