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Gepubliceerd in: Bijblijven 8/2005

01-08-2005 | Artikel

Virale hepatitis

Auteurs: Prof. dr. P. Michielsen, Prof. dr. P. van Damme, Dr. J. E. van Steenbergen

Gepubliceerd in: Bijblijven | Uitgave 8/2005

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Samenvatting

Virale hepatitis is een leverontsteking, veroorzaakt door hepatotrope virussen. Deze virussen veroorzaken gelijksoortige klinische beelden maar zijn taxonomisch geheel verschillend, wat belangrijk is voor epidemiologie, klinisch verloop, behandeling en preventie. In deze bijdrage beperken wij ons tot hepatitis A, B en C.
Hepatitis A wordt overgedragen via de ontlasting en de mond. Bij kinderen verloopt de ziekte veelal subklinisch, een besmetting op volwassen leeftijd verloopt ernstiger. Chroniciteit ontwikkelt zich nooit. De behandeling is symptomatisch.
Hepatitis B wordt overgedragen via seksueel contact, via bloed, van moeder op kind bij de geboorte en ‘horizontaal’, vaak van een chronisch geïnfecteerde op derden via kleine wondjes, beten, krabletsels en speeksel met bloed. Ook hier kan het klinisch beeld variëren van subklinisch tot fulminant, afhankelijk van de sterkte van de immuunrespons. Bij pasgeborenen en kleine kinderen is de afweerreactie afwezig of gering; een acute infectie veroorzaakt bij hen derhalve weinig of geen verschijnselen maar ontwikkelt zich meestal tot een chronische ontsteking die kan leiden tot cirrose en hepatocellulair carcinoom. Op volwassen leeftijd evolueert minder dan 10% van de besmettingen naar chroniciteit, ook hier kunnen zich in bepaalde gevallen cirrose en hepatocellulair carcinoom ontwikkelen. De behandeling van acute hepatitis B is symptomatisch. Bij chronische hepatitis B is de bedoeling van de behandeling de virusreplicatie te onderdrukken zodat de leverbeschadiging tot stilstand komt. Dit kan verkregen worden met interferon-alfa of peginterferon-alfa; een alternatief is behandeling met nucleoside/nucleotide-analogen. De voor- en nadelen van beide therapieën worden besproken.
Hepatitis C wordt overgedragen door bloed, veel minder door seksueel contact of van moeder naar kind. Het klinisch beeld verloopt veelal subklinisch. Tachtig procent van infecties wordt chronisch en kan dan evolueren naar cirrose en hepatocellulair carcinoom. De standaardbehandeling bestaat momenteel uit een combinatie van peginterferon-alfa en ribavirine, met de bedoeling het virus te elimineren.
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Metagegevens
Titel
Virale hepatitis
Auteurs
Prof. dr. P. Michielsen
Prof. dr. P. van Damme
Dr. J. E. van Steenbergen
Publicatiedatum
01-08-2005
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Bijblijven / Uitgave 8/2005
Print ISSN: 0168-9428
Elektronisch ISSN: 1876-4916
DOI
https://doi.org/10.1007/BF03059876

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