Viral Hepatitis

Question 1

Hepatitis Definition

Answer 1

general term for inflammation of the liver

Question 2

Detection of liver inflammation

Answer 2

liver enzymes elevated from damaged or dying liver cells

ALT & AST

Question 3

Causes of Hepatitis

Answer 3

viruses, alcohol, drugs, toxins, autoimmunity

Question 4

Viral agents of acute hepatitis can be divided into 2 major groups

Answer 4

primary hepatitis virus: A, B, C, D, E & G

secondary hepatitis virus: Epstein-Barr virus (EBV) & CMV etc

Question 5

Acute Hepatitis symptoms

Answer 5

general flu like symptoms etc etc

Question 6

Chronic Hepatitis symptoms

Answer 6

liver tenderness, JAUNDICE, dark urine, and light or clay colored feces

Question 7

Hyperbilirubinemia

Answer 7

Jaundice - yellowing of the skin & whites of the eyes

unless increased RBC lysis, jaundice indicates livery injury

Question 8

Hepatitis A General Characteristics

Answer 8

small RNA containing picornavirus, nonenveloped, single stranded RNA
produces an acute hepatitis NOT CHRONIC

Question 9

Hepatitis A epidemiology & transmission

Answer 9

HAV is primarily a disease of young children in developing countries
fecal- oral route!
can be blood borne

Question 10

HAV markers

Answer 10

HAV Ag- shed in the feces & normally not tested for
IgM Ab- detectable in serum indicates acute infection
IgG Ab- indicates immunity to the virus

Question 11

Vaccine available for HAV?

Answer 11

yes for children & high risk adults

Question 12

Hepatitis B General Characteristics

Answer 12

major cause of morbidity & mortality throughout the world mostly in China & Asia
DNA virus, enveloped, Double-shelled ‘ Dane Particle’

Question 13

4 gene products of HBV

Answer 13

HBs, HBcore, HBpolymerase, HBX (transcription factor)

Question 14

HBV epidemiology & transmission

Answer 14

LONG incubation period (45-90 days)
much more stable of a virus than retro viruses:
Percutaneous : contaminated needle stick etc
Permucosal: sexual intercourse & perinatal

Question 15

HBV Surface Antigen

Answer 15

protein present on surface of virus, initial detectable marker found in serum
persence indicats active HBV infection (acute & chronic)

Question 16

HBV Surface Antibody

Answer 16

develops during the recovery from HBV infeciton

serologic marker of recovery & immunity

Question 17

HBV core antigen

Answer 17

only present in infected liver cells & is not detected in the blood

Question 18

HBV acute infection

Answer 18

1st to appear is HBsAg then anti HBs antibody

Question 19

HBV chronic infection

Answer 19

HBsAG is positive, virus remains in body after acute infection is over
NO presence of anti-HBsAg antibody
risk of progressing to chronic is age dependent (90% in infants)

Question 20

HDV General Characteristics

Answer 20

parentally transmitted infection that can only occur in the presence of HBV!
uses HBsAg to assemble into new particles & attach and enter new cells
circular RNA & a single protein, delta antigen, surrounded by HBV viral envelop

Question 21

HDV epidemiology & transmission

Answer 21

uncommon in the US, predominantly IV drug users & sexual partners
high mortality rate
co-infection w/ HBV or superinfection

Question 22

Co-infection with HBV

Answer 22

in which infection of HDV & HBV occurs simultaneously

Question 23

Superinfection

Answer 23

in which HDV infects individuals who are already chronic HBV carriers

Question 24

HDV serological markers

Answer 24

antibodies to HDV antigens:
IgM HDV Ab - acute infection
IgG HDV Ab -indicates recovery from HDV
HDV RNA- indicates active infection

Question 25

Hepatitis C Virus General Characteristics

Answer 25

small, enveloped, single stranded RNA virus w/ 6 different genotypes

Question 26

HCV Acute & Chronic

Answer 26

``` Acute: 70% are asymptomatic Chronic: 75%-85% develop chronic infection 60%-70% will progress to chronic liver disease if untreated ```

Question 27

HCV transmission

Answer 27

transmitted mainly by exposure to contaminated blood IV drug use prior to 1992- blood transfusions were a large risk

Question 28

HCV serological Markers

Answer 28

Anti-HCV antibody- indicates current or past HCV infection CONFIRMATION TEST: RIBA test (recombinant immunoblot assay)

Question 29

HCV vaccine?

Answer 29

no vaccine exists | ribaverin results in a 'cure' in 80% of patients

Question 30

HCV genotyping assays

Answer 30

each different genotype presents a different clinical profile, different severity of liver disease & response to alpha interferon therapy

Question 31

Hepatitis E General Characteristics

Answer 31

Fecal-oral transmission | self limiting / acute