Hepatitis

Question 1

What are the clinical features of Hepatitis A?

Answer 1

• Faecal oral, P2P and foodborne
• ssRNA unenveloped hepatovirus
• Incubation 3-5 weeks
• Acute hepatitis, risk of jaundice increases with age, can be fulminant and can relapse
• Diagnosis with HAV IgM in blood and HAV RNA in blood/stool

Question 2

What are the clinical features of Hepatitis B?

Answer 2

• Sexually, parenterally and perinatally transmitted
• Partially dsRNA hapdnavirus
• Incubation 6 weeks to 6 months
• Acute hepatitis that’s usually asymptomatic in children, rarely fulminant
• Chronic sAg positive >6 months in around 10% of adults and 90% of babies
• Complications include cirrhosis and HCC
• Viral markers:
  
  • Surface antigen (HBsAg) – active infection
  • E antigen (HBeAg) – marker of viral replication and implies high infectivity
  • Core antibodies (HBcAb) – implies past or current infection
  • Surface antibody (HBsAb) – implies vaccination or past or current infection
  • Hepatitis B virus DNA (HBV DNA) – this is a direct count of the viral load
• Management:
  
  • Refer for specialist management
  • Test for complications
  • Treat with 48 weeks of pegylated IFN as first line and Tenofovis or Entecavir as second line

Question 3

What are the clinical features of Hepatitis C?

Answer 3

• Parenterally, sexually and perinatally transmitted
• ssRNA enveloped virus
• Incubation period of 6-12 weeks
• 1/4 fight off infection, 3/4 chronic infection
• HCV antibody test for screening
• HCV RNA to confirm diagnosis
• Management:
  
  • Testing for complications
  • Antiviral tresatment with direct acting antivirals for 8-12 weeks

Question 4

What are the clinical features of Hepatitis D?

Answer 4

• ssRNA virus enveloped by HBsAg
• Defective virus so always uses hepatitis B sAg as a vector in the human body
• Diagnosis looks for delta antibodies and RNA in the blood

Question 5

What are the clinical features of Hepatitis E?

Answer 5

• Faecal oral, P2P and foodborne
• ssRNA unenveloped virus
• Incubation period of 6 weeks
• Acute hepatitis in young adults (resource poor countries) and elderly males (developed countries)
• Fulminant and has haematological and neurological comlications
• Chronic infection only in the immunocompromised
• Diagnosis lookks for HEV IgM, IgG and RNA

Question 6

What are the clinical features of autoimmune hepatitis?

Answer 6

• Type 1
  
  • Occurs in adults
  • Typically affects women in their late 40s and 50s
  • Fatigue and features of liver disease
  • Takes less acute course than type 2
  • ANA, anti-actin and anti-SLA/LP
• Type 2
  
  • Occurs in children
  • Teenagers and in 20s
  • Acute hepatitis with high transaminases and jaundice
  • Anti-LKM1 and anti-LC1
• Management:
  
  • Diagnosis is by liver biopsy
  • Treatment with high dose steroids and immunosuppresants (i.e. azathioprine)