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CSIM 1: Virology Strand > CSIM 1.55: Viral Hepatitis > Flashcards

CSIM 1.55: Viral Hepatitis Flashcards

1
Q

How is Hepatitis A to E usually spread?

A 
A: Enteric (faecal-oral)
E: Enteric (faecal-oral)
C: Parenteral (blood-bourne)
D: Parenteral (blood-bourne)
B: Parenteral (blood-bourne)
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2
Q

Describe the hepatitis A virus:

1) Genus
2) Family
3) Genetic material
4) Incubation period

A

Hepatitis A:

1) Hepatovirus
2) Picornaviridae
3) Positive sense ssRNA
4) 2 to 4 weeks

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3
Q

Describe the resolution of hepatitis A

A

Usually self-resolving after 8 weeks

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4
Q

Which populations are icteric and symptomatic with Hepatitis A?

A

Over 2 years: 80% are anicteric and asymptomatic

Below 2 years: 80% are icteric and symptomatic

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5
Q

What are the symptoms of viral hepatitis?

A
  • Fatigue
    • Anorexia
    • Jaundice
    • Nausea
    • Low fever
    • Headache and myalgia
    • Abdominal pain
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6
Q

How is hepatitis A diagnosed using lab tests?

A
  • Raised liver enzymes
    • IgM (IgG for previous infection)
    • PCR
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7
Q

How is hepatitis A prevented and controlled?

A
  • Good hygiene
    • Immunoglobulin for prophylaxis in high risk contacts
    • Vaccine
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8
Q

How many genotypes of Hep E are there, and which genotype is most prevalent in industrialised nations and why? How is it often acquired?

A

Four genotypes, genotype 3 is the most common in industrialised nations as it is closely related with undercooked pork products

  • Waterborne
  • Faecal-oral
  • Zoonosis
  • Pork food products
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9
Q

Describe the resolution of hepatitis E

A
  • 20% mortality in pregnant women, low mortality otherwise in immunocompetent
    • Self-limiting
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10
Q

Describe the prevention of hepatitis E

A
  • No vaccine available

* In immunocompromised, antivirals used

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11
Q

How many genotypes of hepatitis B are there?

A

8 genotypes

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12
Q

What is tested for when searching for hepatitis B?

A
  • Hepatitis B surface antigen (HBsAg)
    • Antibodies against Hepatitis B core antigen (HBcAg)
    • Viral DNA measurements
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13
Q

What antigen is associated with increased hepatitis B replication?

A

HBeAg

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14
Q

How can hepatitis B be transmitted?

A
  • Transfusion
    • Fluids
    • Transplantation
    • Close contact (horizontal)
    • Mother to baby (vertical)
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15
Q

In what proportions of individuals is jaundice seen with Hepatitis B?

A

10% young children

50% adults

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16
Q

What is fulminant hepatitis?

Which hepatitis virus is this seen with?

A

Severe liver damage in which a liver transplant is required

HBV

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17
Q

What are the complications of ‘complicated’ HBV?

A
  • Chronic active hepatitis
    • This leads to cirrhosis
    • Hepatocellular carcinoma
18
Q

How can one differentiate between a chronic or an acute infection of hepatitis B

A
  • IgM present in acute infections
    • Hepatitis B becomes defined as chronic when HBsAg is found to be present for over 6 months (happens in 25% of people)
19
Q

Which hepatitis becomes latent? Where? What causes reactivation?

A

Hepatitis B becomes latent in liver cells

Reactivation caused when patient becomes immunocompromised

20
Q 
Which of the following markers is present in acute hepatitis B infection?
  •  HBsAg
  •  Anti-HBs ab
  •  Anti-HBc IgM
  •  Anti-HBc IgG
  •  HBeAg
  •  Anti-HBe ab
  •  HBV DNA
A

IMG 123

21
Q 
Which of the following markers is present in chronic hepatitis B infection?
  •  HBsAg
  •  Anti-HBs ab
  •  Anti-HBc IgM
  •  Anti-HBc IgG
  •  HBeAg
  •  Anti-HBe ab
  •  HBV DNA
A

