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3rd Year Infection > Hepatitis Self Learning > Flashcards

Hepatitis Self Learning Flashcards

1
Q

What are the most important viral causes of hepatitis in the UK?

A

A, B, C, E

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2
Q

What else must be done when Viral Hepatitis is diagnosed, separate to the patient?

A

Notify public health

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3
Q

What is anicteric illness?

A

Symptoms with no jaundice

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4
Q

What is icteric illness?

A

Symptoms with jaundice

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5
Q

What is fulminant hepatitis?

A

Severe jaundice with hepatic failure and high mortality

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6
Q

What Liver enzymes are raised in hepatitis? Why?

A

ALT
AST
Released into serum by damaged hepatocytes

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7
Q

What are the initial clinical features of Hepatitis A?

A

Mild/subclinical

Anicteric in children <5

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8
Q

How does the severity of HAV vary with age?

A

Increased severity with age

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9
Q

What is the incubation period of HAV?

A

28 days (10-50)

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10
Q

What is the post-incubation presentation of HAV?

A 
Fever
Malaise
Anorexia
N+V
Upper abdominal pain 
Followed by jaundice later
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11
Q

How is HAV spread?

A

Fecal-oral

Rarely fecal contaminated food/water

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12
Q

Where is HAV endemic?

A

Worldwide

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13
Q

When are HAV patients infectious?

A

1 week before onset of jaundice, few days after

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14
Q

Which groups of the population are at risk of HAV?

A

MSM

IVDA

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15
Q

What type of virus is HAV?

A

Picornavirus

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16
Q

How does HAV present in the serum?

A

Anti-HAV IgM

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17
Q

How is HAV treated?

A

Supportive

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18
Q

When is Anti-HAV IgG raised?

A

Commonly in the general population >60

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19
Q

How is HAV prevented?

A

Personal Hygiene
Sanitation
Human Normal Immunoglobulin for close contacts to patient
Killed virus Vaccine

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20
Q

When is active immunisation against HAV indicated?

A

Risk of exposure:

  • Sewage workers
  • Seronegative haemophiliacs
  • MSM
  • Patients with CLD
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21
Q

When does Acute Hepatitis occur after HBV infection?

A

Weeks - 6 months

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22
Q

What are the symptoms of HBV infection?

A 
Anorexia
Lethargy
Nausea
Fever
Abdominal discomfort
Arthralgia
Urticarial skin lesions
Dark urine
Jaundice
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23
Q

How severe is Acute HBV?

A

Typically mild in 99%

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24
Q

What are the infection outcomes for HBV?

A

Recovery 90-95%

Chronic Infection 5-10%

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25
Q

What type of virus is HBV?

A

Hepadnavirus

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26
Q

What are the viral forms seen in the blood in HBV?

A

Infectious virus particles

Non-infectious spheres and tubules

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27
Q

What antigens are associated with HBV?

A

HBsAg (surface)
HBcAg (core)
HBeAg (“e”)

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28
Q

What is the most important marker in HBV infection?

A

HBsAg

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29
Q

What does HBeAg +ve tell us about chronically infective individuals?

A

Highly infectious

At risk of chronic liver disease and hepatoma

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30
Q

What does HBsAg +ve but HBeAg negative tell us?

A

Highly infectious with high serum HBV DNA with a mutant HBV genome

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31
Q

What are the main routes of transmission of HBV?

A

Perinatal
Sexual
Parenteral

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32
Q

Where is HBV most common?

A 
SEA
China
Equatorial Africa
Oceania
South America
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33
Q

Where is HBV of “intermediate rate”?

A

East Europe
Mediterranean
South America
Middle east

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34
Q

Where is HBV least common?

A

Western Europe
North America
Australia

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35
Q

What are the major predisposing risk factors for HBV in the UK?

A 
MSM
IVDA 
immigration
Learning disability in residential care
Haemodialysis/Haemophilia
Babies born to mothers with HBV
Tattooing/body piercing
Medical equipment
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36
Q

What is the risk of perinatal infection in babies born to HBeAg mothers? How is it managed?

