ACUTE VIRAL HEPATITIS: CHAPTER 339 Flashcards
mean incubation period of
* HAV
* HBV
* HCV
* HDV
* HEV
Hepatitis infection transmitted via fecal-oral route (2)
All hepatitis infection can be transmitted via percutanous route except (1)
hepatitis type that is not transmitted perinatally (2)
only hepatitis type that is not transmitted sexually
type of hepatitis that has the highest chance to be fulminant
type of hepatitis that does not progress to chronic state (2)
type of hepatitis that does not have a carrier (2)
type of hepatitis thatv has the highest chance of progressing to a chronic state
type of hepatitis that does not cause cancer (2)
type of hepatits that has the EXCELLENT vs GOOD prognosis
type of hepatitis wherein prognosis is poorer as patients becomes older
prophylaxis for :
* HAV
* HBV
* HCV
* HDV
* HEV
Treatment for HAV and HEV
Common treatment for HBV,HCV,HDV (1)
first line treatment for HBV (4)
give at least 3 first line treatment for HCV
marker for previous HAV infection,
anti-HAV
As the frequency of HAV infection declines, the likelihood of clinically apparent, even severe, HAV illnesses increases in the susceptible adult population
true or false
true
Percutaneous inoculation is recognized as a major route of hepatitis B transmission
True or False
True
most of the hepatitis transmitted by blood transfusion is not caused by HBV
True or False
True
Among the nonpercutaneous modes of HBV transmission, oral ingestion has been documented as a potential but inefficient route of exposure.
True or False
True
two nonpercutaneous routes considered to have the greatest impact for HBV transmission are (2)
- intimate (especially sexual) contact
- perinatal transmission
Perinatal transmission of HBV occurs primarily in infants born to mothers with (2)
- chronic hepatitis B
- or (rarely) mothers with acute hepatitis B during the third trimester of pregnancy or during the early postpartum period.
most important mode of HBV perpetuation in East Asia and developing countries
perinatal transmission
breast-feeding is not contraindicated in women with hepatitis B
True or False
True
The likelihood of perinatal transmission of HBV correlates with the presence of (2)
- HBeAg
- and high-level viral replication
In most cases, acute infection in the neonate is clinically asymptomatic…
True or False
True
serum marker that is a reflection of previous HBV infection
anti-HBs
most commonly affected age group by Hepatitis B in
* East Asia and Africa vs
* North America and Western Europe
persons with elevated AST or ALT are considered high risk for HBV infection
True or False
True
Blood/plasma/organ/tissue/semen DONORS are considered high risk for HBV infection
true or false
true
the prevalence of HDV infection is highest in what subsets of population (2)
the prevalence of HDV infection is highest in injection drug users (11–36%) and hemophiliacs (19%).
how many genotypes of HDV are out there… and what HDV genotype is distributed worldwide
Of the eight HDV genotypes, genotype 1 is distributed worldwide
Places where the ff HDV genotypes are found:
* 2
* 3
* 4
* 5
* 6
* 7
* 8
- Genotypes 2 and 4 in the Far East,
- Genotype 3 in South America
- Genotypes 5–8 in Africa
Of the eight HDV genotypes, genotype 1 is distributed worldwide
hepatitis C screening is warranted is these age groups (2)
hepatitis C screening to all
* adolescents and
* adults aged 18–79
Hepatitis B accounts for 40% of chronic liver disease
true or false
False… kasi dapat…
Hepatitis C accounts for 40% of chronic liver disease
This hepatitis infection type was the most frequent indication for liver transplantation before the introduction of high-efficacy DAA (direct acting antiviral) therapy
Hepatitis C
most common genotype of HCV
genotype 1
parang HDV din since genotype 1 ang distributed worldwide
Breast-feeding does not increase the risk of HCV infection
true or false
true
According to table 339-4…this age group is high risk for HCV infection
iba yung nakalagay sa text kasi….may dagdag
Persons born between WHAT YEARS , have increased frequency of HCV infection
Persons born between 1945 and 1965 have increased frequency of HCV infection
This type of hepatitis resembles hepatitis A in its primarily enteric mode of spread.
Hepatitis E
The commonly recognized cases of hepatitis E occur WHEN
The commonly recognized cases of hepatitis E occur after contamination of water supplies
An epidemiologic feature that distinguishes HEV from other enteric agents is the….
An epidemiologic feature that distinguishes HEV from other enteric agents is the rarity of secondary person-to-person spread from infected persons to their close contacts.
Large waterborne outbreaks of hepatitis E in endemic areas are linked to WHAT genotypes (2)
Large waterborne outbreaks of hepatitis E in endemic areas are linked to genotypes 1 and 2
HBV infection is the most common cause of acute viral hepatitis.
true or false
false… kasi dapat….
