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High Yield Path - Micro > MI: Viral Hepatitis > Flashcards

MI: Viral Hepatitis Flashcards

(43 cards)

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1
Q

How is hepatitis A spread?

A

Faecal-oral
(food/water + MSM sex)

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2
Q

What is the incubation period for hepatitis A?

A

2-6 weeks

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3
Q

Describe the natural history of hepatitis A infection.

A
  • 2-6 weeks after the infection you will develop hepatitis (transaminitis)
  • This will be accompanied by a rise in IgM
  • A more gradual rise in IgG will follow

NOTE: hepatitis A infection is often subclinical unless underlying disease: nausea, D+V, fecer, jaundice, malaise, abdo pain

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4
Q

What is the diagnostic test for hepatitis A?

A

Anti-hepatitis A IgM (shows acute infection)

presence of IgG shows infection has passed or at recovery phase

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5
Q

Which antibodies will be present if someone has received a hepatitis A vaccine?

A

High IgM and high IgG but NO transaminitis

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6
Q

Treatment for Hepatitis A

A

Supportive

mortality increases with age

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7
Q

How is hepatitis B transmitted?

A
  • Sexually transmitted
  • Blood products
  • Mother-to-baby (e antigen is the biggest predictor)
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8
Q

What is the incubation period of hepatitis B?

A

2-6 months

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9
Q

What is the risk of chronic infection in adults and babies?

A
  • 5-10% in adults
  • 95% in babies
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10
Q

Describe the molecular organisation of hepatitis B virus.

A

DNA virus with four overlapping reading frames (core, X, polymerase and surface antigen)

NOTE: as they overlap, a mutation in one reading frame could affect others

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11
Q

Why do some antiretrovirals work on hepatitis B?

A

HBV uses reverse transcriptase to replicate

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12
Q

Where is the hepatitis e antigen found?

A

Pre-core part of the core reading frame

It’s a marker of active replication and therefore infectivity

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13
Q

What does the presence of the HBV core antigen in serum reflect

A

It reflects infection with the virus - may it be a present infection or a past infection.

Therefore only patients that have been infected with HBV will have antibodies to the core antigen.

+ve IgM HBc —-> acute infection
-ve IgM HBc and +ve IgG HBc —-> chronic infection (if HbsAg present) or past infection (HbsAg not present)

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14
Q

What does the presence of HBs Antigen in serum reflect

A

HBeAg reflects active viral infection

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15
Q

What serological feature is suggestive of recent HBV infection?

A

Anti-HBV IgM antibodies

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16
Q

What serological feature is suggestive of chronic HBV infection?

A

Prolonged presence of HBsAg (more than 6 months)
and
Anti-HBV IgG antibodies

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17
Q

FIll in the following table

A
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18
Q

What are some possible consequences of HBV infection?

Study These Flashcards
A
  • Hepatic fibrosis –> Cirrhosis –> Hepatocellular carcinoma

Tumour marker: alpha fetoprotein

19
Q

List the HBV disease stages.

20
Q

What is a strong indicator of risk of cirrhosis in people with hepatitis B infection?

Study These Flashcards
A

HBV DNA level (copies/mL)

21
Q

List some treatment options for HBV.

Study These Flashcards
A

Acute –> Supporitve
Chronic –> Anti-viral therapy

Complications may require liver transplantation

22
Q

Which treatment of HBV should not be used in liver transplant patients?

Study These Flashcards
A

Interferon alpha

23
Q

When do you NOT give Hep B immunoglobulin to babies born to mothers with Hep B

Study These Flashcards
A

If the mother has anti-HBe (this confers protection to the baby, but you still give the accelerated vaccine)

24
Q

Which patient populations are particularly at risk of hepatitis C virus infection?

25
Which phylogenetic family is HCV a part of?
Flaviviridae
26
What components constitute the viral RNA genome of hepatitis C?
* Core * Envelope * Non-structural components
27
What is the incubation period of HCV?
6-8 weeks - 20-40% clear infection spontaneously (90% asymptomatic) - 60-80% progress to chronicity (many asymptomatic - incidental finding of elevated ALT) - highest chronicity of all Hep viruses.
28
Outline the serological changes that take place following HCV infection.
Anti-HCV antibodies develop after the acute infection has resolved (i.e. ALT has returned to normal)
29
What class of drugs are most antivirals used for hepatitis C
Direct Acting Anti-virals: * Protease inhibitors * Inhibitors of non-structural components
30
How is HCV treated?
Early treatment with Direct Acting Anti-virals (DAAs): e.g. peginterferon alfa 12 week treatment course with daily pill.
31
How is the response to treatment with peginterferon-alfa assessed in HCV infection?
Sustained viral response (SVR12) - no HCV RNA 12 weeks after stopping treatment
32
What is the main difference in the treatment of genotype 1 and non-genotype 1 HCV?
* **Genotype 1** - high-dose long-lasting ribavirin is required for high cure rates * **Non-genotype 1** - ribavirin does NOT increase cure rates
33
What is a key feature about hepatitis D virus?
Requires the presence of hepatitis B to replicate within the host - requires HBV surface antigen to invade liver cells.
34
What is the difference between hepatitis D co-infection and superinfection?
**Co-infection:** * This happens when you are inoculated with HBV and HDV at the same time (e.g. sharing a needle with someone infected by both viruses) * Anti-HDV IgM will rise after inoculation causing acute hepatitis **Superinfection:** * This happens when someone with chronic hepatitis B infection is inoculated by HDV * This is more severe than coinfection * Patients can develop cirrhosis within 2-3 years
35
Which phylogenetic family is heaptitis E a part of?
Herpeviridae
36
How is hepatitis E transmitted?
Faecal-oral
37
Clinical Picture of HEV infection
Commonly asympatomatic but can cause acute hepatitis symptoms: jaundice, RUQ, fever, D+V Commonly occuring in immunocompromised patients. Note - HEV is one of the most common causes of acute hepatitis .
38
What are the genotypes of hepatitis E?
* 1 + 2 = human * 3 + 4 = animals (mainly pigs) NOTE: there is very little person-to-person transmission
39
Which patient group has a high mortality if infected by hepatitis E?
Pregnant women (esp in 3rd trimester) NOTE: mainly associated with genotype 1
40
What is the incubation period of hepatitis E?
3 - 8 weeks
41
List some rare complications of hepatitis E.
* CNS disease (e.g. Bell's palsy) * Chronic infection
42
Outline the treatment of hepatitis E.
* Supportive * Ribavirin
43
Outline the serological changes that take place in hepatitis E infection.
* Acute infection is accompanied by a rise in IgM anti-HEV antibody * Rarely you can get persistently high levels of HEV RNA * HEV RNA detectable in serum and stool during incubation period. NOTE: it generally responds well to ribavirin

High Yield Path - Micro (6 decks)

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