28. Hepatitis virus Infections

Question 1

Clinical symptoms of hep

Answer 1

• jaundice
• dark urine
• abdominal pain
• itching

Question 2

laboratory tests for hep

Answer 2

• levels of liver enzymes (AST, LDH) in blood are elevated

- hep markers

Question 3

is hep cytolytic?

Answer 3

Hep is not cytolytic, doesnt kill liver cells

Question 4

what causes symptoms in acute stage of hepatitis infection?

Answer 4

cytotoxic effects of host immune system.

Question 5

Chronic hepatitis is caused by hep ______, damage to liver is caused by ____.

Answer 5

B, C, D

ineffective host immune system still causes inflammation and low level cytotoxicity.

Question 6

Which hep virus causes the largest % acute disease?

Answer 6

Hep B > Hep A > Hep C

Question 7

Which hepatitis virus do we have a vaccine for?

Answer 7

Hep A and B

NOT for C.

Question 8

Which is more transmissible, hep B or C?

Answer 8

Hep B is more transmissible.

Question 9

Which hepatitis virus can lead to Hepatocellular carcinoma (HCC)?

Answer 9

Hepatitis B and C.

Question 10

% of HBV infections that lead to chronic infec, HCV?

Answer 10

HBV = 10%
HCV = 50%

Question 11

Difference in serology of chronic vs. acute HBV infection.

Answer 11

• difference is that surface protein (HBsAg) continues to be detected bc the virus persists, but no antibodies to the surface protein is developed (no anti-HBs). There are Ab to HBc (core protein) but remember these are not protective.
  If the infection lasts > 6 months, it is considered to be a chronic infection

Question 12

IgM antiHBc (+) and HBsAg (+)

Answer 12

acute HBV infection

Question 13

If a pt shows symptoms of acute hep infection, and tests + for acute HBV infection:

Answer 13

• monitor & re-test after 6 months to determine if chronic, even though most HBV infections DO NOT become chronic.
• Suggest HAV vaccine, male homosexual activity increases risk of HAV infection, which could be more serious if added to HBV infection.
• advise safe sex practices = risk of transmission.
• Close contacts should get HBV vaccine (since he has it)

Question 14

male homosexual activity increases the risk of ____ (hep) infection, which could be more serious with the underlying ___ infection.

Answer 14

HAV (may be more serious with underlying HBV)

Question 15

Decreases in ACUTE hep infections are due to:

Answer 15

• vaccination programs (HAV & HBV)
• screening of blood supply (HBV & HCV)
• increased safe sex practices to prevent HIV infection

Question 16

4 Risk factors for hep A transmission:

Answer 16

1. Travel to a region with endemic HAV (Mexico, India, Africa)
2. Close personal contact with infected (household contact, child day-care centers)
3. male homosexuality
4. Outbreaks due to contaminated food, water (infected food handlers)

Question 17

3 events that occur with recovery from HBV infection:

Answer 17

Loss of symptoms
Loss of HBsAg
Appearance of anti-HBs **

Question 18

key events that differentiate acute/chronic HBV infection:

Answer 18

weaker acute symptoms
anti-HBsAg antibodies never develop (but will show anti-HBc)
virus persists for more than 6 month (life long)

Question 19

HBsAg indicates ___

Answer 19

presence of virus (acute or chronic)

Question 20

IgG-HBc indicates ____

Answer 20

current or past infection

Question 21

IgM anti-HBc indicates ____

Answer 21

current acute infection

Question 22

Anti-HBs indicates ____

Answer 22

was vaccinated (not generally used)

Question 23

What is the key antibody that distinguishes acute from chronic HBV?

Answer 23

IgM anti-HBc (-) = chronic.

Question 24

progression to chronic infection is correlated with ___

Answer 24

age – yonger ppl are more likely to develop.

Question 25

Hepatitis B Vaccine contains ____, recommended for ___

Answer 25

Recombinant HBsAg expressed in yeast
Requires 3 doses
Recommended for all newborns

Question 26

Hepatitis B Immune Globulin (HBIG) – used to treat who?

Answer 26

Post-exposure prophylaxis of HBV infection

For infant born to HBV positive mother and Post liver transplant HBV pts.

Question 27

antibody to HCV indicate __-

Answer 27

• either a past infection (recovered) or a current infection (either acute or chronic).
• Remember, antibody to HCV is NOT protective and will be present at the same time as the infection.

Question 28

if + for antibody to HBc but negative for HBs (viral surface protein) means __

Answer 28

recovered from HBV infection in the past.

Question 29

If pt has antibodies to HCV, testing for ___ can distinguish chronic/acute or past infection with HCV.

Answer 29

HCV RNA
Positive = chronic/acute HCV infec. retest in 6 months.
Negative =

Question 30

if a pregnant woman has chronic HCV, newborn should be ___

Answer 30

tested, but transmission is low for HCV.

Question 31

HCV positive pts are at risk of more severe outcomes for ___

Answer 31

HAV infections