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GI/GU Illness > Viral Causes of Hepatitis > Flashcards

Viral Causes of Hepatitis Flashcards

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1
Q

What viral family is HAV?

A

Picornavirus

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2
Q

What viral family is HEV?

A

Hepevirus

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3
Q

What viral family is HBV?

A

Hepadnavirus

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4
Q

What viral family is HCV?

A

Flavivirus

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5
Q

What is the transmission route of HAV?

A

Fecal-oral

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6
Q

What is the transmission route of HEV?

A

fecal-oral

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7
Q

What is the transmission route of HBV?

A

Parenteral

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8
Q

What is the transmission route of HCV?

A

Parenteral

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9
Q

What viruses other than hepatitis viruses cause liver infections? (6)

A 
Epstein barr
CMV
Rubella
Mumps
ECHO viruses
Yellow Fever
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10
Q

What is the structure of HAV?

A

icosahedral capsid that is enveloped in faeces and can be enveloped or non-enveloped in blood

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11
Q

Why is HAV enveloped in the blood but non-enveloped in the environment?

A

Budding allows for exit without lysis, immune escape in the body - confers resistance to neutralising antibodies,
no envelope outside the body in faeces confers stability and transmission of virus

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12
Q

How many serotypes does HAV have?

A

one serotype based on structural proteins VP1 and VP3

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13
Q

How many genotypes of HAV are there?

A

4 genotypes in humans (1, 2, 3, 7)

3 genotypes in monkeys (4, 5, 6)

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14
Q

HAV genomic RNA is translated into a. . ?

A

polyprotein which is cleaved into structural proteins and replicative proteins

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15
Q

How does HAV infection spread through the body?

A

HAV enters via the oral cavity, crosses the intestines and enters the blood where it can spread to the liver, enter the bile and enter the stool

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16
Q

What is the incubation period for hepatitis A?

A

2-6 weeks

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17
Q

What are the symptoms during the prodromal phase of HAV infection (1-7 days)? (7)

A
  1. Fever
  2. Fatigue
  3. Malaise
  4. Loss of appetite
  5. abdominal pain
  6. nausea
  7. vomiting
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18
Q

What are the symptoms of the symptomatic phase of HAV infection? (3 weeks) (4)

A
  1. Bilirubinuria
  2. Pale/clay coloured faeces
  3. Jaundice
  4. Liver enlargement
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19
Q

What are the complications of HAV infection? (3)

A
  1. cholestatic hepatitis
  2. relapsing hepatitis
  3. fulminant hepatic failure
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20
Q

How does HAV cause liver damage?

A

Immunopathology mediated liver damage

Cytotoxic T cells

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21
Q

What are the characteristics of HAV in regions of high endemicity? (2)

A
  1. disease rates are low as most people are infected at an age when infection is asymptomatic
  2. transmission mainly from person to person but also contaminated food/water
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22
Q

What are the characteristics of HAV in regions of intermediate endemicity? (2)

A
  1. disease rates are high as the age of infection is older

2. person to person transmission and large common source outbreaks

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23
Q

What are the characteristics of HAV in regions of low endemicity? (2)

A
  1. disease rates are low due to lack of exposure but large numbers of children and adults are susceptible
  2. person to person and occasionally food/water transmission
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24
Q

What are the characteristics of HAV in regions of very low endemicity?

