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Microbiology Unit 3 > 8 Viral Hepatitis > Flashcards

8 Viral Hepatitis Flashcards

1
Q

Hepatitis viruses primarily infect and damage the…

A

Liver

Can cause the icteric symptom of jaundice

Release liver enzymes due to tissue damage

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2
Q

Which Hepatitis viruses come from feces and are transmitted by fecal-oral route?

A

Hep A and Hep E

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3
Q

Which hepatitis viruses are blood borne and transmitted by Percutaneous or permucosal means?

A

Hep B
Hep C
Hep D

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4
Q

Which Hepatitis viruses can become chronic infections?

A

Hep B
Hep C
Hep D

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5
Q

Which Hepatitis viruses can be prevented by pre/post-exposure immunization?

A

Hep A and Hep B

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6
Q

Which hepatitis virus can be prevented by blood donor screening and risk behavior modification?

A

Hep C

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7
Q

Which hepatitis virus can be prevented by both immunization and risk behavior modification?

A

Hep D

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8
Q

Which hepatitis virus can be prevented by ensuring safe drinking water?

A

Hep E

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9
Q

How do you recognize subclinical, anicteric hepatitis?

A

Seroconversion

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10
Q

What does typical acute icteric hepatitis look like?

A

Incubation period varies depending on strain

Prodrome (per-icteric phase) - fatigue, malaise, anorexia

Icteric phase - dark urine, jaundice, hepatomegaly and elevation of serum enzymes (ALT, AST)

Followed by convalescent phase - disappearance of jaundice and other symptoms

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11
Q

What is fulminant hepatitis?

A

Hepatitis infection outside the liver itself

High fatality rate

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12
Q

Hepatitis A virus causes…

A

Infectious hepatitis

Does NOT become chronic

A is for assholes - because it’s transmitted fecal-oral

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13
Q

What is the HAV epidemiology?

A

Worldwide distribution, no seasonal pattern to infection

Excreted in feces

Food and water borne transmission - esp SHELLFISH**

Primarily closed populations with poor hygiene at risk

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14
Q

How is HAV diagnosed?

A

IgM antibody demonstrated by ELISA

Many asymptomatic infections occur, so antibody is common

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15
Q

How do you treat Hep A?

A

Bed rest, reduction of activities

Keep patient well hydrated and in good state of nutrition

Avoidance of hepatotoxic (alcohol, drugs, anesthesia)

If IV fluids needed or deteriorating liver function —> hospitalize

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16
Q

How do you prevent Hep A?

A

PROPER HANDWASHING (PATIENT ED)

Avoidance of contaminated food (UNCOOKED SHELLFISH) and water chlorination

Post exposure prophylaxis with immunoglobulin is available

Killed virus vaccine is available

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17
Q

Infectious cause of primary hepatocellular carcinoma

A

Hep B

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18
Q

Common and widespread cause of chronic hepatitis

A

Hep B

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19
Q

Healthy young adults who contract Hep B are most likely to…

A

Resolve successfully

Little kids/babies more likely to become chronic

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20
Q

What is the infectious form of the Hep B virus?

A

Double walled Dane particle

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21
Q

What is the Hep B surface antigen?

A

HBsAg

There are several of them - count em up

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22
Q

What is the Hep B core antigen?

A

HBcAg

If is found INSIDE the virus - useful indicator of an attack by the virus

Presence indicates chronic

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23
Q

What does the HBeAg surface antigen tell us?

A

Presence indicates patient is infectious

Processed at the same time as HBcAg but correlated to ACTIVE infection

The numbers don’t number - if it’s there, it’s an active infection

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24
Q

What are the hyperendemic areas for Hep B?

