IMSERO Flashcards
the most common hepatitis
due to easy transmission
HAV
self-limited, causing only acute diseases
HAV
aka INFECTIOUS HEPATITIS and has an abrupt onset
(short incubation hepatitis)
HAV
Incubation period: 15 – 50 days (ave: 28 days)
HAV
unlike HBV, it does not produce a coat protein and is not detectable in serum
only detectable in the feces
HAV
HAV MOT
1)fecal-oral/fecal matter ingestion, even in microscopic amounts, from:
* close person-to-person contact with infected person
* ingestion of contaminated food or drinks
2)NEW: direct oral-anal sexual contact with infected person
can release viral antigen in the small intestine, passed out during defecation
HAV
Persons at risk with this virus are the following:
* Travelers to region with intermediate/high rates of HAV
* Sex contacts of infected person
* Household members or caregivers of infected persons
* Men who have sex with men (homosexual intercourse)
* Users of certain illegal drugs (injections and non-injection) – very rare, but possible if the infected person have a severe hepatitis A infection that had reached the blood (VIREMIA)
* Persons with clotting-factor disorders (blood transfusions)
HAV
Who are the persons at risk for Hepatitis A virus?
Persons at risk for HAV:
* Travelers to region with intermediate/high rates of Hepa A
* Sex contacts of infected person
* Household members or caregivers of infected persons
* Men who have sex with men (homosexual intercourse)
* Users of certain illegal drugs (injections and non-injection) – very rare, but possible if the infected person have a severe hepatitis A infection that had reached the blood (VIREMIA)
* Persons with clotting-factor disorders (blood transfusions)
very rare but possible in cases when the virus reaches blood
seen in VERY SEVERE HAV cases (rarely)
viremia
presence of viruses in the blood
the spx recommended for antigen testing during first two weeks
used to detect HAV antigen (shed off in the intestine)
stool
px infected in first 2 wk (no Ab in serum)
viral Ag detected in stool is recommended
how long does early shedding of the virus in stool last?
first 15 days / 2 weeks
A marker of HAV infection:
It happens after 2nd week of infection; during onset of symptoms
Icterus/jaundice, inc liver enzyme levels
SGPT/ALT – liver specific
other liver enzymes may also increase (SGOT, nucleotidase)
IgM anti-HAV
IgM Ab starts to be produced in the serum/plasma
A marker of HAV infection:
during recovery phase
IgG anti-HAV and immunity development
detect the presence of specific HAV Abs
- ELISA
- RIA
true or false
INDIRECT ELISA DETECTS ANTIBODY
true
Indirect ELISA is used for detecting antibodies in a sample in order to quantify immune responses
true or false
DIRECT ELISA DETECTS ANTIGEN
true
what spx is used in direct elisa?
stool
Direct ELISA detects viral antigen
what marker is present in:
acute infection with HAV
IgM anti-HAV
what marker is present in:
Old infection (immune to HAV)
IgG anti-HAV
what marker is present in:
convalescence/recovery period in px with HAV
IgG anti-HAV
aka serum hepatitis
HBV
attacks the liver (hepatocytes) causing both acute and progress to chronic disease - more fatal and severe than HAV
HBV
Incubation period: 45-160 days (ave. 120 days)
HBV
MOT somewhat similar to HIV
HBV
MOT for this virus are the following:
o Direct contact with infectious blood, semen, and other body fluids primarily through:
– Birth to an infected mother
– Sexual contact with an infected person
– Sharing of contaminated needles, syringes, or other injection drug equipment
– Needle sticks or other sharp instrument injuries
HBV
what are the modes of transmission of HBV?
- HBV MOT: (somewhat similar to HIV)
o Direct contact with infectious blood, semen, and other body fluids primarily through:
– Birth to an infected mother
– Sexual contact with an infected person
– Sharing of contaminated needles, syringes, or other injection drug equipment
– Needle sticks or other sharp instrument injuries
the one and only DNA virus causing hepatitis
HBV
complete hepatitis B virion is called the _?
dane particle
replicate inside hepatocytes (liver cells)
Family: Hepadnaviridae
what are the six serologic markers of HBV?
