MICRO Flashcards
1
Q
H pylori is associated with what longterm complications?
A
Chronic gastritis
Adenocarcinoma
MALTomas
2
Q
What are the VFs for H pylori?
A
Vac A-> vaculating cytotoxin
PAI-> encodes Type III secreting system
Cag-> rearranges cytoskeleton
Urease
3
Q
Which of the H pylori VFs causes gastritis and adenocarcinoma?
A
Urease-> gastritis
Cag- Carcinoma
4
Q
What are the diagnostic tests for H pylori?
A
Biopsy-> culture
Urea breath test
Serology= Good for treatment and recovery
5
Q
Most common bacterial GI infection in developed countries, caused by Uncooked Poultry and unpasteurized milk?
A
Campylobacter jejuni
6
Q
Spiral shaped G- rod, that causes fever, **Appendicitis like lower abdominal pain,
Watery diarrhea progresses to Bloody/Pus diarrhea?
A
Campylobacter jejuni
7
Q
What is the sequelae for C jejuni infection (Pg)?
A
X-reactive antibodies to Cj lipooligosaccharides cross react with Myelin= Guillain- Barre
8
Q
Curved G- Rod
Oxidase +
Motile
Found in saltwater?
A
Vibrio (cholera)
9
Q
Infection associated with poor sanitation, contaminated water/food, >200 serogroups based on O-antigen (O1 & O139 responsible for pandemics)?
A
Vibrio cholera
10
Q
2-3 days post infection, abrupt onset of Vomiting, HIgh volume Watery diarrhea, eventual death by Dehydration?
A
V cholera–> cholera toxin activates Adenylyl cyclase
11
Q
High volume “Rice water stools?”
A
V cholera
12
Q
What are the VFs for cholera?
A
PAI-> encoded pilus for attachment
Phage encoded toxin
13
Q
Toxin causes ADP ribosylation of GTP-binding protein and activates adenylyl cyclase causing Secretory diarrhea. What is the Dx tests for the organism?
A
Cholera toxin-> Culture on TCBS (thiosulfate citrate bile salts sucrose) or MacConkey agars
14
Q
What are the culture medians used to diagnose cholera?
A
TCBS
MacConkey agars
15
Q
Found in sea-water and SEAFOOD poisoning, MC food born illness in Japan, causing watery diarrhea, Cramps, N/V, **24hrs after exposure?
A
Vibrio parahaemolyticus
16
Q
Found in sea water, infection through RAW Oysters, causes Cellulitis, vomiting, diarrhea, Bullae and septicemia in Immunocomprimised patients?
A
V vulnificus (BULLAE)
**highly fatal (20%)
17
Q
What are the characteristics of Anaerobic infections/bacteria?
A
Lack SOD and Catalase negative
STINKY PUS
Smelly breath
Abscess + tissue necrosis
18
Q
Pt with foul smelling breath and GI infection. What is the most likely characteristic of the infection?
A
Caused by Anaerobic bacteria
19
Q
G- coccobacillus with Anti-phagocytic capsule, most common anaerobic infection causing abscesses, PID, and pulmonary infections?
A
Bacteriodes fragilis
**PID + GI
20
Q
G- coccobacillus + anti-phagocytic capsule
Opportunistic abscess, pulmonary and Periodontal infections?
A
Prevotella melaninogenica
**Periodontal + GI
21
Q
G+ anaerobic spore forming Rods
resistant to high heat + harsh environments
Exotoxins and secrete Hydrolytic enzymes?
A
Clostridium
**ONLY anaerobic spore forming Rod
22
Q
Large Boxcar G+ Rods
Found in soil and intestines
Cause GAS GANGRENE + cellulitis + food poisoning?
A
Clostridium perfringens
23
Q
Contamination of wounds by spores causes necrosis and gas formation?
A
C perfringes Gas gangrene
24
Q
Enterotoxins found in Meats at low temp allowing spores to germinate, causes Nausea, diarrhea, pain, NO Fever or Vomiting within 8-24hrs?
A
C perfringens food poisoning
25
AB neurotoxin entering Neuromuscular junction and transported by motor neurons to ganglia, Cuts V-snare?
C tetani (tetanus toxin)
26
What is the action of Tetanus toxin?
