Hepatatis virus Flashcards
(100 cards)
1
Q
Hepatatis viruses - types
A
HAV, HBV, HCV, HDV, HEV
2
Q
Hepatatis viruses - RNA OR DNA?
A
all rna except HBV
3
Q
Hepatatis viruses - transmission
A
HAV –> fecal-oral (shellfish, travellers, day care)
HBV –> parenteral, sexual, perinatal
HCV –> primarily blood (IVDU, post-transfusion)
HDV –> Parental, sexual, perinatal
HEV –> fecal-oral (espcecially waterborne, undercooked seafood)
4
Q
Hepatatis viruses - carrier?
A
all except HAV and HEV
5
Q
Hepatatis viruses - risk for hepatocellular Carcinoma
A
all except HAV and HEV
6
Q
Hepatatis viruses - incubation
A
HAV --> short (weeks) HBV --> long (months) HCV --> long HDV --> if superinfection (after HBV), short. If coinfection with HBV, long HEV --> short
7
Q
Hepatatis viruses - characteristics and family
A
HAV –> RNA-icosahedral-nonenveloped-SS+nonsegmented-Picornavirus
HBV –> DNA-icosahedral-enveloped-DS circular-Hepadnaviridaeg
HCV –> RNA-icosahedral-enveloped-SS+nonsegmented-Flavivirus
HDV –> RNA-NOT EXACTLY icosahedral nucleocapsid-enveloped-SS(-)circular
HEV –> RNA-icosahedral-nonenveloped-SS+nonsegmented-calcivirus (hepevirus)
8
Q
HDV functional special characteristics
A
HDV is a “defective” virus that requires the presence of HBV to replicate
9
Q
HDV superinfection (after HBV) vs coinfection (with HBV) according to prognosis
A
superinfection is more severe
10
Q
HAV - how many serotypes / MC season
A
only 1.. MC season –> autumn
11
Q
Symptoms and labs for all hepatitis virus (not biopsy)
A
- fever
- jaundice
- INCREASED ALT and AST
12
Q
beside HAVb, Councilman bodies can also be seen in
A
yellow fever
13
Q
HEV - liver biopsy
A
patchy necrosis
14
Q
HAV - liver biospy
A
- hepatocyte swelling
- monocyte infiltration
- Councilman bodies
15
Q
Fecal-oral hepatitis virus - mechanism
A
HAV, HEV
Naked virus do not rely on an envelope, so they are not destroyed by the gut
16
Q
nonenveloped hepatitis virus
A
HAV
HEV
17
Q
HBV - cycle of live
A
the DNA polymerase has both DNA- and RNA-dependent activities. Upon entry into the nucleus, the polymerrase functions to complete the partial dsDNA. The host RNA polymerase transcribes mRNA from viral DNA to make viral proteins. The DNA polymerase then reverse transcribes viral RNA to DNA, which is genome of the progeny virus
18
Q
HCV - liver biopsy
A
Lymphoid aggregates with focal areas of macrovesicular steatosis
19
Q
HBV - liver biopsy
A
- granular eosiniphilic “ground glass appearance”
- cytotoxic T cells
20
Q
HDV - liver biopsy
A
- granular eosiniphilic “ground glass appearance”
- cytotoxic T cells
(SIMILAR TO HBV)
21
Q
breastfeeding - HBV vs HCV according to transmission?
A
neither
22
Q
Hepatitis serologic markers (all)
A
- anti-HAV (IgM)
- anti-HAV (IgG)
- HBsAg
- anti-HBs
- HBcAg
- anti-HBc
- HBeAg
- anti-HBe
23
Q
HCV diagnosis
A
anti-HCV
direct dirextion of HCV RNA (gold standard)
24
Q
anti-HAV (IgM) - marker?
A
IgM antibody to HAV –> best test to detect acute Hepatitis A
25
anti-HAV (IgG) - marker?
