Hepatitis Flashcards
What are the reportable Hepatitis
Hep A, B, C
What is Hepatitis A and how is it spread
RNA virus
spread via fecal-oral route
what are the risk factors for hepatitis A
MSM (men sex with men - questionable)
drug use
homelessness
occupational exposures
What is the incubation period of Hep A
2 weeks - 6 months (avg 30 days)
acute illness
what are common symptoms of Hepatitis A
abrupt or insidious onset
Malaise
myalgia and arthralgia
fatigue
URI symptoms
aversion to smoking
anorexia
N/v
diarrhea/constipation
RUQ or epigastric pain
what is seen on PE with hep A
Low grade fever
hepatomegaly
splenomegaly
lymphadenopathy
+/- Jaundice
what are the lab results of Hep A
Increased AST and ALT
WBC usually normal
+ Hep A serology: IgM (acute), IgG (long term immunity)
what is post-exposure prophylaxis
single dose of HAV vaccine
immunoglobulin
-the sooner the better
What is the treatment of Hep A
self limited: improvement in 2-3 weeks
frequent hand washing to prevent spread
symptomatic treatment: rest, hydration, caloric intake, avoid exertion
What is Hep E
where is is common
what is the transmission
RNA virus
similar to HAV
primarily in India, Asia, Africa, Middle East and Central americas
fecal-oral transmission (contaminated water)
what is the incubation period of Hep E
14-60 days (avg 5-6 weeks)
what are the at risk populations of Hep E
Pregnant women
underlying liver disease
HIV
cancer on chemo
Organ transplant recipient
What are the symptoms of Hep E
most asymptomatic
immune compromise -> symptoms
malaise, myalgia and arthralgias, fatigue, anorexia, N/v, abd pain, jaundice, dark urine, clay colored stool
What are the extra-hepatic manifestations of Hep E
arthritis
pancreatitis
thrombocytopenia
Guillain-Barre
peripheral neuropathy
What are the labs with Hep E
+ AntiHEV igM and - IgG = acute infection
- AntiHEV Igm and + igG = prior infection
may see liver function test derangements similar to HAV
what is the prevention of Hep E
no vaccine
sanitation
purified water or boiling/chlorinating
what is the treatment of Hep E
self limited
symptomatic treatment: rest, adequate fluid and caloric intake, avoid ETOH and other hepatotoxins
What is Hep B
Ds-DNA Virus
inner core and outer surface coats
8 different genotypes
how is Hep B transmitted and what is the incubation
blood born
remains infectious on fomites for up to 7 days
incubation: 6 weeks to 6 months, avg 12-14 weeks
what are symptoms of acute hep B
often asymptomatic
if symptoms - similar to Hep A and E infections: +/- serum sickness (hypersensitivity reaction) in early infection
What are the lab tests for acute hep B
liver function derangements similar to Hep A: higher AST and ALT elevations
+ antigen and antibody testing
HBC DNA (‘viral load’)
what is the surface antigen on Hep B used for
HBV vaccine (recombinant HBsAg)
what antigens indicate viral infection in Hep B
+ HBsAg and HBeAg
what is the natural progression of hep B
acute illness lasts roughly 2-3 weeks
typcially clinical or lab recovery by 16 weeks
longer course in some (immunocomp and children)
may persist as chonic HBV infection
how is Hep B prevented
hand washing
standard precautions
safter sex
post-exposure prophylaxis (immunoglobulin + HBV vaccine)
tx of chronically infected persons
vaccination
what is the treatment of Acute Hep B
usually self limited
symptomatic treatment: rest, hydration, caloric intake, avoid hepatotoxins
if signs of acute liver failure - transplant
what is chronic Hep B
infection persisting longer than 3-6 months
heralded by 3-6+ months of AST/ALT elevations
rates highest in infants and immunocompromised
What are the symptoms of chronic hep B
in absence of cirrhosis, mostly asymptomatic
symptoms generally non-specific
reactivation HBV more sever symptoms (fulminant)
what is the tx of chronic Hep B
active viral replication (+HBeAg and + HBV DNA) - antivirals
nucleoside and nucleotide analogues usually preferred
Goal is serovonverstion from HBeAg to Anti-HBe and HBV DNA suppression
low rates of resistance with enecavir and tenofovir
what is Hep D
transmission
RNA virus
only occurs as co-infection with HBV - requires HBAg
co-infection during actue HBV or superimposed on chronic HBV
blood borne transmission - rare in US
what are the symptoms of Hepatitis D
when co-infection with Acute HB, same symtpoms
when superimposed on chronic HBV:
provokes fluminant hepatitis
decompensation
hastens progression to cirrhosis
more liekly to get HCC
what are the labs wtih Hep D
+ anti-HDV
+ HDAg
or + HDV RNA
what is the treatment of Hep D
spontaneous resolution in most with acute HBV
treat underling chronic HBV if indicated
What is Hep C
single-strand RNA virus
7 Different genotypes - dictates choice of tx
common co-infection with HIV
how is Hep C transmitted
blood borne
IVDU, sexual contact, occupational exposures, early blood/blood products transfusion
what is the incubation of Hep C
Incubation period 2-12 weeks (avg 6-7 weeks)
what are the symptoms of Hep C
often asymptomatic
otherwise, mild non-specific symptoms
often diagnosed with routine screening
what is HCV screening
all US adults at least once
pregnant females (each pregnancy)
one time screening regardless of age: HIV+, Hx or active IVDU, dialysis pts, persistent ALT elevations, following needle sticks, recipients of tranfusions/transplants, children of HCV+ mothers, on request
when is perioidc HCV screening recommended
IVDU
dialysis patients
high-risk comorbidities (HIV+)
what is the screening lab for HEP C
ANti-HCV (antibody)
CHV RNA for confirmation
what is the natural progression of Hep C
spontaneous resolution/clearance in up to 50%
progression to chronic Hep C infection in 50-85%
what is Hep C prevention
decreased incidence of infection following routine screening for transfusion
no vaccine available
safer sex practices and standard precautions
vaccination for HBV and HAV for chronic HCV patients to improve prognosis
What is the treatment for acute HCV
none
consider PEG interferon +/- ribavirin if no spontaneous clearance by 3 months
what is the first line treatment of chronic HCV
first line = ledipasvir + sofosbuvir (harvoni) - genotype 1
what is the goal of treatment of chronic HCV
goal is ‘sustained virologic response’
response dependent on genotype
