Hepatitis Flashcards
Transmission HAV
Faecal oral (parenteral)
Transmission HBV
parenteral sexual, perinatal
Transmission HCV
parenteral sexual, perinatal
Transmission HDV
parenteral
Transmission HEV
faecal-oral
Incubation (days) HAV
28 10-50
Incubation (days) HBV
90 40-160
Incubation (days) HCV
60 150160
Incubation (days) HDV
20-50
Incubation (days) HEV
40 60-20
Main populations at risk in the UK HAV
travellers to endemic areas
sewage workers
contacts of causes
Main populations at risk in the UK HBV
immigrants from high prevelance areas PWID Multiple sexual partners Infant of HBsAg positive mother HCWs
Main populations at risk in the UK HCV
PWID
recipients of unscreened blood products
Main populations at risk in the UK HDV
PWID
Main populations at risk in the UK HEV
travellers to endemic areas
sporadic
exposure to undercooked pig products
Risk of chronic infection HBV
<0.5% of UK population
5-10% of those with acute infection as an adult
Risk of chronic infection HCV
60-80%
Risk of chronic infection HDV
with HBV
Risk of chronic infection HEV
yes if immunocompromosed
Immunoglobulins present HAV
IgM, IgG
Immunoglobulins present HBV
IgM, IgG
Immunoglobulins present HCV
IgG
Immunoglobulins present HDV
IgM, IgG
Immunoglobulins present HEV
IgM, IgG
What types of active immunisation are available and for what types?
HAV - inactivated vaccine HBV - recombinant vaccine HCV - none HDV - Hep B vaccine HEV - only available in China
For what types is passive immunisation available? and what?
HAV - HNIG
HBV - HBIG
Virus type and nucleic acid HAV
Picornavirus
RNA
Virus type and nucleic acid HBV
Hepadnavirus
DNA
Virus type and nucleic acid HCV
Flavivirus
RNA
Virus type and nucleic acid HDV
Defective virus
RNA
Virus type and nucleic acid HEV
Hepeivirus
RNA
What prenatal viruses can cause hepatitis in the neonate?
Rubella
cytomegalovirus
What perinatal viruses can cause hepatitis in the neonate?
CMV
Herpes simplex
parechonvirus
enterovirus
In children and adults what viruses can cause viral hepatitis like syndromes?
CMV
EBV
What non viral infections can cause hepatiitis?
Leptospirosis
Q fever
Psittacosis/Ornthiosis
Clinical features of HAV
mild and subclinical in <5s
fever, malise, anorexia, nausea, vomiting, upper abdo pain, jaundice
Clinical features of acute HBV
anorexia lethargy nausea fever abdo pain arthralgia urticarial skin lesions
Describe the serological profile of acute HBV infection
See notes
define chronic HBV infection
persistence of HBsAg in serum for >6months
In what patients is chronic HBV infection more common?
Male
Immunodeficient
Chronic sequelae HAV
None
Chronic sequelae HBV
chronic hepatitis
cirrhosis
hepatoma
membranous glomerulonephritis and polyarteritis nodasa (rare)
Chronic sequelae HCV
Chronic hepatitis
cirrhosis
hepatoma
Chronic sequelae HDV
chronic hepatitis
cirrhosis
Chronic sequelae
persistant hepatitis and cirrhosis if immunocompromised
Indications for antiviral therapy in HBV
Two of:
HBV DNA >2000 IU/ml
Raised ALT
Significant liver inflammation or fibrosis
Treatment of HBV
long acting peg-alpha interferon SC, weekly for 12 months
Nucleoside analogues
Name nucleoside analogues
lamivudine, adefovir, dipivoxial, telbivudine, entecavir, tenofovir
Clinical features of HCV
Ususally subclinical or mild malaise anorexia fatigue severe hepatitis with jaundice fulminant HCV
with what infection is HDV always associated with?
HBV
