4.1 Viral Hepatitis Flashcards
Is caused by Hepatitis A, B, C, D or E virus that makes the liver inflamed
Viral hepatitis
If diagnosis and treatment are delayed, chronic infection may lead to?
Liver cirrhosis
Hepatocellular carcinoma
Global infection of hepa B?
296 million
Hepatitis B infection, South east asia is ranked?
3rd (60 million)
47% are attributed to Hepa?
B
48% are attribued to Hepa?
C
5% for Hepa?
A and E
The goal of WHO to eliminate Hepa B and C by how many percent by 2030?
90%
Example of Intervention to prevent Hepa virus?
3 doses of HBV vaccine
Blood / Injection safety
Harm reduction
HBV and HCV testing and treatment
Non-envelope hepa virus that contains RNA genome
Hepatitis A
Hepatitis E
Hepatitis B can be shaped as?
Spherical
Elongated
Hepatitis surface antigen is located on?
Envelope
Hepatitis surface antigen is located on?
Envelope
Hepatitis Capsid is also known as the?
Hepatitis Core
Heptitis B virus is a Double stranded DNA?
T or F
T
Enveloped Hepa virus that contains RNA genome
Hepatitis C Virus
Envelope hepa virus that contains RNA genome and requires HBsAg to be distinguished?
Hepatitis D virus
All hepatitis virus contains RNA genome except?
Hepatitis B virus
Hepatitis viruses are known as Obligate intracellular pathogens?
T or F
T
RNA viruses replicates in the?
Cytoplasm
DNA viruses replicates in the?
Nucleus
Immune system fights the specific virus leading to production of Antigens against the specific antibodies
T or F
F
Immune system fights the specific virus leading to production of antibodies against the specific antigen
T or F
How virus replicates?
Attachment
Penetration
Uncoating
Transcription
Translation
Assembly
Budding off
Release
(APUTTA BuR)
Part of virus replication where virus enters into the host cell though endocytosis
Penetrtion
Part of virus replication where virus attaches to a receptor on the host cell surface
Attachment
Part of virus replication where Viral capsid and release of viral nucleic acid
Uncoating
Part of virus replication where produce additional viral nucleic acid
Transcription
Part of virus replication where Viral nucleic acid is translated to produce viral protein
Translation
What part of the human body specifically in the liver does hepatitis virus infects?
Hepatocyte
Functional unit of liver?
Hepatic lobules
Viral protein is assembled in which part of the cell?
Golgi apparatus and endoplasmic reticulum
Once the virus manage to replicates in the cell, the cell will undergo? (Other name of cell death)
Apoptosis
4 phases of viral infection
asymptomatic; laboratory studies demonstrate serologic and enzyme markers?
Phase 1
Phase 1 is also known as?
Viral replication phase
4 phases of viral infection
anorexia, nausea, vomiting, alterations in taste, arthralgia, malaise, fatigue, urticaria, and pruritus;having gastroenteritis or a viral syndrome
Phase 2
Phase 2 is also known as?
prodomal phase
4 phases of viral infection
Dark urine, followed by pale-colored stools
Hepatomegaly
Phase 3
Phase 3 is also known as?
Icteric phase
4 phases of viral infection
Symptoms and icterus resolve, liver enzymes return to normal
Phase 4
Phase 4 is also known as?
Convalescent phase
What are liver enzymes that increases phase 1?
Alanine Aminotransferase
Aspartase aminotransferase
What causes dark urine?
Conjugated and unconjugated bilirubin
Due to excess bilirubin in the blood, this indicates?
Jaundice
Hepatomegaly
Where specifically in the liver cause hepatomegaly?
Right upper quadrant
Is the following virus correct?
Hepatitis A: 2-4 weeks
Hepatitis D: 3-7 weeks
Hepatitis E: 2-10 weeks
T or F?
T
Which of the hepa virus has 4-24 weeks incubation
Hepa B
Which of the hepa virus has 2-24 weeks?
Hepa C
What of the viruses does not chornicity rate > 6 months?
Hepa A
Hepa E (Very rare)
What is the diagnostic marker for HBV?
HBsAg (serum)
What is the diagnostic marker for HCV?
Anti-HCV (Serum)
What is the diagnostic marker for HDV?
Anti-HDV IgM/IgG (Serum)
In hepa B, the chronic state for adults is higher than infants?
T or F
F
Infants: 90%
Adults: 5%
What chornicity rate for HCV is up to 75%?
T or F
T
Chronic infection type for HDV are:
Coininfection
Superinfection
Surfaceinfection
Which of these does not belong?
Surfaceinfection
The following causes hepatocellular carinoma:
HAV
HBV
HCV
HDV
HEV
Which of the following does not cause the carcinoma?
Hepa A
Hepa E
What is the route of transmission for Hepa B, C, and D?
Parental
Sexual
Perinatal
What is the route of transmission for Hepa A and E?
Foodborne
Waterborne
The only virus does not have vaccine?
Hepa C
HEV is availble in China
Hepa D virus can be prevented by Vaccine of Hepa B?
T or F
T
What virus can be CURED?
HCV
The treatment for this virus is lifelong treatment, what virus is this?
Hepa B
If HBV-HDV coinfection treat as HBV?
T or F
T
HAV and HEv does not have treatment?
T or F
T
Supportive treatment meaning, the body can eliminate these viruses
Sample for both HEV and HAV?
