Info

Liver cancer

No

Yes

Yes

No

No

" Coinfection with hepatitis B virus or superinfection of hepatitis B carrier '' Especially waterborne.

' By enzyme immunoassay (or RIA) to identify specific antibody of the IgM class or in the case of hepatitis B virus, HBsAg. There are alternative diagnostic approaches (see Chapters 22, 23, 24, and 26)

" Coinfection with hepatitis B virus or superinfection of hepatitis B carrier '' Especially waterborne.

' By enzyme immunoassay (or RIA) to identify specific antibody of the IgM class or in the case of hepatitis B virus, HBsAg. There are alternative diagnostic approaches (see Chapters 22, 23, 24, and 26)

persistent infections, and this enables them not only to cause chronic disease, including cirrhosis and cancer, but also to be passed on by the aforementioned routes over many years.

There is also a certain irony in the fact that, having waited so long for the identification of the causal agents of "infectious" hepatitis (A) and "serum" hepatitis (B), there seems to be an almost endless succession of non-A, non-B hepatitis viruses waiting in the wings to be discovered. Despite the recent identification of hepatitis C and E viruses, there is good evidence for the existence of at least one additional parenterally transmitted non-A, non-B virus, which was originally extracted from human factor VIII, has since been serially passaged in cynomolgus monkeys in which it causes hepatitis, yet is nonenveloped (as judged by chloroform resistance) and fails to cross-react serologically in either direction with any of the known hepatitis viruses.

It should be stressed, however, that hepatitis is an occasional feature of the clinical syndromes induced by several other viruses as well. This is hardly surprising, as so many of the infections that involve a viremic phase are characterized by amplification of virus in the reticuloendothelial system, including the liver. For example, all of the herpesviruses, especially HSV, EBV, and CMV, can affect the liver, and clinical hepatitis or elevated liver enzyme levels are occasionally seen with the adenoviruses, coxsackieviruses, and sometimes even the common childhood exanthemata, measles and rubella. Second, hepatitis may be prominent and severe in many of the hemorrhagic fevers, particularly in yellow fever (which is characterized by such a severe hepatitis that it takes its name from the jaundice it causes), but also in Marburg, Ebola, Lassa, Rift Valley fever, and Crimean-Congo hemorrhagic fever. Third, hepatitis is a major feature of most of the disseminated viral infections that overwhelm neonates (neonatal herpes simplex or varicella, cytomegalic inclusion disease, congenital rubella syndrome) or immunocompromised patients (herpes simplex, varicella, cytomegalovirus).

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