Hepatitis Viruses Flashcards by Richhpal Singh

Types of Hepatitis

Viral hepatitis
Alcoholic hepatitis
Non alcoholic steatohepatitis
Autoimmune hepatitis
Neonatal hepatitis

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Genome of Hepatitis viruses

Only HBV - DNA
Others - RNA

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HAV belongs to which family

Picornaviridae (Enterovirus 72)

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HBV belongs to which family

Hepadnaviridae

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HCV belongs to which family

Flaviviridae

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HDV belongs to which family

Deltaviridae
Relies on HBV

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HEV belongs to which family

Caliciviridae Now Herpeviridae

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Mode of infection and incubation period of HAV and HEV

Feco- oral
IP - 15-50 Days

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Mode of infection and incubation period in HBV

IP - 50-150 days
Mode - Parenteral, Sexual, Vertical

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Mode of Transmission and incubation period of HCV

IP - 15-150 Days
Transmission - Parenteral, iv Blood transfusion

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Which Hepatitis viruses are enveloped

HBV
HCV
HDV

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Which Hepatitis virus is cultivable

HAV

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Vaccines available against which hepatitis viruses

HAV
HBV
HEV

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Which hepatitis virus is most common cause of Fulminant hepatitis

HDV - 5-20%
HAV - 0.1%

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Which hepatitis is most common cause of Fulminant hepatitis in Pregnancy

HEV - 25%

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Which hepatitis virus infection leads to Chronicity

HBV and HCV

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Hepatitis G affects

Doesn’t cause human infection
Affects monocular cells
Route of transmission - blood transfusion
Can protects against HIV

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Sizes of Hepatitis viruses

Hepatitis A - 27nm
Hepatitis B - 42nm
Hepatitis C - 60nm
Hepatitis E - 30nm

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Genotypes and Serotypes of HAV

Serotype 1
Genotypes - 6, In humans, 1,2,3

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Which genotype of HAV is M/C in world and in India

In world - Type 1
In India - 3

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HAV is susceptible to

Boiling, chlorine, autoclave, Formalin

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Clinical features of HAV

Fever, anorexia
Nausea/Vomiting
Jaundice
Dark urine
Pale feces

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HAV Shedding in stools can be seen for how long

2 weeks prior to 2 weeks after symptoms onset

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When IgM and IgG appears in case of HAV infection

IgM appears with onset of Jaundice
2-4 weeks later IgG seen

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When IgM appears in case of HAV infection

IgM appears with onset of Jaundice

On Liver biopsy, Hepatitis A and Hepatitis E shows

Hepatitis A - Shows increase in Plasma cells Hepatitis E - Shows Cholestasis (Bile plugs)

Vaccines against Hepatitis A

Formaldehyde inactivated vaccine im Live attenuated vaccine

Formaldehyde inactivated vaccine for HAV given after age of and doses

More than 12 months 2 doses apart 6 months gap

Strains of Live attenuated vaccine

OH2 And OLA1 Strain

For postexposure prophylaxis of HAV

Immunoglobulins - within <2 weeks of exposure Protection for 1-3 months

Vaccine against HEV

Recombinant capsid protein (China)

Genotypes of HBV

8 genotypes (A to H)

Serotypes of HBV

aYw adr

Which genotype of HBV is most prevalent in India

D genotype

HBV is double stranded or single stranded DNA virus

HBV - Partial dsDNA virus - 2 linear strands of DNA - 1) Complete strand or minus strand 2) Incomplete or Plus strand

All DNA Viruses are have dsDNA except

ssDNA - Parvovirus Partial dsDNA - HBV

Antigen present in HBV Viruses

P antigen - Largest, DNA polymerase, Reverse transcriptase, RNAase C - Core Antigen S- Surface antigen (HBSAg) - S,M,L X - HbX - carcinogenesis

Which antigen is also known as Australia antigen

S - Surface antigen (HBSAg)

Which antigen is also known as Australia antigen

S - Surface antigen (HBSAg)

Which Antigen of HBV is responsible for carcinogenesis

X - HbX - carcinogenesis - HCC

Infectious particles of HBV

Spherical particles - 42nm Full virions - DANE particles Genome +, Infection +

Non infections particles of HBV

Spheres/tubular Filaments Genome - , Infection -

Mode of infection of HBV

Blood products Sexual intercourse Percutaneous Mother to child Needle stick injury (HBV-30%)

Pathogenesis of HBV

HBV virion entry - endocytosis - Uncoating (partial dsDNA) - cccDNA (Covalently closed Circular DNA) - then converted to complete DNA - Converted to pgRNA via translation - PgRNA is converted to Minus strand DNA with the help of Reverse transcriptase - Then minus strand DNA converted to Plus strand with the help of DNA Polymerase - Assemble in ER - Release

