Hepatitis Flashcards
When can HBsAg test positive?
- Rises and falls within 2 weeks to 3 months during acute infection.
- In chronic disease, remains elevated.
When can HBsAb test positive?
- Begins rising in early recovery period (3-6 months).
- Only HBV antibody produced after vaccination.
- Not present in chronic disease.
When can HBcAb and HBcAb-IgM test positive?
- IgM begins rising at the end of the acute infection and peaks at the beginning of the recovery period. It falls again by the end of the recovery period (core window).
- Total core Ab rises along with IgM, and remains elevated after recovery in both acute and chronic patients.
- ONLY present after natural infection, not vaccination.
When can HBeAg test positive?
- Follows roughly the same trajectory as HBsAg.
- Rises and falls within 2 weeks to 3 months during acute infection.
- In chronic disease, remains elevated.
When can HBeAb test positive?
Follows same trajectory as sAb. Not present in chronic disease.
When can HCV-Ab test positive?
Detects IgG only, which remains positive for life after infection. Detectable 7-8 weeks after exposure.
When can HAV-Ab test positive?
- IgM detectable by onset of symtoms. Becomes undetectable by 6 months.
- Total Ab positive for life after recovery or vaccine (IgG).
Mode of transmission for each form of hepatitis.
- A: Fecal/oral.
- B: Parenteral/bloodborne. Needlesticks are a concern for healthcare workers.
- C: Parenteral/bloodborne. IV drug users at risk.
- D: Blood or body fluids.
- E: Fecal/oral.
Describe symptoms for each form of hepatitis.
- A: Mild sx. Abrupt onset. Resolved in 2 months.
- B: Flu-like, URQ pain, hepatomegaly, jaundice, dark urine, light feces. Sx last 1-4 weeks.
- C: 80% are asymptomatic, but 20% have mild flu-like sx.
- D: General hepatitis sx.
- E: n/v, stomach pain, jaundice, fatigue. Self-limiting.
Incidence of chronicity for each form of hepatitis.
- A: none
- B: 5-10% in adults; 30-40% in children; 90% in infants.
- C: 50%
- D: ???
- E: none
Complications of each form of hepatitis.
- A: none
- B: chronic HBV, HDV infection.
- C: chronic HCV, cirrhosis, carcinoma, cryoglobulinemia.
- D: complication of HBV.
- E: high mortality in pregnant women, liver failure in 3rd trimester.
Describe the relationship between hepatitis B and hepatitis D.
Growth depends on HBV (“defective virus”). Severe, fulminant acute or chronic coinfection.
What is the difference between coinfection and superinfection?
Coinfection: HBV and HDV contracted simultaneously.
Superinfection: chronic HBV is followed by infection with HDV. More common.
What kinds of lab results would you expect to see in the long term for chronic HBV?
Elevated sAg, eAg, and total cAb. No sAb or eAb.
All donor units are tested for which forms of hepatitis?
B & C
Briefly describe the anatomy of the Hepatitis B virus.
State the incidence of hepatitis E infection in the United States and where it is most prevalent.
Rare in US.
Endemic in Asia, Indian subcontinent, Africa.
Describe the clinical etiology of HTLV-I and HTLV-II, their incidence, and disease associations.
Endemic in Caribbean, Japan, Africa, South America. RNA retroviruses.
HTLV-I associated with adult T-cell leukemia (ATL); tropical spastic paraperesis; possibly chronic inflammatory or autoimmune diseases.
HTLV-II has unknown associations, maybe chronic inflammatory or autoimmune diseases.
Chronic hepatitis
smoldering inflammation of the liver lasting 6 months or longer
autoimmune causes of hepatitis
nuclear antibody
smooth muscle antibody
drugs associated with hepatitis
acetaminophen, aspirin, phenytoin, ethanol, etc
The only DNA hepatitis virus. (All the others are RNA.)
HBV
HAV vaccine is —— killed
formalin
3 tests for HAV
IgM
Total Ab
RNA
HBV virus also called a ——- particle
Dane
Most recover from HBV in — months
6
HBsAg is undetectable by —— weeks after onset of sx.
12 to 20
Protective HBsAb titer
10 mIU/mL
There is no test for this HBV antigen.
core Ag.
Explain the core window.
Between the disappearance of the antigen, and isotype switching from IgM to IgG—in this window, sAg and sAb both happen to be low/undetectable, but cAb-IgM and cAb-total are high.
—– Ab is not protective against HBV
core
CLIA
Read using a ——– (instrument)
chemiluminescent immunoassay
luminometer
If a molecular assay for HBV is positive….
Repeat in duplicate. If 2/3 are positive or indeterminate, perform a confirmatory test (ie. neutralization or molecular assay).
Confirmatory test for HBV.
HBV-DNA PCR
When does HBV DNA show up relative to sAg?
DNA shows up 21 days before sAg.
Passive immunity to HBV is conferred by —–
HBIG
HBV treatment
4-month course of 𝛼-interferon (and other antivirals)
monitored with HBV-DNA tests.
For which type of hepatitis can IgM persist in chronic infection?
HDV
Risk factors (besides IV drug use) for HCV.
- history of blood transfusion prior to 1992 (33% chance of contracting at that time)
- long term hemodialysis
- multiple sex partners
- housing contact with HCV
- sharing instruments for drug use.
8-10 weeks before HCV-Ab is positive.
Lag phase
HCV-Ab detectable —– weeks after exposure.
7-8
Hepatitis G infects….
hematopoietic cells and vascular endothelial cells
Known genotypes of HCV (#)
7
Which virus may help protect against HIV?
Patients coinfected with HGV and HIV are more likely to survive HIV.
HTLV
Human T-cell lymphotropic virus
Known genotypes of HCV (#)
7
HCV treatment
𝛼-interferon, ribavirin, and newer antivirals.
Leading indication for liver transplants in US.
What is this assay?
CLIA
Anicteric (see case study #12)
no buildup of bilirubin
How is transmission of HBV different for the Asian pop?
Usually transmitted perinatally rather than in adulthood.
Which forms of hepatitis have vaccines?
A
B (and therefore D)