A

90% if no preventative immunisation given

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37
Q

How is acute HBV virus diagnosed?

A

HBsAg
Later: anti-HBc IgM antibodies
Seroconversion in serological profile

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38
Q

What are the clinical features of chronic HBV infection?

A 
Serum HBsAg for >6mo
Non-specific Sx:
- Fatigue
- Anorexia
- Depression
39
Q

How does risk of chronic infection vary with age?

A

Infants 90%
Children 40%
Adults 5-10%

40
Q

How does risk of chronic infection vary in the population?

A

Age
Men
Immunodeficient

41
Q

What long-term sequelae are associated with chronic HBV?

A 
Chronic Liver Disease
Membranous Glomerulonephritis
Polyarteritis nodosa 
Hepatoma
Cirrhosis
42
Q

Which patients of acute HBV are more likely to progress to chronic disease?

A

Those with mild symptoms

43
Q

What is the prognosis of Chronic HBV?

A

Cirrhosis/Hepatoma -25%

44
Q

How is chronic HBV with raised ALT and HBeAg +ve treated?

A

Antiviral therapy

45
Q

What are the Indications for antiviral therapy in those without cirrhosis?

A

HBV DNA > 2000 IU/ml
Raised ALT
Significant liver inflammation/fibrosis

46
Q

How is chronic HBV treated?

A 
Pegylated a-interferon 
Nucleoside analogues 
Entecavir
Tenofovir
Transplantation
47
Q

When is transplantation indicated in chronic HBV?

A

Advanced cirrhosis

Hepatoma

48
Q

How is the risk of graft infection reduced in HBV?

A

Combined HBIG and antiviral therapy

49
Q

What are the means of preventing HBV infection?

A

Immunisation
Infection control procedures
Screen blood/transplant donors

50
Q

What vaccine is given for HBV?

51
Q

Poor response to HBV vaccination are associated with what?

A 
>40
Obesity
Smoking
Wrong injection site
Immunocompromisation
52
Q

Post-vaccine anti-HBs

level of >100 tells you what?

A

Good responder
No further check
Booster in 5 years

53
Q

Post-vaccine anti-HBs

level of 10-100 tells you what?

A

Poor responder
Booster now and in 5 years
No further check

54
Q

Post-vaccine anti-HBs

level of <10 tells you what?

A

Repeat course and recheck antibody level, 3mo after last dose

55
Q

Active immunisation against HBV is indicated in which groups?

A 
Healthcare personnel 
Prolonged travel to endemic areas
Renal dialysis patients
MSM
Sex workers
IVDA
Emergency service personnel
Those in close contact
56
Q

HBIG and vaccine is given to which patients?

A

Babies born to HBsAg positive mothers
Healthcare workers
Needlestick injury
Previously unprotected sexual contacts and family contacts of HBV patients

57
Q

How should immunocompromised patients at risk of HBV infection be managed?

A

Ongoing prophylactic antiviral therapy

58
Q

Previous HBV patients with no detectable HBsAg can reactivate viral disease how?

A

Chemotherapy
Prolonged immunosuppression
i.e Rituximab

59
Q

What are the clinical features of acute HCV infection?

A 
Mild or subclinical
Vague malaise
Anorexia
Fatigue 
Jaundice is severe
60
Q

What are the outcomes of acute HCV infection?

A 
20-40% full recovery
60-80% chronic infection:
 - 50-80% progress without cirrhosis
 - 20-50% cirrhosis in 30y
    - 10% hepatoma
61
Q

Clearance of HCV is most common in which groups?

A

Icteric illness

Females

62
Q

What do AST or ALT values tell you in HCV infection

A

Can vary wildly in chronic HCV

Increasing AST:ALT indicative of fibrosis/cirrhosis

63
Q

How is HCV spread?

