case 5 - hepatitis Flashcards
what are the three stages of symptoms of hepatitis
prodromal
icteric
convalescent
what happens in the prodromal phase
In the prodromal stage, the virus is in the blood and will release chemicals. These chemicals will create symptoms such as fever, headache, fatigue, nausea, vomiting, skin rashes and joint pains
what happens in the icteric stage
In the icteric stage, conjugated bilirubin and transaminases spills into the blood because of damage of bile ducts and hepatocytes. The conjugated and unconjugated bilirubin make the patient appear yellow and present with dark urine. The liver may become enlarged in this state as well which is termed hepatomegaly
what happens in the convalescent stage
the symptoms become better or the patient returns to normal
what is hepatitis A
an RNA virus of the family Picornaviridae
how is Hep A spread
via fecal or oral route, transfusion of blood or MSM
how do the symptoms appear
like food poisoning symptoms.
is hepatitis A chronic
no
what is the best prevention for Hepatitis A
The best prevention is washing hands, wearing gloves and keeping meticulous hygiene
what is hepatitis B
a DNA virus with 8 different genotypes
how long is the incubation period for hepatitis B
3 to 8 week incubation period
how is hepatitis B transmitted
parenterally, sexually or through mother to baby
how does mother to baby only occur
if the mother was exposed to the virus during the third trimester of preganany
what can the disease cause
The disease can cause liver injury low grade fever, inflammation, risk for Hepatitis C, risk for cirrhosis, risk for liver failure and risk for hepatocellular carcinoma
is the disease severe or chronic
the disease could be severe and chronic
what treatment is given for hepatitis B
Treatment is with nucleotide analogs and interferons and a preventative vaccination is available
what is hepatitis C
a RNA virus with 10 genotypes
how long is the incubation period
40 days incubation period
how is hepatitis C spread
via parenteral route
what are the symptoms
Sometimes there may not be any symptoms to aid in diagnosis but liver enzymes will be elevated
what can hepatitis C increase
the risk for chronic liver disease, cirrhosis, hepatocellular carcinoma, oesophageal varices and potential need for liver transplant
what is the treatment for hepatitis C
Treatment is with antivirals drugs and sometimes drug resistance can develop when disease becomes more severe. There is no vaccination
what is hepatitis D
a defective single stranded RNA virus and usually occurs with Hepatitis B
how is hepatitis D spread
parenterally
what can hepatitis D lead to
liver failure
what is the treatment for hepatitis D
pegylated interferon alpha and treatment has a high failure rate
what is hepatitis E
is an RNA virus in the family Hepevirdae
what is the incubation period for hep e
50 days
how is hepatitis E spread
through fecal oral route, contaminated water or uncooked meat
what does it resemble
Hepatitis A but could be asymptomatic
what can hepatitis E produce
neurological symptoms and impair kidney function
what is the treatment course for hepatitis E
ribavarin and pegylated interferons
what is hepatitis triggered by
many microorganisms such as CMV, EBV, and HSV
what do these viruses do
they enter the blood stream and spread to the liver. they infect the hepatocytes and multiply. they change the antigen structure on the virus site. the body begins to use self-mediated immune response attempting to damage the hepatocytes
what is different in Hepatitis B and C
they can continue this process over and over for years
what virus family does hep d come from
deltavirus
which types of hepatitis have envelopes and which do not
B, C,D all have envelopes
A and E do not have envelopes
which hepatitis are self limited
A and E
which hepatitis must u be co infected with in hepatitis D
must be co infected with hepatitis B
which hepatitis lead to chronic infection
B,C,D
what does enteral route of transmission mean
that it involves the GI tract. the route of transmission can be either oral or faecal
what is the parenteral route of transmission
this involves areas other than the GI tract
which viruses have an enteral route of transmission
hepatits A and E
which viruses have a parenteral route of transmission
hepatitis B,C,d
which hepatitis is double stranded
hepatitis B virus
what antigen will be present in hepatitis D
HBsAg
what do the chronic forms lead to
cirrhosis and hepatocellular carcinoma
what does self limiting mean
that the colony of these viral cells self regulate their growth - infection resolves itself
what is a surface antigen (sAg)
the presence of these indicates the presence of the virus in the body
what is a core antigen (cAg)
indicates the body is producing antibodies against the virus
what is the modified core antigens (eAg)
the presence of these indicates the viral cell is actively replicating. this means the person has higher infectability
what is the immediate response antigen
IgM
what is the chronic response antigen
IgG
what is the surface antigen found on the envelope of HBV
HBsAg
what is the core antigen found around the nucleus of HBV
HBcAg
what is the modified c antigen that appears when the viral cell is actively replicating
HBeAg
the presence of what would give the person immunity against HBV
anti-HBs antibody
what antibody can be HBc IgM or HBc IgG
anti-HBc antibody
the presence of what would reduce infectability
anti-HBe antibody
what are the risk factors for hepatitis A
Travel to endemic areas
Household contact
Contaminated food (Salads/ Berries/ Tomatoes
sundried)
Sex risk (especially male homosexuals
what are the investigations carried out for hepatitis A
The HAV carries a HAV antigen.
Individuals infected by HAV make an antibody against the HAV antigen (anti-HAV).