Cuts V-snare
Vesicles and Neurotransmitters cant fuse with membrane
Prevents Release of Inhibitory NT (GABA and glycine)
27
What bacterial toxin inhibits the blocking of postsynaptic inhibition of spinal motor reflexes (GABA)?
Tetanus toxin
28
What are the signs and symptoms of Tetanus infection?
TRISMUS (Lock Jaw)
Risus sardonicus= facial spasma causing a GRIN
Spasms
Death via exhaustion and Respiratory failure
29
What is the treatment for tetanus poisoning?
HTIG to soak up the excess toxin
| Sedate to avoid exhaustion and allow for new axon generation
30
Trismus + V-snare?
Tetanus toxin
31
Most toxic bacterial exotoxin
Cleave V and T snare
Prevents ACh release?
Botulinum toxin
32
Bacterial spores are resistant to heat and germinate after cooking, toxins are heat labile, but infection causes ACUTE symmetric descending Flaccid Paralysis?
Botulism
33
```
Pt with symptoms 12-36hrs post infections from food contaminated with spores, presents with Nausea
Dry mouth
Diarrhea
Blurred vision
Respiratory failure?
```
Botulism = Inhibits ACh release
34
"Floopy baby" syndrome, infants 3wks-8mo, causing constipation, poor muscle tone, and feeding problems?
infant Botulism
35
Most common nosocomial infection causing diarrhea post-antibiotic therapy?
C difficile
36
What are the actions of C difficile Toxins A and B?
A (enterotoxin)= Diarrhea
| B (Cytotoxin)= Inflammation
37
bacterial infection if hospitalized pt causing Fever, Watery diarrhea -> bloody
and presences of pseudomembranous colitis. What are the diagnostic tests and treatment for this infection?
Dx: Tox B from stool culture
RADT fro Tox A & B in stool
Rx; Discontinue antibiotics
38
Causes Persistant Gi infection?
H pylori
39
Food borne infection + Watery to bloody diarrhea?
C jejuni
40
Watery diarrhea + Food borne + seasonal?
V cholera
| V parahaemolyticus
41
Normal flora + Nosocomial infections?
B fragilis
42
Normal flora + watery diarrhea?
C perfringes
43
Flaccid paralysis ?
Botulism
44
Watery diarrhea + Normal flora + nosocomial infections?
C difficile
45
What organisms can cause watery diarrhea?
V cholera + parahaemolyticus
C perfringens
C difficile
46
Can cause Watery--> Bloody diarrhea?
C jejuni
47
Food borne GI infections?
C jejuni
Vibrio
C perfringens
48
Opportunistic infections caused by normal flora?
B fragilis
| C difficile
49
```
G- facultative anaerobe
Ferments glucose
Oxidase negative
Nitrates--> Nitrites
Motile by peritrichous flagella?
```
Enterobacteriaceae
50
What is a MacConkey agar?
Selective and differential media
Contains chemicals that inhibit G+ organisms
pH indicator= red->yellow when <6.8
Lactose fermentators can cause color change(Ecoli)
51
80-90% of diarrheas in USA are caused by?
VIRUSES
52
Describe non-inflammatory diarrhea?
Watery + HIGH volume
Due to ENTEROTOXIN acting on Ion channels
NO fever
NO fecal leukocytes
53
Describe Inflammatory or invasive diarrhea?
```
LOW volume
Cytotoxin induced
Feces + for Methylene blue and lactoferrin (WBC)
FEVER
Dysentery
BLOOD + Mucus in Feces
TENESMUS= painful spasms of anal sphincter
>2wks= parasite
```
54
What agents usually cause diarrhea in AIDS patients?
Cryptosporidium
Mycobacterium avium
CMV
55
What tests are performed to identify the causative agent of diarrhea?
Culture
Rapid Ag Detection Tests (RADTs) for viruses/toxin
Microscopic exam for parasites
56
What is contraindicated in patients with Enterohemorrhagic E coli Dysentery?
Antibiotic treatment
57
What is the complication of EHEC induced diarrhea?
HUS
58
What is the complication of C jejuni induced diarrhea?
Guillian Barre
59
What organisms are associated with Reiter's syndrome (polyarthritis + conjunctivitis + urethritis) as complications of diarrhea?
Shigella
Campylobacter
Yersinia
Salmonella
60
Lac +
Femrents Glucose with H2
Does NOT produce H2S
Motile?
