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Surgery- Liver, Spleen and Pancreas > Hepatitis Virology > Flashcards

Hepatitis Virology Flashcards

1
Q

Name 4 non infectious causes of hepatitis:

A

Alcoholism
Auto-immune diseases
Drugs
Toxins

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2
Q

Name 4 infectious causes of viral hepatitis:

A
  • Hepatitis viruses.
  • Other viruses I.e. EBV, CMV, HSV, Adenovirus, Haemorrhagic fevers.
  • Bacterial infections I.e. TB
  • Parasitic infections I.e. Malaria
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3
Q

List the 5 types of Hepatitis viruses:

A
  1. Hepatitis A
  2. Hepatitis B
  3. Hepatitis C
  4. Hepatitis D
  5. Hepatitis E
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4
Q

Which 2 Hepatitis viruses is spread faecal orally.

A

Hepatitis A

Hepatitis E

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5
Q

Which of the Hepatitis viruses is spread parenterally (other than through the digestive system)

A

Hepatitis B
Hepatitis C
Hepatitis D

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6
Q

Which viridae does Hepatitis A belong to?

A

PicornA viridae

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7
Q

Which viridae does Hepatitis B belong to?

A

Hepadnaviridae

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8
Q

Which viridae does Hepatitis C belong to?

A

Flavi viridae

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9
Q

Which viridae does Hepatitis D and E belong to?

A

Hepatitis D- Unclassified

Hepatitis E- HepEviridae

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10
Q

Classify the different hepatitis viruses according to whether they are DNA or RNA, as well as enveloped or naked.

A 
Hepatitis A- RNA Virus; Naked
Hepatitis B- DNA Virus; Enveloped
Hepatitis C- RNA Virus; Enveloped
Hepatitis D- RNA Virus; Naked
Hepatitis E- RNA Virus; Naked
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11
Q

What are the incubation periods of the different hepatitis infections?

A

Hepatitis A: 2-4 weeks
Hepatitis B: 4-6 weeks
Hepatitis C: 4-6 weeks
Hepatitis E: 2- 4 weeks

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12
Q

What is the epidemiology of hepatitis A, what is the incidence age and where are outbreaks commonly seen?

A

Hepatitis A is spread due to a lack of sanitation typically in developing countries- poor sanitation and poor hygiene
Children are typically affected
Outbreaks are common in daycares, military and closed institutions.

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13
Q

Is hepatitis A self-limiting or does it present with possible chronic carriage?

A

Self limiting

- Rarely causes fulminant hepatitis

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14
Q

Briefly explain the transmission of Hepatitis A:

A 
Faecal oral transmission 
Contact with contaminated food or water 
    -  Raw shell fish
    - Food contaminated by infected food handlers 
Person to person contact 
    - Day care centers
    - Military personel 
    - Persons in an institution. 
Homosexual contact 
Via IV drug use 
Transmission through blood via blood transfusion.
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15
Q

Briefly explain the faecal-oral transmission of Hepatitis A:

A 
Ingestion of infected material.
Absorption into the small intestines from the stomach. 
Replication in the liver 
Secretion into bile. 
Excretion in stool
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16
Q

Name 3 ways that hepatitis A can be diagnosed:

A

RT-PCR
Serology (HAV; IgM or IgG)
Electron microscopy

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17
Q

What is the treatment for hepatitis A?

A

No treatment: Self limiting infection.

Not chronic.

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18
Q

Give 6 ways that Hepatitis A can be prevented:

A 
Improving sanitation practices 
Vaccination
  - Live attenuated 
  - Inactivated
Adherence to sanitary practices I.e. washing Hands.
Chlorination a certain disinfectant solutions. 
HAV immunoglobulins. 
Heating food appropriately
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19
Q

What 2 types of pre-exposure prophylaxis are available for Hepatits A?

A

HAV Vaccine:
- EPI younger than 1 years old
- Booster at 18 months
- Traveling to endemic areas:
Children and adults must get vaccinated 2 weeks before travel.
Pt. with chronic liver disease: vaccination 1 month before travel.

HAV Immunoglobulins:

  • Provides 3 month protection
  • Given to patients under 12 months who need the protection
  • Given to patients traveling to endemic areas.
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20
Q

What post exposure prophylaxis is available for exposure to Hepatitis A?

A

HAV immunoglobulins

  • Given within 72 hours
  • Can be used up to 2 weeks

HAV Vaccine

  • 2 -40 years old
  • Within 2 weeks after exposure.

15- 27 days since exposure
- Immunoglobulins can be considered for high risk patients.
> Underlying liver disease.
> Immunosuppressed patients

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21
Q

What is the epidemiology of hepatitis E and what is the incidence age?

A 
Hepatitis E (Hepe viridae) is caused by water contamination. 
Children are typically infected.
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22
Q

Name 3 main clinical signs of Hepatitis E:

A

Jaundice
Hepatomegaly
Anorexia

Other signs include: Abdominal pain and tenderness, Nausea, vomiting, fever.

23
Q

Does Hepatitis E present with Chronicity in immunocompromised patients?

