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What is Evaluation of specimen from a patient with hepatocellular carcinoma demonstrates presence of single strand RNA virus. Which of the following is the most probable etiological agent - and explain in detail?
Ans. is 'c' i.e., Hepatitis C virus * Following table enumerates the factors associated with increased risk of hepatocellular carcinomaFactors associated with an Increased risk of developing HCCCommonUnusualCirrhosis from any causeHepatitis B or C chronic infectionEthanol chronic consumptionNASH/NAFLAFLATOXIN B1 or other mycotoxinsPrimary biliary cirrhosisHemochromatosisal Antitrypsin deficiencyGlycogen storage diseasesCitulinemia Porphyria cutanea tordaHereditary tyrosinemiaWilsons disease* From the options given, chronic infection with either Hepatitis B or Hepatitis C is associated with increased risk of hepatocellular carcinoma.* Hepatitis B virus is a DNA virus either double stranded or single stranded* Hepatits C virus is RNA virus single stranded.* Thus isolation of single stranded RNA virus from the specimen points to Hepatitis C virus as the etiological agent for this particular patient. HAVHBVHCVHDVHEVCommon nameInfectious hepatitisSerum hepatitisNon A non B or Post transfusion hepatitisDelta agentNon A non B enteric transmitted hepatitisFamilyEntero 72HepadnaFlavi viridaeViroid likeCalci viridaeAgeChildren, young adultsYoung adults, babies, toddlersAny age, but more common in adultsAny age (similar to HBV)Young adult (20- 40 years)RouteFaeco-oral (MC) blood (+/-) sexual (+/-)Blood (MC) Sexual, verticalBlood (MC) sexual (+/-) vertical (+/-)Blood (MC) sexual (-H-) vertical (+)Faeco-oralI.P (days)15-45, mean 3030-180, mean 60-9015-160, mean 5030-180, mean 60-9014-60, mean 40OnsetAcuteInsidiousInsidiousInsidiousAcuteFulminant0.1%0.1-1%0.1%5-20%Usually 1 -2% and pregnancy 20-40%CarrierNone01-30%1-5-3 2%VariableNoneChronicityNoneOccasional (1- 10%) (90% of neonates)Common (85%)CommonNoneOncogenicNilPresent (neonate)Present+/-NilAssociated other featureSecondary attack rate 10-20%HCC, cirrhosis, autoimmune disorder like AGN, arthritis PANHCC, cirrhosis, autoimmune- AGN arthritis, cryoglobulinemiaHCC, cirrhosis, fulminant hepatitisSecondary attack rate 1-2% not seen western countriesPrognosisExcellentWorse with age, debilityModerateAcute-good chronic-poorGoodProphylaxisIG, Inactivated vaccineHBIG, recombinant vaccineNoneHBV vaccine (none for HBV carriers)Recombinant vaccineTharapyNoneInterferon lamivudine adefovir entecavirPegylated interferon plus boceprevirInterferon +- ribavirin talaprevitNone