VIRAL INFECTIONS CONT. & HEPATITIS Flashcards
(161 cards)
1
Q
A
Viral Hepatitis
HIV
Dengue
Herpes Virus infections: infectious mononucleosis, Epstein Barr Virus, Cytomegalovirus
2
Q
Submicroscopic particle (size is measured in nanometers)
A
VIRUSES
3
Q
VIRUSES Basic Structure:
A
core of DNA or RNA
4
Q
Intracellular pathogens
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VIRUSES
5
Q
First line of protection (nonspecific immunity)
A
INNATE IMMUNITY AGAINST VIRUSES
6
Q
Interferon-a and Interferon-b
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INNATE IMMUNITY AGAINST VIRUSES
7
Q
Inhibits viral replication
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Interferon-a and Interferon-b
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Q
Enhances activity of NK cells
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Interferon-a and Interferon-b
9
Q
B cells and plasma cells
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HUMORAL DEFENSE
10
Q
Produces virus specific antibodies
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HUMORAL DEFENSE
11
Q
Ab prevents spread of viral replication through neutralization
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HUMORAL DEFENSE
12
Q
: promotes phagocytosis thru opsonization
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IgG
13
Q
: Agglutinates viral particles
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IgM
14
Q
Upon activation of [?], CD8+ Cytotoxic T cells (CTL) become programmed to expand in number and attack the virus-infected cells.
A
CD4+ T helper cells and cytokines
15
Q
Cytotoxic T cells (CTL) produce
A
proteins and proteases
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Q
- pore forming protein, bubutasan nila ung host cell. It will create a pore in the membrane of the host cell.
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Perforin
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Q
- they will now enter the pore and will activate apoptosis
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Granzymes
18
Q
Increase [?] its original number
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50,000 times out of
19
Q
Produces new viral antigens – not recognized immediately by initial immune response
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They undergo frequent genetic mutations
20
Q
Ex. Covid-19
Frequently undergo genetic mutation due to presence of nucleic acids
Production of new viral antigens that are not recognized immediately by the innate immune response
A
They undergo frequent genetic mutations
21
Q
For example, the Hepatitis C virus (HCV) can block the degradation of viral RNA that is induced by interferons.
A
Some viruses can evade actions of the component of the immune response
22
Q
For example, cytomegalovirus and human immunodeficiency virus can reduce the expression of major histocompatibility complex molecule on the surface of virus infected cells making them less likely to be recognized by B cells
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Viruses can evade the hosts defense by suppressing the immune system
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Q
STRATEGIES ON HOW VIRUSES ESCAPES IMMUNE MECHANISMS
A
They undergo frequent genetic mutations
Some viruses can evade actions of the component of the immune response
Viruses can evade the hosts defense by suppressing the immune system
24
Q
LABORATORY TESTING FOR VIRAL INFECTION
A
Serologic testing
Molecular assays
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– monitors the course of infection, detects past infection, can assess immune status
Serologic testing
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Indicates current or recent infection or acute infection
Specific IgM antibody
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[?] in newborns indicates congenital infection with virus
Specific IgM antibody
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Indicates current or past infection and in most cases immunity
IgG antibodies
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[?] in newborns are mainly maternal antibodies
IgG antibodies
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can cross the placenta; thus normal
IgG
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Demonstrated using [?] (compound for bacteria)
electron microscope
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DNA or RNA is packed in [?] and some virus’s capsid is surrounded by outer envelope such as glycolipids and proteins.
protein coat or capsid
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They are going to rely on host cells for replication and survival.
Intracellular pathogens
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No host =
dormant
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[?]infects the host cell by attaching to specific receptors in their target cells
Virion
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It penetrates the cell membrane
Virion
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directs the host cell machinery to produce more viral nucleic acid and proteins
Release of nucleic acid (RNA or DNA)
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assemble inside the cell to form the intact virus, which is released thru cell lysis or budding of the cell surface
Release of nucleic acid (RNA or DNA)
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Viruses destroy the cells leading to [?]
decreased cell count
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Target cell:
CD4 T cells
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(virus-infected cells; produced in the recognition of TLRs)
Interferon-a and Interferon-b
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By inducing transcription of several genes that will code for proteins w/ antiviral activity
Inhibits viral replication
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Binds virus-infected cells and release cytotoxic proteins like perforin (substance that create pores) and granzymes
Enhances activity of NK cells
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– primary cells involved of humoral defense
B cells and plasma cells
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antibodies specific for a component of the virus that binds to a receptor on the host cell membrane will bind to the virus and prevent it from attaching to and penetrating the cell
Produces virus specific antibodies
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neutralize viruses in the mucosal surfaces
Secretory IgA antibodies
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can bind to viruses in the bloodstream and inhibit dissemination of the infection.
