Hepatitis Flashcards
a. Which hepatitis viruses can be transmitted by the faecal-oral route?
b. How can these infections be prevented?1. a.
Hepatitis A and hepatitis E virus.
b. Good personal hygiene, good sanitation, clean water. Human normal immunoglobulin
(hepatitis A). Active immunisation (hepatitis A).
How is hepatitis A diagnosed in the virus laboratory
Detection of hepatitis A lgM antibody in a serum sample. (Detection of HAV RNA may be
required to diagnose HAV in Immunocompromised patients)
Which hepatitis viruses are spread by infected blood?
b. How can these infections be prevented?
- a. Hepatitis B, C, D
b. Infection control precautions, screening blood products, vaccination against hepatitis
B.
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.
b. What percentages of people will become chronically infected following acute infection
with HBV in i) infants ii) children iii) adults
c. What is the clinical significance of prolonged HBsAg and HBeAg carriage?
. HBsAg is present in serum for at least 6 months.
b. i) 90% ii) 40% iii) 5-10%
c. Patients are at risk of long-term sequelae including chronic liver disease, cirrhosis and
increased risk of hepatoma.
Make a list of those groups of people who you think should be offered hepatitis B vaccine.
Health care personnel.
Close contacts of patients with acute or chronic HBV infection.
Selected police and emergency services personnel.
PWID.
Individuals who change sexual partners frequently.
Some patients with chronic liver disease or chronic renal failure.
Inmates of custodial institutions.
a. What is the clinical importance of infection with hepatitis C?
b.What laboratory assessment would you make of someone with antibodies to HCV?
a. 60-80% of patients will show evidence of chronic liver disease and are at risk of
progression to cirrhosis.
b. Serum ALT, HCV RNA.
a. What factor is essential for the transmission of hepatitis D?
b. What is the commonest mode of hepatitis D transmissio
a. Presence of HBsAg.
b. Injecting drug use.
History of recent jaundice in a 26 year old homosexual.
Hepatitis B surface antigen negative.
Hepatitis B core antibody negative.
Hepatitis A IgM positive
Evidence for recent hepatitis A infection. No evidence for infection with hepatitis B.
Comment:
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.
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.
esults 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.
Her sexual partner and other household contacts should be checked for past infection (anticore total antibody) and be offered immunisation if this is negative. She should be offered
assessment by a physician with a special interest in liver disease as those with high levels of
DNA may be offered antiviral in the last trimester to reduce the viral load and therefore the
risk of transmission to the baby.
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.
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 A should 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 A detected.
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 A and B should be considered. Immunisation
against Yellow Fever and typhoid may also be indicated.
