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1、PartVIIIViruspersistentinfectionSectionITypeofinfectionSectionII ThemechanismofpersistentinfectionpersistentinfectionlatentinfectionchronicinfectionslowvirusinfectionSectionIIExampleofpersistentinfectionI.HepatitisBvirus,HBV乙型肝炎病毒1.Biologicalpropertiesamembe
2、rofthehepadnavirusfamilyacircular,partiallydouble-strandedDNA,aprimerprotein,andaviral-specificDNApolymeraseassociatedwiththeDNA.complexvirionstructure.thevirion,alsocalledthedaneparticle,is42nmindiameter.stableat-20℃andsensitivetohighertemperature(100℃for1m
3、inute)HBVgenomeorganizationtwounevenstrandsofDNA:(-)sensestrand:3.0-3.3kb(+)sensestrand:1.7-2.8kbBaruchBlumberg,1963:‘Australianantigen-Au'.1967:Auwasaviralantigen=HBsAg(surfaceantigen)Dane,1970:Discovered42nm'Daneparticles‘HBcAg(coreantigen).1973:HBeAgdisco
4、vered(endogenousantigen=atruncatedversionofHBcAg).secretedfilamentsecretedspherehepatitisBvirion2.TheHBVlifecycle3.Clinicalfindings3.1acuteinfection:symptomsduringtheprodromalperiodmayincludefever,yellowjaundice.Theclassicictericsymptomsofliverdamagefollowso
5、onthereafter.recoveryisindicatedbyadeclineinthefeverandrenewedappetite.AcuteViralHepatitisSource:CDC3.2chronicinfection:chronichepatitisoccursin5%to10%ofpeoplewithHBVinfections,usuallyaftermildorinapparentinitialdisease.itmaybedetectedonlybyfindingelevatedli
6、verenzymelevelsonaroutinebloodchemistryprofile,butasmanyas10%ofpatientswithchronichepatitismaydevelopcirrhosis,primaryhepatocellularcarcinoma国人感染HBV起始于围产或幼龄期幼龄感染成年感染90%慢性化10%清除病毒急性肝炎<1%暴发肝炎非活动性携带慢性肝炎（HBeAg－）（HBeAg+/-）40%肝硬化95%清除病毒5%慢性感染非活动性携带慢性肝炎（HBeAg）（HBeA
7、g+/）15~20%肝硬化4.LaboratorydiagnosisThedetectionofHBeAgisthebestcorrelatetothepresenceofinfectiousvirus.AchronicinfectioncanbedistinguishedbythecontinutedfindingofHBeAg,HBsAg,orbothandalackofdetectableantibodytotheseantigens.Duringthesymptomaticphaseofinfectio
8、n,detectionofantibodiestoHBeAgandHBsAgisobscuredbecausetheantibodyiscomplexedwithantigenintheserum.thebestwaytodiagnosearecentacuteinfection,especiallyduringtheperiodwhenneitherHBsAgnoranti-HBsc
