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Virology 11-20 > #15 viral hepatitis > Flashcards

#15 viral hepatitis Flashcards

1
Q

what is hepatitis

A

inflammation of the liver

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2
Q

what are symptoms of acute hepatitis

A
  • dark urine
  • pale faeces
  • jaundice
  • flu like symptoms
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3
Q

how long does acute hepatitis last for

A

weeks to months

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4
Q

how long does chronic hepatitis last for

A

years to lifelong

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5
Q

what cells are infected from hepatitis

A

liver cells called hepatocytes

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6
Q

what causes liver damage in hepatitis?

A

the immune response against the virus

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7
Q

how can hepatitis enter the hepatocytes?

A

via immune cells in the circulation
via the circulation
via DCS

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8
Q

what are later phase symptoms of hepatitis

A

cirrhosis of the liver from chronic liver damage - can damage and lose function of the liver
hepatocellular carcinoma

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9
Q

is hepatitis cytopathic

A

no - its non-cytopathic

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10
Q

what determines the outcome of hepatitis infection?

A

age related outcomes!
younger people will have a less severe acute infection but they will have a higher chance of developing a chronic infection (as they have a immature immune system)
older people will have severe acute infection vbut may clear the virus and not become chronic

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11
Q

is there cross reactivity between the hepatitis viruses

A

there is no cross reactivity

infection with one virus will not protect from another hepatitis virus

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12
Q

can you clear Hep. B?

A

no - lifelong infection

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13
Q

can you clear hep. c?

A

no - lifelong infection EXCEPT if you are treated with antivirals

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14
Q

where is the source of Hep A and Hep. E

A

faeces

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15
Q

how do you catch Hep A and E

A

contaminated water or food/ fecal oral route is the main source
however it can be transmitted by blood, and sexual activity!

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16
Q

what type of infection is Hep A and E

A

acute

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17
Q

how can you prevent hep. E

A

clean drinking water

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18
Q

how can you prevent hep. A

A

pre or post immunisation

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19
Q

how is Hep. B transmitted

A

percutaneous
or
permucosal

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20
Q

how is Hep. C transmitted

A

percutaneous
or
permucosal

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21
Q

how is Hep. D transmitted

A

percutaneous
or
permucosal

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22
Q

what type of infection is Hep. B C and D

A

chronic

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23
Q

where is the source of Hep B C and D

A

blood and bodily fluids

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24
Q

how do you determine an acute infection?

A

ELISA serological test: test for high IgM - IgM presence or rising IgG to viral proteins is an indicator of a acute infection

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25
Q

can you use nucleic acid tests to detect acute infection?

A

PCR yes - but it will not tell you how long the person has been infected for like ELISA can

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26
Q

what family is Hep. A and what is the genome

does it have an envelope

A

picornaviridae
small +ssRNA
no envelope (resistant to stomach acid)

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27
Q

is there a vaccine for Hep. A

A

yes

it can be cultured

28
Q

describe the life cycle of Hep A and E

A
  • virus ingested via food or water
  • replicates in the intestine epithelium then accesses blood to perform primary viremia
  • accesses hepatocytes
  • replicates in liver and is secreted into bile and faeces
29
Q

what is the incubation period for Hep. A

A

30 days

30
Q

what are the symptoms by age for Hep. A

A
  • under 5 less than 10% will show symptoms

- over 14 70-80% will show symptoms

31
Q

what are the symptoms of Hep. A

A

pale faeces
dark urine
jaundice
vomiting

32
Q

what is the chronic sequalae of Hep. A?

A

none. doesnt cause chronic infection

33
Q

when can you measure virus in the faeces in Hep. A infected patient

A

virus can be measured in faeces before symptoms appear

34
Q

what antibodies will be produced in a hep. a infection

A

firstly IgM will be produced then when the virus is being cleared they will class switch to IgG

35
Q

what family is Hep. E in
does it have an envelope
what type of genome does it have

A

Hepeviridae
its a Hepevirus
no envelope
+ssRNA

36
Q

what are outbreaks of Hep. E associated with

A

outbreaks of fecally contaminated drinking water

37
Q

how do you prevent Hep. E

A

clean sanitised drinking water

38
Q

what is the incubation period for Hep. E

A

40 days

39
Q

what is the chronic sequalae for hep E

A

none - does not cause a chronic infection

40
Q

what does ALT mark

A

ALT is a marker of virus replication in the liver. increased ALT means increased virus replication

41
Q

when do the symptoms of Hep. E show in comparison to when the virus is detectable?

