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Gastrointestinal - Microbiology > Hepatitis > Flashcards

Hepatitis Flashcards

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1
Q

What are the two types of viral hepatitis that can be transmitted via the fecal oral route?
• why does this make sense based on their structure?

A

Hepatitis A and E are both non-eveloped so they don’t need to say moist while B and C both have envelopes so they can only be transmitted in fluids.

*Hepatitis D is non-enveloped, but is dependent on co-infection or superinfection with hepatitis B which IS enveloped

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2
Q

What is the only way that you can get infected with hepatitis D?

A

Co-infection with hepatitis B

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3
Q

What two types of Hepatitis can be chronic?

A

Hepatitis C - most often chronic

Hepatitis B - rarely chronic except in young children

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4
Q

What is the only DNA hepatitis virus?

A

Hep B (note that EBV and CMV can cause hepatitis, but they are not one of the classic hepatitis viruses)

**Remember that any case of chronic hepatitis puts you at an increased risk for hepatocellular carcinoma

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5
Q

HAV:
• Virus Family
• Virus Genus
• Structure

A

Family: Picornaviridae
Genus: Enterovirus
Structure: Nonenveloped icosahedral capsid, 7kb ssRNA

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6
Q

HEV:
•Virus Family
• Virus Genus
• Structure

A

Family: Calciviridae
Genus: Hepevirus
Structure: Noneveloped icosahedral capsid, 7.5 kb ssRNA

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7
Q

Why is HAV a good disease target for eradication?

A
  • One Serotype

* Human Reservoir

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8
Q

What are the reservoirs for HEV?

• where is it most prevalent?

A

Reserviors:
• Swine or other animal reserviors

Prevalence:
• Not common in the US

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9
Q

What complication of HEV is VERY important to know?

A

There is a 20% fatality in pregnant women

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10
Q

How long is the incubation period for HAV?
• When are patients contagious?
• when in the course of life is disease most common?
• Most common symptoms?

A

How Long:
• 2-4 wks Post Exposure

This typically occurs in EARLY CHILDHOOD and is most commonly ASYMPTOMATIC

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11
Q

T or F: HAV accounts for a significant amount of US acute hepatitis?

A

True, 1/3 of all Acute hepatitis in the US is due to HAV

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12
Q

How long is the symptomatic period of Hep A?

• what are they symptoms?

A

4-10 weeks

Symptoms:
• Vomiting, anorexia, malaise, fever, headache, jaundice (aversion to cigarettes)

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13
Q

T or F: 1/3 of the US population has had HCV.

A

False, 1/3 of the US population has had HAV not HCV

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14
Q

How do outbreaks of HAV typically happen?

A

Salad bars on cruise ships and Raw Shellfish

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15
Q

During what weeks after initial infection would you expect to have a high ALT as a result of HAV?
• what about anti-HAV IgM?

A

ALT begins to elevates at wk 4
Peaks at week 7
Decrease to normal at week 10

• anti-HAV IgM parallels ALT, but doesn’t max until week 8 then falls back down by week 12

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16
Q

What happens to IgG levels in HAV infection?

A

IgG starts kicking in around week 4 and peaks around week 12

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17
Q

Who is at the greatest risk of contracting HAV?
• on a normal basis?
• During outbreaks?

A
  • Household or sexual contacts
  • Travelers to endemic areas
  • Inhabitants of American Indian Reservations

During outbreaks:
• Diners, Day care center workers, Gay men, Injecting Drug Users (REMEMBER ONLY DURING OUTBREAKS)

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18
Q

Is HAV considered an STD?

A

NO, but it is fecal oral and sex opens the door to this type of transmission

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19
Q

How is the diagnosis of HAV made?

A
  • Presumptive diagnosis on the basis of appearance

* Detection of anti-HAV IgM

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20
Q

If you have a close contact with HAV, how can you avoid getting the disease?

A

Passive immunization with gamma globulin

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21
Q

What vaccines are available for HAV and for whom?

A
  • Inactivated Vaccine - 2 years or older
  • Combination HAV/HBV vaccine - (just the inactivated vaccine + HBV vaccine) => for children 18 years or older

***Travelers to endemic areas should definitely get the vaccine

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22
Q

What prevented the HAV outbreak in memphis in the 90s from becoming widespread?

A

• the HAV vaccine was used here to prevent new disease

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23
Q

HBV
• Virus Family
• Structure

A

Family:
Hepadnavirus

Structure:
EVELOPED, PARTIALLY dsDNA CIRCULAR genome - DNA pols just stops part way through the replication of the 2nd strand

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24
Q

What are the 5 MAJOR proteins of HBV?