A
  1. disease is limited to adults in defined risk groups such as international travellers
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25
How is HAV diagnosed in a lab? (2)
1. liver function tests eg ALT 2. Serology IgM anti-HAV Total anti-HAV
26
How can HAV be prevented?
1. improved standards of hygiene and sanitation 2. immunization passive - immune serum globulin active - inactivated whole virus vaccines
27
What is the host range of HEV genotype 1 and 2?
Humans
28
What is the host range of HEV genotype 3?
Human Pig Rabbit Deer
29
What is the host range of HEV genotype 4?
Human | Pig
30
What is the host range of HEV genotype 5 and 6?
Wild boar
31
What is the host range of HEV genotype 7?
Camel
32
What happens to HEV's envelope?
Non-enveloped in the faeces, enveloped in the body
33
What is HEV's genome?
positive sense ssRNA
34
What is the incubation period for HEV?
2-6 weeks
35
What type of infection can HEV cause? (3)
1. asymptomatic 2. icteric 3. fulminant
36
What are the symptoms of HEV? (6)
1. fever 2. nausea 3. abdominal pain 4. jaundice 5. long periods of viraemia 6. faecal shedding
37
What is the mortality rate of pregnant women infected with HEV1 and HEV2?
20-25% mortality rate
38
What genotypes of HEV cause chronic infections in immunocompromised people?
HEV3 and HEV4
39
What are neurological complications of infection with HEV1 and acute and chronic HEV3? (4)
1. Guillain-Barre 2. Bell's Palsy 3. Acute transverse myelitis 4. Acute meningoencephalitis
40
What are renal complications of HEV infection?
membranoproliferative glomerulonephritis (MPGN)
41
What are the muscular complications of HEV infection? (2)
1. athralgia | 2. myalgia
42
What are the haematological complications of HEV infection? (2)
1. thrombocytopaenia | 2. aplastic anaemia
43
What is the route of transmission of HEV1 and HEV2?
Faecal oral route in developing countries
44
What is the route of transmission of HEV3 and HEV4?
zoonotic transmission in developed countries
45
Which HEV genotype can be transmitted via blood?
HEV3
46
Which HEV genotype can be transmitted vertically from mother to child?
HEV1
47
How is HEV diagnosed in a lab?
serology - anti-HEV IgM
48
How can HEV be prevented?
improved sanitation | two commercial vaccines
49
How many genotypes of HBV are there?
HBVA-J (10)
50
What are the transmission routes of HBV? (3)
1. Blood and Blood products 2. Sexual contact 3. Perinatal
51
What is the main mode of transmission of HBV in regions of high endemicity?
perinatal transmission
52
What is the main mode of transmission of HBV in regions of medium endemicity?
childhood and percutaneous transmission
53
What is the main mode of transmission of HBV in regions of low endemicity?
adult, sexual and percutaneous transmission
54
What are the HBV proteins? (4)
1. S - surface proteins (HBsAg) 2. C - core proteins (HBeAg, HBcAg) 3. P - polymerase, reverse transcriptase 4. X - HbX
55
What percent of adults have complete recovery from HBV within 1-3 months?
95%
56
What is the incubation period of HBV?
1-4 months
57
What are the characteristics of the immune tolerant phase (phase 1) of HBV infection? (4)
1. HBeAg+ 2. High HBV DNA 3. ALT normal 4. Minimum or no inflammation
58
What are the characteristics of the immune active/clearance phase (phase 2) of HBV infection? (4)
1. HBeAg+ 2. High/declining HBV DNA levels 3. ALT high 4. moderate to severe liver inflammation
59
What are the characteristics of the inactive phase (phase 3) of HBV infection? (5)
1. HBe negative/anti-HBe positive 2. ALT levels normal 3. Low HBV DNA 4. minimum inflammation in liver 5. low risk of cirrhosis or HCC
60
What are the characteristics of the reactivation phase (phase 4) of HBV infection?
1. HBe negative/ anti-HBe positive 2. High HBV DNA and ALT levels 3. Inflammation and fibrosis 4. pre core mutations
61
increased risk of cirrhosis is associated with which HBV mutant?
HBe negative HBV mutant
62
What are the characteristics of occult HBV (phase 5)?
1. unexplained liver disease in HBsAg negative, anti-HBc positive 2. normal ALT levels 3. detectable HBV DNA in blood or liver by sensitive molecular methods
63
How can severity of HBV liver disease be assessed through biochemical parameters? (7)
1. liver enzymes 2. alkaline phosphatase 3. bilirubin levels 4. albumin levels 5. gamma globulins 6. full blood count 7. prothrombin time
64
How can severity of HBV liver disease be assessed through physical examination? (3)
1. abdominal ultrasound is recommended for all patients 2. liver biopsy 3. transient elastography
65
What are the indications for treatment of chronic HBV?
1. serum HBV levels > 2000 IU/mL 2. Serum ALT levels > ~40 IU/mL 3. moderate necroinflammation and/or moderate fibrosis or cirrhosis
66
What are the treatment strategies for HBV? (2)
1. pegylated interferon | 2. nucleoside analogues: lamivudine, entecavir, tenofovir
67
How is HBV monitored?
1. HBV viral load assays 2. genotyping assays 3. drug resistance mutation assays 4. liver enzymes 5. serology for HBeAg and anti-HBeAg
68
How is an acute infection of HBV diagnosed?
IgM and anti-HBcAg
69
How can HBV be prevented?
vaccination
70
How can vertical transmission from mother to child be prevented?
HB Ig and vaccine should be given to infants born to HBV positive mothers
71
How many different genotypes of HCV are there
7 genotypes 1-7
72
What are the clinical manifestations of acute HCV?
1. malaise 2. nausea 3. dark urine 4. jaundice
73
What is the incubation period of acute HCV?
7 weeks
74
What percentage of HCV infections become chronic?
50-80%
75
What percentage of chronic HCV infections become cirrhosis?
20%
76
What are the skin complications of HCV infection? (2)
1. porphyria cutanea tarda | 2. lichen planus
77
What are the renal complications of HCV?
1. membranoproliferative glomerulonephritis (MPGN)
78
What are the haematological complications?
cryoglobulinaemia
79
What are the CNS complications of HCV infection?
Depression
80
What are the neuromuscular complications of HCV infection? (2)
1. arthritis | 2. peripheral neuropathy
81
What are the vascular complications of HCV infection?
polyarteritis nodosa
82
What does "sustained virological response" mean?
refers to the absence of HCV RNA in serum 12 weeks after stopping treatment
83
What does "non-responder" refer to?
people in whom HCV RNA levels remain stable during treatment
84
What does "rapid virological response" mean?
undetectable HCV RNA at 4 weeks
85
What does "early virological response" refer to?
undetectable HCV RNA at 12 weeks
86
How is HCV diagnosed?
serology ELISA measures antibodies against NS4, core, NS3, NS5 6-8 weeks after exposure
87
How is HCV monitored?
viral load

GI/GU Illness (15 decks)

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