A

China, Alaska, Africa

25
Hep B virus can be present in...
Serum Blood Semen
26
How is Hep B spread?
Needle sharing, acupuncture, ear piercing, tattooing
27
What is the major reservoir for HepB?
Chronic hepatitis patients Serological screening of blood has reduced risk of infection from blood and blood products Virus is shed during asymptomatic periods though
28
Perinatal-congenital infection is possible with ...
Hep B HBeAg positive mother is at greatest risk
29
____% of infants infected with Hep B become chronic
90% | !!!!!
30
Populations at risk for Hep B infection
``` HEALTHCARE WORKERS*** IV DRUG USERS Homosexuals Promiscuous heterosexuals Institutionalized persons Family contacts of infected individuals ```
31
Hepatitis B virus replicates where?
Almost exclusively in the liver Incubation period is 50-180 days —> insidious onset
32
What are the clinical manifestations of Hep B?
Insidious onset - incubation 50-180 days Prodrome: fever, rash (urticaria), arthralgias (symmetrical) Subclinical possible (recognized only by presence of anti-HBsAg) Self-limited infection in most ADULTS (but 90% of newborns who are infected become chronic)
33
What % of total Hep B infections in adults fail to resolve?
5-10% - usually established after inapparent infections Often noted by detection of INCREASED SERUM LIVER ENZYMES 10% of these will develop cirrhosis and liver failure Chronic cases are reservoirs for future infections
34
80% of primary hepatocellular carcinoma is linked to ...
Chronic Hep B Cancer induction may be due to promotion of liver repair and growth in response to tissue damage or due to viral integration directly
35
How is Hep B diagnoses?
Clinical Sx Serum - presence of liver enzymes Hep serology
36
________ are secreted into the blood stream during Hep B infection
HBsAg, HBeAg
37
Hallmark of initial ongoing Hep B infection if present together with HBsAg
IgM anti-HBc
38
________ indicates past Hep B infection, but if present with HBsAg indicates chronic infection
IgG anti-HBc
39
Detection of ______ is best indication of the presence of infectious Hep B virus
HBeAg
40
Continued detection of ______ and _____ or both without antibody to these antigens reveals probably chronic Hep B
HBeAg and HBsAg
41
What does the rapid hepatitis virus test actually test for?
Detection of Hep B surface antigen only
42
What is the treatment for Hep B?
No specific curative treatment exists, as most patients will resolve the infection
43
Treatment for chronic Hep B patients
PEG-interferon plus a variety of agents to inhibit viral replication Monitor liver damage and viral load Attempt to prevent liver damage progression ***These do not result in cures - viral DNA still present in cells
44
Newborn infants of HBsAg positive mothers should receive...
Immunoglobulin within one week of exposure Should also vaccinate them
45
What’s the deal with Hep D?
It’s a viral parasite of another virus - specifically Hep B Replication requires the presence of HepB virus for helper functions Basically, Hep D makes B badder, longer
46
What are the conditions under which a patient could be infected with Hep D?
Coinfection with Hep B (likely to resolve) Superinfection in patients with chronic Hep B
47
Hep D increases the severity of ...
Hep B infections Fulminant hepatitis more likely with Hep D
48
How do you prevent Hep D?
HBV vaccine prevents both HBV and HDV Supportive therapy and PEG-interferon to suppress active virus replication
49
An important form of post-transfusion viral hepatitis in the US
Hep C
50
Establishment of chronic infections is the hallmark of ...
Hep C 15-30% fully recover but 70-85% develop chronic infections
51
Hep C often progresses to...
Cirrhosis and liver failure (but not usually cancer)
52
anti-HCV antibodies are present within a few months of infection but ...
They are not protective against the virus Levels of anti-HCV remain high during chronic infection
53
The actual reservoir of Hep C is...
Not well understood - disease onset is hard to pinpoint For over 50% of cases, the source of the infection is not definitively known
54
Risk factors for Hep C
``` IVDU Hemodialysis Tattoos (not proven) Blood transfusions Organ transplants Contact with health care providers ```
55
Factors that promote Hep C infection progression
``` Alcohol use Infection at age >40 Male sex Hep B co-infection HIV co-infection ```
56
How is Hep C diagnosed?
For chronic state and acute phase patients - test for virus DIRECTLY not antibodies (b/c they aren’t reliable) Enzyme immunoassay detection of antibody for screening
57
What is the current treatment for HepC?
Direct-acting antiviral agents (DAAs) - possibly curative Combination regimens that vary with virus genotype are also available (virus protease or polymerase inhibitors) Can use alpha-interferon for some genotypes
58
What is the best way to prevent Hep C?
Blood screening Efforts to identify compensated, unrecognized infections
59
What are the leading causes of hepatic transplant?
Cirrhosis and hepatocellular carcinoma For both HBV and HCV, transplants are sometimes the only curative option Recurrent infection is a concern and patients are immune suppressed Also possible to have HCV-positive donors

Microbiology Unit 3 (10 decks)

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