A
  1. DNA pols (REVERSE transcriptase)
  2. HBsAg (surface antigen, attachment protein)
  3. HBcAg (core antigen, capsid protein)
  4. HBeAg (derivative of HBcAg, important serologic marker)
  5. X antigen (influences gene expression)
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25
Q

What feature(s) of HBV allow use to simultaneously treat HBV and HIV?

A

• DNA pols is also reverse transcriptase - allows us to simultaneously treat HIV and HBV

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26
Q

What is the role of the X antigen in altering gene expression?

A

X antigen - allows the HBV genome to be effectively expressed in liver cells

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27
Q

What are the steps in infection of a cell with HBV?

A
  1. Viral envelope fuses with the cell to enter
  2. Uncoats and the 1st thing that occurs is the *VIRAL pols * that is associated with the genome when it comes in goes ahead and completes full length synthesis so that you get a dsDNA genome
  3. DNA goes into the nucleus and gets transcribed to RNA with HUMAN RNA pols (dna dependent rna pols)
  4. RNA exits the nucleus and the Hep B DNA pols uses its REVERSE TRANSCRIPTASE capacity to convert RNA into DNA

This is the opposite of what HIV does

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28
Q

What countries are you most likely to acquire HBV in?

A
  • China

* Sub-Saharan Africa

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29
Q

How is HBV transmitted?

A

Transmission:
• Sexual - blood, semen, and vaginal secretions
• Parenteral - IV drug use
• PERINATAL delivery

30
Q

Does the baby of a mom with HBV automatically have HBV?

• what should you do when they are born?

A

NO - HBV is acquired during delivery

Start treating them for HBV when they are born

31
Q

Compare the infectivity or HBV and HAV.

A

HAV is much more infective than HBV

32
Q

Compare the amount of time it takes for ALT to become elevated in HAV to HBV.

A

HBV has an ALT that doesn’t start to elevate until 8 weeks and doesn’t max until week 16 (goes back to baseline about week 28)

Compare this to HAV that starts to elevate at week 4 and maxes out at week 7

33
Q

How long is the incubation period for HBV?

• symptomatic period?

A

8 weeks after initial infection

10-36 weeks after initial infection

34
Q

If HBV has not resolved in _____ months its considered chronic.
• what is typically the first sign of chronicity?

A

HBV that has not resolved for 6 months is considered chronic

Chronicity is usually not noticed until patients present with cirrhosis or HCC appears

35
Q

Which HBV marker tells you that you’re acutely infected?

A

HBsAg (the actual antigen can only be elevated in someone with actual virus in them)

36
Q

Which HBV marker is an ID of persons who have had HBV infection or received the vaccine?

A

Anti-HBs (antibody to the surface antigen can be in people who have recently received the vaccine)

37
Q

Which HBV marker is an indicator of active infection?

A

HbeAg (this is the ID of people who are at HIGH RISK OF TRANSMITTING THE VIRUS)

38
Q

Which HBV marker is the ID of people who have HBsAg but have only a low risk of transmission?

A

Anti-HBe - Anti-HBe + Anti-HBsAg => low risk of transmission

39
Q

What is the ID HBV marker of persons with a past infection?

A

Anti-HBc (core antibody will only be elevated in people that ACUTALLY get infected)

40
Q

What does it mean if someone has a high IgM Anti-HBc?

A

IgM anti-core antibody is only elevated in people with ACUTE infection

41
Q

What two actual virus particles appear in the serum after the Hep B surface antigen?

A

E antigen and HB DNA are the next things to appear in the serum

42
Q

How long before IgM appears in a Hep B infection

A

Typically starts appearing 8 wks after infection and doesn’t peak until about week 20

43
Q

What serologic markers of the Hep B virus would you expect to see in someone who has been vaccinated?

A

IgG for Surface Antigen ONLY

44
Q

What state of disease is someone in if they have core and surface antigens as the only markers in their serum for Hep B infection?

A

These markers indicate a resolved acute infection

45
Q

Hepatitis D

• Structure

A

Eveloped ss RNA virus (very small)

46
Q

Compare symptoms and risk of chronic infection in Co-infection of HBV and HDV to superinfection of HBV with HDV.

A

Coinfection:
• WORSE bout with HBV than with HBV alone, but your risk of becoming chronic is the SAME

Superinfection:
• This is a person who has HBV but has had no infection for years and shows back up with Worsening symptoms
• These people are at a higher risk of CHRONIC HBV infection

47
Q

Why do we screen people born between 1945 and 1965 for HCV?

