E2- Viral Hepatitis Flashcards
What is a common symptom of hepatitis?
Icteric symptoms (jaundice, dark urine, hepatomegaly)
What is the most common route of transmission of Hep A and E?
Fecal-oral
What two types of hepatitis are acute?
Hep A and E (cannot become chronic)
What is the source of Hep B, C, and D?
Blood, serum, semen
What three types of hepatitis can cause chronic infection?
Hep B, C, and D
What type of hepatitis is “infectious?”
Hep A
What type of hepatitis is “serum?”
Hep B
What type of hepatitis is “transfusion-associated”/
Hep C
What type of hepatitis is “delta agent, only in pts with active HBV infection?
Hep D
How does typical acute icteric hepatic present?
Prodrome: fatigue, malaise, anorexia
Icteric phase: dark urine, jaundice, hepatomegaly, elevated ALT, ASP
Convalescent phase: disappearance of symptoms
What type of hepatitis has high fatality rates?
Fulminant hepatitis
more likely with HDV
How is HAV diagnosed?
IgM antibody demonstration by ELISA
How is HAV treated?
Bed rest
Hydration and good nutrition
Avoid hepatotoxins (alcohol, drugs, anesthesia)
How is HAV prevented?
Proper hand washing
Avoid contaminated food (uncooked shellfish)
Post exposure prophylaxis with immunoglobin
Killed virus vaccine
Education** commonly transmitted to personal contacts
What is a infectious cause of primary hepatocellular carcinoma?
HBV
80% of primary hepatocellular carcinoma is linked to chronic HBV
What is a major determinant of whether HBV becomes chronic or not?
Age
Self-limited in most adults
90% of children become chronic
What is done to prevent chronic HBV in children?
Vaccine is offered very early in life
What is the HBV surface antigen?
HBsAg
What is the HBV core antigen?
HBcAg
Does the HBcAg provide protection?
No
What antigen indicates that the patient is infetious?
HBeAg
Can a patient still be infectious if the HBeAg is not present?
Yes
What is the infectious form of HBV?
Dane particle
How is HBV spread?
Needle sharing, IV drug use, acupuncture, ear piercing, tattooing
Who is a major reservoir of HBV?
Chronic hepatitis pts
What has reduced the infection from blood and blood products?
Serological screening
What is the greatest risk factor for perinatal-congenital infection?
Chronic infection in mother
HBeAg positive mother is greatest risk
Who is at greatest risk for HBV infection?
Healthcare workers
IV drug users
How is the subclinical infection of HBV recognized?
anti-HBsAg
What complications can chronic HBV lead to?
Cirrhosis and liver failure
What is the hallmark of initial ongoing HBV infection if present with HBsAg?
IgM anti-HBc
What indicates past infection of HBV, if present with HBsAg indicates chronic infection?
IgG anti-HBc
What is the best indication of the presence of infectious HBV virus?
HBeAg
What do the following test results indicate?
HBsAg- negative
AntiHBc- positive
AntiHBs- positive
Immune due to natural infection
What do the following test results indicate?
HBsAg- negative
AntiHBc- negative
AntiHBs- positive
Immune due to hepatitis B vaccination
What do the following test results indicate?
HBsAg- positive
IgM antiHBc- positive
AntiHBs- negative
Acutely infected
What do the following test results indicate? HBsAg- positive AntiHBc- positive IgG antiHBc- positive AntiHBs- negative
Chronically infected
The HBV vaccine prevents what strains?
HBV and HDV
What can be used to treat HBV and HDV?
PEG-interferon
Although Hep B, C, and D can all become chronic, which is most likely to progress to a chronic infection?
HCV
How is HCV treated?
Direct acting antiviral agents (DAAs)
Virus protease or polymerase inhibitors
Alpha-interferon (PEG interferon) for some genotypes
What might DAA treatment cause in a patient with a HCV and HBV co-infection?
Activation of HBV infection
What type of hepatitis requires the presence of HBV for replication?
HDV
increases severity of HBV infection
What are the leading causes for liver transplant?
Cirrhosis and hepatocellular carcinoma
What is the test to screen for HCV?
Enzyme immunoassay detection of antibody against HCV
Why are direct assays for the HCV virus helpfu in confirmation of diagnosis of HCV?
Chronic state and acute phase viremic patients often escape detection