11-30 Treatment of Hepatitis DSA - Phys & Tx Guidelines Flashcards
What is the case definition of acute viral hepatitis?
- Discrete onset of symptoms – nausea, anorexia, fever, malaise, or abdominal pain;
- PLUS jaundice or elevation in serum aminotransferase levels.
How do you confirm Dx of hepatitis?
serological testing, clinical characteristics similar
What can untreated acute viral hepatitis lead to?
Untreated, hepatitis B and C infections may cause significant disease leading to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). These infections are associated with high morbidity and mortality.
Compare Hepatitis A, B, and C viruses in regards to:
RNA or DNA
A - RNA
B - DNA
C - RNA
Compare Hepatitis A, B, and C viruses in regards to:
Transmission
A - fecal oral
B - sexual, parenteral, perinatal
C - sexual, parenteral, perinatal
Compare Hepatitis A, B, and C viruses in regards to:
Incubation period
A - 28 (15-50 days)
B - 90 days (60-150 days)
C - 4-12 weeks (2-24 weeks)
Who is at risk in catching Hepatitis A?
Travelers to countries with high/intermediate prevalence of HAV
Children, household, or personal contacts
Men who have sex with men
Injection drug users
Persons with clotting factor disorders
Low socioeconomic status (poor sanitation/overcrowding)
Persons working with nonhuman primates
Who is at risk in catching Hepatitis B?
Sex partners of infected persons
Infants born to infected mothers
Men who have sex with men
Injection drug users
Household contacts of persons with chronic HBV
Healthcare workers at risk for occupational exposure
Hemodialysis patients
Travelers to countries with high/intermediate prevalence of HBV
Who is at risk for catching Hepatitis C?
Current or former injection drug users
Recipients of clotting factor concentrates before 1987
Recipients of blood transfusions or solid organ transplants before July 1992
Chronic hemodialysis patients
Persons with known exposure to HCV
Persons with HIV
Children born to HCV-positive mothers
What does Hepatitis A cause, in terms of SSXs?
Acute, self-limiting illness which confers lifelong immunity once exposed.
Adults – symptoms usually last < 2 months; most common sign is jaundice (70%).
Children < 6 years – no jaundice occurs; majority asymptomatic but viral shedding can last for months (serve as a highly infectious reservoir).
What is the incidence of Hepatitis A?
Incidence of acute HAV has dropped 95% (1995-2013), likely due to vaccination recommendations.
What is the testing for Hepatitis A?
Serologic test: immunoglobulin M (IgM) antibody to HAV.
What is the treatment for Hepatitis A?
Treatment: supportive care; nearly all patients will have clinical resolution within 6 months of infection (majority will experience clinical resolution earlier, within 2 months).
What is the prevention and prophylaxis of Hepatitis A?
Prevention and prophylaxis – good hand hygiene; vaccination.
Immunoglobulin (Ig) for pre-exposure and post-exposure prophylaxis (passive immunity).
Vaccination preferred (active immunity) but Ig used when vaccine not an option (i.e., allergy).
How infectious is Hepatitis B? Is it curable?
Highly infectious (50-100x more than Human Immunodeficiency Virus); infection is not curable.
How has the incidence of Hepatitis B changed?
Incidence of acute HBV has dropped ~82% (1991-2013); the greatest decline has occurred among children born since 1991 (routine vaccination recommendations implemented).
What are the SSXs of Hepatitis B infection?
Symptoms: fever, anorexia, nausea, vomiting, jaundice, dark urine, pale stools, abdominal pain, fatigue, joint pain.
Many neonates, children, and adults have no clinical symptoms.
Children (perinatal exposure) pose a special problem as viral replication may last decades while patient is asymptomatic, undiagnosed, and highly infectious.
In testing for Hep B, when does HBsAg occur?
Hepatitis B surface antigen (HBsAg) – HBV surface protein; high levels occur during acute or chronic infection. If HBsAg found, patient is infectious. Normal immune response produces antibodies to this antigen (HBsAg used to make HBV vaccine).