24
Q

Describe the pathogenesis and transmission of hepatitis E:

A

Faecal- oral transmission
Ingestion of contaminated water- Endemics
Ingestion of high risk foods e.g.
- Raw shell fish (oysters, clams etc.)
Zoonosis
- Pigs, Silva deer, wild boar

25
Q

Name 2 complications of hepatitis E contraction:

A

It is more severe than Hepatitis E

Increased severity in pregnancy

26
Q

Name 3 ways that Hepatitis E can be diagnosed:

A

Serology: HEV IgM or IgG, serum antiHEV
HEV RT- PCR in serum.
Electron microscopy

27
Q

Provide 2 methods for Hepatitis E prevention:

A

Stricter zoonotic regulations

Improve sanitation - purification and water filtration

28
Q

What is the pre-exposure prophylaxis for a Hepatitis E infections?

A

There is no vaccine available

29
Q

What is the post prophylaxis treatment of Hepatitis E?

A

There is no vaccine available
Hepatitis E serum immunoglobulins
- Used in endemic countries

30
Q

Which of the hepatitis viruses is a virusoid?

A

Hepatitis D

31
Q

Explain the mechanism in which hepatitis D works:

A

Hepatitis D has a circular ssRNA structure
Requires a helper virus for replication
The helper virus that hepatitis D uses, is Hepatitis B.
- It uses HBsAg as an envelope protein.

32
Q

Name 4 complications of a Hepatitis D co-infection:

A

Increased chronicity and mortality rate
Increase in the progression of liver cirrhosis
Increase in viral fulminant hepatitis; more common with HDV co-infection.
Difficulty in treatment:
- HDV only responds to interferon alpha treatment
- Doesn’t respond to HBV treatment- Lamivudine.

33
Q

Name 5 ways that Hepatitis C is transmitted:

A 
IV drug use 
Sexual transmission 
Blood transfusion 
Nosocomial: Hospital workers and perinatal. 
HIV/HCV co-infection is common. 
(Unknown. )
34
Q

Name 3 ways that Hepatitis C can be diagnosed:

A

Serology
RT-PCR: Used as confirmation
Molecular diagnosis
- Gold standard for active infection

35
Q

Name 4 ways the Hepatitis C can be prevented

A

Provision of safe blood/ blood products and organ transfusion
Do not share needles
Immunization
Needle stick injury managed by early detection and treatment.

36
Q

What is considered the gold standard of showing active viral infecti9n of Hepatitis C?

A

Detection of viral genomic RNA

36
Q

Give 2 types of Hepatitis C treatments:

A
  1. Pegylated interferon and ribavirin (standard approach)
  2. Direct acting antivirals
    • Protease inhibitors : Simeprevir
    • Polymerase inhibitors
    • NS5A inhibitors
38
Q

At what point is a patient considered chronically ill with Hepatitis C?

A

When HCV RNA is detected after 6months

39
Q

Which 2 hepatitis strands present with chronicity?

A

Hepatitis B and C

40
Q

Which 2 Hepatitis strands are vaccine presentable:

A

Hepatitis A and B

41
Q

What complications do immunosuppressed patients face with regards to hepatitis:

A

Severe hepatitis

False negative serology (mainly antibodies)

42
Q

Which hepatitis virus is the leading cause of chronic hepatitis, cirrhosis , hepatocellular carcinoma, with portal hypertension?

A

Hepatitis B

43
Q

Name 6 ways that hepatitis B can be transmitted:

A 
Vertical transmission- child to child ( e3yeras and younger)
Horizontal transmission- perinatally 
Sexual transmission 
Nosocomial 
Parental- blood products 
Sporadic
44
Q

Name 3 HBV Screening markers:

A
  1. HBsAg (Hepatitis B surface antigens)
  2. Anti- HBs (Hepatitis B antigens)
  3. Total anti-HBc ( IgG and IgM antibodies to HBcAg- HepB core antigens)
45
Q

What are the 3 markers of a direct Hepatitis B infection: (2 Antigens and HB-DNA)

A
  1. HBsAg (Hepatitis B surface antigen)
  2. HBeAg (Hepatitis B soluble e antigen)
  3. HB-DNA
46
Q

What are the 3 markers of a indirect Hepatitis B infection: (2 Antibodies)

A
  1. Anti-HBs (Antibodies to HB surface antigen)
  2. Anti- HBe (Antibodies of the HB soluble e antigen)
  3. Total Anti- HBc
  4. Anti- HBc IgM
50
Q

What is a marker of reactivation acute Hepatitis B infection or?

A

Anti-HBc IgM

52
Q

What is required for eAg -> anti HBe seroconversion

soluble e antigen -> Hepatitis B soluble e antibody

A

A strong immune response is required for the seroconversion of:
- eAg -> anti HBe

54
Q

What is the viral load of a simple, Hepatitis B, carrier?

A
  • Less infectious

- Lower viral load

55
Q

Name 3 treatments for HBV:

A

Antiretroviral drugs

  1. Interferon alpha and Pegylated interferon alpha 2
  2. Lamivudine
  3. Tenofovir
  4. Adofovir
56
Q

How can the spread of hepatitis B be prevented in adults with testing positive with HB-Ag?

A

Wear protection during sexual intercourse
Ensure sexual partners are vaccinated against hepatitis an
Do not share tooth brushes and razors
Do not donate blood, organs or sperm
Clean up blood spills with bleach and strong detergents z
Cover up all cuts and bumps

57
Q

What is the viral load of a super, Hepatitis B, carrier?

A

Higher titles of HB (Hepatitis B)

58
Q

What is eAg indicative of in a Hepatitis B infection?

A

eAg- Soluble e Antigen

  • Marker of high replication: Super carrier
  • This indicates a high viral load in the patient.

Surgery- Liver, Spleen and Pancreas (10 decks)

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