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DTM&H > Hepatitis and STIs > Flashcards

Hepatitis and STIs Flashcards

1
Q

What type of virus is hepatitis A?

A

RNA Virus

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2
Q

What is the epidemiology of HAV?

A

Suspect in the returning traveller with Hepatitis features
1.5 million infections worldwide, most are probably sub-clinical

You can do population wide testing to determine the epidemiology of HAV in your country:
* Use IgG to determine population exposure
* Low <15%, intermediate 15-50%, high >50%

High population exposure = high levels of immunity

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3
Q

Explain who Low, Intermediate and high endemnicity are important concepts in HAV?

A

Areas with Low transmission: probably people are unlikley to present with the virus, so from a public health perspective you don’t need to worry too much about the virus

Areas with high transmmission: The general population have a baseline good immunity against HAV so are unlikely to get very sick from it

Intermediate: There is reasonably high risk of getting HAV + reasonably low risk of having immunity against it –> highest clinical burden of HAV disease

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4
Q

How is HAV spread?

A

Faecal - Oral route

**wash your fruit and veg

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5
Q

Who is more likely to present with HAV - children or adults?

A

Adults –> do have clinical symps of HAV, adults only need a low serovar, but children need a very high level of infection to show symptoms

> 90% of children under 5 are asymptomatic

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6
Q

What is the incubation of HAV?

A

7-14 days (hence, the returning traveller); it is an ACUTE virus remember!

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7
Q

How does HAV present?

A

Acute Hepatitis:
* Jaundice
* Anorexia, fever, fatigue, malaise, diarrhoea,
abdominal pain
* Spontaneous resolution without chronic sequelae

Extra-Hepatic features:
- myocarditis, GBS, AKI, Interstitial nephritis

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8
Q

What is the Liver Enzymes picture in HAV?

A

ALT >1000
Raised AST, raised GGT, raised Alk Phos

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9
Q

How do you diagnose HAV?

A

Anti-HAV IgM (acute infection)
Anti-HAV IgG (shows immunity; can be raised for decades after initial infection)
HAV RNA

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10
Q

What are the complications of HAV?

A
  • Recurrence (3-20%)
  • Fulminant Hepatitis (more common in Hep E)
  • Death (2-5% in adults)
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11
Q

How do you prevent HAV?

A

WASH
Food Hygiene
Vaccination (2x dose vaccine in high-risk people; travellers, MSM, children in intermediate risk countries)

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12
Q

How do you manage HAV?

A

Supportive care only

some patients might be considered for liver transplant

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13
Q

What is the epidemiology of Hep B?

A

Western Pacific
Subsaharan Africa
Asia

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14
Q

What kind of virus is Hep B?

A

DNA

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15
Q

Does HBV cause acute or chronic infection?

A

Primarily chronic (but some people do present with acute hepatitis)

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16
Q

How is Hep B transmitted?

A

Blood Borne

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17
Q

Why is PMTCT important in the context of HBV?

A

90% of infants infected will go on to have chronic liver damage/chronic infection

Maternally acquired HBV associated with:
* Increased risk of progression to cirrhosis
* Lower rate of spontaneous HBsAg loss
* Higher rate of viral replication

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18
Q

What 3 things can you do to prevent HBV vertical transmission?

A
  1. Vaccine neonate within the first 24h of life
  2. Give tenofovir to mothers with High HBV DNA (>200000) or HBeAg
  3. Give HBV immunoglobulin to the neonate within 24h if maternal HBV DNA >200000 or HBeAg +ve

Re: HBeAg = indicator of actively replicating virus

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19
Q

Is there a vaccine for Hep B?

A

Yes - 3 doses
**Birth dose is crucial, but often missed, increasing the risk of maternal to child transmission

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20
Q

How do you diagnose HBV?

A

HBsAg - indicates active infection
±HBV DNA (helps to determine severity)
±HBeAg (indicates actively replicating)

–> can be RDT or ELISA

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21
Q

In regards to HBV, What does HBeAg tell you?

A

Presence of actively replicating virus

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22
Q

In regards to HBV, what does Anti HBc tell you?

A

Exposure to HBV (past or current)

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23
Q

In regards to HBV, what does Anti-HBs tell you?

A

Immunity to HBV

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24
Q

Who and how do you treat HBV?

A

WHO:
All people who are also HIV +ve
Pregnant women with high viral loads

In HIV negative people, people should be treated for
HBV based on:
* ALT
* HBV DNA
* HBeAg
* Age
* Family history of HCC
* Extent of liver fibrosis

HOW:
Tenofovir or entecavir

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25
Q

How does HIV promote increased fibrosis in HBV/HCV infection?

A
  • HIV has tropism for hepatic stellate cells via CXCR4 and CCR5
  • HIV triggers proinflammatory cascade in hepatic stellate cells
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26
Q

What is the Epidemiology of Hep C?

A

Western Pacific
Subsaharan Africa
Eastern Europe

27
Q

What kind of virus is HCV?

A

RNA virus

28
Q

Which chronic Hepatitis virus can be cured?

A

HCV

29
Q

What is the most important risk factor for HCV infection?

A

IVDU

30
Q

How do you diagnose HCV?