Anti-HAV of the IgM type = indicates a primary immune response (diagnostic of an acute HAV infection).
Anti-HAV of the IgG type = this antibody persists for years after infection (no diagnostic value), but it can be used as a marker of previous HAV infections. Its presence indicates immunity to HAV.
what is given as prevention of hepatitis A
human normal immunoglobulin
what is the hepatitis A vaccination
harvix
what are the symptoms of Hepatitis B
Many people have no symptoms during the initial infection but some develop a rapid onset of sickness with vomiting,yellow skin, feeling tired, dark urine andabdominal pain.
Often these symptoms last a few weeks and rarely does the initial infection result in death.
what is a current infection of hepatitis B indicated by
the presence of HBsAg in the blood
what is a past infection of Hepatitis B indicated by
the presence of anti-HBs antibodies in the blood
what is the replication steps of hepatitis B
- HBV binds to the NTCP bile receptor on hepatocytes. this allows the virus to enter the cell
- the HBV DNA is partially double stranded
- the viral DNA enters the host cell nucleus and uses the host cell’s DNA to complete its DNA from partially double-stranded to a covalently closed circular DNA - cccDNA
- the viral DNA is now transcribed into viral RNA
- this is then translated to produce viral antigens and other viral proteins
- the viral RNA undergoes reverse transcription in the viral nucleocapsid to form its partially double stranded DNA once again
- this is now packaged within the viral antigens
- this is then exocytosed and infects other cells
what does it mean if someone as the HBsAg antigen
current infection (acute or chronic)
what does it mean if someone has the anti-HBc antibody
infection at some time (current or past)
what does it mean if someone has the anti-HBc IgM+ antigen
recent acute infection
what does it mean if someone has the anti-HBs antibody
past infection: anti HBc+
vaccination: if no other HBV markers
how to tell if someone has ever been exposed to hepatitis B
total antibody to hepatitis B core antigen (Anti-HBc)
what is an acute infection indicated by
IgM antibody to core antigen
anti-HBc-IgM
how to tell how infectious the patient is to their contacts
positive for e antigen (HBeAg) and/or high levels of HBV DNA
summary of the antigens and antibodies for Hepatitis B
HBsAg = this is the surface antigen found on the envelope of HBV.
HBcAg = this is the core antigen found around the nucleus of HBV.
HBeAg = this is the modified c antigen that appears when the viral cell is actively replicating.
Anti-HBs antibody = the presence of this would give the person immunity against HBV
Anti-HBc antibody = this can be HBc IgM (immediate) or HBc IgG (chronic)
Anti-HBe antibody = the presence of this would reduce infectability.
Anti-HBc IgG + HBsAg = the presence of this combination indicates a chronic infection.
Anti-HBc IgG + Anti-HBsAg = the presence of this combination indicates complete immunity against the infection.
what is the Hepatitis B virus life cylce
immune tolerance
immune clearance
low replication inactive carrier
reactivation
what are the aims of HBV therapy
to convert HBV from high replication phase to a low replication phase
HBeAg+ to anti-HBe
ALT normalisation
reduced hepatic inflammation
what are the antiviral agents active in hepatitis B
interferon - if HBeAg+ low HBV DNA, more chance of losing HBsAg but side effects
nucleoside analogues
lamivudine (3 TC) - Adefovir + Entecavir + Tenofovir
what happens if the mother is HBeAg positive
active infection, high HBV viral load
hepatitis B immunoglobulin plus
hepatitis B vaccine (accelerated schedule)
what happens if the mother is anti-HBe positive
hepatitis B vaccine only
describe the HCV antibody test
total antibody
slow response - 8-12weeks
no IgM assay
describe the HCV PCR
appears early
marker of infectivity and active infection
monitor HCV RNA viral load for treatment response
what is included in the HCV therapy
combination therapy 24-48 wees
pegylated interferon alpha weekly
ribavirin
what is ribavirin
RNA-dependent RNA polymerase inhibitor
reduces GTP pool
RNA mutagen giving defective HCV
immunomodulator
what are the aims of HCV therapy
Sustained Viral Response
Undetectable HCV RNA 6months post-treatment
40-80% of cases with IFN/ribavirin
Important to test:
Ever injected illegal drugs
Received clotting factors made before 1987
Received blood/organs before July 1992
Ever on chronic haemodialysis
Evidence of liver disease
Early treatment
Blood exposure eg Health Care Workers, baby
what are telaprevir and bocepravir
protease inhibitors
what is an example of a polymerase inhibitor
Sofusbuvir
what are the interferon-free treatments
daclatasvir + asunaprevir
ombitasvir–ABT-450/r and dasabuvir with ribavirin
sofosbuvir + simepravir
what are the two different forms of hepatitis D infection
coinfection with HBV
superinfection
what is co infection with HBV
HDV is acquired at same time as HBV
increase in fulminant hepatitis
what is a superinfection
HDV acquired by hepatitis B carrier
high risk of progression to corrhosis
high risk of hepatocellular carcinoma
what are some of the symptoms of hepatitis E
jaundice
abdominal pain
nausea and vomiting
anorexia
what does anicteric mean and who is common in
without jaundice
and common in children
what is the most common cause of sporadic hepatitis in adults in endemic areas
hepatitis E
what do stellate cells turn into
myofibroblasts