IgM and IgG antibodies
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promote phagocytosis of viruses through their opsonizing activity
IgG antibodies
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can also inactivate viral particles by agglutinating them.
IgM antibodies
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also activate complement
IgG and IgM antibodies
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leading to elimination of intracellular viruses required for replication
Cytotoxic T cells (CTL)
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General term for inflammation of the liver
HEPATITIS
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([?]– liver,[?] – inflammation)
hepa; itis
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T or F
Most people though that the cause of hepatitis is virus but there are also other causes
T
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HEPATITIS Causes:
viral infection, chemicals, ionizing radiation and autoimmune process
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HEPATITIS TWO STAGES
Acute stage
Progressive/Chronic stage
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: General flu like symptoms
Acute stage
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Hepatomegaly (enlargement of the liver)
Progressive/Chronic stage
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jaundice (yellowish discoloration of the skin)
Progressive/Chronic stage
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dark urine (due to increase of urobilinogen passing through urine)
Progressive/Chronic stage
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light feces (due to increase of stercobilin)
Progressive/Chronic stage
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(enlargement of the liver)
Hepatomegaly
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(yellowish discoloration of the skin)
jaundice
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dark urine (due to increase of [?] passing through urine)
urobilinogen
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light brown feces (due to increase of [?])
stercobilin
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INITIAL LABORATORY TEST
Elevations in bilirubin and liver enzymes (ALT)
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Non-enveloped, single stranded RNA virus.
HEPATITIS A VIRUS
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They belong to the Hepatovirus genus of Picornaviridae family.
HEPATITIS A VIRUS
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It is responsible for tens of millions of hepatitis A virus infection worldwide.
HEPATITIS A VIRUS
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MOT: fecal-oral route, close person to person contact, and ingestion of contaminated food.
HEPATITIS A VIRUS
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This may be due to poor sanitation, poor hygiene, and overcrowding.
HEPATITIS A VIRUS
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The infection caused do not usually progress to chronic stage, only to acute stage.
HEPATITIS A VIRUS
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Symptoms are usually self-limiting, typically result within two months.
HEPATITIS A VIRUS
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DIAGNOSIS: Demonstration of [?] to HAV
IgM antibodies
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Detected by Solid phase antibody-capture enzyme immunoassay
HEPATITIS A VIRUS
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Detectable on the onset of clinical symptom (present infection)
HEPATITIS A VIRUS
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TEST for TOTAL HAV detects [?]
IgG
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Competitive inhibition EIA format
HEPATITIS A VIRUS
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Major cause of mortality and morbidity worldwide.
HEPATITIS B VIRUS
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WHO estimated about 500,000 to 1.2 million deaths each year due to liver disease.
HEPATITIS B VIRUS
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Highly endemic in far east, middle east, and subSaharan Africa & amazon.
HEPATITIS B VIRUS
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HEPATITIS B VIRUS MOT:
Parenteral route by contaminated blood (main) and Sexual transmission by semen, vaginal secretion, and saliva
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It also has something to do with the production of antigens and antibodies when it comes to HBV infection.
Mnemonic:
SEC-CES
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The first 3 letters will denote the [?] and the last 3 letters denote [?].
antigen
antibodies
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For the letters SEC:
surface antigen
envelope antigen
core antigen
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For the last 3 letters CES:
core antigen
envelope antigen
surface antigen
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INCUBATION PERIOD HEPATITIS B VIRUS
Average (8-13 weeks)
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The time between being exposed to the viral hepatitis and showing the first symptoms.
HBV ACUTE INFECTION
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2 weeks- 3 months
HBV ACUTE INFECTION
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So the 1st antigen to produce is surface
HBV ACUTE INFECTION
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Next antigen produced is the envelope antigen.
HBV ACUTE INFECTION
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Lastly, core antigen is produced.
HBV ACUTE INFECTION
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3-6 months
HBV EARLY RECOVERY
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HBV EARLY RECOVERY
First Ab produced is [?] followed shortly by [?]
Then, [?]. Maproduced na kasabay ng pagdecline ng Ag.
Lastly, [?].
Anti-HBC total or Core Ab; Anti-HBc IgM
Anti-HBe; Anti-HBs
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REMEMBER: SECCES
Antigen (Surface, Envelope, Core)
Antibody (Core, Envelope, Surface)
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appears shortly after HBsAg
HBEAG
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Maybe elevated during acute phase
HBEAG
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Present during period of active replication
HBEAG
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Indicated that virus has high degree of infectivity (mabilis makahawa)
HBEAG
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Not detected in the serum.
HBCAG
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Detected in liver biopsy.