A 
<5% sexual contact
<6% mother-child (unless HIV+) 
20-50% IVDA 
Haemophiliacs 
Blood products prior to '89/'91
Tattooing
Household contacts
Dental/medical treatment
64
Q

Where is the incidence of HCV high?

A 
Japan
New Guinea
Gambia
Zaire
Brazil
Egypt
65
Q

What type of virus is Hepatitis?

A

Flavivirus (RNA Virus)

66
Q

How is HCV diagnosed?

A

IgG detectable late/remains negative
HCV antigen
HCV-RNA
Sequencing

67
Q

How is HCV managed?

A

Abstinence
Test for HAV/HBV + immunisation
Pegylated a-interferon
Ribarvirin

68
Q

Viral clearance is lower in which type of HCV?

A

HCV Genotype 1

69
Q

What are the 4 recognised response patterns to HCV antiviral therapy?

A

Non-responder
Viral breakthrough
Relapser
Sustained viral response

70
Q

What is a Viral breakthrough response?

A

Initial response to antiviral therapy followed by increase in the measured circulating level of virus by a factor of 10

71
Q

What is a non-responder response?

A

Despite antiviral therapy, virus remains detectable

72
Q

What is a relapser response?

A

Virus undetectable during antiviral therapy but becomes detectable on stopping treatment

73
Q

What is a sustained viral response?

A

Virus undetectable for 6 months after antiviral therapy

74
Q

Response to anti-HCV therapy depends on what?

A 
Viral genotype
Age
Gender
Stage of liver disease
Viral load
75
Q

How is the risk of progression to chronic HCV infection prevented?

A

Early diagnosis and treatment with pegylated a-interferon and Ribavirin

76
Q

What are the factors in reducing risk of HCV transmission?

A

Blood, organ and tissue donor screening
Not sharing equipment
Covering cuts/lesions

77
Q

What is essential for HDV infection?

A

HBV infection

78
Q

How can HDV infection occur?

A

Co-infection (simultaneous)

Superinfection (HBV then HDV)

79
Q

What is the most common route of HDV infection?

A

IVDU

Vertical/sexual transmission rare

80
Q

Where is HDV infection most common?

A

Southern Europe
Middle East
Africa
South America

81
Q

How is HDV diagnosed?

A

Anti-HDV IgG/IgM
HDV-RNA
HDAg

82
Q

How is HDV co-infection distinguished from superinfection?

A

Co-infection: High levels of anti-HBc IgM

83
Q

How is HDV treated?

A

Prolonged pegylated a-interferon

84
Q

How does HEV infection present?

A 
~40 days post-exposure
Similar to HAV
Increased mortality in pregnant women (<20%)
Arthritis
Anaemia
Neurological symptoms
85
Q

When can persistent HEV infection develop?

A

Immunocompromised patients

86
Q

Where is HEV endemic?

A

Globally

Seasonal variation in developing countries

87
Q

How may HEV spread?

A 
Undercooked pork (85% of British pigs infected with HEV)
Contaminated water
Game 
Occupation 
Donated blood (not screened)
88
Q

How is HEV diagnosed?

A

IgG
IgM
HEV-RNA

89
Q

What type of virus is HEV?

A

Henevirus (small RNA virus)

90
Q

How is HEV treated?

A

Supportive (self-limiting)
Reduced immunosuppression
Ribavirin if severe
Good hygiene/cooking

91
Q

What are the HEV genotypes?

A

1 and 2 - epidemics in developing countries
3 - sporadic
3 and 4 - worldwide

92
Q

When are healthcare workers with hepatitis excluded from exposure prone procedures?

A
  1. Hep B e antigen positive
  2. Hep B s antigen positive (HBV DNA >1000/ml)
  3. Hep C PCR positive
93
Q

After percutanous exposure to blood/body fluids, how should you respond?

A
  1. Encourage bleeding
  2. Wash thoroughly
  3. Cover with waterproof plaster
  4. Report to supervisor/GP

Approach source and request blood test with consent
Repeat blood testing on victim 3 and 6mo post

3rd Year Infection (16 decks)

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