E coli
* *salmonella= H2S +
* *Shigella= H2S - & NO gas (H2)
61
What strain of E coli causes Hemorrhagic colitis with Sudden onset of Severe abdominal cramps and Watery diarrhea that is Bloody within 24hrs?
Enterohemorrhagic E coli (EHEC)
**O157:H7
62
4 yo child with Bloody diarrhea for 1-8 days
NO Fever and absent leukocytes
Anemia and Thrombocytopenia. What is the most likely complication?
HUS--> acute kidney failure
| **MCC of pediatric acute renal failure
63
What symptoms are complications are associated with E coli O157:H7?
HUS--> acute renal failure
* *Seizures + Strokes
* *Anemia + Thrombocytopenia
64
Child with Anemia, Thrombocytopenia, and uremia, possibly seizures?
HUS--> EHEC infection
65
Reservoir is cattle but does not cause infections in cattle, Major source of human infection is GROUND BEEF, unpasteurized milk, and juice, lettuce, or salami. Can also spread in child care centers?
```
EHEC
**Recent outbreaks associated with:
Spinach
Unpasteurized juice
Alfalfa sprouts
```
66
What are the VFs for EHEC (O157:H7)?
Enterotoxin= Shiga-like Toxins
**Inhibits protein synthesis and results in cell death--> disseminates to Kidneys
Pathogenicity island= Type3 secretion system
LEE PAI= Causes diarrhea
67
What are the diagnostic tests for EHEC (O157:H7)?
Sorbitol MacConkey agar
**O157:H7 is Sorbitol negative but Normal Ecoli is Sorbitol +
RADT for Shiga Toxins in stool
68
What organism is the leading cause of bacterial diarrhea and TRAVELERS diarrhea?
ETEC (enterotoxigenic E coli)
| **contain enterotoxins and fimbriae
69
What type of E coli cannot ferment Sorbitol?
EHEC O157:H7
70
Causes noninflammatory HIGH volume diarrhea similar to cholera. Contains 2 VFs: LT and ST?
ETEC
* *LT= heat labile= Acts just like Cholera toxin
* *ST= heat stable= increases cGMP-> cAMP
71
What G- rod organism has a AB toxin that binds ganglioside receptors and enzymatically activates adenylyl cyclase leading to Chloride efflux?
ETEC= LT TOXIN
| **Cholera Like toxin
72
WHat is the function of ST toxin of ETEC?
Binds Guanylyl cyclase receptor= activates PKA
Increased cAMP = activation of CFTR
Diarrhea
73
What type of E coli resembles Cholera and Shigella?
```
Cholera= ETEC
Shigella= EIEC
```
74
E coli serotype that causes Dysentery-like diarrhea and fever. organism lacks fimbrial adhesions and does not produce LT or ST toxins, NON motile and LAC-?
EIEC
75
```
E coli strain with:
Fimbrial adhesions (CFA1&2)
LT & ST toxins
Watery diarrhea in infants/travelers= NO fever
High infectious dose?
```
ETEC
76
```
E coli strain with:
Nonfimbrial adhesins
penetrates and multiply in epithelial cells
NO Shiga Toxin
Dysentery like Diarrhea + FEVER?
```
EIEC
77
E coli strain with:
Intimin adhesin proteins
EAF binds to intestinal cells
Infantile diarrhea?
EPEC
78
E coli strain with:
NO characterized adhesins
ST like toxin and Hemolysin
Persistant diarrhea in Young children?
EAEC
79
```
E coli strain with:
Fimbrial adhesin
Phage coded Shiga toxin
Copious bloody diarrhea + intense inflammation
MCC of hemorrhagic colitis in US
LOW INFECTIOUS DOSE?
```
EHEC = causes HUS
80
What is the function of K antigen in UPEC?
Polysaccharide capsule protects against Phagocytosis by PMNs + Ab and complement deposition
K-1= antiphagocytic and antigenic disguise
81
What is the major E coli VF that causes neonatal Meningitis?
K-1 antigen = Homopolymer of sialic acid
82
Lac-
Ferments Glucose + H2 gas formation
H2S + ?
Salmonella
| **only difference with E coli is Lac (+)
83
What are the sources of Salmonellosis infections?