HEV infection as the most common cause of acute viral hepatitis.
clinically apparent acute hepatitis E is extremely rare
true or false
true
older age was associated with anti-HEV seropositivity
true or false
true
Evidence supports a zoonotic reservoir for WHAT HEPATITIS VIRUS… primarily in swine (but also in deer, camels, and rabbits)
Evidence supports a zoonotic reservoir for HEV primarily in swine (but also in deer, camels, and rabbits)
incubation period of hepatitis A vs E
incubation period of hepatitis B vs C vs D
A low-grade fever between 38° and 39°C (100°–102°F) is more often present in hepatitis B and C than in hepatitis A and E
true or false
False.. kasi dapat…
A low-grade fever between 38° and 39°C (100°–102°F) is more often present in hepatitis A and E than in hepatitis B or C
when THIS HEPATITIS is heralded by a serum sickness–like syndrome; rarely, a fever of 39.5°–40°C (103°–104°F) may accompany the constitutional symptoms
when hepatitis B is heralded by a serum sickness–like syndrome; rarely, a fever of 39.5°–40°C (103°–104°F) may accompany the constitutional symptoms
With the onset of clinical jaundice, the constitutional prodromal symptoms usually diminish
true or false
true
After how many months is complete clinical and biochemical recovery is to be expected in :
* hepatitis A
* hepatitis B
* hepatitis C
* hepatitis E
the duration of HBV infection determines the duration of HDV infection.
true or false
true
Infection with HDV can occur in the presence of acute or chronic HBV infection
true or false
true
As opposed to patients with acute HBV infection, patients with chronic HBV infection can support HDV replication indefinitely
true or false
true
Superinfection with HDV in a patient with chronic hepatitis B often leads to clinical deterioration
true or false
true
What can explain the sometimes emergence acute hepatitis-like clinical events in persons with chronic hepatitis B (3)
Acute hepatitis-like clinical events in persons with chronic hepatitis B may accompany :
* superinfections with other hepatitis agent
* spontaneous HBeAg to anti-HBe seroconversion or
* spontaneous reactivation (i.e., reversion from relatively nonreplicative to replicative infection)
serum AST and ALT FOLLOWS the rise in bilirubin level
True or False
serum AST and ALT precede the rise in bilirubin level
Peak levels of AST and ALT these levels are usually reached at the time the patient is clinically icteric
True or False
True
The level of AST and ALT does not correlate well with the degree of liver cell damage.
True or False
True
Jaundice is usually visible in the sclera or skin when the serum bilirubin value is >43 μmol/L (____mg/dL).
Jaundice is usually visible in the sclera or skin when the serum bilirubin value is >43 μmol/L (2.5 mg/dL).
The serum bilirubin may continue to rise despite falling serum aminotransferase levels.
True or False
True
Bilirubin levels >340 μmol/L (____mg/dL) extending and persisting late into the course of viral hepatitis are more likely to be associated with severe disease.
Bilirubin levels >340 μmol/L (20 mg/dL) extending and persisting late into the course of viral hepatitis are more likely to be associated with severe disease.
Measurement of the THIS LAB RESULT is important in patients with acute viral hepatitis, because a prolonged value may reflect a severe hepatic synthetic defect, signify extensive hepatocellular necrosis, and indicate a worse prognosis.
Measurement of the prothrombin time (PT) is important in patients with acute viral hepatitis, because a prolonged value may reflect a severe hepatic synthetic defect, signify extensive hepatocellular necrosis, and indicate a worse prognosis.
antibodies to LKM may occur in these 2 types of hepatitis
Hepatitis C and D
a diagnosis of hepatitis A is based on detection of ____ during acute illness
a diagnosis of hepatitis A is based on detection of IgM anti-HAV during acute illness
____can give rise to false-positive results in tests for IgM anti HAV
Rheumatoid factor can give rise to false-positive results in this test.
Infrequently, levels of HBsAg are too low to be detected during acute HBV infection, even with contemporary, highly sensitive immunoassays.
In such cases, the diagnosis can be established by the presence of WHAT SERUM MARKER
nfrequently, levels of HBsAg are too low to be detected during acute HBV infection, even with contemporary, highly sensitive immunoassays.
In such cases, the diagnosis can be established by the presence of IgM anti-HBc.
The titer of HBsAg bears little relation to the severity of clinical disease.
True or False
True
a DIRECT correlation exists between the serum concentration of HBsAg and the degree of liver cell damage.
True or False
False.. kasi dapat
inverse correlation exists between the serum concentration of HBsAg and the degree of liver cell damage.
in hepatitis B the degree of liver cell damage and the clinical course are related to variations in the patient’s immune response to HBV rather than to the amount of circulating HBsAg.
True
True or false
True
serum marker that is indicator of relative infectivity.
HBeAg
After immunization with hepatitis B vaccine, which consists of HBsAg alone, ____is the only serologic marker to appear.
