Hepatitis Flashcards
Acute Hepatitis
A, E
Chronic Hepatitis
B, C, D
Fecal derived hepatitis
A, E
Blood derived hepatitis
B, C, D
Hepatitis immunization
A, B/D
“Infectious hepatitis”
A
“Serum hepatitis”
B
“Transfusion-associated hepatitis”
C
“Virus parasite”
D
Hepatitis most associated with liver cancer
B
Possible course of viral hepatitis
- Subclinical and anicteric
- Typical acute icteric hepatitis
- Fulminant hepatitis
- Chronic hepatitis
- Subclinical and anicteric
Recognized by seroconversion
- Typical acute icteric hepatitis
Incubation period varies depending on type:
- A: 2-6 weeks
- B: 2-6 months
- C: 2-24 weeks (most 6-7)
- D: 1-6 months
- E: 3-9 weeks
- Prodrome (pre-icteric): Fatigue, malaise, anorexia
- Icteric phase: Yellow skin, elevated liver enzymes
- Convalescent phase: Disappearance of jaundice and symptoms
- Fulminant hepatitis
Disease outside the liver
HIGH FATALITY RATE
- Chronic hepatitis
Very infectious (lots of virus in blood) Only for B, C, and D
Hepatitis A
Infectious hepatitis Does NOT become chronic Excreted in feces Food and water borne transmission Closed populations with poor hygiene Disease is typically mild
Hep A transmission
Entry through intestine after ingestion
Fecal-oral route
Hep A Diagnosis
IgM antibody by ELISA
Hep A prevention
Handwashing
Avoid contaminated food (uncooked shellfish)
Post-exposure prophylaxis with immunoglobulin
Killed virus vaccine available
EDUCATION (break chain of transmission)
Most common cause of chronic hepatitis
Hep B
Most likely results of Hep B infection in adults
Resolution
Most likely results of Hep B infection in kids
Chronicity
Hep B Antigens
HBsAg - Surface antigen
HBcAg - Core antigen
HBeAg - Surface antigen (always have c too)
Double-walled Dane particle
Infectious form of Hep B
Hep B transmission
Present in serum, blood, semen
Spread by needle:
- Acupuncture
- Piercings
- Tattooing
Major reservoir for Hep B
Chronic hepatitis patients
Risk factors for perinatal-congenital infection of Hep B
- Chronic infection in mother
- HBeAg positive mother
- *90% of infected infants will become chronically infected
Populations at risk for Hep B
Healthcare IV drugs users Homosexuals Promiscuous heterosexuals Institutionalized persons Family contacts of infected individuals
Where does Hep B replicate
Liver
Hep B clinical manifestations
Incubation period of 50-180 days
Insidious onset
Prodrome: Fever, rash (urticarial), arthralgias (symmetrical)
Self-limited in most adults
Subclinical infection possible - Recognized by presence of anti-HBsAg
Complications of Hep B infection
Cirrhosis
Liver failure
Hepatocellular carcinoma
Hep B Diagnosis
Clinical symptoms
Liver enzymes
Serum antibodies
Antigens secreted into blood stream during infection
HBsAg
HBeAg
IgM anti-HBc WITH HBsAg
Hallmark of initial ongoing HBV infection
IgG anti-HBc WITHOUT HBsAg
Indicates past HBV infection
IgG anti-HBc WITH HBsAg
Indicates chronic HBV infection
Best indication of the presence of infectious Hep B virus
HBeAg
Continued detection of HBeAg and HBsAg or both without antibody to these antigens
Probable chronic HBV state
How long does it take to determine resolution vs chronicity of Hep B
At least 6 months
Rapid Hepatitis Virus Test detects
HBV surface antigen
Hep B treatment/prevention
NO CURE EXISTS
Can treat to prevent liver damage and progression
Vaccine available!
Immunoglobulin for prophylaxis (w/in 1 week of exposure)
-Give to newborns with HBsAg positive mothers
The delta agent
Hep D
Hep D
- A viral parasite of another virus
- Replication requires the presence of HBV for helper functions
- Increases severity of HBV
Hep D disease requirements
- Coinfection with HBV
- Superinfection in pts with chronic HBV
Fulminant hepatitis most likely with
Hep D
Hep D transmission
Same routes as Hep B
Hep D diagnosis
ELISA for delta antigen or antibodies
Hep D prevention
HBV vaccine
Post-transfusion Hepatitis
Hep C
Hallmark of HCV infection
CHRONIC infection (70-85%) Often progresses to cirrhosis and liver failure
Hep C transmission
Not well understood
Hep C risk factors
IV drug use Hemodialysis Blood transfusions Organ transplants Contact with health care providers Tattoos?
Factors that promote HCV infection
Alcohol Infection at age >40 Male sex Hep B co-infection HIV co-infection
Hep C diagnosis
EIA
Seroconversion at 24 weeks
***Chronic state and acute phase viremic patients often escape detection!!! - Direct assays helpful and recommended for confirmation
HCV Presentation
ASYMPTOMATIC (often) - Goes undiagnosed
HCV Treatment
Direct-acting antiviral agents (DAAs) - Possible cure
HCV prevention
Blood screening
Identify compensated, unrecognized infections