A
  • Before 1989 we didn’t know about HCV so blood supplies weren’t screened
  • Most people who received blood before 1989 were in this age group so its important to screen
48
Q

HCV
• Family
• Structure

A

Family:
•Hepacivirus

Structure:
• Enveloped icosahedral capsid
• 9.4 kb ssRNA POSITIVE sense genome

49
Q

What is unique about the enveloping of HCV?

• what is the importance of this envelope in the host response to infection?

A

HCV:
• has TWO envelope proteins E1 and E2

• E2 is immunodominant and mutates A LOT so even the same infection morphs over time creating QUASI-SPECIES allowing the infection to persist by evading host response

50
Q

What are the two most common subgroups of HCV in the US?

A

HCV 1a and 1b are the most common in the US

51
Q

T or F: the US prison population has a much higher risk of HCV compared to the NL US population.

A

True, US prison population has rates of 16-41% while the general population has rates of ~2%

52
Q

What are the Risk Factors for acquiring Hep C infection?

A
  • Born Between 1945 and 1965
  • Illicit (IV) drug use
  • Perinatal infection at birth
53
Q

Compare acute infection of HBV to acute infection with HCV.

A

Acute infections with HCV are generally much milder than acute infections with HBV

54
Q

Compare the pattern of ALT overtime in a chronic HCV to HBV.

A

HCV has up and down pattern of ALT because of Re-infection as the result of Quasi-Species

55
Q

What is the actual cause of liver damage in ALL Hepatitis infections?

A
  • OUR OWN IMMUNE RESPONSE VIA CYTOTOXIC T CELLS IS WHAT CAUSES THE PROBLEMS
  • Hepatitis viruses are not cytolytic
56
Q

What percentage of chronic hepatitis cases are due to HCV?

• HBV?

A

HCV:
• Accounts for 40% of all cases of Chronic Hepatitis

HBV:
• Accounts for 20% of all cases of Chronic Hepatitis

***5% of HBV cases are HDV positive

57
Q

How does your chance of developing a CHRONIC HBV infection change with the age at which you were infected?

A
  • Less than 1 y/o then 90% Chronicity
  • 1-5: 30% Chronicity
  • Greater than 5: 2% Chronicity
58
Q

What are some extrahepatic disease that you can develop as a result of HBV?

A
  • Polyarteritis nodosum (erythema nodosum, and arthralgia)
  • Membranous Glomerular nephritis
  • Membranoproliferative Glomerular Nephritis
59
Q

What are the 3 stages of Hep B infection?

• when do we become symptomatic?

A

3 stages:
1. Immune Tolerance phase - virus proliferates and is unrecognized by the immune system, there is NO CELL DAMAGE, and NO SYMPTOMS

  1. Immune Clearance phase - virus proliferates and the immune system attacks the cells.
  2. Residual phase
60
Q

What percentage of patients with HCV acute infection will become chronic?

A

85% of these patients will become chronic

61
Q

***Why does it take so long for cancer to develop in Chronic Hepatitis patients?

A

The hepatitis viruses do NOT integrate into the host cell DNA, therefore they do not cause disease as quickly as viruses like HPV

**The problem in Hepatocellular Carcinoma is that Liver Cells are not made to regenerate effectively so when they do they are more prone to error

62
Q

What vaccine should you suggest in patients with chronic HBV or HCV infections?
• what other dietary recommendation should you make?

A

HAV vaccine should be given to these patients because they are at increased risk of Acute Liver Failure if they acquire the infection

Patients SHOULD NOT DRINK EtOH

63
Q

What antigens and antibodies can be detected for HCV via ELISA?
• what else do you need to find when you get an HCV infection?

A

anti-HCV antibodies

HCV RNA

64
Q

When is Hep B Ig used?

A

Exposed Individuals
• Newborns
• Prophylactically for Travelers

65
Q

For which types of Hepatitis is there a vaccine available?

A

HAV and HBV

66
Q

How do we now prevent most HCV infections?

A

Screen the Blood supply

67
Q

What is unique about the treatment of HCV?

A

IT IS A CHRONIC DISEASE THAT WE CAN CURE

68
Q

What determines the specific treatment you will use for HCV?

A

The GENOTYPE of the virus

69
Q

Enecavir works by binding the Hep B DNA pols and seizing it up

A

Tenofovir works by preventing the addition of another nucleotide in Hep B infection

70
Q

T or F: Adults over 40 are at higher risk of HAV

A

True, so are people with existing liver disease so make sure they get Hepatitis vaccines for the type of hepatitis that they do not have

Gastrointestinal - Microbiology (5 decks)

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