IgG antibody indicates prior HAV infection and/or prior vaccination
protects against reinfection
26
HBsAg - marker / indicates
antigen found on surface of HBV
| indicates hepatitis B infection (acute or chronic)
27
anti-HBs - marker / indicates
antibody to HBsAg
| indicates immunity to hepatitis B
28
HBcAg
antigen associated with core of HBV
29
anti-HBc - marker
antibody to HBcAg (HBV)
IgM = acute/recent infection (+ in window)
IgG = prior exposure or chronic infection
30
anti-HBc - window
IgM anti-HBc may be the sole positive marker of infection during window period
31
HBeAg - marker
a differnet antigenic determinant in the HBV core
| indicates active viral replication and therefore high transmissibility (acute HBV or chronic high infectivity)
32
anti-HBe - marker
antibody to HBeAg
| indicates low transmissibility (positive in window, recovery, chronic HBV infection with low infectivity)
33
HBV structure
```
DNA-icosahedral-enveloped-DS circular (PARTIALLY)
diameter 42mm
DNA polymerase
Core antigens: HBcAg, HBeAG
Coat proteins: HBsAG
```
34
HBV: DNA polymerase abilities
has both DNA- and RNA-dependent activities
35
HBV serologic markers
```
HBsAG
anti-HBs
HBeAg
Anti-HBe
anti-HBc
```
36
HBV - states
```
Acute HBV
window
Chronic HBV (high infectivity)
Chronic HBV (low inectivity)
Revocery
Immunized
```
37
HBV - markes during acute infection
HBsAG
HBeAg
anti-HBc - IgM
38
HBV - markes during window
anti-HBc - IgM
| Anti-HBe
39
HBV - markes during Chronic infection with high infectivity
HBsAG
HBeAg
anti-HBc - IgG
40
HBV - markes during Chronic infection with low infectivity
HBsAG
Anti-HBe
anti-HBc - IgG
41
HBV - markes during recovery
anti-HBs
Anti-HBe
anti-HBc - IgG
42
HBV - markes during immunized
anti-HBs
43
HBV infection - serology during incubation period
HBsAg
44
HBV infection - anti-HBc is getting + at (time)
the beginning of the acute state (2 months)
45
HBV infection - HBsAg is getting + at (time)
the incubation period (1 month)
46
viral hepatitis vs alchoholic hepatitis according to labs
viral: ALT>AST
alcoholic: AST>ALT
47
Hepatatis viruses - vaccines and types
```
HAV --> yes (killed)
HBV --> yes (subunit)
HCV --> no
HDV --> no
HEV --> no
```
48
viral subunit vaccines - types
HBV (HBsAG)
| HPV (types 6, 11, 16, 18)
49
HBV - window period - when
5,5-6 months
50
HBV - anti-HBs if recovery - when
after windorw period (6 months)
51
HBV - acute disease - when
2.25-5.25 mounths
52
HIV - characteristics
RNA virus - icosahedral nucleocapsid - enveloped - SS+ diploid - Retrovirus -
53
Retrovirus - viruses?
1. HIV
2. HTLV - 1
3. HTLV - 2
54
HIV - structural genes - how many and which
1. env (gp120 and gp41)
2. gag (p24 and p17)
3. pol
55
HIV - structural genes - env is formed from
cleavage of gp160 to form envelop glycoproteins (gp120 and gp41)
56
HIV - structural genes - function
1. env (gp120 and gp41)
gp120 --> attachment to host CD4+ T cells (docking protein)
GP41 --> fusion and entry
2. gag (p24 and p17)
p24 --> capsid protein
p17 --> matrix protein
3. pol --> reverse transcriptase, aspartate protease, integrase
57
HIV - gp120 and gp41 - according to location
both on lipid membrane
gp120 outer (non-transmembrane)
gp41 transmembrane
58
HIV - gp120 and gp41 -aquired through
budding from host cell plasma membrane
59
HIV - proteins from outer to inner
out - gp120 - gp41 - Matrix protein (p17) - capsid protein p24 - reverse transcriptase - inne
60
HIV1 vs HIV2
HIV1 --> worldwide and more severe and more transmissible
| HIV2 --> primarily in West Africa, less severe, less transmissible
61
HIV - reverse transciptase - function
synthesize dsDNA from genomic RNA
62
HIV - synthesis of dsDNA - next?
dsDNA integrats into host genome
63
virus to enter the host cells --> ....
binds CD4 as well as coreceptor, either CCR5 on macrophages (early infection) or CXCR4 on T cells (late infection)
64
HIV - mutations on host coreceptors:??
homozygous CCR5 mutation = immunity
| Heterozygous CCR5 mutation = slower course
65
HIV diagnosis - protocol
Presumptive diagnosis made with ELISA --> positive results are then confirmed with Western blot assay
66
HIV diagnosis - characteristics of ELISA
sensitive, high false positive, low threshold, RULE OUT test
67
HIV diagnosis - characteristics of Western Blot assay
specific, low false-positive, rate and high threshold, rule in test
68
HIV diagnosis - rule in and rule out test
rule in --> Western Blot assay
| rule out --> ELISA
69
HIV - ELISA/Western blot test look for
antibodies to viral proteins
70
HIV - ELISA/Western blot test - disadvantages
1. falsely negative in the fist 1-2 months of HIV infection
| 2. falsely positive in babies born to infected mothers (anti-gp120 crosses placenta)
71
how to diagnose HIV in infants younger than 18 months (no antibodies production) born to seropositive mothers
p24 antigen test
PCR
viral culture (not common)
72
AIDS diagnosis?