After immunization with hepatitis B vaccine, which consists of HBsAg alone, anti-HBs is the only serologic marker to appear.
Like HBeAg, serum ____ is an indicator of HBV replication, but tests for HBV DNA are more sensitive and quantitative.
Like HBeAg, serum HBV DNA is an indicator of HBV replication, but tests for HBV DNA are more sensitive and quantitative.
Except for the early decades of life after perinatally acquired HBV infection (see above), in immunocompetent adults with chronic hepatitis B, a general correlation exists between the level of HBV replication, as reflected by the level of serum ____, and the degree of liver injury.
Except for the early decades of life after perinatally acquired HBV infection (see above), in immunocompetent adults with chronic hepatitis B, a general correlation exists between the level of HBV replication, as reflected by the level of serum HBV DNA, and the degree of liver injury.
Among patients with chronic hepatitis B, high levels of ____ increase the risk of cirrhosis, hepatic decompensation, and hepatocellular carcinoma
Among patients with chronic hepatitis B, high levels of HBV DNA increase the risk of cirrhosis, hepatic decompensation, and hepatocellular carcinoma
Serologic pattern in ACUTE HEPATITIS B, HIGH INFECTIVITY
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe
Serologic pattern in CHRONIC HEPATITIS B, HIGH INFECTIVITY
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe
Serologic pattern in RECOVERY FROM HEPATITIS B
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe
Serologic pattern in IMMUNIZATION WITH HBSAG (after vaccination)
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe
Serologic pattern in LATE ACUTE OR CHRONIC HEP B, LOW INFECTIVITY
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe
Serologic pattern in PRECORE-MUTANT
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe
Serologic pattern in ACUTE HEPATITIS B
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe
Serologic pattern in ANTI HBC WINDOW
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe
Serologic pattern in LOW LEVEL HEP B CARRIER
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe
Serologic pattern in HEPATITIS B IN THE REMOTE PAST
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe
In patients with hepatitis B, an episodic pattern of aminotransferase elevation is common.
True or False
False…. kasi dapat…
In patients with hepatitis C, an episodic pattern of aminotransferase elevation is common.
A specific serologic diagnosis of hepatitis C can be made by demonstrating the presence in serum of ____.
A specific serologic diagnosis of hepatitis C can be made by demonstrating the presence in serum of anti-HCV.
When contemporary immunoassays are used, anti-HCV can be detected in acute hepatitis C during the initial phase of elevated aminotransferase activity and remains detectable after recovery (which is rare) and during chronic infection (common).
True or False
True
Non-specificity can confound immunoassays for anti-HCV, especially in persons with a low prior probability of infection, such as volunteer blood donors, or in persons with circulating rheumatoid factor, which can bind nonspecifically to assay reagents;
testing for ____ can be used in such settings to distinguish between true-positive and false-positive anti-HCV determinations.
Non-specificity can confound immunoassays for anti-HCV, especially in persons with a low prior probability of infection, such as volunteer blood donors, or in persons with circulating rheumatoid factor, which can bind nonspecifically to assay reagents;
testing for HCV RNA can be used in such settings to distinguish between true-positive and false-positive anti-HCV determinations.
____ are the most sensitive tests for HCV infection and represent the “gold standard” in establishing a diagnosis of hepatitis C.
Assays for HCV RNA are the most sensitive tests for HCV infection and represent the “gold standard” in establishing a diagnosis of hepatitis C.
If all these serologic tests are negative and the patient has a well-characterized case of hepatitis after percutaneous exposure to blood or blood products, a diagnosis of ____ can be entertained.
If all these tests are negative and the patient has a well-characterized case of hepatitis after percutaneous exposure to blood or blood products, a diagnosis of hepatitis caused by an unidentified agent can be entertained.
Determination of HCV RNA level is a reliable marker of disease severity or prognosis but is not helpful in predicting relative responsiveness to antiviral therapy.
True or False
False… kasi dapat…
Determination of HCV RNA level
* is not a reliable marker of disease severity or prognosis
* but is helpful in predicting relative responsiveness to antiviral therapy.
What is the sine qua non for determining on-treatment and durable responsiveness in hepatitis C
HCV RNA monitoring during and after antiviral therapy
Detectable anti-HCV in the absence of HCV RNA signifies WHAT
Detectable anti-HCV in the absence of HCV RNA signifies spontaneous or therapeutically induced recovery from (“cured”) hepatitis C.
The presence of HDV infection can be identified HOW (2)
The presence of HDV infection can be identified by
* demonstrating intrahepatic HDV antigen
* or, more practically, an anti-HDV seroconversion (a rise in titer of anti-HDV or de novo appearance of antiHDV).
When a patient presents with acute hepatitis and has HBsAg and anti-HDV in serum, determination of the ____ is helpful in establishing the relationship between infection with HBV and HDV.
