Hepatitis

Question 1

What is the incubation periods for Hep A?

Answer 1

30 days

Question 2

What is the biggest determining factor for the severity of Hep A?

Answer 2

Age

children most at risk

Question 3

What is the vaccine for Hep A?

Answer 3

Inactivated virus

2nd dose of it gives immunity for life

Question 4

What is the only DNA Hepatitis virus?

Answer 4

Hep B

Question 5

What the incubation of Hep E?

Answer 5

40 days

Question 6

List some complications of Hep E, and who is most at risk of these severe complications?

Answer 6

Neurological deficits.

• guillain barre syndrome
• encephalitis

**Associated with Genotype 3

High mortality in Pregnant women in 3rd trimester

**associated with Genotype 1

Question 7

Whats the incubation of Hep B and what is the most common type of transmission?

Answer 7

2-6 months - due to lack of lytic activity

Vertical

Question 8

If a child has Hep B from birth what is the likely outcome?

Answer 8

Asymptomatic with chronic disease

Question 9

List some severe symptoms of Hep B:

Answer 9

Cachexia

Bloody Ascites

Weight loss

Severe abdominal pain

Question 10

Those with chronic Hep B may develop what?

Answer 10

Cirrhosis

Hepatic cellular carcinoma

Question 11

List the two treatments used for chronic Hep B:

Answer 11

Interferon alpha

• immune modulatory
• *remember it is the cytotoxic T cell activation that causes the most damage

Tenofovir
Entecavir
- reduce viral replication

Question 12

What is it called when a person already has Hep B then develops Hep D on top of this?

Answer 12

Super infection

- severely ill usually

Question 13

What drugs are used against Hep C? and what determines their regime?

Answer 13

Direct Acting Antivirals

Regime is decided on:

• serology of Hepatitis
• Severity of cirrhosis

Question 14

Outline and contrast the difference in infection of Hep A and Hep B between children and adults

Answer 14

Both depend on the level of the immune response.
because the childs immune system is not as strong the immune response is less.

In Hep A - this leads to less severe disease with lasting immunity

In Hep B - there is a less severe symptoms but chronic state develops as child doesn’t clear the virus - unlike adults who would

Question 15

Those with Chronic Hep B - what percentage will develop cirrhosis/ liver cancer

Answer 15

25%

Question 16

Would a person who has been vaccinated against Hep but never actually been infected by Hep B, have cAb positive?

Answer 16

No they wouldn’t have a core antibody

the vaccine only has surface antigen

Question 17

How do you manage Hep B?

Answer 17

Can only manage Chronic
- interferon

• Tenofovir

Vaccinate babies immediately after born to prevent spread

Question 18

What is the only treatment for Hep D?

Answer 18

Interferon

Question 19

Why can you get infected by Hep C over and over?

what percentage will go on to get chronic infection?

Answer 19

Don’t produce adequate antibodies

~70-75%

Question 20

If a person has a Anti HCV IgG positive result, what does it mean? and what would the next test be?

Answer 20

means the person either has/ or has had Hep C

next test would be viral PCR to check for viraemia

Question 21

Histologically what may Hep B appear like, and what is a specific marker for it?

Answer 21

May appear like acute inflammation

Ground glass appearance - accumulation of antibodies on it.

Question 22

Outline the Life cycle of Hep B:

Answer 22

Stage 1:
Immune tolerance
Viral Replication
No liver damage

Stage 2:
Immune activation
Viral replication attacked
- liver damage

Stage 3.
Low replication of virus
Immune still active
limited liver damage

• *during this stage the HbsAg can’t be detected and neither can the surface antigen.
• only the core may be detected.

Stage 4:
Reactivation
Immune system reactivates in response
cirrhosis and damage to liver