A

Anti-HCV Antibody (RDT, ELISA)
+
HCV RNA

Why confirm?? Because 50% of HCV +ve cases are false positives on RDT

31
Q

Who should get HCV treatment?
A. Patients with cirrhosis
B. HCV RNA >100,000 IU/ml
C. Persistent ALT elevation
D. Everyone

A

D. Everyone (curable, not worth the risk of HCC/cirrhosis)

32
Q

What is the most common drug used in HCV treatment?

A

Sofosbuvir

**many drugs available, but you should use a regime that is PAN-GENOTYPIC

33
Q

What hepatitis viruses are spread through the faecal oral route?

A

A, E

34
Q

Which Hepatitis Viruses are BBVs?

A

B, C, D

35
Q

What is the most common form of Hepatitis globally?

A

Hepatitis B

36
Q

What is the most common cause of ACUTE hepatitis globally?

A

Hepatitis E

37
Q

What is Hepatitis D?

A

HDV is a small satellite RNA virus that can cause co- infection with HBV or super infection in HBsAg positive people

38
Q

What viral co-infection is required for Hepatitis D (HDV) to cause infection?

A

HBV

39
Q

How does Hepatitis D cause disease?

A
  1. Acute co-infection with HBV Virus:
    - Acute Hepatitis –> Fulminant Hepatitis –> Hepatic necrosis –> Death
  2. Super co-infection with HBV Virus:
    - Chronic hepatitis –> accelerated fibrosis
    - high risk of HCC
40
Q

What are the main complications of Hepatitis B and hepatitis D?

A

Fulminant Liver Failure (acute)
Liver cirrhosis
HCC
Death

41
Q

How do you diagnose HVD infection?

A

Anti HDV Antibodies (IgM or IgG) (ELISA)
+
HDV RNA for confirmation

42
Q

What is the epidemiology of HDV?

A

5% of people with HBV have HDV
endemic in West and Central Africa,
Middle East, Eastern Europe and Mongolia

43
Q

How is HDV transmitted?

A

Blood Borne Virus

44
Q

What are the risk factors for HDV?

A

IVDUs
MSM
Commercial sex work
Haemodialysis
Hep B and C
HIV

45
Q

How do you manage HDV?

A
  • Only licensed treatment is interferon- disappointing results- SVR in 20-30%
46
Q

How can you prevent HDV?

A

Vaccine against HBV
Prevent MTCT
Encourage safe sex
Screen blood for HBV

47
Q

What type of Virus is Hep E?

A

RNA Virus

48
Q

What is the epidemiology of Hep E?

A

Commonest cause of acute Hepatitis World wide

3 million symptomatic cases/year
70000 deaths

49
Q

What are the 4 main genotypes of HEV?

A

HEV 1: Acute infection, Faecal oral route, occurs in humans. Linked to waterborne outbreaks
HEV 2: Acute infection, Faecal oral route, occurs in humans. Linked to waterborne outbreaks
HEV 3: Zoonotic and humans. Can cause chronic infection in immunocompromised people. Linked to infected meat consumption
HEV 4: Zoonotic and humans. Linked to infected meat consumption

50
Q

Who is most at risk of severe Hepatitis E infection?

A

Pregnant women

  • Significantly higher mortality in pregnant women
  • Seen only with HEV 1 and 2
  • Mortality 20-25%, usually in 3rd trimester
  • Stillbirth common, 3000/year
    Theory: maternal immune tolerance
51
Q

What is the incubation of Hepatitis E?

A

2-6 weeks

52
Q

How does Hep E present?

A

Hepatitis
Jaundice
Fever, nausea, abdominal pain, vomiting,
hepatomegaly

Neuro Sequelae (more common than in HAV) - occurs in 5% of cases
GBS
Meningoencephalitis

53
Q

What does the ALT look like in HEV?

A

ALT >1000-4000

54
Q

How do you diagnose HEV?

A

Anti HEV Antibodies (IgM/IgG)
+
HEV RNA

55
Q

Is there a vaccine for HEV?

A

Yes - but only recommended in OUTBREAKS

56
Q

What is the management of HEV?

A

Ribivirin
±
Interferon
(esp. in immunocompromised with HEV Type 3)

57
Q

Which HEV is assocaited with immunosuppressed patients?

A

HEV 3

58
Q

Which of these infectious diseases is
associated with the highest annual global
mortality?
A. HIV
B. Tuberculosis
C. Malaria
D. Viral hepatitis
E. Dengue

A

E: Viral Hepatitis

A. HIV 1.07 million
B. Tuberculosis 1.18 million
C. Malaria 619,000
D. Viral hepatitis: 1.45 million
E. Dengue 40,467

HBV and HCV: 96% of viral hepatitis mortality and 91% of viral hepatitis DALY

59
Q

What is the only DNA Hepatitis virus?

A

HBV

60
Q

What are the three primary causes of genital ulceration?

A

Syphilis
Genital Herpes
Chancroid

61
Q

What is the management of Syphillis?

A

IM benzathine penicillin 2.4 million units

62
Q

What Bacteria causes Chancroid

A

Haemophylus Ducrei

63
Q
A

DTM&H (29 decks)

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