Hepatitis and Tuberculosis

Question 1

Several weeks of incubation, flu-like symptoms, fever, myalgias, pharyngitis, jaundice, painful liver and marked elevations in LFTs is typically of what kind of category of hepatitis?

Answer 1

Acute

*resolves spontaneously. Can be Hep A, E or B

Question 2

Often asymptomatic, what category of hepatitis may present with portal hypertension or liver inflammation, normal or elevated LFTs and Persists for years or decades?

Answer 2

Chronic hepatitis

*Can be Hep C or B

Question 3

Which type of Hepatitis is the most common cause of acute hepatitis, transmitted fecal-oral and is a non-enveloped ssRNA?

Answer 3

Hepatitis A

*prevent through hand hygiene and two dose Hep A vaccine

Question 4

Which type of hepatitis is a non-enveloped ssRNA virus causes acute hepatitis that is indistinguishable from Hep A, and is spread via fecal contaminated water?

Answer 4

Hepatitis E

Question 5

Which type of hepatitis is and Enveloped DNA virus that is partially dsDNA and partially ssDNA with overlapping reading frames?

Answer 5

Hepatitis B

Question 6

What are the 5 main proteins Hepatitis B produces?

Answer 6

1-Surface protein (HbsAg)
2-Core nucleocapsid protein (HBcAg)
3-HBeAg
4-DNA polymerase
5-HBxAg (relevance unknown but can bind p53)

Question 7

What are the 3 main ways Hepatitis B is transmitted?

Answer 7

1-Perinatal (passed from the mother)
2-Parenteral (blood-borne in healthcare)
3-Sexual

Question 8

What are the percentages for HBV, HCV and HIV infection risks?

Answer 8

HBV-30%
HCV-3%
HIV-0.3%

Question 9

What are the two types of antivirals used to treat hepatitis B?

Answer 9

1-IFN
2-Nucleoside analogs

*Tenofovir and Entecavir are 1st line in the US

Question 10

Which type of hepatitis is a defective ssRNA virus and is a passenger virus that accompanies Hep B?

Answer 10

Hepatitis D

Question 11

Which hepatitis is an enveloped RNA virus in the flavivirus family along with yellow fever, dengue and west nile and is transmitted through blood?

Answer 11

Hepatitis C

*leads to chronic hepatitis in 60-80%. can be treated to have a sustained virologic response (cure)

Question 12

What should be tested for along with hepatitis B?

Answer 12

HIV

*determining genotype of hepatitis B is important

Question 13

What is the worldwide prevalence of tuberculosis? (both latent and active)

Answer 13

33%

*TB is 2nd most common infectious cause of death in adults worldwide

Question 14

What slow growing (24hr/doubling time) is detected using acid fast bacilli test and causes tuberculosis?

Answer 14

Mycobacterium tuberculosis

*Humans are the only known reservoir. Spread in droplets

Question 15

What are the 4 outcomes of TB exposure?

Answer 15

1-Clearance (no infection)
2-Latent infection (infection w/o symptoms)
3-Primary disease (infection with immediate symptoms)
4-Reactivation disease (development of systems months or years later)

Question 16

What happens during the delayed-type hypersensitivity macrophage activating response of TB?

Answer 16

• MTB is ingested by alveolar macrophages
• decreased acidification of phagosome prevents fusion with lysosome
• MTB replicates inside phagosome

Question 17

What is the pathologic hallmark of MTB infection?

Answer 17

Granuloma formation

Question 18

What are two tests used to diagnose Latent TB through immune response?

Answer 18

1-PPD skin test

2-IGRA exposure of blood cells to TB antigens and IFNy release

Question 19

What is the treatment for TB?

Answer 19

4 drugs for 2 months, 2 drugs for 4 months

*RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

Question 20

MDR TB is resistant to what?

Answer 20

Isoniazid and Rifampin

Question 21

XDR TB is resistant to what?

Answer 21

Isoniazid, rifampin, all fluoroquinolone and any injectable

Question 22

What has the most powerful known risk for reactivating latent TB?

Answer 22

HIV

*TB is the most common cause of AIDS mortality