When a patient presents with acute hepatitis and has HBsAg and anti-HDV in serum, determination of the class of anti-HBc is helpful in establishing the relationship between infection with HBV and HDV.
What class of anti-Hbc will be detectable in …..
* In simultaneous acute HBV and HDV infections
* in acute HDV infection superimposed on chronic HBV infection
The serologic/virologic course of events during acute hepatitis E is entirely analogous to that of acute hepatitis A
True or False
True
A patient with acute hepatitis should undergo four serologic tests
- HBsAg
- IgM anti-HAV
- IgM anti-HBc
- anti-HCV
Serologic pattern for ACUTE HEP B
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV
Serologic pattern for CHRONIC HEP B
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV
Serologic pattern for ACUTE HEP A SUPERIMPOSED ON CHRONIC HEP B
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV
Serologic pattern for ACUTE HEP A AND B
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV
Serologic pattern for ACUTE HEP A
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV
Serologic pattern for ACUTE HEP A and B (HBSAG BELOW DETECTION THRESHOLD)
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV
Serologic pattern for ACUTE HEP B (HBSAG BELOW DETECTION THRESHOLD)
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV
Serologic pattern for ACUTE HEP C
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV
The presence of WHAT SEROLOGIC MARKER , with or without IgM anti-HBc, represents HBV infection.
The presence of HBsAg, with or without IgM anti-HBc, represents HBV infection.
A diagnosis of acute hepatitis B can be made in the absence of HBsAg when IgM anti-HBc is detectable.
TRUE OR FALSE
TRUE
A diagnosis of acute hepatitis A is based on the presence of WHAT SEROLOGIC MARKER
A diagnosis of acute hepatitis A is based on the presence of IgM anti-HAV.
Absence of all serologic markers is consistent with a diagnosis of “non-A, non-B, non-C” hepatitis
TRUE OR FALSE
TRUE
In patients with chronic hepatitis, initial testing should consist of WHAT 2 SEROLOGIC MARKERS
In patients with chronic hepatitis, initial testing should consist of
* HBsAg
* anti-HCV
WHAT SEROLOGIC MARKER supports VS establishes the diagnosis of chronic hepatitis C
Anti-HCV supports and HCV RNA testing establishes the diagnosis of chronic hepatitis C.
Virtually all previously healthy patients with hepatitis A recover completely with no clinical sequelae.
TRUE OR FALSE
TRUE
These 4 lab results suggest a more complicated and protracted course of hepatitis
- a prolonged PT,
- low serum albumin level
- hypoglycemia
- very high serum bilirubin values
Patients with simultaneous acute hepatitis B and D do not necessarily experience a higher mortality rate than do patients with acute hepatitis B alone
True or False
True
When HDV superinfection occurs in a person with chronic hepatitis B, the likelihood of fulminant hepatitis and death is increased substantially
True or False
True
Term for outbreaks of severe HDV superinfection in isolated populations with a high hepatitis B carrier rate and has a mortality rate >20%
Lábrea fever
Another unusual variant of WHAT HEPATITIS…. is cholestatic hepatitis, characterized by protracted cholestatic jaundice and pruritus
Another unusual variant of acute hepatitis A is cholestatic hepatitis, characterized by protracted cholestatic jaundice and pruritus
During the prodromal phase of acute hepatitis B, a ____characterized by arthralgia or arthritis, rash, angioedema, and, rarely, hematuria and proteinuria may develop in 5–10% of patients.
During the prodromal phase of acute hepatitis B, a serum sickness–like syndrome characterized by arthralgia or arthritis, rash, angioedema, and, rarely, hematuria and proteinuria may develop in 5–10% of patients.
____ is an immune-complex disease that can complicate chronic hepatitis C and is part of a spectrum of B-cell lymphoproliferative disorders, which, in rare instances, can evolve to B-cell lymphoma
EMC (Essential mixed cryoglobulinemia) is an immune-complex disease that can complicate chronic hepatitis C and is part of a spectrum of B-cell lymphoproliferative disorders, which, in rare instances, can evolve to B-cell lymphoma
Hepatitis associated with porphyria cutanea tarda and lichen planus
Hepatitis C
The most feared complication of viral hepatitis is ____
The most feared complication of viral hepatitis is fulminant hepatitis (massive hepatic necrosis)
Fulminant hepatitis is seen primarily in what hepatitis (3)
Fulminant hepatitis is seen primarily in hepatitis B, D, and E
Hepatitis C accounts for >50% of fulminant cases
True or False
False… kasi dapat…
Hepatitis B accounts for >50% of fulminant cases
In acute hepatitis, the combination of rapidly shrinking liver size, rapidly rising bilirubin level, and marked prolongation of the PT, even as aminotransferase levels fall, together with clinical signs of confusion, disorientation, somnolence, ascites, and edema, indicates that the patient has WHAT COMPLICATION
in acute hepatitis, the combination of rapidly shrinking liver size, rapidly rising bilirubin level, and marked prolongation of the PT, even as aminotransferase levels fall, together with clinical signs of confusion, disorientation, somnolence, ascites, and edema, indicates that the patient has hepatic failure with encephalopathy.
