Hepatatis virus Flashcards Preview

Microbiology > Hepatatis virus > Flashcards

Flashcards in Hepatatis virus Deck (100):
1

Hepatatis viruses - types

HAV, HBV, HCV, HDV, HEV

2

Hepatatis viruses - RNA OR DNA?

all rna except HBV

3

Hepatatis viruses - transmission

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

Hepatatis viruses - carrier?

all except HAV and HEV

5

Hepatatis viruses - risk for hepatocellular Carcinoma

all except HAV and HEV

6

Hepatatis viruses - incubation

HAV --> short (weeks)
HBV --> long (months)
HCV --> long
HDV --> if superinfection (after HBV), short.
If coinfection with HBV, long
HEV --> short

7

Hepatatis viruses - characteristics and family

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

HDV functional special characteristics

HDV is a "defective" virus that requires the presence of HBV to replicate

9

HDV superinfection (after HBV) vs coinfection (with HBV) according to prognosis

superinfection is more severe

10

HAV - how many serotypes / MC season

only 1.. MC season --> autumn

11

Symptoms and labs for all hepatitis virus (not biopsy)

1. fever
2. jaundice
3. INCREASED ALT and AST

12

beside HAVb, Councilman bodies can also be seen in

yellow fever

13

HEV - liver biopsy

patchy necrosis

14

HAV - liver biospy

1. hepatocyte swelling
2. monocyte infiltration
3. Councilman bodies

15

Fecal-oral hepatitis virus - mechanism

HAV, HEV
Naked virus do not rely on an envelope, so they are not destroyed by the gut

16

nonenveloped hepatitis virus

HAV
HEV

17

HBV - cycle of live

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

HCV - liver biopsy

Lymphoid aggregates with focal areas of macrovesicular steatosis

19

HBV - liver biopsy

- granular eosiniphilic "ground glass appearance"
- cytotoxic T cells

20

HDV - liver biopsy

- granular eosiniphilic "ground glass appearance"
- cytotoxic T cells
(SIMILAR TO HBV)

21

breastfeeding - HBV vs HCV according to transmission?

neither

22

Hepatitis serologic markers (all)

1. anti-HAV (IgM)
2. anti-HAV (IgG)
3. HBsAg
4. anti-HBs
5. HBcAg
6. anti-HBc
7. HBeAg
8. anti-HBe

23

HCV diagnosis

anti-HCV
direct dirextion of HCV RNA (gold standard)

24

anti-HAV (IgM) - marker?

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