hepatitis Flashcards
hepatitis infects
liver
-liver enzymes elevated
causes mild jaundice to death
how is hepatitis diagnosed
serologically
how to treat hepatitis
can’t really but viral agents can reduce duration
hepatitis A also known as
enterovirus
-infects enteric tract and liver
what kind of virus is hep A
RNA
non enveloped
-short incubation up to 30 days
how is hep A transmitted
fecal to oral
-contaminated hands of food handler
illegal drug use- not main
contaminated blood -RARE
(blood products in US not tested for hep A)
mother to baby
when is hep A most infectious
right before the onset of symptoms
rarely causes life threatening illness
when is fecal HAV found
2 - 7 weeks after exposure
where can hep A be found
in stool
short life in blood stream so rarely look there
IgM anti-HAV
acute infection
IgG anti-HAV
second
how to determine if acute infection with IgG
look for 4 fold titer
when is vaccine for hep A recommended
when traveling to 3rd world countries
how to prevent hep A
-wash hands
-vaccination if at risk (underlying liver disease, homeless)
no known carrier state
what enzymes increased in acute viral hep A
AST 4+
ALT 4+
ALP 2+ (lower)
hep b is what type of virus
DNA
circular
double and single stranded
envelope- bud out
hep B route of transmission
-sexual
-mother to baby
-contaminated blood
hep b virus is found in
every body fluid- transmissible
-blood
-sweat
-urine
-semen
-breast milk
hep b incubation period
after transmission can have incubation period up to 90 days
what percent of hep b people will get fulminating
1%
lead to liver cancer
high mortality rate
what percent of people with hep b will recover within 6 months
90%
what percent of people will develop chronic hep B
8-9%
dane particle-envelope composed of
HBcAg: core capsule
-hep b core antigen
HbsAg: surface
-hep b surface antigen
-infectious particle
what makes up subviral particle
-spherical and filamentous
both contain surface antigen, no nucleic acid (not infectious)
very immunogenic, we can produce antibodies against it
first antigen to rise in hep B infection
HBsAg
used to be known as australian antigen
-earliest indicator of hep B
-will not see if vaccinated/ people recovered
-increases in ALP or AST
found in core of dane particle
hepatitis B core antigen
-is NOT a marker of hep B infections
-not seen in serum/plasma
if you have this you are in acute phase of hep B
HBeAg
-indicated virus is reproducing in host
-more E= higher infectivity
-we want this to be undetectable in someone recovering
-not in vaccinated people
if E antigen and surface antibody found at same time
chronic infection
Anti-Hbs
producing antibodies to surface antigen
-indicate recovery
-WILL HAVE when vaccinated
-present for life
window period
both surface antigen and antibody are non detectable
-look for core antibody
anti-Hbc
hepatitis b core antibody
HBsAg +
HBcAb +
HBcAb -
acute hep b
HBsAg -
HBcAb IgM +
HBsAb -
Window period; late acute phase
HBsAg -
HBcAb -
HBsAb +
vaccinated
anti-HBe
e antibody
sign of recovery
person is becoming noninfectious
will not rise until E antigen has fallen
never get rid of surface antigen, no production of surface antibody, IgG positive for core antibody
chronic infection
hepatitis b carrier state
will not clear from system when recovering
-underlying illness
2 ways you are carrier
- If you are hepatitis B surface antigen + on 2 tests 6 months apart
- Surface antigen +, core IgM antigen -, core IgG antibody + on a single specimen
if a carrier higher risk of liver cancer
when will you get full immunity from hep b vaccine
when you get all 3 shots
90% will be antibody + 6 months after last shot
10-20% people will need a 4th booster
If we have a mother who is hep b surface antigen + upon delivery, you have to give infant
antibody to hep B within 12 hours of birth
hep D known as
delta virus
-mutant
needs hep B in order to replicate
what kind of virus is hep D
RNA
hep D can either be
co infect or super infector
co infect
does not make hepatitis B infection anymore serious; might change the way we treat
super infector
hep D change hep B from mild case to full blown bad case (even death)
when should hep d be suspected
if patient isn’t recovering from hep b or see biphasic ALT pattern
-ALT will go up, come down and go back up
for blood donations what do u test for
hep b- deferred for life
hep c
-surface antigen, core antibody, surface antibody
if vaccinated do not donate blood for
21 days after vaccination
If you’ve had exposure to hep b and are given passive antibodies you are deferred for
1 year
what kind of virus is hep C
RNA virus
no vaccine
what program was made by CDC for Hep C
look back program
- look back file and anyone who received blood donation before 1992 and were sent a notion saying they needed to come in and get tested for Hep C because was not tested before this year
how is hep C transmitted
blood products, mother to baby, and sexually
incubation period of hep C
short incubation period to not being symptomatic for 20 years
known as silent hep
which hepatitis can lead to chronic infection
B and C
some people can spontaneously heal with what hep
acute hep C
70% will have chronic
1 cause of liver transplants
hep C
-now on list for carcinogens
testing for hep C starts with
antibodies
Antibody -= non reactive Antibody + = next is Hepatitis C RNA look for presence
RNA +
current hep C virus
RNA -
no current infection to Hep C; past infection or below detectable limits
If you take immunosuppressant drugs can cause
HEP B OR C flare up if below detectable limits
viral load testing
determine the number of RNA iu/mL of blood you have of the virus
-always done when +RNA test
baseline to determine treatment is working
treatment for hep C
Harvoni
-can cause flare up
-interferon base
Can see hep B and C in same people because
same transmission and same risk group
acute phase reactant that everyone makes and excreted by virally infected cells and surrounds non virally infected cells to prevent them from coming infected
interferon
what determines the type of treatment given for hep C
genotype
-different ethnicities has different genotypes
african american respond worst to treatment
what kind of virus is hep E
RNA
what population does hep E infect
pregnant women
-cause acute liver failure
think this if preg women goes into liver failure with nothing before
what transmission is thought for hep E
contaminated water