Poultry
Eggs
Reptiles
Turtles
84
Pt with N/V, abdominal cramps, and diarrhea 20-72hrs post infection. Bacteria enters M cells in the distal small intestine or proximal colon and is localized within Macs in the Lamina propria?
Salmonella (enteritidis or typhimurium)
85
Enteric Febrile infection caused by dissemination of a bacterial parasite. Longterm infection carried in the Gallbladder because organism is phagocytosed but NOT killed in Macs. Eventually can cause Splenic rupture?
Salmonella typhi
86
Patient with headache, HIGH fever, confusion, slow pulse, and skin rash. NO diarrhea. What are VFs for this organism?
S typhi VFs=
T3 secretion system
LPS
Vi ag (capsule)
87
What is the treatments available for S typhi?
Antibiotics
| Live attenuated Vaccine
88
What is th cause of 70% of dysentery shigellosis in children in US?
Shigella sonnei
89
Describe the Pathogenesis of shigellosis?
Shigella enters into Microfolds cells
Escapes from Phagocytic vesicles
Uses polar actins to burrow into neighboring cells
90
Child with watery diarrhea, abdominal pain, then becomes bloody with Mucus/Pus. Along with Severe cramps and tenesmus. Fecal sample shows Sheets of leukocytes?
Shigellosis
91
```
Lac -
No H2 from Glucose
NON motile
H2S -
Cytotoxin causes protein inhibition by cleaving 28rRNA?
```
Shigella
92
What two Gi organisms produce HIGH amounts of cytotoxins and can Cause HUS?
EHEC
| Shigella dysenteriae
93
What bacterial diarrheal infection presents with LLQ pain?
Yersinia enterocolitica = Mimics Appendicitis
94
Opportunistic heavily Capsulated pathogen that causes Aspiration pneumoniae in Alcoholics or Neutropenics?
Klebsiella
95
Highly necrotic pneumoniae and "Current Jelly" sputum?
Klebsiella
96
Opportunistic pathogen causing Pneumoniae with BRICK RED colonies?
Serratia marcescens
97
Nosocomial/ post antibiotic Diarrhea. Urease producing organism that increases pH of urine and causes UTIs leading To STONE formation. Culture shows SWARMS and Antigens are used is Rickettsiae (Weil-Felix Test)?
Proteus (vulgaris)
98
Which bacterial species require LOW # of cells for infection?
C jejuni
EHEC
Shigella
99
```
What results are seen on KIA for:
E coli?
Shigella?
Proteus?
Pseudomonas?
```
1. E coli= Entirely Yellow (Lac+) + Bottom gap (H2+)
2. Shigella= Red Top (Lac-) + Y bottom (Gluc +) + No gap (H2-)
3. Proteus= Entirely Black (H2S +)
4. Pseudomonas= All Red no gaps or black (No fermentation or gas)
100
Pt with persistent week long diarrhea. MCC?
parasite = Giardia
101
What is the reason Resident E coli do not cause diarrhea?
Lack VFs = PAIs
102
Describe the Pathogenesis of EPEC infections?
1. Pili binds enterocyte
2. T3 system injects cell with Receptor
3. Bacteria binds Receptor
4. causes cytoskeletal changes
103
What lysogenic phage encoded toxin cleaves 28S rRNA and what bacteria secrete it?
Shiga toxin
| Shigella + EHEC
104
What is the function of EHEC Locus Enterocyte Effacement (LEE)?
```
PAI
T3 secretion system
Delivers E coli to host receptor
Pedestal formation
RESPONSIBLE for Diarrhea
```
105
Why is antibiotic therapy Contraindicated in EHEC infections?
Exacerbates HUS
106
Causes High volume Travelers diarrhea by way of LT toxin?
ETEC
| **CFA I & II for attachment
107
Lac - and non motile (similar to shigella) Dysentery causing E coli that affects children <5yo?
EIEC
108
What is the pathogenesis of the spread of Shiegella and EIEC infections?
Invasion of enterocyte
Form Actin tail
Push through the cell membrane into adjacent cell
109
Causes watery infant diarrhea and loss of Brush boarder and microvilli. Pedestal formation via LEE?
EPEC
110
Infection of small bowel, T3 secretion inject effector M cells that form membrane "Ruffles" and cause endocytosis of bacteria. Once through BM they infect and KILL MACS?
