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Unit 6: Micro > Hepatitis Virus > Flashcards

Hepatitis Virus Flashcards

1
Q

Virology for Hepatitis A?

A
  • Picornavirus
  • Fecal Oral Transmission
  • One Serotype
  • IgG protective against reinfection
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2
Q

Px of Hep A infection?

A

Most people recover completely - no chronic infection

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3
Q

What determines the severity of Syx of Hep A infection?

A

Severity is directly correlated with age of patient

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4
Q

Clinical findings of Hep A?

A
  • Jaundice
  • Fatigue, Fever
  • Anorexia, Nausea, Vomiting
  • Dark Urine, Pale Feces
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5
Q

Lab tests for Hep A?

A
  • Enzyme Immunoassay (EIA) for Anti-HepA IgM (Acute)
  • EIA for Anti-Hep A IgG (chronic)
  • Ultrasound biopsy if concerned about fulminant hepatic failure
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6
Q

What is the general trend of Hepatitis A time course of infection?

A
  • Viremia
  • Virus in feces
  • Elevated transaminases (Syx and Jaundice occur w/i this timeframe)
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7
Q

Hepatitis A prevention?

A
  • Hep A vaccine (Twinrix: HAV and HBV)
  • Serum Ig prophylaxis
  • Handwashing, sanitation
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8
Q

Tx for Hep A?

A

Bed rest, hydration

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9
Q

Hep E virology?

A
  • Small, naked ssRNA (hepevirus)
  • Fecal oral
  • “The Hep A of China”
  • One serotype
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10
Q

Hep E disease highlights?

A
  • Very similar acute disease of Hep A
  • Mortality rate is 10X > Hep A
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11
Q

Stages of Hep E?

A
  1. Prodrome - Anorexia, Nausea, Vomiting
  2. Icteric Phase - Jaundice, Dark Urine, Pale Feces
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12
Q

Labs used to detect Hep E?

A
  • Serology not widely available - send to CDC
  • High serum ALT, AST, bilirubin w/ negative Ab for other Hep viruses
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13
Q

Tx and prevention for Hep E?

A
  • Prevention: Boil water, IgG prophylaxis is NOT available, HEV239 vaccine
  • Tx - Light activity, supportive Tx
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14
Q

Difference b/w Hep A and E?

A
  • Hep A is picornavirus
  • Hep E has a higher mortality
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15
Q

Virology of Hepatitis B?

A
  • Human-restricted
  • Hepadnavirus
  • Messy virus
  • Enveloped
  • Only one serotype
  • Carries reverse transcriptase
  • Leaves behind integrated copies of viral DNA
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16
Q

Transmission of Hep B?

A

Injection of blood, less efficiently by sexual or birth contact

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17
Q

Difference b/w HepB and Heps A&E?

A
  • HepB is enveloped and has a DNA genome
18
Q

Describe the timecourse of HBV infection

A
  1. Surface antigen (HBsAg) appears early
  2. Surface Ab (HBsAb) rises as HBsAg falls
  3. Core antibody (HBcAb) arises a little later IgM for acute, IgG for chronic
  4. E antigen detectable when virus is most transmissible
19
Q

What are the four stages of Hep B/immune interaction?

A
  1. Immune tolerance - Virus replicates w/o Syx; Hep B DNA and antigens in serum
  2. Immunogenic Syx - ALT increases, Hep B DNA declines; Either 3-4 wk OR chronic and leads to cirrhosis
  3. Clearing the virus - viral replication shuts down, HBeAb detected, HepB DNA not detected, ALT declines, HBsAg remains
  4. Viruse cleared - No viral Ag, permanent HBsAb IgG
20
Q

Typical outcome of HBV in adults?

A
  • 90% Resolution
  • 1% fulminant hepatitis
  • 9% HBsAg+ > 6months: Patients can resolve, be aSyx carriers, Chronic persistent hepatitis or Chronic active hepatitis leading to cirrhosis HCC or extrahepatic disease
21
Q

Describe the pathogenesis and complications of chronic Hep B infection

A
  • T-cell response is cytotoxic and causes cirrhosis
  • Accumulation of Hep AgAb leads to kidney damage/arthritis
  • Virus genome integration, expression of viral transcriptional transactivators leading to cancer
22
Q

Exam findings for Hep B?

