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Microbiology Unit 3 > 8 Viral Hepatitis > Flashcards

8 Viral Hepatitis Flashcards

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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
Q

Hep B virus can be present in…

A

Serum
Blood
Semen

26
Q

How is Hep B spread?

A

Needle sharing, acupuncture, ear piercing, tattooing

27
Q

What is the major reservoir for HepB?

A

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
Q

Perinatal-congenital infection is possible with …

A

Hep B

HBeAg positive mother is at greatest risk

29
Q

____% of infants infected with Hep B become chronic

A

90%

!!!!!

30
Q

Populations at risk for Hep B infection

A 
HEALTHCARE WORKERS***
IV DRUG USERS
Homosexuals
Promiscuous heterosexuals
Institutionalized persons
Family contacts of infected individuals
31
Q

Hepatitis B virus replicates where?

A

Almost exclusively in the liver

Incubation period is 50-180 days —> insidious onset

32
Q

What are the clinical manifestations of Hep B?

A

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
Q

What % of total Hep B infections in adults fail to resolve?

A

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
Q

80% of primary hepatocellular carcinoma is linked to …

A

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
Q

How is Hep B diagnoses?

A

Clinical Sx

Serum - presence of liver enzymes

Hep serology

36
Q

________ are secreted into the blood stream during Hep B infection

A

HBsAg, HBeAg

37
Q

Hallmark of initial ongoing Hep B infection if present together with HBsAg

A

IgM anti-HBc

38
Q

________ indicates past Hep B infection, but if present with HBsAg indicates chronic infection

A

IgG anti-HBc

39
Q

Detection of ______ is best indication of the presence of infectious Hep B virus

A

HBeAg

40
Q

Continued detection of ______ and _____ or both without antibody to these antigens reveals probably chronic Hep B

A

HBeAg and HBsAg

41
Q

What does the rapid hepatitis virus test actually test for?

A

Detection of Hep B surface antigen only

42
Q

What is the treatment for Hep B?

A

No specific curative treatment exists, as most patients will resolve the infection

43
Q

Treatment for chronic Hep B patients

A

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
Q

Newborn infants of HBsAg positive mothers should receive…

A

Immunoglobulin within one week of exposure

Should also vaccinate them

45
Q

What’s the deal with Hep D?

A

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
Q

What are the conditions under which a patient could be infected with Hep D?

A

Coinfection with Hep B (likely to resolve)

Superinfection in patients with chronic Hep B

47
Q

Hep D increases the severity of …

A

Hep B infections

Fulminant hepatitis more likely with Hep D

48
Q

How do you prevent Hep D?

A

HBV vaccine prevents both HBV and HDV

Supportive therapy and PEG-interferon to suppress active virus replication

49
Q

An important form of post-transfusion viral hepatitis in the US

A

Hep C

50
Q

Establishment of chronic infections is the hallmark of …

A

Hep C

15-30% fully recover but 70-85% develop chronic infections

51
Q

Hep C often progresses to…

A

Cirrhosis and liver failure (but not usually cancer)

52
Q

anti-HCV antibodies are present within a few months of infection but …

A

They are not protective against the virus

Levels of anti-HCV remain high during chronic infection

53
Q

The actual reservoir of Hep C is…

A

Not well understood - disease onset is hard to pinpoint

For over 50% of cases, the source of the infection is not definitively known

54
Q

Risk factors for Hep C

A 
IVDU
Hemodialysis
Tattoos (not proven)
Blood transfusions
Organ transplants
Contact with health care providers
55
Q

Factors that promote Hep C infection progression

A 
Alcohol use
Infection at age >40
Male sex
Hep B co-infection
HIV co-infection
56
Q

How is Hep C diagnosed?

A

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
Q

What is the current treatment for HepC?

A

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
Q

What is the best way to prevent Hep C?

A

Blood screening

Efforts to identify compensated, unrecognized infections

59
Q

What are the leading causes of hepatic transplant?

A

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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