Salmonella enteritidis
111
What is the function of the Vi capsule antigen on S typhi?
inhibits PMN phagocytosis
112
What is the DOC for the treatment of a disseminated bacterial infection that kills via Splenic Rupture?
Salmonella Typhi = Ceftriaxone
113
What is MCC of severe diarrhea in INFANTS and young children Worldwide?
Rotavirus (Reoviridae)
114
Describe the genome of the Rotaviruses?
NON enveloped particles (double shelled)
SEGMENTED
DS RNA
Only 4 G-P combinations cause 90% of human infections
115
What is the basis for development of vaccines for Rotaviruses?
ONLY 4 G-P combinations cause >90% of human infections
116
Describe the replication process of Rotaviruses?
1. Virus endocytosed
2. Capsid proteins Proteolytically processed-> produce infectious subviral particles
* *3. CORE released into Cytoplasm= synthesizes mRNA
4. Assembly of virus in cytoplasm
5. Release via cell lysis
117
Major cause of foodbrone epidemic acute gastroenteritis in Older children and adults?
Noroviruses (Norwalk)
118
Young (1-2yo) child with severe diarrhea. MCC?
Norwalk virus
119
MCC of community based outbreaks of nonbacterial gastroenteritis in School aged children and adults?
Norwalk virus
120
What are some of the sources of Norwalk outbreaks?
Food (shellfish, frosting, salads)
| Cruise SHIPS
121
How would a person with a Norwalk infection most likely present?
```
Nausea
Vomiting
Diarrhea
Fever
Dehydration
```
122
What is the pathogenesis for the inflammatory diarrhea caused by Norwalk viruses?
Infects Villus epithelium of small bowel
Replication = cell lysis
Loss of epithelial cells= Functional alterations
Glucose coupled Na transport is Impaired= diarrhea
123
WHat is the bases for the watery diarrhea seen in a patient with a norwalk virus infection?
Impaired Glucose coupled Na absorption in the small intestine= Inflammatory diarrhea due to Loss of cells
**Adenylate cyclase and cAMP not affected
124
What is the difference between the antibody production against Rotavirus vs. Noroviruses?
```
Rota= Abs obtained EARLY in life
Noro= Gradual/increase steadily over persons life
```
125
What are the ways to prevent/treat Rotavirus infections?
Hydration therapy (ORT)
RotaTeq-> Pentavalent bovine/human Live attenuated vaccine
Rotarix-> human monovalent life attenuated vaccine
**NOrwalk virus--> NO vaccines
126
What are the genomic characteristics of Enteroviruses?
NON enveloped (STABLE)
+ RNA
Acid stable
Replicate @ 37 degrees
127
Which type of enterovirus causes flaccid paralysis (wheel chair)?
Poliovirus
128
Enterovirus that causes myocarditis and pericarditis?
Coxsackievirus
129
What is significant about the replication of Enteroviruses?
Similar to Rhinovirus-> Protease cleaves mRNA with 5 cap
* *Replicate in lymphoid of URT and GUT
* *Asymptomatic infections
130
Pt complains of fever, malaise, headache, nausea, abdominal pain then develops muscle weakness and CONFUSION. What should be tested?
CSF--> Bacterial or Viral Meningitis
**Enteroviruses cause Meningitis
131
Pt with abrupt onset of fever and chest describes as substernal and spasmodic. What virus will most likely be cultured from this patient?
Coxsackie group B
132
Pt with ulcerative lesion in mucosa of the mouth followed by vesicular lesions on the soles and palms. What virus is most likely responsible?
group A16 Coxsackie
* *Hand Foot and Mouth disease
* *Hemorrhagic conjunctivitis
133
Which virus family is NON segemented ss + RNA that causes meningitis, pleuritis, and skin lesions on soles/palms?
Picornaviridaee viruses
* Coxsackie
* Enteroviruse
* Echovirus
134
What is the genome for virus family responsible for most of the severe diarrhea in INFANTS and children?
Rotavirus--> SEGMENTED ds RNA
135
Non segmented ss + RNA virus responsible for most of the food-borne epidemics of acute gastroenteritis in YOUNG children and adults?
Norwalk virus
136
What is special about the genome of Rotaviruses?
Segmented--> Reassortment= Antigenic diversity
**Similar to Influenza virus
137
What are the similarities between Rotaviruses and Norwalk viruses?