The likelihood of remaining chronically infected after acute HBV infection is especially high among what subset of population (4)
The likelihood of remaining chronically infected after acute HBV infection is especially high among
* neonates,
* persons with Down’s syndrome,
* chronically hemodialyzed patients,
* immunosuppressed patients, including persons with HIV infection.
the presence of ____ on liver biopsy during protracted, severe acute viral hepatitis suggest progression of acute hepatitis to chronic hepatitis
presence of bridging/interface or multilobular hepatic necrosis on liver biopsy during protracted, severe acute viral hepatitis
Acute hepatitis D infection increases the likelihood of chronicity of simultaneous acute hepatitis B
True or False
False…. kasi dapat….
Acute hepatitis D infection does not increase the likelihood of chronicity of simultaneous acute hepatitis B
This suggests progression of acute hepatitis to chronic hepatitis:
* the persistence of HBeAg for ____months or HBsAg for ____months after acute hepatitis
* failure of the serum aminotransferase, bilirubin, and globulin levels to return to normal within ____ months after the acute illness
- the persistence of HBeAg for >3 months or HBsAg for >6 months after acute hepatitis
- failure of the serum aminotransferase, bilirubin, and globulin levels to return to normal within 6–12 months after the acute illness
hepatitis D has the potential for contributing to the severity of chronic hepatitis B.
True or False
True
After acute HBV infection, the likelihood of remaining chronically infected approaches 85–90%.
True or False
False…. kasi dapat…
After acute HCV infection, the likelihood of remaining chronically infected approaches 85–90%.
Among cirrhotic patients with chronic hepatitis C, the annual risk of hepatic decompensation is ___ %
Among cirrhotic patients with chronic hepatitis C, the annual risk of hepatic decompensation is ~4%.
neither HAV nor HEV causes chronic liver disease in immunocompetent hosts
true or false
true
Term for the disease in children with hepatitis B that may present rarely with anicteric hepatitis, a nonpruritic papular rash of the face, buttocks, and limbs, and lymphadenopathy
In children, hepatitis B may present rarely with anicteric hepatitis, a nonpruritic papular rash of the face, buttocks, and limbs, and lymphadenopathy (papular acrodermatitis of childhood or Gianotti-Crosti syndrome).
The finding on liver biopsy of fatty infiltration, a neutrophilic inflammatory reaction, and “____” would be consistent with alcohol-induced rather than viral liver injury.
he finding on liver biopsy of fatty infiltration, a neutrophilic inflammatory reaction, and “alcoholic hyaline” would be consistent with alcohol-induced rather than viral liver injury.
Viral hepatitis in the elderly is often misdiagnosed as ____
Viral hepatitis in the elderly is often misdiagnosed as obstructive jaundice resulting from a common duct stone or carcinoma of the pancreas.
These diseases can be confused with viral hepatitis during pregnancy (4)
- Acute fatty liver of pregnancy
- Cholestasis of pregnancy
- Eclampsia
- HELLP (hemolysis, elevated liver tests, and low platelets) syndrome
the most potent and least resistance-prone agents for severe acute hepatitis B (2)
entecavir or tenofovir
Treatment for acute hepatitis B should continue until
* ____ months after HBsAg seroconversion
* ____ months after HBeAg seroconversion.
Treatment for acute hepatitis B should continue until
* 3 months after HBsAg seroconversion
* 6 months after HBeAg seroconversion
in this type of hepatitis, progression to chronic hepatitis is the rule.
acute hepatitis C
recommended duration of treatment for acute hepatitis C
full 8- to 12-week course
Forced and prolonged bed rest is not essential for full recovery in acute hepatitis
true or false
true
Type of diet recommended for patients with acute hepatitis
A high-calorie diet is desirable, and because many patients may experience nausea late in the day, the major caloric intake is best tolerated in the morning.
If severe pruritus is present in acute hepatitis , the use of this drug is helpful.
If severe pruritus is present in acute hepatitis , the use of the bile salt–sequestering resin cholestyramine is helpful.
Glucocorticoid therapy has no value in acute viral hepatitis
True or False
True
Glucocorticoids can increase the risk of chronicity of hepatitis
True or False
True
most patients hospitalized with hepatitis A excrete little, if any, HAV
True or False
True
standard precaution should be applied to acute viral hepatitis patients
true or false
false… kasi dapat
universal precautions
in fulminant hepatitis, protein intake should be restricted
true or false
true
oral lactulose should not be administered in fulminant hepatitis
true or false
false… it should be administered
____ is the one factor that appears to improve survival in fulminant hepatitis
prophylactic antibiotic coverage is the one factor that appears to improve survival
In clinically severe acute hepatitis E or acute-on-chronic liver failure, successful therapy with____ (600 mg twice daily, 15 mg/kg) has been reported anecdotally.
