Hepatitis Flashcards
what is the incubation period for hepatitis B
40 days - 160 days
Describe the hepatitis B virus
Hepatitis B is a circular, partially double stranded DNA virus.
how can people catch Hepatitis B
Vertically : mother to baby
blood borne virus - needle stick injury, IVDUs sharing needles, sex, infected blood products/contaminated health care equipment (this is very rare in the UK)
what is the leading cause of hepatitis worldwide?
Hepatitis B
what are the consequence of chronic hepatitis B
HCC (hepatocellular carcinoma) and liver cirrhosis –> Acute liver failure
what proportion of patients with acute hepatitis B infection will be asymptomatic?
up to 50% of patients
Patients with acute hepatitis B - how many will go on to develop chronic hepatitis B (adults)
9/10 patients with acute hepatitis B will clear the virus without treatment. This is only true of adults.
Infants and children infected at birth - the majority will go on to develop chronic hepatitis B
what is the first serological marker that appears in acute hepatitis B infection
HBsAg
how is chronic hepatitis B defined serologically?
HBsAg presence for >= 6 months
A patient has Anti-HBs +ve. Does this mean they have previously had the hepatitis B vaccine or past infection? how would you investigate further
The presence of anti-HBs implies immunity to hepatitis B either by vaccination or previous cleared infection. In order to work this out request anti-HBc - if this is positive then implies previous cleared infection,
what is the difference between Anti-HBc IgM and anti- HBc IgG
IgM antibody is present in acute infection and over time is gradually replaced by IgG which represents past infection.
what does the presence of HBeAg indicate
HBeAg can be present in acute and chronic infection. It is a marker of infectivity and implies high HBV viral load therefore suggests high risk of transmission.
A patient has the following hepatitis serology, how would you define it?
HBsAg +ve, HBeAg +ve, anti-HBc IgM +ve, HBV DNA present
acute infection - highly infectious
A patient has the following hepatitis serology, how would you define it?
HBsAg +ve, HBeAg +ve, anti-HBc IgG +ve, HBV DNA high
chronic infection (active)
A patient has the following hepatitis serology, how would you define it?
HBsAg +ve, anti-HBe +ve, anti-HBc +ve (IgG), HBV dna low
chronic infection (inactive)
A patient has the following hepatitis serology, how would you define it?
Anti-HBs +ve, Anti-HBc (IgG +ve), anti-HBe +ve
HBV DNA -ve
Immunity, following acute infection
A patient has the following hepatitis serology, how would you define it?
Anti-HBs +ve
Immunity following vaccination
How would you counsel a patient when informing them of a positive hepatitis B serology blood test - HBsAg +ve, anti-HBc +ve IgM, HBeAg +ve
These results imply they have acute hepatitis B infection.
check their understanding
explain that hepatitis means inflammation of the liver.
There are lots of different causes of inflammation to the liver; can be due to infective causes, alcohol or drugs and other diseases. Hepatitis B is a viral infection that lives in the blood. It is transmitted in different ways including from mum - to baby at the time of delivery, sharing of needles, occupational exposure e.g. sharps injury, through sexual contact.
hepatitis B can be defined as either acute or chronic. 90% of adults that acquire hepatitis B infection will clear the virus themselves. the remaining 10% can develop chronic infection. it is important we monitor the virus as chronic hepatitis B infection can lead to scarring and permanent damage of the liver. This is what we call cirrhosis. Overtime this increases your risk of developing HCC (liver cancer).
What we need to do today are further investigations - specifically bloods to check how your liver is working (LFTs), a marker to check for Liver cancer (AFP), STI screen and chic for other types of hepatitis and immunity to hepatitis A ( HIV, STS, hepatitis A antibody, hepatitis C and D), imaging - USS and a special type of scan called a fibroscan to check for scarring of the liver.
We will refer you to a liver specialist.
In the meantime things you can do to prevent onward transmission to partners and close contacts:
1. avoid sharing razors, toothbrushes
2. don’t donate blood/semen/ organs until told not infectious
3. PN - disclosure to partners, no sex until partners fully vaccinated and confirmed immunity
4. cover up any cuts and grazes
5. clean any blood spillages
6. reduce alcohol intake/abstain to prevent liver cirrhosis
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once a patients serology confirms hepatitis B what other investigations do you need to do to investigate further?
Hepatitis A antibody (immunity), hepatitis C, hepatitis D
HIV blood test +/- STI screen
AFP
imaging - liver USS + fibroscan
refer to hepatology clinic
what percentage of babies born from mothers with hepatitis B infection will acquire hepatitis B
up to 90% will acquire hepatitis B
Children vertically infected with hepatitis B; what percentage will clear the virus and what percentage go on to develop chronic hepatitis B?
90% of children infected with hepatitis B will develop chronic hepatitis B; only 10% of children clear the virus
The aim of hepatitis B treatment is to achieve cure? T/F
False there is no cure for hepatitis B - treatment works to try and suppress the virus and prevent cirrhosis of the liver
A patient is diagnosed with acute hepatitis B infection. He informs you he has a wife and they had sex 2 days ago. How would you manage this situation?
Get the wife into clinic urgently - screen for HBsAg, anti-HBs, anti-HBc
discuss with virology as need to consider HBIG 500 I.U IM - this can be given ideally < 12 hours post exposure, but up to 7 days.
If no immunity and no evidence of acute hepatitis B - give HBIG and also provide super accelerated hep B vaccine (0, 7, 21 days and booster at 12 months) - check anti-HBs following third dose of the vaccine
avoid sex until anti- HBs > 10
when would you consider treating a patient with known hepatitis B infection?
- deranged LFTs - rising ALT
- high HBV DNA
- evidence of cirrhosis and scarring on USS/fibroscan
- deranged clotting
when would you consider treating a pregnant lady with hepatitis B
- consider treating a pregnant lady in the third trimester if high levels of HBV DNA to reduce vertical transmission
- on delivery: screen the baby, give HBIG and also vaccinate against hepatitis B
What HBV viral load is treatment of hepatitis B usually considered in a/s with liver cirrhosis?
HBV viral load > 2000 IU/ml + evidence of inflammation/fibrosis of the liver
prior to commencing anti-viral Rx of hepatitis B what other blood borne virus is it essential to test for and what is the reason for this?
essential to test for HIV
this is because anti-viral medications used to treat HBV are also Rx options for HIV and if unknown can lead to mutations in HIV which can lead to resistance causing difficulty in treatment options
out of the following list which of the hepatitis viruses are single stranded RNA viruses
Hepatitis A, B , C, D and E
hepatitis A, C, D and E are all single stranded RNA viruses
hepatitis B is the only double stranded virus in this group
vertical transmission in hepatitis A is common?
True or false
false
rarely reported
What family of viruses does hepatitis A belong to
Flaviviridae
Picornavirus
lentovirus
Picornavirus
what family of viruses does hepatitis C belong to
Flaviviridae
Picornavirus
lentovirus
flaviviridae single stranded RNA virus
how is hepatitis A spread
faecal-oral route, highly infectious
only hepatitis B and C are notifiable conditions
True or false
false all the hepatitis viruses are notifiable conditions
hep C treatment aims to
A) suppress virus
B) cure the virus
B ) cure the virus
