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Microbiology Exam 3 > 39 - Viral Infections of the GI Tract I > Flashcards

39 - Viral Infections of the GI Tract I Flashcards

1
Q

What is hepatitis?

A

A disease marked by inflammation of the liver

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2
Q

What are the three main clinical presentations of hepatitis?

A
  • Acute hepatitis
  • Chronic hepatitis
  • Fulminant hepatitis
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3
Q

What are the symptoms of acute viral hepatitis?

A
  • Jaundice
  • Dark urine
  • Alcoholic stool
  • Prodrome
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4
Q

What is “alcoholic stool”?

A

A light or clay-colored stool due to reduction in bile production

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5
Q

What is prodrome?

A

1-2 weeks prior to jaundice

  • Headache
  • Myalgia
  • Arthralgia
  • Fatigue
  • Nausea
  • Vomiting
  • Pharyngitis
  • Mild fever
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6
Q

Why do we see jaundice?

A

Because bilirubin is not properly recycled, so it is elevated in the body

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7
Q

What do we define jaundice as?

A

More that 3 mg/dL of bilirubin

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8
Q

What does bilirubin in the urine indicate?

A

Liver disease

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9
Q

What liver enzymes will be elevated in hepatitis?

A

ALT: alanine aminotransferase
AST: aspartate aminotransferase

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10
Q

When will these enzymes become elevated?

A

In the prodrome phase

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11
Q

Are these enzymes typically more elevated in a viral infection or in hepatitis from alcoholism, etc.?

A

Higher in viral infection

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12
Q

How do we define chronic viral hepatitis?

A
  • Hepatitis which does not resolve within 6 months
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13
Q

What does chronic viral hepatitis predispose individuals to?

A

Hepatocellular carcinoma and cirrhosis

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14
Q

What phases would someone in chronic viral hepatitis go through?

A

There is damage, but also regeneration, so you can go through phases of better and worse

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15
Q

What is fulminant viral hepatitis?

A

Rapid and severe hepatitis which results in massive hepatic necrosis

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16
Q

What else does fulminant viral hepatitis cause?

A
  • Encephalopathy
  • Edema
  • GI bleeding
  • Sepsis
  • Organ failure
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17
Q

What does the encephalopathy cause?

A

CNS effects

  • Confusion
  • Disorientation
  • Coma

Cerebral edema can compress the brainstem

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18
Q

What is something that can be lifesaving to patients with fulminant viral hepatitis?

A

Liver transplant

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19
Q

What are the five types of hepatitis?

A 
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
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20
Q

What virus family is Hepatitis A from?

A

Picornavirus

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21
Q

What is the invubation period for Hepatitis A?

A

2-4 weeks

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22
Q

What is the transmission type for both Hepatitis A and Hepatitis E?

A

Fecal-oral route

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23
Q

What else do Hepatitis A and Hepatitis E have in common?

A

Neither can cause a chronic infection

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24
Q

What is the virus family for Hepatitis B?

A

Hepadnavirus

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25
Q

What is the incubation period for Hepatitis B?

A

6 weeks to 6 months

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26
Q

What type of transmission do we see for Hepatitis B, Hepatitis C and Hepatitis D?

A

Body fluids

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27
Q

What else do Hepatitis B, Hepatitis C, and Hepatitis D have in common?

A

They can cause a chronic infection

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28
Q

What virus family is Hepatitis C from?

A

Flavivirus

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29
Q

What is the incubation period for Hepatitis C?

A

2 months

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30
Q

What is the virus family for Hepatitis D?

A

Deltavirus

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31
Q

What is the incubation period for Hepatitis D?

A

2 to 12 weeks

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32
Q

What is the virus family for Hepatitis E?

A

Hepevirus

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33
Q

What is the incubation period for Hepatitis E?

A

6 to 8 weeks

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34
Q

Which Hepatitis virus is the ONLY one with a DNA genome?

A

Hepatitis B

All the others have a RNA genome

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35
Q

What age groups are most susceptible to Hepatitis A?

A

All age groups

Children are usually asymptomatic

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36
Q

How long does it typically take to resolve an infection from Hepatitis A?

A

2 months

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37
Q

Can Hepatitis A cause fulminant hepatitis?

A

Very rarely

38
Q

How do you diagnose Hepatitis A?

A

Test for IgM antibodies against the Hepatitis A virus

39
Q

Why wouldn’t you want to test for IgG antibodies against Hepatitis A virus?

A

Because these are protective immunity and are normally present (does NOT indicate an infection)

40
Q

How do we prevent Hepatitis A?

A

Vaccination

The inactivated vaccine has been available since 1995

Two IM doses, universally recommended for infants

41
Q

What can you do prophylactically after an exposure?

A

Vaccinate or give anti-HAV IgG antibodies

42
Q

What is unique about the Hepatitis B virus?

A

is has a partially dsDNA genome

43
Q

What does this allow to be part of the viruses life cycle?

A

Reverse transcription

Not a retrovirus though

44
Q

How do you diagnose Hepatitis B?

A
  • Viral antigens and anti-HBV antibodies
45
Q

What marks an active infection?

A

HBsAg (HB=hep B, Ag=antigen) in the blood

46
Q

When would you see Hepatitis B antigens in the blood (HBsAg)?

A

Acute infection

Chronic infection

47
Q

When would you see antibodies for the Hepatitis B antigen in the blood?

(anti-HBsAg)

A

Vaccinated individuals

Previously infected individuals

48
Q

When would you see IgM antibodies against Hepatitis B?

A

Acutely infected only

49
Q

When would you see all antibodies against Hepatitis B?