IMG 124

22
Q 
Which of the following markers is present in a past or remote hepatitis B infection?
  •  HBsAg
  •  Anti-HBs ab
  •  Anti-HBc IgM
  •  Anti-HBc IgG
  •  HBeAg
  •  Anti-HBe ab
  •  HBV DNA
A

IMG 125

23
Q 
Which of the following markers is present in a person vaccinated against hepatitis B?
  •  HBsAg
  •  Anti-HBs ab
  •  Anti-HBc IgM
  •  Anti-HBc IgG
  •  HBeAg
  •  Anti-HBe ab
  •  HBV DNA
A

IMG 122

24
Q

What does the hepatitis B vaccine produce antibodies against?

A

HBsAg

25
Q

How is hepatitis B treated and prevented?

A

TREATMENT:
Antivirals
• (formulary:) Tenofovir
• Interferon-based

PREVENTION:
• Vaccines (pre and post-exposure)
• Hepatitis B immunoglobulin (passive immunity for babies born to HBV mothers)
• Infection control

26
Q

Describe the HBV vaccine

A
  • Recombinant DNA (no live virus)

* Combined with HAV vaccine

27
Q

Who is given a Hep B vaccine in the UK?

A
  • HCPs
    • Injecting drug users
    • Promiscuous individuals
    • Close family of case or carrier
    • Chronic renal or liver disease
28
Q

How is Hepatitis B vaccination administered? (time-wise

A

3 doses
• 0 months
• 1 month
• 6 months

Post exposure accelerated:
• 0 months
• 1 month
• 2 months

29
Q

Which hepatitis virus requires the ‘machinery’ of hepatitis B to replicate? How do both of these infections occur together?

A

Hepatitis D - delta virus

Coinfection:
• Both viral infections occur at the same time
Superinfection:
• Hepatitis B infection already present
• Subsequent hepatitis D infection occurs

30
Q

What antigens are seen in hepatitis D?

A
  • Outer HBsAg (needs hep B to make the coat for it)

* Inner HDAg

31
Q

How is hepatitis D detected?

A
  • IgM and IgG

* PCR not possible as the genetic information is too small

32
Q

How is HDV prevented?

A

By virtue of hepatitis B vaccination and prevention, hepatitis D is prevented

33
Q

How can HDV be treated?

A

Interferon antivirals

34
Q

What are the Hepatitis C genotypes?

A 
6 genotypes:
  •  1a
  •  1b
  •  1c
  •  1d
  •  1e
  •  1f
35
Q

Describe the hepatitis B virus:

1) Genus
2) Family
3) Genetic material
4) Incubation period

A

Hepatitis B:

1) Orthohepadnavirus
2) Hepadnavirus
3) dsDNA
4) 40 to 100 days

36
Q

Describe the hepatitis C virus:

1) Genus
2) Family
3) Genetic material
4) Incubation period

A

Hepatitis C:

1) Hepacivius
2) Flaviviridae
3) Positive sense ssRNA
4) 8 weeks

37
Q

Describe the hepatitis D virus:

1) Genus
2) Family
3) Genetic material
4) Incubation period

A

Hepatitis D:

1) delta virus
2) ?
3) Negative sense ssRNA
4) 3 to 7 weeks

38
Q

Describe the hepatitis E virus:

1) Genus
2) Family
3) Genetic material
4) Incubation period

A

Hepatitis E:

1) Hepevirus (not ‘herp-‘)
2) Hepeviridae
3) Positive sense ssRNA
4) 6 to 9 weeks

39
Q

Which hepatitis is asymptomatic acutely?

A

Hepatitis A when over 2 years of age (80%)

Hepatitis C

40
Q

What proportion of hepatitis C infections become chronic? What does this cause?

A

80% become chronic

  • Chronic liver disease
  • Cirrhosis
  • Hepatocellular carcinoma
41
Q

How is HCV detected in the lab?

A
  • HCV antibody or antigen test

* PCR for RNA

42
Q

How is HCV prevented?

A
  • No vaccine
    • Standard infection control
    • Targeted screening

NB treated with antivirals - curable

CSIM 1: Virology Strand (12 decks)

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