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YR5 Microbiology > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What is Hepatitis A?
Family
Genus
Genome

A

Family: Picornaviridae
Genus: hepatovirus

Single-stranded, +ve sense RNA

Quasi-enveloped virions

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2
Q

How is Hepatitis A transmitted? What is the incubation period? What is the treatment?

A

Faeco-oral
Incubation period of 2-6w
Usually 28-30d

Supportive
No chronicity

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3
Q

What is the epidemiology of Hepatitis A?

A

Developing countries with poor socio-economic conditions

300-500 cases annually in the UK

Mostly among age 15-34+ non-travellers

Outbreaks among MSM + IVDU

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4
Q

What are 6 signs and symptoms of Hepatitis A?

A

Fever
Malaise
Anorexia
Abdominal pain
Diarrhoea
Signs + Sx of high BR

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5
Q

List 4 signs and symptoms due to elevated bilirubin in hepatitis

A

Jaundice
Dark urine
Pale, grey, white stool
Pruritis

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6
Q

What is the infectious period of Hepatitis A?

A

2w pre-Sx onset + 1w post-jaundice onset

Isolate for 7d from onset of Sx

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7
Q

What test can be used to confirm acute cases of Hepatitis A infection?

A

Stool HVA RNA PCR

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8
Q

How is Hepatitis A diagnosed?

A
  • 1st week: Anti-HAV IgM -ve if ALT <500
  • Acute infection: Anti-HAV IgM +ve
  • Past infection/ immunisation: Anti-HAV IgG
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9
Q

What are the public health implications of Hepatitis A?

A

Notifiable disease- report to UKHSA

Pre-exposure immunisation among population at risk

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10
Q

Which populations are considered “at risk” for hepatitis A?

A

Travel to endemic country
Chronic liver disease
Chronic Hep B/C
Haemophilia
IVDU
MSM
Occupational risk

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11
Q

How does age effect outcome of hepatitis A?

A

Mortality increases with age
Kids: usually asymptomatic/ mild disease/ jaundice
Elderly: higher change of fulminant hepatitis, necrosis + complications

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12
Q

What is Hepatitis B?
Family
Genome

A

Family: Hepadnaviridae

ds-DNA with reverse transcriptase

Enveloped virions

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13
Q

How is Hepatitis B transmitted? What is the incubation period?

A

Blood-borne transmission: horizontal + vertical

Incubation period of 40-160 days

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14
Q

What is the typical presentation of acute Hepatitis B?

A

Age related presentation + prognosis in acute hepatitis B.

Neonates & children: Mostly asymptomatic or anicteric; 90% HBV-infected neonates develop CHB, + 30% among children age <5y.

Adult: 30-50% icteric hepatitis; 10% become CHB.

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15
Q

What are risks associated with acute Hepatitis B infection?

A

0.1-0.05% risk of fulminant hepatitis; related to co-infection with HCV/HDV.

Maternal HBeAg/Ab status + HBV viral load.

HBeAg as the most important risk predictor for vertical transmission.

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16
Q

What is the definition of chronic Hepatitis B infection?

A

Persistence of HBsAg for 6 months or more after acute HBV infection.

17
Q

What are risks associated with chronic Hepatitis B infection?

A

Cirrhosis: 8-20% untreated CHB in 5y;

Hepatocellular carcinoma: The annual risk of 2-5% among CHB cirrhotic patients; affected by host (e.g. alcohol abuse) + viral factors (e.g. high HBV viral load + qHBsAg).

18
Q

What is the epidemiology of Hepatitis B?

A

Approximately 296 million people are living with CHB worldwide; CHB-related mortality at roughly 820,000 people per year.

19
Q

What are the public health implications of Hepatitis B infection?

A

Acute hepatitis B: A notifiable disease

Pre-exposure prophylaxis:

  • Routine childhood immunisation in the UK since 2017
  • High risk population

Post-exposure prophylaxis:

  • Neonate born to mother living with hepatitis B.
  • Sexual partner: HBV vaccine +/- HBIG (within one week from the contact).
  • Needle stick injury.
20
Q

What is Hepatitis D?