Serum or Stool
What is being detected in serological test?(Immunoassays)
Antibodies
Viral antigen
What is being detected in molecular? (PCR)
Parts of the virus
Viral nucleic acid (DNA or RNA)
Single-used disposable assays
Qualitative in under 30 mins
Rapid diagnostic test
What are the specimen used in Rapid diagnostic test (RDT)?
Finger stick
Venous whole blood
Serum or plasma
Oral fluid
EIA, CLIA, ECLS detects antibodies, antigens or a combination of both
T or F
T
A Cut-Off value specifies that point at which the results are considered to be reactive
T or F
T
How is EIA being reported?
Optical density / Cut off
Uses a magnetic particle coated with anti Hbs
What immunoassay is this?
Chemiluminescent microparticle immunoassay (CMIA)
What measures CMIA?
luminometer
Neutralization assay confirms?
HBsAg
Confirmed as positive for Neutralization assay is the reduction in signal of the neutralized specimen is at least 75%?
T or F
F
50%
Line immunoassay and Immunoblot confirms?
Hepatitis C virus
To confirm the presence of antibodies to HCV that have already been detected by other serological assays
Line immunoassay and immunoblot
Detection of low levels of the virus
Detect genotypes or subtypes
Requires sophisticated equipment
Molecular assays
In HAV
Serological markers that indicates recent or acute infection
Anti-HAV IgM
In HAV
Serological markers that indicates past exposure or due to vaccination
Anti-HAV IgG
HAV antigens present in stool is significant in the diagnosis?
T or F
F
Not significant
In HAV
Molecular test only test symptomatic patients
T or F
T
Molecular test for HAV uses blood or feces?
T or F
T
What are the HBV proteins?
S antigen (HBsAg)
E antigen (HBeAg)
Core antigen (HBcAg)
“Acute” infection of HBV markers?
HBsAg
Indicates replication of HBV?
HBeAg
Recovery phase indicatorys?
Anti-HBe
More than 6 months and HBeAg still active along with HBsAg means?
Anti-HBV IgG (+)
Chronic infection
Cut off for Anti HBs in vaccination
10 IU/mL
HBsAg: Negative
Anti-HBc: Negative
Anti-HBs: Negative
Susceptible
HBsAg: Negative
Anti-HBc: Positive
Anti-HBs: Positive
Immune due to natural infection
HBsAg: Negative
Anti-HBc: Negative
Anti-HBs: Positive
Immune due to hepatitis B vaccination
HBsAg: Negative
Anti-HBc: Negative
Anti-HBs: Positive
Immune due to hepatitis B vaccination
HBsAg: Positive
Anti-HBc: Positive
IgM anti-HBc: Positive
Anti-HBs: Negative
Acute infection
HBsAg: Positive
Anti-HBc: Positive
IgM anti-HBc: Negtaive
Anti-HBs: Negative
Chronically infected
HBsAg: Negative
Anti-HBc: Positive
Anti-HBs: Negtaive
Unclear
- Resolved infection (Most common)
- False-positive anti-HBc; thus susceptible
- “Low level” chronic infection
- Resolving acute infection
In molecular assays for HBV DNA:
HBV DNA Qualitative determines presence or absence of HBV DNA
HBV DNA quantitative measures the viral load
T or F
T
More than 200,000 copies/mL indicates?
Rapid replication (Clinically significant
Less than 300 copies/mL indictes?
Low or undetectable
Viral load is useful to monitol treatment response
T or F
T
After 6 months, HCV RNA is diminished or gone
ALT level is returning back to normal
Infection is resolved
Acute HCV infection: Resolved
HCV RNA is persistent, and anti HCV
Fluctuating ALT
HCV chronic infection
Serologic markers for HCV?
Anti-HCV IgM
Anti-HCV IgG
Used to confirm infection in HCV positive antibody testing
HCV RNA qualitative
To measure a patient’s baseline viral load prior to starting HCV therapy
To monitor a patient’s response to therapy
To determine whether a patient has achieved a sustained virologic response (SVR)
HCV RNA quantitative
HCV RNA qualitative positive is detected _________ weeks after infection
1-3
Determine the exact genotype and subtype of the virus
Genotyping
Purpose of genotyping is to provide effective treatment
T or F
T
PEG-IFN-a/Ribavirin treatment is more effective in patients with genotypes 1 or 2 than in patients with genotype 3
T or F
F
PEG-IFN-a/Ribavirin treatment is more effective in patients with genotypes 2 or 3 than in patients with genotype 1
HCV antibody nonreactive indicates?
No HCV antibody detected
HCV antibody reactive indicates?
Presumptive HCV infection
HCV antibody reactive,
HCV RNA detected
indicates?
Current HCV infection
HCV antibody reactive,
HCV RNA not detected
indicates?
No current HCV infection
Serologic markers for HDV:
HBsAg and HDV positive indicates?
Co-infection from HBV and HDV
Serologic markers for HDV:
Anti-HDV positive plus IgM anti-HBc indicates?
Co infection
Serologic markers for HDV:
Anti-HDV positive plus IgG anti-HBc indicates?
Superinfection
Serologic markers for HEV:
Anti-HEV IgM indicates?
Acute infection that is elevated in 4 weeks
Serologic markers for HEV:
Anti-HEV IgG indicates?
Past infection that is elevatd after 4 weeks to years
Gold standard for molecular in HEV?
HEV RNA PCR
HEV appearances in feces late about ___ weeks than blood specimen
2
HEV RNA is undetectable 3 weeks after showing symptoms
T or F?
T