Fecal-Oral transmission
Nonenveloped = Very stable
Very Infectious--> 10-100 particles
Hand washing is preventative
138
Young child with nausea, fever, Watery diarrhea, no leukocytes in stool, and prominent Vomiting?
Norwalk infection
139
What is the simple pathogenesis for the "Watery diarrhea" seen in Norwalk infections?"
Loss of Microvilli in small and large intestines due to cell death= loss of Glu/Na cotransporters
140
Enterically-transmitted "infectious" hepatitis?
HAV
141
Parentarally transmitted "serum" hepatitis?
HBV
142
Dependent upon coinfection hepatitis virus?
HDV
143
Which hepatitis virus is related to poliovirus and Coxsackie viruses?
HAV (Picornovirus)
144
Acute hepatitis, Fecal oral transmission, and extremely prominent in USA?
HAV
145
Hepatitis virus related to Norwalk virus, most prevalent in developing countries, FATAL in pregnant women?
HEV (ONLY ACUTE)
146
Vaccinations have caused Rapid decline in infections rates of what hepatitis virus worldwide?
HAV
147
What is a Dane particle?
Enveloped HAV particle
148
What is the Only dsDNA hepatitis virus?
HepaDNAvirus--> HBV
149
A patiente infected with HBV will have what in their blood after 1mo?
DANE particles
Trillions of 20nm particles and Filaments
HBsAg and phospholipids
NO GENOME
150
What four proteins does the HBV genome encode?
Reverse Trasncriptase
HBsAg
HBcAg--> HBeAg
151
What virus markers are seen in an acute HBV infections?
HBV DNA
HBsAg
HBc Ab (IgM)
152
Describe the replication process of HBV?
```
Fusion + attachement
Virus enters nucleus
**FInished short to make FULL dsDNA
**transcribe DNA-> mRNA
Make capsid proteins in cytoplasm
***Reverse Transcriptase== mRNA -> DNA
Cell buds of ER (no lysis)
```
153
WHat hepatitis virus is endemic is China and Africa + sexually transmitted?
HBV
154
What serological findings are seen in a Resolved HBV infection?
Loss of HBV DNA
| HBsAg GONE--> HBs Antibodies formed
155
When can a patient be HBsAg negative but HBeAg positive?
NEVER
156
What serology is seen in a chronic HBV infection?
HBsAg
HBV DNA
EIther HBe Ag (infective) or HBe Antibody (carrier)
157
Hepatitis virus with circular ssRNA genome that requires another virus for infection?
HDV --> requires HBV
158
When does HDV cause Severe acute disease vs. HIgh risk of Severe Chronic disease?
Co-Infection with HBV= Severe ACUTE
| Superinfection == Severe Chronic
159
A patient with chronic HBV infection suddenly has onset of jaundice, fatigue, and malaise?
Superinfection with HDV
160
ssRNA+ genome that encodes for 3000+ AA polytprotien that requires NS3 protease for cleavage?
HCV
161
What hepatitis infection is associated with DRUG USE, transfusions, and sex?
HCV
162
What hepatitis virus is prevalent in 45-55 yo and has a 70% chance of becoming chronic?
HCV
| **Bouts of acute disease due to several different strains
163
Why can a person have several bouts of HCV infection?
Antigenic variation facilitates immune escape
164
Hepatitis virus infecting Sexual partneres, International travelers, AMERICAN INDIANS?
HAV
165
Hepatitis affecting Day Care workers, IVDA?
HAV
166
Hepatitis affecting IVDA, healthworkers, hemophiliacs?
HBV
167
Hepatitis affecting Healthcare, HIV patients, Dialysis, Alcoholics?
HCV
168
Which hepatitis viruses are NOT cytolytic?
HBV
HCV
**Immune mediated destruction
169
Enterically transmitted Hepatitis viruses with abrupt onset of sharp fever?
HAV
| HEV
170
parenterally transmitted hepatitis viruses with insidious onset of fever?
HBV
| HCV
171
Why is HBV chronicity depend on the age of infection? 90% if 5 yo
Immune tolerance phase= high HBV DNA, HBeAg +
| **Longer is Children because of Lack of strong Innate and CTL immune response to fight of virus)
172
What defines the immune clearance phase of HBV infections? Residual phase?
seroconversion from detectable HBeAg-> HBe Antibodies
| Residual phase= Loss of HBsAg + DNA
173
What is time line for chronic HCV to become cirrhosis, HCC?
