hepatitis Flashcards
what is most obvious sign hepatitis
jaundice with hepatic tenderness
viral hepatitis should be notified to
public health
subacute illness
no symptoms
anicteric illness
symptoms with no jaundice
icteric illness
symptoms w jaundice
fulminant hepatitis
severe jaundice with hepatic failure and high mortality
acute infections biochemistry
raised ALT and AST which are released into serum in excess quantities by damaged hepatocytes
HAV severity
usually mild and often subclinical/anicteric in <5yrs
severity inc w age but fulminant hepatitis is rare
HAV incubation
mean incubation 28ay s
HAV clinical features
fever, malaise N&V anorexia upper abdo pain jaundice developing 3-10days later
spread of HAV
fecal-oral route
when is HAV most infectious
~1wk before jaundice and a few days after
HAV virological diagnosis
antiHAV-IgM present in serum from onset symtoms until 3-6mo
antiHAV-IgG represents immunity
HAV Mx
no specific treatment
supportive management
who is at risk of HAV in UK
travellers to endemic areas sewage workers contacts of cases MSM PWID
prevention of HAV
good personal hygiene + sanitation
HNIg (prophylaxis for contacts)
innactivated vaccing
HAV who is offered vaccine
PWID MSM multiple partners travellers to endemic areas sewage workers seronegative haemophiliacs
when may acute hepatitis occur after HBV infection
few weeks - 6mo
symptoms acute hepatitis
anorexia lethargy nausea fever abdominal pain urticarial skin lesions jaundice
HBV viral forms seen in blood
infectious viral particles
non-infectious spheres and tubules containing HBsAg
HBV: core/nucleocaspid contains
HBcAg
hepaitits B core e antigen
splits of from HBcAg in liver cells during new virus formation + released in free soluble form in the serum
HBV: markers for viral replication
HBeAg
HBV-DNA
where is HBV-DNA present
infectious viral particles in the serum
HBsAg
on outershell of HBV
marker for acute + chronic HBV infection
HBV routes of transmission
perinatal
parenteral
sexual
HBV: main populations at risk UK
immigrants from high prevelence areas PWID multiple sexual partners healthcare workers babies of HBsAg + mums
HBeAg chronically infected patients
highly infectious
at risk of chronic liver disease and hepatoma
diagnosing acute HBV
HBsAg in serum
anti-HBV IgM
chronic HBV infection
persistence of HBsAg in serum >6mo
90% infants
40% kids
5-10% adults
HBV: who is chronic infection more common in
men, immunodeficient
patients with mild/asymptomatic acute infection rather than severe symptoms
chronic HBV long-term sequelae
chronic hepatitis
cirrhosis
hepatoma
clinical features of chronic HBV
fatigue, anorexia, depression
jaundice unusual unless advanced disease
who gets HBV anti-viral Rx
those w asymptomatic HBV w raised ALT, HBeAg positive + progressive lier disease
those w cirrhosis + evidence of viral replication (HBV-DNA)
HBV: ART indications in those without cirrhosis
2/3 of
- raised ALT
- HBV-DNA >2000
- signigicant liver inflammation, fibrosis
HBV Rx options
pegylated alpha-interferon injection
nucleoside analogues
liver transplant
HBV nucleoside analogues
inhibit viral enzyme transcriptase
entecavir, tenofovir
HBV vaccine poor responders
> 40yrs
obese
wrong injection site
immunocompromised
HBV vaccine >100
good response
HBV vaccine 10-99
poor response - booster now and in 5yrs
HBV vaccine <10
no response
repeat course
who gets HBV vaccine
healthcare workers PWID multiple sexual partners renal dialysis travellers to endemic areas
HBV passive immunisation
HBIg
- infants born to HbsAg positive mothers
- healthcare worked without anti-bodies who are exposed
- close contacts cases
HCV acute infection
usually subclinical/mild
malasie, anorexia, fatigue
severe hepatitis w jaundice may occur
HCV chronic infection
develops in most
most no symptoms
wide variations AST/ALT levels
HCV transmission
blood-borne
sexual
perinatal
HCV main populations at risk UK
PWID
recipients of unscreened blood products
HCV diagnosis
antiHCV-IgG
HCV-RNA
HCV chronic sequelae
chronic hepatitis
cirrhosis
hepatoma
HCV Mx
hep A + B vaccine
combo of pegylated alpha-interferon and ribavirin
HCV Rx: non-responsed
virus remains detectable
HCV Rx: viral breakthrough
initial response to ART followed by increase circulating level virus
HCV Rx: relapser
virus undetectable during ART but beomes detectable when stop Rx
HCV Rx: sustained viral response
virus undetectable for 6mo after
HVC: response to Rx varies according to
viral genotype age gender stage liver disease viral load
how is HDV a defective virus
always found with HBV
HBV essential for its transmission
HDV co-infection
simultaneous infection w HDV and HBV
HDV superinfection
person w chronic HBV catches HDV
HDV transmission
parenteral
HDV main pops at risk UK
PWID
HDV chronic sequelae
chronic heaptitis
cirrhosi s
HDV diagnosis
anti-HDV IgM, IgG
HDV how can co-infection and superinfection be distinguished
high levels anti-HBV IgM in co-infection
HDV Rx
pegylated alpha-interferon
HEV
subclinial/mild ilmness
most severe disease in elderly men
HEV incubation
40ays
HEV route
fecal-oral
HEV developing countries
extra-hepatic features e.g. arthritis, anaemia
HEV chronic infection
immunocompromosed
persistent hepatitis and cirrhosis
HEV main pop at risk UK
travellers to endemic areas
exposure to under-cooked pig products
HEV genotypes 1 + 2
developing countries
HEV genotypes 3 + 4
developed countries
HEV diagnosis
IgM, IgG
HEV-RNA
HEV Mx
no licensed Rx, mostly self limiting
HEV prevention
good personal hygiene and sanitation
adequate cooking food
vaccine in china only
HBV incubation
90 days
HCV incubation
60 days
when are healthcare workers with hepatitis excluded from performign EPP
HBeAg positive
HBsAg positive + HBV-DNA 1000+
HCV PCR +ive
exposure prone procedure
risk that injury to worker may result in exposure of patient’s open tissues to blood of worker