A

Single-stranded, circular RNA genome.

A defective virus that relies on HBV for propagation.

21
Q

How is Hepatitis D transmitted?

A

Blood-borne transmission

Incubation period: 3-6 weeks

22
Q

What is the association between Hepatitis B and Hepatitis D?

A

HBV/HDV simultaneous co-infection: Similar to classic acute hepatitis B; mostly self-limited. <5% chronic infection.

HDV super-infection in CHB: 80% chronic infection. Increased risk of cirrhosis and HCC than CHB alone.

23
Q

How is Hepatitis D diagnosed and treated?

A

Anti-HDV serology; other HDV investigations rarely used.

PEG-interferon alpha licensed for HDV superinfection in CHB.

Pre-exposure HBV immunisation.

24
Q

WHat are the public health implications for Hepatitis D infection?

A

Notifiable disease

25
Q

What is Hepatitis C?

A

The family Flaviviridae, genus Hepacivirus.

Single-stranded, positive sense RNA genome.

26
Q

How is Hepatitis C transmitted?

A

Blood borne transmission.

Incubation period: 2-6 weeks.

27
Q

What is the epidemiology of Hepatitis C?

A

58 million people living with chronic hepatitis C worldwide.

1.5 million new cases every year.

28
Q

What is the presentation of Hepatitis C infection?

A

Acute infection:

  • 30% spontaneous clearance
  • 70% become chronic hepatitis C (CHC)

Hepatic versus extra-hepatic manifestation.

Cirrhosis (15-30% in 20 years) & HCC as complication of CHC.

29
Q

How is Hepatitis C treated?

A

Revolutionised the treatment for acute/chronic HCV infection.

Any HCV cases should be considered:

  • 8 or 12 weeks
  • Sustained virological response (SVR) at week 12
  • Pan-genotypic regimen
  • Single-tablet regimen
  • Drug-drug interaction
30
Q

What are the public health implications of Hepatitis C infection?

A

Notifiable disease in the UK.

Nil vaccine available.

Nil post-prophylaxis available.

Active HCV screening.

Risk reduction (e.g. safe handling and disposal of sharps, protected sex).

31
Q

What is Hepatitis E?

A

The family Hepeviridae, genus Orthohepevirus; species A strains (8 genotypoes) infect humans.

Single-stranded, positive sense RNA genome.

Quasi-enveloped HEV.

32
Q

How is Hepatitis E transmitted?

A

Faeco-oral versus blood-borne transmission

Incubation period: 15-60 days

33
Q

What are the natural reservoirs for the different strains of Hepatitis E?

A

G1 & G2: Obligate human pathogens

G3 & G4: Zoonotic; pigs & wild boar are natural hosts

34
Q

What is the epidemiology of Hepatitis E?

A

Approximately 20 million new HEV cases worldwide annually

3.3m symptomatic hepatitis E

44,000 mortality annually

UK is a HEV G3 endemic country

35
Q

What is the clinical manifestation of Hepatitis E?

A

Mostly self-limited; advised against alcohol during the course

Hepatic and systemic symptoms

36
Q

Which groups are particularly at risk of developing Hepatitis E infection?

A

Pregnant women: G1; fulminant hepatic failure and obstetric complications (e.g. eclampsia and haemorrhage); 25% maternal mortality & high perinatal infant mortality.

Chronic liver disease patients.

Immunocompromised patients: May develop chronic hepatitis E (G3 & G4)/

37
Q

How is Hepatitis E diagnosed?

A

Immunocompetent: HEV serology

Immunocompromised: HEV PCR

38
Q

What are the public health implications of Hepatitis E infection?

A

Notifiable disease

HEV patient should avoid prepping food during the first 2 weeks.

Immunocompromised and chronic liver disease patients should avoid consumption of undercooked meat (pork, wild boar and venison) and shellfish.

HEV vaccination: Only licensed in China.

39
Q

What is the treatment of Hepatitis E?

A

Only indicated in chronic hepatitis E as most acute HEV infection are self-limited.

YR5 Microbiology (23 decks)

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