Overview II

Question 1

Which hepatitis virus is DNA based?

Answer 1

HBV

Question 2

How are hepatitis A and E transmitted?

Answer 2

Fecal-oral route

Question 3

How are hepatitis B, C, D transmitted?

Answer 3

Blood-to-blood contact

Question 4

What hepatitis viruses can cause acute hepatitis?

Answer 4

All forms

Question 5

Which hepatitis viruses can cause chronic hepatitis?

Answer 5

B, C, D

Question 6

Symptoms of acute hepatitis

Answer 6

• Flu
• Fatigue, fever
• Cough, runny nose, pharyngitis
• Jaundice after 1-2 weeks
• Painful, enlarged liver
• Will have ↑ AST, ALT, GGT, Alk phos

Question 7

Why is chronic hepatitis harder to diagnose?

Answer 7

• Typically asymptomatic
• Might have large, tender liver
• Might have ↑ liver function tests

Question 8

Viral hepatitis usually causes what liver functions to elevate the most?

Answer 8

• AST and ALT
• This is because virus takes over and damages hepatocytes
• Other levels will he higher, later in the infection

Question 9

What is genetic material of HAV?

Answer 9

• (+) RNA

* Picorna family

Question 10

Who is infected with HAV?

Answer 10

• Huge numbers of people
• Only 5% develop chronic
• Very few people die from this

Question 11

What antibodies are used for hepatitis viruses?

Answer 11

• IgM first

* IgG second

Question 12

What is structure of HBV?

Answer 12

• Enveloped
• Icosahedral
• dsDNA
• HBsAG (Hep B surface antigens)

Question 13

How do Hep B antibodies work?

Answer 13

• Act against HBsAG
• If these are removed, Ab is ineffective
• There are HBcAG (core) but these are not protective

Question 14

What is the marker for active HBV disease?

Answer 14

Cleaved HBsAG

Question 15

How can a pregnant mother transmit HBV to child?

Answer 15

• 90% through blood

* 10% through birth canal

Question 16

What types of hepatitis can HBV cause?

Answer 16

• Acute
• Fulminant → severe acute with rapid liver destruction
• Chronic
-Asympotomatic → no liver injury
-Chronic-persistent → low grade “smoldering” hepatitis
-Chronic-active → acute without normal recovery
-Co-infection with HDV

Question 17

What is common sequela of HBV?

Answer 17

Primary hepatocellular carcinoma

Question 18

What can you give to a patient infected with HBV?

Answer 18

• Lamivudine (anti-HIV)
-Most PTs have relapse if drug is discontinued
• IFN-α → helps prevent cirrhosis

Question 19

What does HDV need to replicate?

Answer 19

• An envelope form HBV

Question 20

How can HDV cause a superinfection?

Answer 20

• Occurs in a person with HBV already

* Acute on chronic hepatitis → can lead to fulminant hepatitis

Question 21

What is structure of HCV?

Answer 21

• RNA
• Enveloped
• Icosahedral
• Probably a flavivirus

Question 22

What is the huge concern with HCV infection?

Answer 22

• Cirrhosis

* 50% of PTs develop

Question 23

What is structure of HEV?

Answer 23

• Probably calcivirus
• ssRNA
• Naked

Question 24

Where can most herptic viruses reside?

Answer 24

• In sensory ganglia

* Can migrate out and cause destruction

Question 25

* What class of herpes viruses cause cell damage? | * What viruses are in this family?

Answer 25

• Αlpha class -HSV 1 and 2 -Varicella-zoster • Causes separation of epithelium → blistering -All have multinucleated giant cells

Question 26

* What class of herpes viruses don't cause cell damage? | * What viruses are in this family?

Answer 26

• Gamma group -Epstein-Barr • Βeta group -CMV

Question 27

What are some common clinical conditions caused by HSV-1?

Answer 27

* Gingivostomatosis * Herpetic keratitis * Encephalitis * Cold sores

Question 28

What is gingivostomatosis?

Answer 28

* Painful swollen gums and mucous membranes with vesicles | * Can have fever and systemic symptoms

Question 29

What is the most common cause of corneal blindness in the USA?

Answer 29

* Herpetic keratitis | * HSV-1

Question 30

What is the most common cause of viral encephalitis in the USA?

Answer 30

* HSV-1 * Cell death and brain swelling * Fever and focal neurological abnormalities

Question 31

What is the common clinical manifestation of HSV-2?

Answer 31

* Vesicles on genitalia | * Often with burning, itching with urination

Question 32

How can a pregnant mother pass herpes on to her baby?

Answer 32

* Via placenta | * Via birth canal if active infection

Question 33

Where does varicella replicate?

Answer 33

* Respiratory tracts | * Followed by viremia

Question 34

Describe a chickenpox rash?

Answer 34

* Dew on a rose petal * Red base with fluid filled vesicles on top * Rash is in different stages throughout the body!

Question 35

What are sequela of primary varicella in adults and immunocompromised PTs?

Answer 35

* Pneumonia | * Encephalitis

Question 36

Can CMV cross the placenta?

Answer 36

* Yes * Part of TORCHES * Most common viral cause of mental retardation, other congenital disorders

Question 37

How common is CMV?

Answer 37

* 80% of adults have antibodies | * Majority of adults are asymptomatic

Question 38

What can CMV cause in young adults?

Answer 38

A mononucleosis-like illness

Question 39

If CMV is reactivated in an immunocompromised adult, what might you see?

Answer 39

* Retinitis (blindness) * Pneumonia (severe) * Disseminated infection * Even death

Question 40

What does EBV attack?

Answer 40

* B cells * Binds to C3d receptor (complement) and then internalized * These cells proliferate

Question 41

What cancers is EBV implicated in?

Answer 41

* Burkitt's lymphoma | * B-cell lymphoma

Question 42

What are symptoms of mononucleosis?

Answer 42

* Fever, chills * Headache * Sweats * Very painful pharyngitis * Enlarged lymphnodes and spleen (due to B-cell proliferation)

Question 43

What would CBC for mononucleosis show?

Answer 43

High white count with atypical lymphocytes