A

Acutely infected
Chronically infected
Previously infected

50
Q

What are some ways that Hepatitis B can be transmitted through body fluids?

A
  • Sexual
  • Needle stick
  • Perinatal
51
Q

What percentage of infected adults are asymptomatic?

52
Q

Are the acute symptoms of Hepatitis A or Hepatitis B more severe?

A

Hepatitis A

Acute hepatitis symptoms of Hepatitis B are often milder than Hepatitis A

53
Q

What are Hepatitis B infected individuals at risk for?

A

Chronic infection

54
Q

What is the risk of chronic infection correlated with?

A

Age at the time of infection

The younger the individual is, the higher the risk of chronic infection

55
Q

How do we treat acute Hepatitis B?

A

There is no treatment for the acute infection

56
Q

How do we treat chronic Hepatitis B?

A
  • Lamivudine (reverse transcriptase inhibitor)
  • Famcyclovir/Adefovir dipivoxil (nucleoside inhibitor)
  • Interferon-alpha
57
Q

What does a vaccine for Hepatitis B contain?

A

Purified HBsAg protein

58
Q

How soon after birth of an infant exposed to Hep B during labor would you want to give the vaccine?

A

Within 12 hours

Along with HBIG

59
Q

What is the difference between premature births and full term births interms of Hep B treatment?

A

If you don’t know it the mother was Hep B positive or not and the infant was premature, you give the treatment as a precaution

If the baby is full term, only give the treatment if you knwo the mother is Hep B positive

60
Q

When else would you give this preventative treatment?

A

Health care worker exposure

61
Q

Do we test donated blood for Hep B?

A

YES

  • Hep B surface antigen
  • Hep B core antibody

Also, the general test for hepatitis is ALT elevation

Hep C is the other one that is specifically tested for

62
Q

What is Hepatitis C typically associated with?

A

Injection drug use

It is estimated that 45% of injection drug users between 18 and 45 have Hepatitis C

63
Q

How else can you get Hepatitis C?

A
  • Tatoos
  • Needle sticks
  • Perinatal transmission
  • Sexual encounters
64
Q

How do you diagnose Hepatitis C?

A
  • Screening test - antibody test for anti-HCV antibodies

- Confirmatory test - neucleic acid based tests for detection of the viral genome

65
Q

In what order will you be able to detect Hepatitis C from laboratory results?

A

1 - Hepatitis C virus RNA
2 - ALT elevation
3 - Anti-Hepatitis C virus antibodies

66
Q

Is the acute disease from Hepatitis C more or less severe than Hepatitis A and B?

A

Less severe

67
Q

How do you treat Hepatitis C?

A

It depends on the genotype of chronic Hepatitis C that your patient has

68
Q

How do you treat chronic genotype I Hepatitis C virus?

A

Three options
1 - ledipasvir/sofosbuvir
2 - paritaprevir/ritonavir/ombitasvir, dasabuvir, and ribavirin
3 - sofosbuvir and simeprevir ± ribavirin

KEY drug: Sofosbuvir

69
Q

How do you treat chronic genotype II or III Hepatitis C virus?

A

sofosbuvir and ribavirin

KEY drug: Sofosbuvir

70
Q

How do you treat chronic genotype 4, 5 or 6 Hepatitis C virus?

A

No guidelines

71
Q

What drug do you need to remember for the treatment of chronic Hepatitis C

A

Sofosbuvir

72
Q

Why is there controversy over Hepatitis C treatment?

A

$84,000 for a 12-week course of treatment

That’s $1000 per pill

73
Q

How do we prevent Hepatitis C?

A

No vaccine available

  • Reduce risky behaviors
  • Screen blood donation supply
74
Q

How do we screen blood for Hepatitis C?

A
  • Nucleic acid test
  • Hepatitis C antibody test
  • ALT elevation (general)
75
Q

What is unique about Hepatitis D?

A

It only infects cells that have been previously or are currently infected with Hepatitis B

76
Q

What types of proteins does Hepatitis D encode?

A
  • Delta short antigens
  • Delta long antigens

These proteins cover the virion

77
Q

What type of virus does this make Hepatitis D?

A

A unique helper-dependent virus

78
Q

How do Hepatitis B and Hepatitis D interact?

A

Hepatitis B surface antigen forms the external surface of the virion.

Replication of Hepatitis D requires Hepatitis B

79
Q

What percent of Hepatitis B patients are infected with Hepatitis D?

80
Q

What is more likely when someone is infected with both Hepatitis B and D?

A

Fulminant hepatitis

81
Q

What is very unique about the pathogenesis of Hepatitis D?

A

It is the ONLY hepatitis virus that directly injures hepatocytes

82
Q

How do we diagnose a Hepatitis D infection?

A

ELISA to detect Hepatitis D antibodies or the delta antigens on its surface

83
Q

How do we treat Hepatitis D?

A

No specific recommendation

84
Q

How do we prevent Hepatitis D?

A

Prevent Hepatitis B

85
Q

How is Hepatitis E transmitted?

A

Fecal-oral route

86
Q

Can Hepatitis E cause a chronic infection?

87
Q

What are most cases in the US associated with?

A

Recent travel

88
Q

What areas do we see epidemics of Hepatitis E?

A
  • India
  • Pakistan
  • Nepal
  • Burma
  • N Africa
  • Mexico
89
Q

What population is at high risk for fatality from Hepatitis E?

A

Pregnant women - etiology is unknown

90
Q

How do we treat Hepatitis E?

A

Supportive

91
Q

How do we prevent Hepatitis E?

A

Clean water and proper food handling

Microbiology Exam 3 (8 decks)

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