Hepatitis Flashcards
Viral Hepatitis is a disease which
should be notified to health protection
what is the mean incubation period in hepatitis a
28 days
how many days after initial symptoms in hep a does jaundice present
3-10 days
why does urine become dark in hepatitis
conjugated bilirubin
how is hepatitis a spread
faecal oral route
when are patients infectious in jaundice
a week before onset of jaundice
what type of virus is Hep A
Picornavirus - RNA
which antibodies are present in serum for hep A
IgM
how long does it take for hep A antibodies to decline
3-6 months
treatment for hep a
none
Acute clinical hepatitis may occur when after infection with HBV
Few Weeks to 6 Months
What type of virus is hep b virus
Hepadnavirus
what are markers of viral replication in Her B
Serum HbeAg and HBV-DNA
what is major marker for identifying acutee and chronic HBV infection
HbSAg
which patients are highly infectious and at risk of developing chronic liver disease and primary liver cell cancer (hepatoma)
patients with HBeAg
Route of transmission in patients with Hep B
Vertical (Perinatal)
Horizontal (sexual, Parenteral eg Needlestick)
Transmission from family or person living close is form of what transmission in Hepatitis
Horizontal
Factors predisposing to increased risk of Hepatitis in UK
- Injecting Drugs
- Multiple Sexual Partners regardless of sexuality
- Immigration
- Learning Disability in Residential Care
- Haemodialysis Patients
- Haemophilia Patients
- when a sexual partner has risk factors
- Babies born to mothers with risks
- Tattooing or Body Piercing with Non Sterile
Babies born to mothers with what Hepatitis antigen are at high risk of perinatal infection and become chronically infected if no preventative immunisation given
HBeAg
Diagnosis of Acute HBV Infection can be made if
high levels of anti HbC IGM antibodies present
Chronic HBV Infection definition
Presence of HBsAg in serum for more than 6 months.
Who is particularly at risk of chronic HBV infection
infants
Male
Immunodeficient
what can chronic hbv infection lead to
chronic liver disease
membranous glomerulonephritis
Cirrhosis
Hepatoma
who is more likely to progress to chronic infection
Patients with asymptomatic or mild
Which Hepatitis complication is the third most common cause of cancer in world
Hepatoma
Treatment for Asymptomatic Chronic HBV Infection with Raised ALT HBeAG Positive and with Liver Disease or Cirrhosis
Anti Viral Therapy
Indications for Antiviral for those without Cirrhosis 2 out of three of
HBV DNA >2000
Raised ALT
Significant Liver inflammation or fibrosis
The active immunisation for Hepatitis contains
HbsAG
When should you test for adequate protective antibody after immunisation in hepatitis
2-4 months after last dose
How to tell further antibody checks not needed after immunisation
> 100 Post Vacine Anti Hbs
When are boosters of Hepatitis vaccine needed
Every 5 Years
What is a reliable indicator of liver inflammation in Hep C
ALT and Increasing AST
Hep C is a type of which virus
Blood Borne
Rate of transmission from mother to baby with Hep C is high when mother has
HIV
Hep C mainly affects
injecting drugs
Haemophiliacs
Needle Stick
Blood Transfusion
Hep C is in what virus family
RNA of Flavirus
how to test for Hep C
Sequencing
Treatment for Hep C
Pegylated A Interferon
Ribavirin
Which hepatitis is always found in patients who have hepatitis B
Hepatitis D
commonest mode of transmission for hep d
Parenteral Infection
tests for hepatitis D
IgG
IgM
treatment for hepatitis d
pegylated a interferon
Symptoms develop in Hepatitis E how soon after incubation
40 days
most common cause of acute viral hepatitis
Hepatitis E
Hepatitis E is what type of virus
RNA Henevirus
Hepatitis E tests
IgG and IgM and HEV
When can healthcare workers with hepatitis not perform EPP
Hepatitis B Antigen Pos
Hep B surface Antigen Pos and HBV DNA of 1000 or more
Hep C Pos
Which hepatitis viruses can be transmitted by the faecal-oral route?
Hep A and E
How can these infections be prevented?
Hygiene, Clean Water, Immunisation (Hep A)
. How is hepatitis Adiagnosed in the virus laboratory?