A
  • Acute phase: Icteric - Fatigue, Fever, Jaundice, Aversion to food/cigs, anorexia, nausea, vomiting
  • Chronic: Spider angiomas, palmar erythema, hepatomegaly
23
Q

Hep B laboratory tests?

A
  • HepB antigens (HBsAg, HBeAg)
  • Anti-HepB Ab (surface, core, e antigen)
  • ALT, AST, bilirubin
24
Q

When is liver biopsy performed for Hep B? Findings?

A

Chronic/active infection; Inflammation around portal tracts, ground glass cytopathology, positive staining for Hep B antigens

25
Q

What is the best method for HBV prevention?

A
  • Vaccination (HBsAg)
  • Ab prophylaxis (HBsAb)
  • Condoms
26
Q

Tx strategy for Hep B?

A
  • Supportive care for acute hep
  • Active chronic infection - 1 year of polymerase inhibitors PLUS 4 months of pegylated alpha-interferon
27
Q

What are the issues with treatment of HBV?

A

Pegylated alpha interferon has significant toxicity

28
Q

Virology of Hep D?

A
  • VIRIOID
  • Cannot replicate by itself
  • Requires Hep B
  • Spread by blood and sex
  • Produces Delta antigen - cytotoxic
29
Q

Describe the relationship b/w Hep B and Hep D

A
  • Coinfection: Same clearance rate as Hep B alone
  • Superinfection: Chronic Hep B then acquires hep D results in fulminant disease
30
Q

Hep D Dx?

A

EIA for anti-delta Abs

31
Q

Prevention and Tx for Hep D?

A
  • Hep B vaccincation or Ig
  • If HepB + halt risky behavior
  • Tx: year of pegylated alpha-interferon - Px grim
32
Q

Hep C virology?

A
  • Flavivirus
  • Enveloped
    • RNA genome
  • Transmitted efficiently by blood
  • Higher potential for chronic infection than Hep B
  • NO vaccine
33
Q

Outcome of Hep C infection?

A
  • 85% progress to persistent infection and chronic hepatitis resulting in liver failure, cirrhosis, or HCC
34
Q

What are some red flags for Hep C infection?

A
  • Baby boomer who got a tatoo way back
  • Travel to Egypt - blood fluke eradication gone wrong
35
Q

Signs of HCV infection on exam?

A
  • Milder Syx than HBV - Arthralgia, myalgia, pruritus
  • Liver failure - jaundice, vasculitis, autoimmunity, palmar erythema, icteric sclera
36
Q

Hep C lab Dx?

A
  • LFTs
  • EIA followed by a RIBA
  • RTPCR for viral RNA
37
Q

What is a RIBA and why is it used?

A

Recombinant Immunoblot assay for HCV used as a follow up for HCV because HCV serology gives many false positives;

Vendor provides HCV antigens, patient’s serum is used and then fluorescent Abs provided by the vendor are used to ID HCV Abs in the patient’s serum

38
Q

Hep C Prevention and Tx

A
  • Prevention: No vaccine
  • Acute infection: Short course of pegIFN reduces rate of chronic infection
  • Chronic infection: Proceed w/ drug Tx of Ribavirin (chain terminator), PegIFN, IF SEROTYPE 1 - HCV protease inhbitor
39
Q

What is the goal of Tx for Hep C and why is Tx still beneficial if Tx “failed”?

A
  • Goal: Sustained viral response: Remission
  • Failed Tx may still reduce risk of HCC
40
Q

What Hep C serotypes have bette response to Tx?

A
  • Serotypes 2 and 3 >50% SVR rate with 6 months PegInterferon + ribavirin
  • Serotypes 1 and 4 require 1-2 yrs Tx and still have lower recovery rates
41
Q

What Hep patients can potentially utilize liver transplant?

A

Hep C and possible HepB/D

42
Q

What should be performed before transplant occurs?

A

Hit patient hard with pegIFN to clear body of as much virus as possible

Unit 6: Micro (13 decks)

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