- HBsAg
- HBcAg
- HBeAg
- Anti-HBs
- Anti-HBc
- Anti-HBe
a marker of HBV infection
previously known as the Australia antigen
HBsAg (hepatitis B surface antigen)
a marker of HBV infection
best indicator of early or acute hepatitis infection
HBsAg (hepatitis B surface antigen)
a marker of HBV infection
presence indicates active infection in either acute or chronic stage
HBsAg (hepatitis B surface antigen)
a marker of HBV infection
screened routinely; determines whether the patient requires vaccine or booster
HBsAg (hepatitis B surface antigen)
a marker of HBV infection
found within the core of intact virus
HBcAg (hepatitis B core antigen)
a marker of HBV infection
not detectable in serum; found only in hepatocytes (uncoats inside the cell/tissues)
HBcAg (hepatitis B core antigen)
a marker of HBV infection
specimen for detection: liver biopsy
HBcAg (hepatitis B core antigen)
a marker of HBV infection
NOT routinely tested in hepatitis profile
HBcAg (hepatitis B core antigen)
a marker of HBV infection
indicates chronic hepatitis
HBeAg (hepatitis B envelope antigen)
a reliable marker for the presence of high viral load, high degree of infectivity
HBeAg (hepatitis B envelope antigen)
first Ab to appear at the same time that liver enzyme elevations are first seen
Anti-HBc (anti-hepatitis B core)
a marker of HBV infection
found among asymptomatic carriers
Anti-HBc (anti-hepatitis B core)
only marker present during the WINDOW period
Anti-HBc (anti-hepatitis B core)
first serologic evidence of convalescence/recovery phase from hepatitis infection
Anti-HBe (anti-hepatitis B envelope)
may also indicate low level of virus; low degree of infectivity
Anti-HBe (anti-hepatitis B envelope)
bestows long-term immunity to further HBV infection
Anti-HBs (anti-hepatitis B surface)
measured several months after hepatitis B vaccination (assess vaccine effectiveness or if booster shot is needed)
Anti-HBs (anti-hepatitis B surface)
developed by a patient who had been infected to HBV or vaccinated
Anti-HBs (anti-hepatitis B surface)
confirms that the patient had past infection to HBV
Anti-HBc
Five possibilities:
* Resolved infection (most common)
* False-positive anti-HBc, thus susceptible
* “Low level” chronic infection
* Resolving acute infection
* Window/recovery period
Anti-HBc
what marker/s is/are present?
HBV chronic infection
- HBsAg
- Anti-HBc
- IgG anti-HBc
what marker/s is/are present?
HBV acute infection
- HBsAg
- anti-HBc
- IgM anti-HBc
what marker/s is/are present?
immunity due to HBV vaccination
Anti-HBs
what marker/s is/are present?
Immune due to natural infection (Past infection)
- Anti-HBc
- Anti-HBs
One way to improve immunity is __________. It promotes faster release and movement of lymphocytes in the blood. High levels produce sensitive and active immune response. Ab titer will remain in high levels for a long period.
exercise/physical activities
enumerate the tests for HBV detection
- 1st generation test - ouchterlony
- 2nd generation test
1. Counter Immunoelectrophoresis
2. rheophoresis
3. complement fixation - 3rd generation test
1. reverse passive latex agglutination
2. reverse passive hemagglutination
3. ELISA
4. RIA
HBV detection
1st generation test
ouchterlony
HBV detection
2nd generation test
- Counter Immunoelectrophoresis (CIE)
- Rheophoresis
- Complement Fixation
HBV detection
3rd generation test
- Reverse Passive Latex Agglutination
- Reverse Passive Hemagglutination
- ELISA
- RIA
what is the specific procedure of ouchterlony?