In clinically severe acute hepatitis E or acute-on-chronic liver failure, successful therapy with ribavirin (600 mg twice daily, 15 mg/kg) has been reported anecdotally.
when fulminant hepatitis E occurs in pregnant women, Ribavirin can be safely administered.
True or False
False… because ribavirin is teratogenic
In cases of hepatitis E in organ-transplant recipients,
these 2 methods have been shown to be effective, often without antiviral therapy, in achieving eradication of HEV.
- reduction in overall immunosuppressive drug doses and
- switching from tacrolimus to cyclosporine A
In cases of hepatitis E in organ-transplant recipients, if a change in immunosuppression is inadequate… this drug should be given for 3 months
ribavirin
active immunization is the preferable approach to prevention for these hepatitis (3)
hepatitis A, B, and E
For postexposure prophylaxis of intimate contacts (household, sexual, institutional) of persons with hepatitis A, the administration of ____mL/kg is recommended as early after exposure as possible
0.02 mL/kg
For postexposure prophylaxis of intimate contacts (household, sexual, institutional) of persons with hepatitis A, it may be effective even when administered as late as ____weeks after exposure.
as late as 2 weeks after exposure
Recommended postexposure prophylaxis for hepatitis A
hepatitis A vaccine
recommended for preexposure prophylaxis prior to international travel to HAV-endemic areas.
hepatitis A vaccine
interval of administration of vaccine as preexposure prophylaxis against hepatitis B
0, 1,6 months
Pregnancy is not a contraindication to vaccination
True or False
True
Recommended prophylaxis for unvaccinated persons sustaining an exposure to HBV
postexposure prophylaxis with a combination of HBIG and hepatitis B vaccine
Recommended prophylaxis for perinatal exposure of infants born to HBsAg-positive mothers,
- a single dose of HBIG, 0.5 mL, immediately after birth,
- then course of three injections of recombinant hepatitis B vaccines approved for children (see doses above) to be started within the first 12 h of life.
Recommended prophylaxis for those experiencing a direct percutaneous inoculation or transmucosal exposure to HBsAg-positive blood or body fluids
- a single IM dose of HBIG, 0.06 mL/kg, administered as soon after exposure as possible,
- then a complete course of hepatitis B vaccine to begin within the first week.
For pregnant mothers with high-level HBV DNA (>2 × 10^5 IU/mL), adding WHAT DRUG CLASS during the WHAT trimester of pregnancy reduces perinatal transmission even further.
For pregnant mothers with high-level HBV DNA (>2 × 10^5 IU/mL), adding antiviral nucleoside analogues during the third trimester of pregnancy reduces perinatal transmission even further.
Recommended prophylaxis for persons exposed by sexual contact to a patient with acute hepatitis B,
- a single IM dose of HBIG, 0.06 mL/kg, should be given within 14 days of exposure,
- to be followed by a complete course of hepatitis B vaccine.
When both HBIG and hepatitis B vaccine are recommended, they may be given at the same time but at separate sites.
True or fFalse
True
Currently, booster immunizations are not recommended routinely, except in these 2 population….
Currently, booster immunizations are not recommended routinely, except in
* immunosuppressed persons who have lost detectable anti-HBs
* or immunocompetent persons who sustain percutaneous HBsAg-positive inoculations after losing detectable antibody.
for HD patients, how often is anti-HBs testing recommended
Specifically, for hemodialysis patients,
* annual anti-HBs testing is recommended after vaccination;
* booster doses are recommended when anti-HBs levels fall to <10 mIU/mL.
for HD patients, booster doses of hep B vaccine are recommended when anti HBs levels fall to ____mIU/mL
<10 mIU/mL
Infection with hepatitis D can be prevented by vaccinating susceptible persons with WHAT
Infection with hepatitis D can be prevented by vaccinating susceptible persons with hepatitis B vaccine.
For stable, monogamous sexual partners, sexual transmission of hepatitis C is likely, and sexual barrier precautions are recommended.
True or False
False… kasi dapat…
For stable, monogamous sexual partners, sexual transmission of hepatitis C is unlikely, and sexual barrier precautions are not recommended.
For persons with multiple sexual partners or with sexually transmitted diseases, the risk of sexual transmission of hepatitis C is increased, and barrier precautions (latex condoms) are recommended.
True or False
True
A person with hepatitis C should avoid sharing such items as razors, toothbrushes, and nail clippers with sexual partners and family members.
True or False
True
No special precautions are recommended for babies born to mothers with hepatitis C, and breast-feeding does not have to be restricted.