HBCAG
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First to appear
IGM ANTIHBC
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Indicates current or recent infection.
IGM ANTIHBC
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Appears during recovery period in acute infection.
ANTI-HBS
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Pinakalast Ab na maproproduce.
ANTI-HBS
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It will appear few weeks after HBs antigen disappears and will persist for years and provide protective immunity.
ANTI-HBS
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– means the patient doesn’t show any signs or symptoms
Window Period
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– period wherein the antigen slowly drops down and slowly increases the antibodies
Covalascent
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Progress to chronic state
Covalascent
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METHODS INTRODUCE TO PREVENT HBV INFECTION
Screening of blood donors
Treating plasma derived products to inactivate HBV
Implementing infectious control measures
Immunization with Hepatitis B vaccine
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Screening of blood donors
(Hepatitis C, Hepa B, syphilis, malaria, HIV)
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known as a major public health problem, also known as Non-A or Non-B infection (NANB)
HEPATITIS C VIRUS
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Common worldwide
HEPATITIS C VIRUS
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RNA, flaviviridae
HEPATITIS C VIRUS
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Transmission: parenteral
HEPATITIS C VIRUS
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Less common to sexual transmission than hepatitis B
HEPATITIS C VIRUS
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Asymptomatic
HEPATITIS C VIRUS
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HCV Average incubation period:
7 weeks
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Screening test for HCV:
Detection of HCV IgG antibodies using third generation (ex: rapid test kits)
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Confirmatory test for HCV
Recombinant Immunoblot Assay (RIBA)
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Replaced with molecular methods
Recombinant Immunoblot Assay (RIBA)
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Incomplete or defective virus
HEPATITIS D VIRUS
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Needs Hepa B Virus to replicate: requires surface Ag for replication
“Coinfection”
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HEPATITIS D VIRUS also known as
Delta hepatitis
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is a nonenveloped, single-stranded ribonucleic acid (RNA) virus that belongs to the genus Hepevirus, in the family Hepeviridae
HEPATITIS E VIRUS
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MOT: ingestion (like Hep A), fecal-oral route
HEPATITIS E VIRUS
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Following an incubation period of 3 to 8 weeks
HEPATITIS E VIRUS
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causes an acute, self-limiting hepatitis that lasts 1 to 4 weeks in most people who become infected
HEPATITIS E VIRUS
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Like HAV, the infection does not progress to a chronic carrier state
HEPATITIS E VIRUS
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Diagnosis relies on serologic testing (Because HEV is not easily cultured)
HEPATITIS E VIRUS
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Acute infection demonstrate the presence of [?]
IgM antiHEV
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- detectable during clinical onset
IgM antiHEV
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Identified by highly sensitive enzyme immunoassay
IgM antiHEV
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: Conjugation of bilirubin
LIVER
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Waste product of heme
BILIRUBIN
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120 days: apoptosis. - release of Hb - dissected to heme and globin - waste prod:
indirect/unconjugated bilirubin (toxic)
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Excretion thru [?]
urine and stool
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Further converted to [?] (yellow color of urine)
urobilin/urochrome
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: brown color of urine
Stercobilin
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: Yellowish discoloration of the skin
Jaundice
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: Yellowish discoloration of the brain
Kermicterus
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: Specimen req for bilirubin due to photo-sensitivity
Carbon paper/amber bottle
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Ingestion of street foods; Shed in stool
HEPATITIS A VIRUS
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Persists for life
HEPATITIS A VIRUS
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May be positive in the context of (-) IgM test
HEPATITIS A VIRUS
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Blood transfusion, Occupational needlestick injury, IV drug users - ex. Heroin, Tattooing
HAV
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hepatitis B surface antigen, or HBsAg, HBeAg, With signs and symptoms
After incubation period
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: 3 to 6 months,Anti-HBc
Early recovery
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: Anti-HBs
Decline phase
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is not seen in serum, only in liver biopsy
Core antigen
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Blood bank in the US
HBV
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: whole blood w/o plasma
Packed rbc
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: processed as a base in vaccine; converted to Albumin
Plasma
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Treated w/ chemicals such as detergents (to inactivate virus)
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Blood transfusion, IV drug users, Hemodialysis, Organ transplantation
HCV
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Only seen in chronic infection
HEPATITIS C VIRUS
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Most commonly progress to chronic state
HEPATITIS C VIRUS
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Causes LIVER CIRRHOSIS
HEPATITIS C VIRUS
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Only increased during chronic infection
HCV IgG antibodies
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Most common cause of blood transfussion hepatits
HCV IgG antibodies
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Tests for RNA content (same w/ PCR); Old test but expensive
Recombinant Immunoblot Assay (RIBA)