Chronic severe== 10years
Cirrhosis== 20 years
HCC== 30 years
174
How is each type of hepatitis virus screened?
```
HAV= ELISA for HAV IgM
HBV= sAg, eAg, eAb, DNA
HCV= cAg, RNA (genotype by serology/RT PCR)
```
175
What is a definitive form of screening or treatment for HAV?
Havarix vaccine--> inactivated
* * vaccinate
* *>40yo --> Gamma globulin
176
What is a definitive form of screening or treatment for HBV?
Screen Blood supplies
Vaccines (Yeast or plasma derived HBsAg)
Alpha 2 interferon, lamivudine, adefovir
177
What is a definitive form of screening or treatment for HCV?
Screen blood for HCV RNA
| PEG interferon and Ribavarin
178
What is a AE of Ribavarin?
Teratogenic
| Anemia
179
Which hepatitis viruses are associated with HCC?
60% due to HBV
| 22% due to HCV
180
What Hepatitis vaccine ONLY has 1 serotype and human reservoir?
HAV -- bases for vaccine
181
Which Hepatitis virus has a revers transcriptase?
HBV
182
Which hepatitis viruses are enveloped vs. Non enveloped?
```
Enveloped== B, C, D
Non== A, E
```
183
What is the route of transmission of HBV?
Parenteral--> Blood, semen, vaginal secretions
184
Describe the HBV replication cycle?
```
Entry
Complete DNA synthesis= FULL ds DNA
Nucleus--> transcribe mRNA
Capsid proteins
RNA--> DNA
2nd strand synthesis halted early
Package-> ER--> Release
```
185
What is different about the symptoms associated with HAV vs HBV?
HAV--> symptoms @ 4 wks
| HBV--> symptoms @ 8wks
186
What HBV marker is associated with carriers and acutely infected?
HBsAg
187
What HBV marker is associated with a person who has HAD the disease or been vaccinated?
HBs antibody (IgG)
188
HBV marker that ID those at increased risk of transmission?
HBeAg (active marker)
189
HBV marker that ID carriers at LOW risk for transmission?
HBe antibody
190
HBV marker that ID person with Past infection?
HBc Antibodies (IgG)
191
HBV marker that ID acute or recent infection?
Anti-HBc IgM
192
What kind of HBV markers are present in a vacinee?
Anti-HBs
193
What kind of HBV markers are present in resolved acute infection?
Anti-HBs
| Anti-HBc IgM
194
What kind of HBV markers are present in a low risk carrier?
HBs Ag
HBV DNA
Anti- HBe
195
What kind of markers are present in a HIGH risk carrier?
HBs Ag
HBV DNA
HBe Ag
196
Why do HCV infected individuals have multiple bouts?
Reinfection with anther strain
| Emergence of quasi-species
197
Which Hepatitis viruses are NOT cytolytic thus cause damage via immune response?
HBV
| HCV
198
What hepatitis virus has maternal-fetal, sexual, and IVDA transmission routes and is prevalent in SE asia?
HBV
199
IVDA associated Hepatitis virus?
HCV
200
Sexually active female with Elevated ALT + AST. What is the most likely hep virus?
HBV = Sexually transmitted
201
Recent traveler with Increases ALT/AST. Which hep virus?
HAV
202
What is the only cause of a AST> 5000?
Acetaminophen toxicity
203
What is the clinical picture for Acute hepatitis?
```
Fever
Fatigue
Abdominal pain
Enlarged tender liver
High ALT/AST (1000-5000)
High billirubin (both)
```
204
Person with HCV infection and ALT/AST > 200 means?
Something else is causing Acute liver damage.
| HCV never ACUTE
205
Which Hepatitis virus will not have an IgM response?
HCV--> NOT ACUTE
**IgM: Anti HEV/HAV/HBcore
206
What does viral DNA or RNA in serum indicate?
Active infection but NOT chronic or acute
207
Acute hepatitis patient presents with altered mental status (encephalopathy due to Cerebral edema). What is the Dx & Tx?
Fulminant Hepatic failure
Urgent Liver Transplant ONLY
**90% mortality