True or False
True
timing of giving Hep E vaccine
0, 1, and 6 months
All these human hepatitis viruses are RNA viruses, except for hepatitis ____, which is a DNA virus but replicates like a retrovirus.
All these human hepatitis viruses are RNA viruses, except for hepatitis B, which is a DNA virus but replicates like a retrovirus.
all types of viral hepatitis produce clinically similar illnesses.
True or False
True
Hep A virus replication is limited to the liver
True or False
True
in hepatitis A, fecal shedding, viremia, and infectivity diminish rapidly once jaundice becomes apparent.
True or False
True
HAV RNA has been reported to persist at low levels in stool, the liver, and serum for up to several months after acute illness; levels correlate with persistent infectivity, probably because of the presence of neutralizing antibody.
True or False
False… kasi dapat….
HAV RNA has been reported to persist at low levels in stool, the liver, and serum for up to several months after acute illness; however this does not correlate with persistent infectivity, probably because of the presence of neutralizing antibody.
the diagnosis of hepatitis A is made during acute illness by demonstrating what serologic marker…
the diagnosis of hepatitis A is made during acute illness by demonstrating antiHAV of the IgM class.
After acute illness, anti-HAV of the IgG class remains detectable indefinitely
True or FAlse
True
Classification/type of virus of Hepatitis A, B, C, D, vs E
Of the three particulate forms of HBV (Table 339-1), the most numerous are the 42-nm particles
True or False
False… kasi dapat…
Of the three particulate forms of HBV (Table 339-1), the most numerous are the 22-nm particles
The envelope protein expressed on the outer surface of the hepatitis virion and on the smaller spherical and tubular structures is referred to as ____.
The envelope protein expressed on the outer surface of the virion and on the smaller spherical and tubular structures is referred to as hepatitis B surface antigen (HBsAg).
genotype A of hepatitis B appears to be associated with less rapidly progressive liver disease and cirrhosis and a lower likelihood, or delayed appearance, of hepatocellular carcinoma
True or False
False…. kasi dapat…
genotype B of hepatitis B appears to be associated with less rapidly progressive liver disease and cirrhosis and a lower likelihood, or delayed appearance, of hepatocellular carcinoma
The antigen expressed on the surface of the nucleocapsid core is ____, and its corresponding antibody is ____
The antigen expressed on the surface of the nucleocapsid core is hepatitis B core antigen (HBcAg), and its corresponding antibody is anti-HBc.
qualitative marker of HBV replication and relative infectivity
HBeAg
disappearance of WHAT SEROLOGIC MARKERM may be a harbinger of clinical improvement and resolution of infection in hepatitis B
HBeAg
Persistence of HBeAg in serum beyond the first 3 months of acute infection may be predictive of WHAT
Persistence of HBeAg in serum beyond the first 3 months of acute infection may be predictive of the development of chronic infection,
largest of the HBV genes
the P gene
After a person is infected with HBV, the first virologic marker detectable in serum within 1–12 weeks, usually between 8 and 12 weeks, is WHAT
HBsAg
HBsAg follows elevations of serum aminotransferase activity and clinical symptoms
True or False
False… kasi dapat….
HBsAg precedes elevations of serum aminotransferase activity and clinical symptoms by 2–6 weeks
This serologic marker remains detectable during the entire icteric or symptomatic phase of acute hepatitis B
HBsAg
THIS SEROLOGIC MARKER is readily demonstrable in serum, beginning within the first 1–2 weeks after the appearance of HBsAg
anti-HBc
During the “gap” or “window” period, THIS SEROLOGIC MARKER may represent the only serologic evidence of current or recent HBV infection
During this “gap” or “window” period, anti-HBc may represent the only serologic evidence of current or recent HBV infection
pano nagkakaron ng gap or window period sa hepatitis B
- Because variability exists in the time of appearance of anti-HBs after HBV infection, occasionally a gap of several weeks or longer may separate the disappearance of HBsAg and the appearance of anti-HBs.
- During this “gap” or “window” period, anti-HBc may represent the only serologic evidence of current or recent HBV infection
most instances of isolated anti-HBc represent active virus replication
true or false
false… kasi dapat
isolated anti-HBc does not necessarily indicate active virus replication; most instances of isolated anti-HBc represent hepatitis B infection in the remote past.
IgM anti HBc predominates during the first ____ months after acute infection,
first 6 months
Infrequently, in ≤1–5% of patients with acute HBV infection, levels of HBsAg are too low to be detected; in such cases, the presence of THIS SEROLOGIC MARKER establishes the diagnosis of acute hepatitis B.
Infrequently, in ≤1–5% of patients with acute HBV infection, levels of HBsAg are too low to be detected; in such cases, the presence of IgM anti-HBc establishes the diagnosis of acute hepatitis B.