A

the virus is detectable before the presence of symptoms

42
Q

what family is hep b
what is its genome
is it enveloped

A

hepadnaviridae
dsDNA
enveloped

43
Q

what are HBsAg

A

Hep. B surface antigens. they are produced as non-infectious particles
they circulate in high levels in the blood
contain only envelope proteins

44
Q

what does the Pre-C region encode on Hep. B

A

it is the pre-core region on the genome
encodes for HbeAg
it is antigenic
it determines replicating virus in cells

45
Q

explain the lifecycle of Hep. B

A
  • virus enters via blood or sex or needles
  • if its on the mucosa it will penetrate into the blood (if transmitted by needle it already enters the blood)
  • will access hepatocytes of liver and replicate there
    (it only replicates in the liver!!)
46
Q

how much is Hep. B concentrated in secretions and blood?

A

highest in blood and serum
moderate: semen, vaginal fluid and saliva
low/not detectable: urine, faeces, sweat, tears, milk

47
Q

what is the incubation period for Hep. B

A

60-90 days

48
Q

what is the rate of chronic infection in people less than 5 yrs old for hep B

A

60-90% develop chronic infection due to immune system unable to clear the virus

49
Q

what does the outcome depend on for hep. b infection?

A

the immune system
under 5: low acute phase, high risk of chronic infection

over 5: acute phase severe, and less likely to develop chronic hep. b

50
Q

if a person develops chronic Hep. B what else can develop

A
  • chronic > cirrhosis > liver cancer (end stage)
51
Q

what is the serological response of a Hep. B acute infection?

A
  • HbsAg rises as virus is replicating
  • immune response may cause symptoms
  • HbeAg will be measured in early stages - this will in the later stages switch to Anti-Hbe which indicates the virus is being controlled and will be cleared!!
52
Q

what is the serological response of a Hep. B chronic infection?

A
  • HbeAg will be ongoing and is showing that virus is replicating - indicator of chronic virus
  • no Anti-Hbe will be made
  • there are sustained levels of Ab for the core protein -AntiHbc
  • no viral clearance
53
Q

what is the sequelae of Hep. B

A

chronic infection
causes liver damage from the immune system
cirrhosis, liver failure, hepatocarcinoma
Hep. B is most common cause of liver cancer

54
Q

how can hep. b infection be prevented

A

vaccination

it can be cultured

55
Q

how is hep. b diagnosed

A
  • A battery of serological tests are used for the diagnosis of acute and chronic hepatitis B infection.
  • HBsAg - used as a general marker of infection
  • Anti-HBs Ig - used to document recovery and/or immunity to HBV infection, but also successful vaccination
  • anti-HBc IgM - marker of acute infection
  • anti-HBc IgG - past or chronic infection
  • HBeAg - indicates active replication of virus and therefore effectiveness of therapy.
  • Anti-HBe Ig - virus no longer replicating. However, the patient can still be positive for HBsAg which is made by integrated HBV
    HBV-DNA - indicates active replication of virus, more accurate than HBeAg especially in cases of escape mutants. Used mainly for monitoring response to therapy
56
Q

what does Hep. B vaccine protect against

A

Hep. B and D

57
Q

what family is Hep. D

what is its genome

A

Deltavirus

+ssRNA - highly complimentary

58
Q

what us unique about Hep. D infection

A

it only co-infects with Hep. B

it uses Hep. B surface antigen to gain access to hepatocytes

59
Q

what family is Hep. C

what is its genome

A

flaviviridae

+ssRNA

60
Q

80% of Hep. C infections occur through….

A

intravenous drug use

61
Q

what percentage of people develop chronic hep. c infection

A

70% - high!

62
Q

is there a vaccine for Hep. C

A

no - no animal model either

63
Q

what proteins make up the viral RdRp of Hep. C

A

NS5B protein and NS3 protein make up the RdRp. it is highly error prone and introduces mutations

64
Q

what is the incubation period for Hep. C

A

6-7 weeks

65
Q

what percentage of people become infected with Hep. C

A

70% - high!

66
Q

what is the sequalae of Hep C

A

liver damage - cirrhosis

is the primary cause of hepatocellular carinoma

67
Q

can Hep. C be cured?

A

yes - with antivirals

Virology 11-20 (8 decks)

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