Hep Viruses Flashcards
Hep A
Transmission, Vaccine, Type of injury, Incubation Period, Diagnosis, Risk groups
Fecal-Oral
- contaminated food, water, Oysters, Cockles
1 Serotype
- Vaccine available, Lifelong immunity
- Acute, Hep B people immunize w Hep A;
Incubation Period: 4-6 weeks
Diagnosis
- IgM
- found in feces before symptoms;
Risk Groups:
- Food handlers, Sewage workers
- Travelers
- HBV, HCV infected
Hep E
Transmission, Vaccine, Diagnosis, Pregnancy severity
Fecal-Oral
No vaccine, AB dont last
Diagnosis
- IgM, IgG, PCR
Severe in pregnant women
- later trimesters more dangerous
VS Rubella, TORCH - earlier more dangerous
Hep B
Transmission, Period, Characteristics, Genome
Diagnosis, Time frame, Vaccine, Infectivity, HCC risk
Blood, Sex
- 4-6 months
- only dsDNA, Reverse transcriptase
- Coat C antigen, Coat-associated E antigen
- Surface S antigen
Diagnosis
- HBVsAg, IgM-HBVc !!!
= S antigen and IgM C
- IgM c does not protect but is a marker for natural infection as Ag C not found in blood;
Time frame goes from
S, IgM C, IgG C, IgM S (note C not found in blood, only liver)
- IgM C useless but means natural infection, vaccine no C, vaccine uses A epitope
- Note IgM S is fucking late
IgM S confers protection, not IgM C
Dane Particles - Virions,
S particles alone “Subviral particles” USELESS
Vaccine against S, w a common ‘a’ epitope
- if infant post-infect alr give passive AB too;
- Infectivity - levels of E, otherwise DNA levels
- E not found in “pre-core” mutants
HCC risk by HBx protein
Hep B carrier numbers;
Carrier definition
- S antigen > 6 months
- E antigen +/- for infectivity
Infections lead to 90% recover, 10% carrier
1/3 of carrier goes to chronic
Pregnant wahmen WITH ANTIGEN EEEEEEEE+;
- 90% infants carrier, 10% recover
1/3 of carrier goes to Cx
If Pregnant wahmen WO ANTIGEN EEE but antigen S
(where S = Carrier)
- 10% infant, 90% ok
Hep B IgM-c
- positive/negative meaning
Positive - acute
Negative - chronic/carrier/past infection
Note acute and chronic may not have Anti-S present in tests
Hep C
Carrier rate 80% vs 10% B
Chronic rate 80% vs 1/3 B
Incubation period 2wks to 6 mths vs 4-6 mths B
Diagnosis:
- RNA PCR vs S + IgMc vs IgM (HAV, HEV)
- note IgM not detectable
Vaccine
- IgG useless - Genomically unstable
Hep D
Satellite Virus - needs HbsAg to coat
- Superinfection - on HBV
- Co-infection - on healthy person;
Vaccinate HBV
Hep B chronic timeline
Immune tolerance
- Low AST, ALT
- Virus replicating, no immune action
Immune clearance
- High AST, ALT,
- Seroconversion, Anti E AB positive, E decreases
Note liver injury is due to immune response
Management
Acute + Chronic
- electrolyte balance
- good nutrition
- Bowel Movement - lactulose - clear gut toxins; decrease risk of hepatic encephalopathy; Lactulose helps trap the ammonia (NH3) in the colon and bind to it
- Bile acid - Ursodiol; IV vit K - for cholestasis
Chronic
- Diuretics
- Beta-blockers for decreasing venous pressure, for portal hypertension and varices bleeding - they block vasoconstriction on Alpha receptors; slow heart rate w Beta
Recall Alpha - vasoconstriction of organs, skin
Beta - vasodilation of muscles
Give overall vaccine comparisons between ABCDE
A: yes, 1 serotype, give on HBV+, HCV+ B: yes, 4 serotype, 1 common 'a' epitope C: no, unstable genome, note IgM undetectable D: no, give HBV Vaccine E: no, AB useless
Compare Incubation of ABC
4-6 Weeks
4-6 Months
2wks-6 Months
Compare Diagnosis of ABC
A: IgM
B: S + IgM C
C: PCR RNA
Compare carrier stats of B vs D and chronic stats of B vs D
10% vs 80% (high carrier of Hep C)
1/3 vs 80% (high chronicity of Hep C)
Compare and contrast Hep A and Hep E
- Type of infection, genome
- key property
- vaccine status + when to give
ssRNA, enveloped (hep A is weird for envelop)
FECAL-ORAL; sex also
- Filter feeding fishes - cockles, oysters
- vs Pregnancy
Vaccine
- Hep A yes = killed virus
- Hep A vaccine given for Hep B infected
- Hep E no, AB do not lasts
Note chronic hepatitis cases
Hep B 70% then Hep C 20%
Liver cancer
Hep B 70% then Hep C 20%
But infected to carrier
Hep B 10%; Hep C 70%
But carrier to chronicity
Hep B 10%; Hep C 60-80%
okay