Generally, in persons who have recovered from hepatitis B, THESE 2 SEROLOGIC MARKERS persist indefinitely.
Generally, in persons who have recovered from hepatitis B, anti-HBs and anti-HBc persist indefinitely.
protective antibody for hepatitis B
anti-HBs
patients with precore mutations who cannot synthesize WHAT SEROLOGIC MARKER
patients with precore mutations who cannot synthesize HBeAg
2 serologic markers that can be detected during the replicative phase of chronic infection
- HBeAg
- HBV DBA
Seroconversion from the replicative to nonreplicative phase is heralded by elevation of what LAB FINDING
elevation of ALT
what is the qualitative vs quantitative marker of replicative phase of hepatitis B
HBeAg is a qualitative marker and HBV DNA a quantitative marker of this replicative phase of hepatitis B
even in the so-called nonreplicative phase, HBV replication can be detected at levels of approximately ≤10^3 virions/mL
True or False
True
high-titer IgM anti-HBc can reappear during acute exacerbations of chronic hepatitis B,
True or False
True
Term for this HBV mutant in which a single amino acid substitution, from glycine to arginine, occurs at position 145 of the immunodominant “a” determinant common to all HBsAg subtypes.
HBV mutants consists of escape mutants, in which a single amino acid substitution, from glycine to arginine, occurs at position 145 of the immunodominant “a” determinant common to all HBsAg subtypes.
this hepatitis virus is a defective RNA virus
Hepatitis D
HDV RNA requires WHAT ENZYME from the host for its replication
HDV RNA requires host RNA polymerase II for its replication
Although complete hepatitis D virions and liver injury require the cooperative helper function of HBV, intracellular replication of HDV RNA can occur without HBV.
True or False
True
Both HBV and HDV enter hepatocytes via WHAT RECEPTOR
Both HBV and HDV enter hepatocytes via the sodium taurocholate cotransporting polypeptide receptor
Differentiate HDV coinfection vs superinfection
HDV can either infect a person simultaneously with HBV (coinfection) or superinfect a person already infected with HBV (superinfection)
HDV assumes the HBsAg subtype of the DONOR. True or False
False… kasi dapat….
.
.
HDV assumes the HBsAg subtype of the recipient, rather than the donor.
the duration of HDV infection is determined by the duration of (and cannot outlast) HBV infection.
True or False
True
patients with hepatitis D tend to have lower levels of HBV replication.
True or False
TRUE
HDV replication tends to suppress HBV replication; therefore, patients with hepatitis D tend to have lower levels of HBV replication.
The most sensitive indicator of HCV infection is the presence of WHAT SEROLOGIC MARKER
The most sensitive indicator of HCV infection is the presence of HCV RNA
precore genetic mutants of HBV have been associated with the more severe outcomes of HBV infection (severe chronic and fulminant hepatitis
True or False
True
- in patients who undergo liver transplantation for end-stage chronic hepatitis B, occasionally, rapidly progressive liver injury appears in the new liver.
- This clinical pattern is associated with an unusual histologic pattern in the new liver is called ____.
- in patients who undergo liver transplantation for end-stage chronic hepatitis B, occasionally, rapidly progressive liver injury appears in the new liver.
- This clinical pattern is associated with an unusual histologic pattern in the new liver, fibrosing cholestatic hepatitis, which, ultrastructurally, appears to represent a choking of the cell with overwhelming quantities of HBsAg.
a period of dissociation between high level HBV replication and a paucity of inflammatory liver injury
“immunotolerant” phase
when clinically apparent liver injury and progressive fibrosis emerge during later decades
immunoreactive, or immunointolerant, phase
Persons infected as neonates tend to have
○ a relatively higher level of immunologic tolerance (high replication, low necroinflammatory activity) during the early decades of life
True or False
True
Persons infected as neonates tend to have a relatively lower level (but only rarely a loss) of tolerance (and necroinflammatory activity reflecting the level of virus replication) in the later decades of life
True or False
True
rheuma disease associated with Hepatitis B
Polyarteritis nodosa
nephro condition associated wtih hepatitis C
Immune-complex glomerulonephritis
neuro condition associated with hepatitis E
GBS
Term for this histologic finding in hepatitis:
Liver cell damage consists of hepatic cell degeneration and necrosis, cell dropout, ballooning of cells, and acidophilic degeneration of hepatocytes
Councilman or apoptotic bodies
microvesicular steatosis occurs in what hepatitis
microvesicular steatosis occurs in hepatitis D.
another term for subacute or confluent necrosis or interface hepatitis
bridging hepatic necrosis
In massive hepatic necrosis (fulminant hepatitis, “acute yellow atrophy”), the striking feature at postmortem examination is the finding of _____.
In massive hepatic necrosis (fulminant hepatitis, “acute yellow atrophy”), the striking feature at postmortem examination is the finding of a small, shrunken, soft liver.
