Microbiology 11 - Viral Hepatitis

Question 1

Recall 2 RFs for Hep A transmission

Answer 1

1. Drinking from dodgy water supply
2. MSM

Question 2

What is the incubation period for hepatitis A?

Answer 2

2-6 weeks

Question 3

Which immunoglobulin is indicative of previous Hep A infection/ vaccine?

Answer 3

IgG without high ALT

Question 4

What test is used to identify acute hepatitis A?

Answer 4

Anti-hepatitis A virus IgM

Question 5

What are the clinical features of HepA

Answer 5

↑ age → ↑ symptomatic

fever

malaise

anorexia/nausea

abdo discomfort

diarrhoea

jaundice

extra-hepatic diseases

Question 6

How to manage HepA infection?

Answer 6

supportive

post exposure prophylaxis

HAV vaccine +/- HNIG (≥60 years, chronic liver disease, immunocompromised)

Question 7

For how long does hepatitis B infection have to persist to be considered “chronic”?

Answer 7

6 months

persistance of HbsAg >6months

Question 8

How is HepB transmitted?

Answer 8

Sexually transmitted

Blood products

Mother-to-Baby (vertical)

Question 9

What is the most important risk predictor for vertical transmission of HBV?

Answer 9

HbeAg

need to check maternal HbeAg/Ab

Question 10

What puts you at risk of fulminant hepatitis in HBV?

Answer 10

co infection with HCV/HDV

Question 11

What are the chances of developing chronic HepB?

Answer 11

Adults - (5-)10% chance of developing chronic infection

Babies have a 95% chance of developing chronic infection

Question 12

What is the incubation period for hepatitis B?

Answer 12

2-6 months

Question 13

Which HBV Ab gives protection?

Answer 13

Anti HbS

Question 14

Recall the stages of hepatitis B infection

Answer 14

1. Immune tolerant
2. Immune reactive
3. Inactive HBV carrier state
4. HBe antigen negative chronic HBV
5. HBs antigen negative phase

Question 15

What do the presence of the following markers suggest

HBsAg

HBsAb

HBcAb

HBeAg

Answer 15

HBsAg - current infection

HBsAb - immunity (from infection/immunisation)

HBcAb - exposure (IgM = acute)

HBeAg - replication activity

Question 16

Fill in the blanks

Answer 16

Question 17

What are the complications of chronic hepatitis B?

Answer 17

Hepatic fibrosis → cirrhosis → HCC

Most common cancer associated = Hepatocellular carcinoma (HCC)

Question 18

What treatments are available for chronic hepatitis B?

Answer 18

Interferon alpha
Lamivudine
Tenofovir

liver transplant

Question 19

when is PEP given for HepB?

Answer 19

neonate born to mother with HepB

sexual partner - HBV vaccine +/- HbIg (within 1w conact)

needlestick injury

Question 20

What does the hepatitis B vaccine contain?

Answer 20

Surface antigen

Question 21

What is the incubation period of hepatitis C?

Answer 21

2 - 6 weeks

Question 22

What are the main routes of transmission of hepatitis C?

Answer 22

Blood products
MSM/IVDU

Question 23

What % of people who get infected with hepatitis C go on to have chronic hep C?

Answer 23

60-80% -> CHC

20-30% spontatneously clear

Question 24

What test is used to diagnose hep C infection?

Answer 24

cannot check anti-HCV during acute hepatitis – check viral load (HCV RNA) instead

Anti-HCV antibodies tend to develop after acute infection (i.e. ↑ ALT) has disappeared

HCV RNA best way to check virus in blood

Question 25

What treatments are available for hepatitis C?

Answer 25

Direct Acting Antivirals (DAAs) 8/12wks

Question 26

What is measured to monitor response to therapy in hep C?

Answer 26

Measure SVR12 (12 weeks) sustained virological response

Question 27

What are the components in directly acting antivirals (DAA)

Answer 27

NS3/4 serine protease = ‘-previr’\ NS5a RNA (unknown action) = ‘-asvir’ NS5b RNA dependent RNA polymerase = ‘-buvir’

Question 28

Hepatitis D infection is always superimposed upon which type of infection?

Answer 28

Hepatitis B -- increases risk of cirrhosis nd HCC in chronic HBV

Question 29

Diagnostics for HDV

Answer 29

IgM anti-HDV rise after inoculation → nasty acute hepatitis

Question 30

How to treat HDV?

Answer 30

medications used in HBV NOT EFFECTIVE against HDV – tx with peg-IFN-a PrEP HV imms

Question 31

Which type of hepatitis only ever takes an acute course?

Answer 31

Hepatitis E

Question 32

What is one particularly risky food for hepatitis E infection?

Answer 32

Wild boar also in Shellfish consumption, blood transfusion, sausages, pig liver consumption

Question 33

What are the possible complications of hepatitis E infection?

Answer 33

CNS Disease (Bell's palsy, Guillain-Barre) Chronic infection Very dangerous to pregnant women (esp. third trimester)

Question 34

Which hepatitides are spread through faecal oral route?

Answer 34

A and E

Question 35

What will be raised in HCC in hepB?

Answer 35

alfa-fetoprotein

Question 36

How can HEV be diagnosed?

Answer 36

acute infection ↑ IgM anti-HEV antibody HEV RNA detectable in serum and stool in incubation period

Question 37

What is the treatment for HEV?

Answer 37

Supportive -acute treatment only indicated in rare chronic form Ribavirin Vaccine - trials with recombinant HEVg1 in China