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Infection > Hepatitis B > Flashcards

Hepatitis B Flashcards

1
Q

Acute clinical hepatitis can occur any time between

A

A few weeks and 6 months after infection with hepatitis B virus

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2
Q

State the symptoms of acute clinical hepatitis

A

Anorexia, lethargy, nausea, fever, abdominal discomfort, arthralgia and urticarial skin lesions, then dark coloured urine and jaundice

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3
Q

State the mechanism of acute hepatitis

A

Immune-mediated, the greater the antigen/antibody reaction the more severe clinical and biochemical hepatitis

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4
Q

State the percentage of patients hospitalised with acute infection of hepatitis B and fulminant hepatitis with dissemninated intravascular coagulation and encephalopathy

A

1%

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5
Q

State the possible outcomes of acute hepatitis B virus

A

Recovery (90-95%) or HBsAg positive chronic infection (5-10%)

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6
Q

What type of virus is hepatitis B

A

Hepadnavirus

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7
Q

State the three forms of the virus seen in blood

A

Infectious viral particles and non-infectious spheres and tubules

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8
Q

What do the non-infectious spheres and tubules consist of

A

HBsAg

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9
Q

The core of the hepatitis B virus contains what

A

HBcAg

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10
Q

What is HBeAg

A

Split from HBcAg in the liver cell during new virus formation and released in a free soluble form in the serum

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11
Q

State the markers of viral replication in hepatitis B

A

Serum HBeAg and HBV-DNA

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12
Q

What is HBsAg used for

A

To detect both acute and chronic HBC infection

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13
Q

Patients positive with HBeAg are

A

High infectious and at risk of developing chronic liver disease and hepatoma

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14
Q

Describe patients who are HBsAg positive but HBeAg negative

A

Highly infectious with high serum HBV DNA as a result of chronic HBV infection with a virus with a mutant genome

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15
Q

Statte the routes of transmission of hepatitis B

A

Vertical (perinatal) and horizontal (sexual, parenteral, needle stick injury)

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16
Q

State what makes hepatitis B so infectious

A

May be 100million infectious particles per mL of blood, it is also stable and may survive outside of the body for weeks

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17
Q

State the number of people worldwide effected by HBV

A

350million

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18
Q

State the countries with the highest rates of hepatitis B infection (HBsAg 5-10%)

A

South-East Asia, China, Africa, Oceania and South America

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19
Q

State the countries with intermediate rates of hepatitis B infection (2-5%)

A

Eastern Europe, Mediterranean, south Ameria and the Middle East

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20
Q

State the countries with the lowest rates of hepatitis B infection (<2%)

A

Western Europe, North America and Australia

21
Q

List the factors with increased risk of infection in the UK

A

IVDU, MSM, Immigration from areas of high endemicity, patients with learning disability who live in residential care, patients in haemodialysis units, babies born to mothers who are at risk, tattooing or body piercing with non-sterile equipment

22
Q

State the number of women in areas of high endemicity who may be infection with HBeAg

A

10-15%

23
Q

State the risk of transmission of infection from HBeAg positive blood

A

30%

24
Q

State the risk of infection from Anti-HBe positive blood

A

0.1%

25
Q

State how acute hepatitis B infection is usually diagnosed

A

HBsAg can be detected in serum, if not present, confirmed if high levels of anti HBc IgM antibodies are present

26
Q

What is seroconversion

A

Development of significant levels of specific antibody following the infection or vaccination

27
Q

Describe seroconversion in terms of hepatitis B

A

Anti-HBs from AntiHBc occurs some weeks after the disappearance of HBaAg

28
Q

Define chronic hepatitis B infection

A

Persistence of HBsAg in the serum for more than 6 months

29
Q

When is chronic hepatitis B more common

A

90% of infants, children, males and immunodeficiency

30
Q

Patients with chronic hepatitis B are more at risk of

A

Chronic liver disease, membranous glomerulonephritis and polyarteritis nodosa

31
Q

Whos more at risk of developing chronic disease

A

Patients who have asymptomatic or mild acute infection

32
Q

State the symptoms of chronic hepatitis B

A

Fatigue, anorexia, depression, jaundice

33
Q

What results in raised Serum AST and ALT levels

A

Immune system may begin to respond to the foreign viral proteins and attack the infected liver resulting in symptoms

34
Q

State the percentage of individuals with chronic hepatitis B who can progress to cirrhosis or hepatoma

A

25%

35
Q

State those who should be considered for antiviral treatement aimed at inhibition of HBV replication

A

Asymptomatic chronic HBV infection with raised ALT who are HBeAg positive and those with progressive liver disease

36
Q

State the indications of use of antiviral therapy in the treatment of hepatitis B

A

Cirrhosis with evidence of ongoing viral replication in the form of circulating HBV DNA, or the presence of 2 of:
HBV DNA>2,000 IU/ml
Raised ALT
Significant liver inflammation or fibrosis

37
Q

State the go to antiviral treatment for hepatitis B

A

A long acting preperation of pegylated alpha interferon given subcutaneously once per week for 12 months or nucelotide analogues (especially in chronic hepatiits B patients)

38
Q

State the two nucelotide analogues used in the treatment of hepatitis B

A

Entecavir and tenofovir

39
Q

When should liver transplantation be considered in hepatitis B

A

Advanced cirrhosis or hepatoma

40
Q

State the most important means of preventing HBV infection

A

Immunisation, infection control procedures, screening of blood donors and transplant donors

41
Q

Active hepatitis B vaccine contains what

A

HBsAg produced by recombinant DNA technology

42
Q

State the conditions with are associated with poor responses to the vaccine

A

Age over 40, obesity, smoking, wrong site of injection and immunocompromised

43
Q

A person with post-vaccine antiHBs level of >100

A

Good responder, no further antibody check, booster given in 5 years

44
Q

A person with post-vaccine antiHBs level of 10-<100

A

Poor responder, booster now and in 5 years

45
Q

A person with post-vaccine antiHBs level of <10

A

No response to vaccine, repeat course of vaccine and recheck antibody level, 3 months after the last dose

46
Q

List the people recommended to have active vaccination against hepatitis B

A

direct contact with blood or body fluids, those travelling to endemic areas for prolonged stay (>1yr), renal dialysis patients, those who change sexual partners frequently (particularly MSM and both
male and female commercial sex workers), PWID, selected police and emergency services personnel, and close contacts of those with acute or chronic HBV infection.

47
Q

How can passive immunisation against HBV be given

A

Hepatitis B specific immunoglobulin

48
Q

When is a combination of passive and active immunisation used

A

Infants born to mothers with chronic HBV infection or who are HBsAg positive after acute infection
Healthcare workers not known to have adequate antiHBs
Previously unprotected sexual contacts and family contacts of individuals who have acute or chronic HBV infection

Infection (24 decks)

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