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STEP 1 Microbiology > GI/urinary- viruses and antivirals > Flashcards

GI/urinary- viruses and antivirals Flashcards

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Biology 101 flashcards
1
Q

Hepatitis B- classification

A

Hepadnavirus; partially dsDNA, circular, enveloped

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2
Q

Where does hepatitis B replicate?

A

Nucleus and cytoplasm

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3
Q

How does hepatitis B structure change during replication?

A

Viral DNA polymerase completes the circular dsDNA. Host RNA polymerase makes mRNA, which is reverse transcribed by viral polymerase to DNA

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4
Q

Hepatitis B- transmission

A

1) Sexual contact
2) Bloodborne
3) Vertical (if mixing of blood during delivery- TORCH infection)

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5
Q

Hepatitis B- presentation

A

Liver inflammation (RUQ pain, jaundice, etc.) May be acute or chronic (5-10%; mostly young children).

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6
Q

How do you distinguish alcoholic from viral hepatitis (without serology)?

A

Liver enzymes. In alcoholic hepatitis, AST > ALT. In viral hepatitis, ALT > AST. Note that ALT may be normal in neonatal hepatitis B.

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7
Q

Hepatitis B- long-term sequelae

A

Cirrhosis, hepatocellular carcinoma

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8
Q

Hepatitis D depends on which virus for infection?

A

Hepatitis B (requires surface antigen for coinfection or superinfection)

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9
Q

Hepatitis D- classification

A

RNA deltavirus; RNA (-) virus, circular enveloped

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10
Q

Which is worse, HDV confection or superinfection?

A

Superinfection

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11
Q

Hepatitis B- treatment

A

Lamivudine and other NRTIs; interferon-alpha therapy

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12
Q

What should be given to neonate of HBV-positive mother?

A

Anti-HBV IgG and HBV immunization

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13
Q

Hepatitis A- classification

A

Picornavirus; ssRNA (+), naked, acid-stable

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14
Q

Hepatitis A- transmission

A

Fecal-oral route (acid-stable characteristics resist stomach acid); may contaminate water supplies, or (uncooked) shellfish caught in caught from contaminated water

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15
Q

How can hepatitis A be eliminated from water?

A
  • Chlorination
  • Bleaching
  • UV/irradiation
  • Boiling
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16
Q

Hepatitis A- presentation

A
  • may be subclinical/anicteric
    Acute viral hepatitis may include fever, hepatomegaly, and jaundice (usually adults), vomiting, aversion to tobacco products
  • Symptoms last about one month; no carrier state
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17
Q

Hepatitis A- vaccine

A

Inactivated; given in endemic areas, to patients with chronic liver disease, and with men who have sex with men

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18
Q

Hepatitis C- classification

A

Flavivirus; ssRNA (+), enveloped

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19
Q

Hepatitis C- transmission

A

1) Bloodborne
2) Sexual contact
3) Placenta

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20
Q

Hepatitis C- presentation

A
  • acute viral hepatitis with jaundice, RUQ pain, hepatomegaly, increased liver enzymes
  • 60-80% of cases become chronic
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21
Q

Why can’t vaccines to HIV and HCV be easily created?

A

Antigenic variability in the envelope proteins

22
Q

Mechanism of antigenic variability in HCV envelope proteins

A

Lack of proofreading exonuclease activity in viral RNA polymerase in 3’-5’ direction

23
Q

Hepatitis C- long term sequelae

A
  • Fibrosis/cirrhosis

- Hepatocellular carcinoma

24
Q

Hepatitis C

A

Acute: ALT will rise and fall by 6 months, with HCV at 2-3 months (due to mutant strains)
Chronic: VIral RNA persists after 6 months, with lymphocytes in portal tract.

25
Q

Hepatitis B- extrahepatic manifestations

A
  • Prodromal serum sickness-type illness (rash and arthralgias)
  • Polyarteritis nodosa
  • Glomerulonephritis (membranous > membranoproliferative)
  • Aplastic anemia
26
Q

Hepatitis C- extrahepatic manifestations

A
  • Cryoglobulinemia
  • Increased risk of non-Hodgkins lymphoma
  • Idiopathic thrombocytopenic purpura
  • Autoimmune hemolytic anemia
  • Glomerulonephritis (membranoproliferative > membranous)
  • Leukocytoclastic vasculitis
  • Sporadic phorphyria cutanea tarda
  • Lichen planus
  • Increased risk of DM
  • Autoimmune hypothyroidism
27
Q

HBsAG- interpretation

A

Active hepatitis B infection

28
Q

Anti-HBs- interpretation

A

Immunity to hepatitis B (recovery, or immunization if no other antibodies to HBV)

29
Q

Anti-HBc- interpretation

A

Antibodies to core antigen; may be the only detectable marker during window period

30
Q

HBeAg- interpretation

A

Active replication and high transmissiblity

31
Q

Anti-HBe- interpretation

A

Low transmissibility

32
Q

What can be treated with interferon-alpha?

A
  • Hepatitis B
  • Hepatitis C
  • Condyloma accuminata (HPV)
  • Malignant melanoma
  • Hairy cell leukemia
  • Kaposi sarcoma
  • Renal cell carcinoma
33
Q

Interferon-alpha- adverse effects

A
  • Flulike syndrome
  • Neurotoxicity (mood disorders and confusion)
  • Fatigue
  • Tinnitus
  • Retinopathy
  • Myelosuppression (especially if given with Zidovudine)
  • Drug-induced lupus
34
Q

What should occur before a treatment plan for hepatitis C is determined?

A

HCV genotyping and assessment of fibrosis stage

35
Q

What is sustained virologic response (SCR) for hepatitis C?

A

HCV RNA is not detected for 6 months after stopping therapy

36
Q

Hepatitis C- treatment (traditional)

A

Pegylated-interferon alpha with daily oral ribavirin

37
Q

Ribavirin- MOA

A

Guanosine nucleoside analog (must be phosphorylated for activation!) to inhibit RNA production

38
Q

Ribavirin- adverse effects

A
  • Dose-dependent hemolytic anemia
  • Teratogenic (category X)
  • Contraindicated in MEN or WOMEN who cannot use contraception
39
Q

What else can ribavirin be used for?

A

Respiratory syncytial virus (RSV)

40
Q

Sofosbuvir- MOA

A

Nucleoside analog that inhibits NS5B RNA-dependent RNA polymerase

41
Q

Sofosbuvir- adverse effects

A
  • Fatigue

- Nausea

42
Q

NS3/4A protease inhibitors- use

A

HCV genotype 1

43
Q

NS3/4A protease inhibitors- key example

A

Simeprevir

44
Q

Simeprevir- MOA

A

NS3/4A protease inhibitor

45
Q

Simeprevir

A

Substrate and inhibitor of cytochrome P45 system

46
Q

Norovirus- classification

A

Calicivirus; ssRNA (+), naked

47
Q

Norovirus- transmission

A

Outbreaks are common on cruises (90% of diarrheal illness on cruise ships); daycare centers; consumption of shellfish/buffets; raspberries

48
Q

Norovirus- presentation

A

(Explosive) viral gastroenteritis

49
Q

Where does norovirus replicate?

A

The cytoplasm (like all positive-sense RNA)

50
Q

Most common Calicivirus

A

Norovirus

STEP 1 Microbiology (22 decks)

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