Specific procedure: double-diffusion double-dimension
ouchterlony specific procedure
HBV detection
Principle: Precipitation reaction
Specific procedure: double-diffusion double-dimension
1st generation test
ouchterlony
HBV detection
principle: precipitation with current
2nd generation test
counter immunoelectrophoresis
HBV detection
principle: precipitation by evaporation
2nd generation test
rheophoresis
HBV detection
Agglutination
Anti-HBsAg artificially/passively coated with latex particles (latex – carrier for anti-HBs to detect HBsAg)
detected: _
carrier: _
3rd generation test
reverse passive latex agglutination test
Detected: HBsAg
Carrier: latex
what is the most sensitive test in HBV detection?
3rd generation test (MOST SENSITIVE)
HBV detection
Principle: Hemagglutination
Anti-HBsAg passively attached to RBCs carrier to detect Ag
Carrier: __
3rd generation test
Reverse Passive Hemagglutination
HBV detection
commonly used test to confirm hepatitis B infection
3rd generation test
ELISA
true or false
Direct ELISA – detects HBsAg (hepa B antigen)
true
true or false
Indirect ELISA – detects Anti-HBs (hepa B antibody)
true
what HBV marker?
first to appear
HBsAg
hepatitis B surface antigen
what HBV marker?
signifies high viral load = px highly infectious
HBeAg
|hepatitis B envelope antigen
what HBV marker?
starts to peak as HBeAg levels decrease, since it signifies recovery; thus, low viral load.
Anti-HBe
anti-hepatitis B enveloope
Made by a recombinant strain of the yeast
Saccharomyces cerevisiae - common bakers’ yeast
HBV Vaccine (1982)
common baker’s yeast
Saccharomyces cerevisiae
HBV Vaccine (1982)
Made by a recombinant strain of the yeast
Enumerate disease states caused by HBV
- acute hepatitis
- fulminant hepatitis
- chronic
- co-infection with HDV
delta virus requires HBsAg for its replication
HBV and HDV simultaneously infect and replicate in hepatocytes
co-infection with HDV
asymptomatic carrier; chronic persistent hepatitis; chronic active hepatitis
chronic hepatitis
sudden, severe onset of a condition
fulminant hepatitis
starts with infection; progress to cancer if not managed
infectious cancer
a liver cancer, severe progression if HBV infection is not controlled
PRIMARY HEPATOCELLULAR CARCINOMA (HEPATOMA)
give the infectious type of cancer:
HBV
hepatoma
give the infectious type of cancer:
HPV
cervical cancer
give the infectious type of cancer:
EBV
nasopharyngeal cancer
dx hbv serologic test
no active infection, cured, long term immunity
Anti-HBsAg
dx hbv serologic test
active/on-going infection, either acute/chronic
HBsAg
dx hbv serologic test
not new nor old
both IgM & IgG anti-HBc
“Middle infection”
dx hbv serologic test
old infection, may persists for years
IgG Anti-HBcAg
dx hbv serologic test
new/early stage of infection
IgM Anti-HBcAg
true or false
HBcAg - antibodies; no antigen
true
core Ag not detected in serum, only found in liver intact cells/biopsy
true or false
core antigen is detected in serum
found in liver intact cells/biopsy and other tissues
false
core antigen not detected in serum, only found in liver intact cells/biopsy
dx hbv serologic test
low infectivity, low viral load
Anti-HBeAg
dx hbv serologic test
High infectivity, high viral load
HBeAg
true or false
In viral serology, antibody detection comes first before antigen appearance
false
In viral serology, Ag detection comes first before Abs appearance
true or false
Ag is responsible for stimulating the immune system to produce Ab
true
true or false
It is also impossible to detect only the antibody (i.e. HBcAg)
false
true or false
Delayed dx (asymptomatic patient) – antigen can be tested;
While antibody is recommended in early stages
false