1. less than two hundred CD4+ cells/mm3
2. HIV+ with AIDS-defining conditions
3. CD4 percentage less than 14%
73
normal CD4 COUNT
500-1500 cells/mm3
74
HIV transmission
1. sexual contact
2. infected blood,
3. cross placenta
4. birth
5. breast milk
75
HIV infection - first signs (and when)
acute HIV syndrome (not always) - flu like
| 2 weeks-2.5 months
76
HIV infection - stages (and when)
four stages (4fs)
1. flu like (acute) --> 2 weeks-2.5 months
2. Feeling fine (latent) --> 2.5 months-8 years
3. Falling count
4. Final crisis
77
constitutional symptoms of HIV (AND WHEN)
fever, night sweats, diarrhoea, weight loss.
| 8-11 years
78
HIV infection - death - when (if untreated)
11 years
79
HIV infection - opportunistic infection - when (if untreated)
9-11 years
80
mechanism of virus during the acute phase of infection
wide dissemination of virus
| seding of lymphoid organs
81
mechanism of virus during the latent phase of infection
virus replicates in lymph nodes
82
Common diseases of HIV positive adults - mechanism
As CD4+ decreases:
1. risks of reactivation of past infections (e.g. TB, HSV, shingles)
2. dissemination of bacterial infections and fungual infections (e.g. coccidioidomycoses)
3. increased risk for non-Hodgkin lymphomas
83
HIV - disease (and pathogen) IF CD4 lower than 500
1. oral thrush - Candida ablicans
2. Oral hairy leukoplakia (EBV)
3. Kaposi sarcoma (HHV-8)
4. Chronic Watery diarrhea (Cryptosporidium spp)
5. SCC, commonly of anus (men who have sex with men, or cervix (HPV)
6. Bartonella henselae
84
Candida related oral thrush - findings
Scrapaple white plaque
| pseuohyphae on microscopy
85
Oral hairy leukoplakia - findings
Unscrapable white plaque on lateral tongue
86
Chronic Watery diarrhea (Cryptosporidium spp) - findings
acid-fast oocyts in stool
87
HIV - disease (and pathogen) IF CD4 lower than 200
1. dementia (HIV)
2. Progressive multifocal leukoencephalopathy (JC)
3. Pneumocystic pneumonia (Pneumocystis jirovecii)
88
Brain abscesses (Toxoplasma gondi) - findings
Multiple ring-enhancing lesions on MRI
89
Progressive multifocal leukoencephalopathy (JC) findings
Non-enhancing areas of demyelination on MRI
90
Pneumocystic pneumonia (Pneumocystis jirovecii) - findings
Ground-glass opacities on CXR
91
HIV - disease (and pathogen) IF CD4 lower than 100
1. Hemoptysis, pleuritic pain (Aspergilus)
2. Meningitis (Cryptococcus neoformans)
3. esophagitis (Candida)
4. Retinitis, esophagitis, colitis, pneumonitis, encephalitis (CMV)
5. B-cell lymphoma (non-Hodgkin, CNS) (EBV)
6. Fever, weight loss, fatique, cough, dyspnea, nausea, vomiting, diarrhea (Histoplasma)
7. Nonspecific systemic infection (fever, nigh sweats, weight loss) or focal lymphadenitis (M. avium-intracellulare)
8. Brain abscesses (Toxoplasma gondi)
92
HIV - Hemoptysis, pleuritic pain (Aspergilus) - findings
Caviation or infiltrates on chest imaging
93
HIV - esophagitis (Candida) - findings
white plaques on endoscopy
| yeast and pseudohyphae on biopsy
94
HIV - Retinitis, esophagitis, colitis, pneumonitis, encephalitis (CMV) - findings
linear ulcer on endoscopy
cotton-wool spots on fundoscopy
Biopsy: cells with intranuclear (owl eye) inclusion bodies
95
HIV - EBV - CNS lymphoma - findings
ring enhancing, may be solid solitary
96
HIV - IMAGING - toxoplasma vs CNS lymphoma
both ring enhancing
Toxoplasma --> multiple
CNS lymphoma --> solitary
97
HIV - Fever, weight loss, fatique, cough, dyspnea, nausea, vomiting, diarrhea (Histoplasma) - findings
oval yeast cells with macrophages
98
HDV - antigen / protection against
HBsAg
| HBV vaccine
99
HIV - viral load test determine
the amount of viral RNA in the plasma
100
HIV - viral load test determinations - clinical importance
High viral load associated with poor prognosis
| monitor effect of drug therapy