Detection of hepatitis A lgM antibody
in a serum sample.
Which hepatitis viruses are spread by infected blood?
Heb B,C and D
What is the purpose of testing serum for anti-HBc IgM antibody?
Its presence indicates recent hepatitis
B infection. If a patient is tested late in the course of illness, HBsAg may have disappeared but the presence of IgM-anti HBc indicates recent infection.
Define chronic hepatitis B infection.
HBsAg is present in serum for at least 6 months.
What percentages of people will become chronically infected following acute infection with HBV in i) infants ii) children iii) adults
i) 90% ii) 40% iii) 5-10%
What is the clinical significance of prolonged HBsAg and HBeAg carriage?
Patients are at risk of long-term sequelae including chronic liver disease, cirrhosis and increased risk of hepatoma.
What is the clinical importance of infection with hepatitis C?
60-80% of patients will show evidence of chronic liver disease and are at risk of progression to cirrhosis.
What laboratory assessment would you make of someone with antibodies to HCV?
. Serum ALT, HCV RNA.
What factor is essential for the transmission of hepatitis D?
Presence of HBsAg.
What is the commonest mode of hepatitis D transmission?
Injection of Drugs
History of recent jaundice in a 26 year old homosexual.
Hepatitis B surface antigen negative. Hepatitis B core antibody negative. Hepatitis A IgM positive.
MSM are at increased risk of hepatitis A as well as hepatitis B. Prevention of hepatitis A is possible by active immunisation with the killed vaccine.
Evidence for recent hepatitis A infection. No evidence for infection with hepatitis B.
Antenatal screen in a 30 year old woman.
Hepatitis B surface antigen positive. Hepatitis B e antigen positive.
Hepatitis B e antibody negative. Hepatitis B core IgM antibody negative. Hepatitis B core total antibody positive.
Results consistent with chronic hepatitis B infection. The presence of surface antigen indicates infectivity. The presence of e antigen indicates high infectivity.
The absence of IgM anti-core indicates the infection is not recent.
Comment:
Arrangements should be made in advance so that active (hepatitis B vaccine) and passive (hepatitis B immunoglobulin) can be given immediately after birth to the neonate.
Follow up arrangements should be made
so that the infant gets the second dose of hepatitis B vaccine at age 4 weeks, the third dose at 8 weeks, and a fourth dose at 12 months, when hepatitis B serology (surface antigen) should also be checked to ensure the child is not infected.
History of past injecting drug use.
Hepatitis A antibody negative
Hepatitis B surface antigen negative. Hepatitis B core total antibody positive. Hepatitis B surface antibody positive. Hepatitis C antibody positive.
Hepatitis C RNA positive.
5.
No recent or past infection with hepatitis A. Results consistent with past hepatitis B. Results indicate on-going hepatitis C infection.
Comment:
Both hepatitis B and C are common in PWIDs. Persistent infection is more common with hepatitis C than hepatitis B. Immunisation against hepatitis B is NOT indicated. Immunisation against hepatitis Ashould be offered. Assess suitability for hepatitis C treatment.
Recent onset jaundice in a 65 year old diabetic man who has not been abroad recently.
Hepatitis A IgM negative.
Hepatitis B surface antigen negative. Hepatitis B core total antibody negative. Hepatitis C antibody negative.
Hepatitis E IgG antibody positive. Hepatitis E IgM antibody positive. Hepatitis E RNA positive
Results consistent with recent hepatitis E. No evidence for recent hepatitis Adetected. No evidence for infection with hepatitis B detected.
Comment:
Both hepatitis A and E may be acquired
in the UK (although HAV infection is now uncommon) and abroad. The incubation period of hepatitis E (mean 40 days) is longer than hepatitis A (mean 28 days). Remember to mention travel history on laboratory request forms.
Going to live in Africa. Is immunisation needed?
Hepatitis A total antibody positive. Hepatitis B core total antibody negative
Evidence for past infection with hepatitis A. Immunisation not indicated.
No evidence for previous hepatitis B infection. Immunisation indicated.
Comment:
A person who plans to stay for a lengthy period in an area of high prevalence is in
a category for whom immunisation against both hepatitis Aand B should be considered. Immunisation against Yellow Fever and typhoid may also be indicated.