1st virological marker of HBV in blood

HBV DNA

1st antigen to appear in case of HBV and when it appears and disappears

HBsAg - onset of infectivity Appears 2-6 weeks before onset of symptoms Disappears 1-2 month after onset of jaundice

Epidemiological marker of HBV

Anti HBs - comes after gap

When HBeAg appears and what it indicates

Appears shortly after HBsAg Indicate active infections and high infectivity

AntiHBe indicates

It indicates decrease in infectivity

Core Ag/HBcAg and AntiHBc antibodies

Not detected in blood AntiHbc antibody - IgM (Marker of window period) and IgG

Interpretation of lab diagnosis findings in case of Acute Hepatitis B - high infectivity

HBsAg + Anti HBs - Anti HBc - IgM HBeAg + Anti HBe -

Interpretation of lab diagnosis markers in Chronic Hepatitis B - High infectivity

HBsAg + Anti HBs - Anti HBc - IgG HBeAg +

Interpretation of lab diagnosis markers in HBV Recovery phase

Antibodies +ve Anti HBs + Anti HBc - IgM + IgG Anti HBe +

Lab diagnosis findings in case of HBV vaccination/immunity

Anti HBs +ve

Lab diagnosis finding in case of HBV window period

Anti HBc IgM +ve

How much risk of transmission of HBV to baby if mother is HBeAg +ve

90% risk of transmission

Risk of transmission of HBV to baby if mother is HBe antibody +ve

10-15% risk of transmission

Prophylaxis of neonate born to HBV +ve mother

One arm immunoglobulins Other arm HB vaccine (0,1,6 months)

Hepatitis B vaccine and it's schedule

Prepared in Yeastv(Saccharomyces cerevicae) Recombinant killed vaccine Schedule - 0,1, 6 months

Prophylaxis of HBV in case of Needle stick injury in unvaccinated healthcare worker on basis of different sources

If HBsAg +ve : Ig + 0,1,6 vaccine If HBsAg -ve : 0.1,6 vaccine If Source unknown: 0,1,6 vaccine

Prophylaxis of HBV in case of Needle stick injury in vaccinated and responder healthcare worker on basis of different sources

Responder - Anti HBs >10IU/ml No Prophylaxis needed

Prophylaxis of HBV in case of Needle stick injury in vaccinated and non responder healthcare worker on basis of different sources

Non responder - Anti HBs <10IU/ml If HBsAg + : Ig + 0,1,6 vaccine No Prophylaxis if HBsAg -ve or if source unknown

Carriers of HBV are classified into

If HBsAg +ve beyond 6 months Simple carriers Super carriers

HBV simple carriers Lab findings

HBsAg +ve HBeAg -ve Low DNA Polymerase

HBV Super carriers lab findings

HBsAg +ve HBeAg +ve High DNA Polymerase Increased liver enzymes

Escape mutants means

No HBsAg, So anti HBs antibodies will not able to neutralize the escape mutant

Most common cause of Fulminant hepatitis

Hepatitis D

HDV Coinfection means

HBV + HDV infection together In Iv drug users mostly leads to Fulminancy

HDV Superinfection means

Patient is already infected with HBV gets Superadded infection with HDV Causes fulminant hepatitis

Which hepatitis virus is highly mutable and it's most mutable protein

Hepatitis C Most mutable protein - E2

Lab diagnosis findings of HCV

IgM HCV Hep C Tridot testing HCV RNA PCR - Diagnosis of choice

Morphological changes in Acute hepatitis

Bodies - Councilman bodies (Hep.C) Spotty necrosis - Dropout necrosis Kupffer cell hyperplasia (Macrophages)

Morphological changes of Chronic hepatitis

Ito/Stellate cells - Fibrosis

Histological finding of Hepatitis B infection

Ground glass hepatocyte (diffusely pink cells) - contains surface antigen in ER

Histological findings in case of Hepatitis C

Macrovascular steatosis (fatty changes) Lymphoid follicles (prominent)

Histological findings of Hepatitis D infection

Microvascular steatosis

Most common cause of Sporadic Acute hepatitis in India

Hepatitis E

Most common of Fulminant viral hepatitis

HDV

Most common cause of Fulminant viral hepatitis in Pregnancy

HEV

Most common cause of transfusion related hepatitis

HBV

Most common cause of Chronic hepatitis

HBV

Which hepatitis virus have Maximum risk of potential of chronicity

HCV

Most common cause of carrier state

HBV

Most common cause of viral Hepatocellular carcinoma

HBV

Which hepatitis virus have strong association with Hepatocellular carcinoma

HCV

Extra hepatic manifestations of Hepatitis B

Polyarteritis Nodosa Membranous glomerulopathy

Extra hepatic manifestations of Hepatitis C

Mixed Cryoglobulinemia (M/C) Lichen planus MPGN

Hepatitis Viruses Flashcards

(87 cards)