Sketchy Micro: Hepatitis B Flashcards
Hepatitis B is in the ____________ family.
Hepadnavirus (short for HEPAtitis DNA VIRUS)
Think of the Hippie PAD.
Describe HBV.
- DNA virus (like the blue and green tones)
- Enveloped (like the hippies’ flowing shirts)
- Circular (like the circle of hippies)
- Partially double-stranded (like the circle with part of it two rows deep)
Uniquely, HBV replicates _______________.
both inside the nucleus and in the cytoplasm (which is why there’s a hippie inside the dome and a bunch outside the dome)
How is HBV transmitted?
- By blood and sex (like the hippie sign for “Sex, Drugs, and Rock & Roll”)
- Mothers can give it to babies during labor by blood exposure (like the hippie pushing her baby in a stroller – both are splattered in red clothing to hammer home the image; also, there are torches by them)
How does HBV replicate?
It uses reverse transcriptase (like the new age girl with the spell book) to replicate via a ssRNA intermediate.
Discuss the rates at which people infected with HBV develop chronic liver infection.
Only about 5% of adults infected with HBV go on to develop chronic liver disease, but almost 90% of neonates will.
(Think of the mother and baby sharing the cookie that looks like a cirrhotic liver – the baby has about 90% of it!)
List some of the extrahepatic manifestations of HBV.
- Arthralgia (like the pain lines emanating from the kneeling hippie)
- Polyarteritis nodosa (like the red beads in her hand), with accompanying kidney disease
- Non-blanching, purpuric, macular rash (like the henna tattoos on her body)
- MPGN and membranous glomerulonephritis (like the other kidney box with two knots in the string above)
In alcoholic liver disease, _____ is usually higher.
In HBV, __________ is usually higher.
AST (Souses Soar)
ALT (like the ALT ball being spiked by the hippie man)
In _____________, transaminase levels are usually normal.
neonatal HBV
Talk about what you’ll find in the serum of someone who’s been infected with HBV.
- HbSAg (this is surface antigen)
- HbEAg (this is the E antigen, which correlates with infectivity)
- Anti-HbC (antibody to core antigen)
- Anti-HbEAg (antibody to E antigen)
- Anti-HbSAg (antibody to surface antigen)
(Think of the hippie van with the word “SpECiES” written on the side: the S and E –correlating with HbSAg and HbEAg – are spikey and antigenic. C is in the window, because this is common in the window period during with people begin to develop antibodies. The second E and S are antibodies to E and S antigens.)
What two serum markers are likely to be elevated in a patient with symptomatic HBV?
HbSAg and HbEAg (which is why Sketchy put these two letters over the flat tire!)
Antibodies to ____________ indicates recovery from HBV.
HbSAg
Immunized people do not have _______________.
anti-HbC or anti-HbE antibodies, so presence of these in the serum indicates past infection
Chronic HBV can cause ____________.
HCC (like the tarot card reader turning over the crab card on the liver-shaped rock)
Describe HDV.
- Negative-sense ssRNA (like the hippie children wearing orange with the moon necklaces)
- Enveloped (like the orange robes they’re wearing)
- Circular genome (like the orange headbands they’re wearing)
Which method of HDV transmission has worse outcomes?
Superinfection
Co-infection, in which HBV and HDV are transmitted together, is less bad (like the kid nicely holding the dad’s hand). Superinfection, when HDV is infected on top of existing HBV, leads to worse outcomes (like the dad obviously displeased with the other kid on his shoulders).
What three drugs treat HBV?
- Lamivudine (like the LAMb on the “Make Peace / Not War” poster)
- Reverse transcriptase inhibitors (like the she-elf on the same poster)
- Interferon alpha (like the bent antenna in the shape of alpha, getting interference)
How is neonatal HBV treated?
With immunoglobulins (like the baby with the IgG rattles)
