Infections of GI tract-Hepatitis (schoenwald): slides 1-29

Question 1

Which types of Hepatitis are spread through blood and body fluids? Which are spread through feces?

Answer 1

Blood/body fluids: B, C, D
Feces: A, E

Question 2

Viral Hepatitis: A -Source of virus? -Route of transmission? - Chronic infection? -prevention?

Answer 2

Hep A: -source: feces -route: fecal-oral -NO chronic infection -pre/post exposure immunization

Question 3

Viral Hepatitis: B -Source of virus? -Route of transmission? - Chronic infection? -prevention?

Answer 3

Source: blood/blood-derived body fluids Route: percutaneous permucosal Chronic infection: yes -pre/post exposure immunization

Question 4

Viral Hepatitis: C -Source of virus? -Route of transmission? - Chronic infection? -prevention?

Answer 4

Source: blood/blood-derived body fluids Route: percutaneous permucosal Chronic infection: yes Prevention: blood donor screening; risk behavior modification

Question 5

Viral Hepatitis: D -Source of virus? -Route of transmission? - Chronic infection? -prevention?

Answer 5

Source: blood/blood-derived body fluids Route: percutaneous permucosal Chronic infection: yes Prevention: pre/post exposure immunization; risk behavior modification

Question 6

Viral Hepatitis: E -Source of virus? -Route of transmission? - Chronic infection? -prevention?

Answer 6

source: feces Route: fecal-oral Chronic infection: no Prevention: ensure safe drinking water

Question 7

Hepatitis: chronic infections can occur in ____

Answer 7

**B,C and D. (chronic hepatitis just means they never cleared the infection)

Question 8

Acute Hepatitis – Clinical Symptoms: -asymptomatic> symptomatic> fulminant> liver failure >_____

Answer 8

Asymptomatic > Symptomatic > Fulminant Liver Failure > Death

Question 9

Acute Hepatitis: Sx? -Are Sx different for Hep A,B,C, D) ?

Answer 9

-Sx (if present) are the same, regardless of cause (e.g., A, B, C, other viruses, toxins): -Nausea, vomiting -Abdominal pain -Loss of appetite -Fever -Diarrhea -Light (clay) colored stools -Dark urine -Jaundice (yellowing of eyes, -skin

Question 10

Concentration of Hepatitis A virus in various body fluids: -greatest concentration in _____

Answer 10

-Greatest concentration of Hep A virus in Feces, 2nd greatest amount in serum, and 3rd amount in saliva

Question 11

Geographic distribution of Hepatitis A: -regions with Higher prevalence?

Answer 11

High: Iceland, Africa, mexico and central america

Question 12

Hepatitis A virus transmission: List 3 examples of common transmission routes

Answer 12

-close personal contact (ie household contact, sex contact, child day care centers) -contaminated food, water(ie infected food handlers) -Blood exposure (rare) ie injection drug use, rarely by transfusion

Question 13

Laboratory testing for Hep A: -Hepatitis A IgG= -Hepatitis A IgM=

Answer 13

IgG= chronic, Pt immune IgM= acute infection

Question 14

Hepatitis A: -vaccine preventable?

Answer 14

-**Vaccine preventable -Hepatitis A vaccine (Havrix) –FDA approved in age 12 months and older: -Children and adolescents- 0.5 ml dose, 2 shot series given 6 months apart -Adult- 1ml dose , 2 shot series given 6 months apart

Question 15

Describe the Hepatitis A/B combo vaccine:

Answer 15

-*Hepatitis A/B combination (Twinrix) 2 FDA approved dosing schedules: -Standard: 3 shot series given at day 0, 1 month, and 6 months -Accelerated schedule 4 shot series given at day 0, day 7, day 21 and 1 year (note: twinrix is for children 18+)

Question 16

Hepatitis A Treatment:

Answer 16

supportive (notes: Say there’s an outbreak and your Pt was exposed to hep A –prophylaxis is Hep A vaccine)

Question 17

Hepatitis B is the most _____ ______ of all blood borne pathogens

Answer 17

-easily transmissible -**Disease more prevalent and infectious than HIV

Question 18

Hepatitis B may lead to _____ and/or _____

Answer 18

-May lead to cirrhosis and/or cancer of the liver

Question 19

Hepatitis B: -Risk of transmission? -Vaccine?

Answer 19

-Risk from single needle stick 6-30% if not immunized -Vaccine preventable -Vaccine is 99.9% effective

Question 20

Hepatitis B virus: -Describe the concentrations of Hep B virus in various body fluids

Answer 20

High: blood, serum, wound exudates Moderate: semen, vaginal fluid, saliva Low: urine, feces, sweat, tears, breastmilk

Question 21

Hepatitis B virus Modes of transmission (top 3)

Answer 21

-sexual -Parenteral -perianal

Question 22

Outcome of HBV Infection: infection can lead to–>

Answer 22

-asymptomatic–> resolved immune OR chronic infection–> asymptomatic OR cirrhosis liver cancer -Infection–> symptomatic acute Hep B—> resolved immune OR Chronic infection–> asymptomatic OR Cirrhosis: liver cancer

Question 23

HBsAg=

Answer 23

=hepatitis B surface antigen -(anyone who has an infection will have an HBsAg) -Surface antigen(s) of HBV detectable in large quantity in serum, infectious

Question 24

Anti-HBs=

Answer 24

=antibody to HBsAg -indicates past infection w/ immunity to HBV, passive antibody from HBIG, or immune response from HB vaccine

Question 25

HBcAg=

Answer 25

Hepatitis B core antigen -No commercial test available

Question 26

Anti-HBc=

Answer 26

antibody to HBcAg -indicates prior or recent infection with HBV

Question 27

IgM anti-HBc=

Answer 27

IgM class antibody -Indicates recent infection with HBV; detectable for 4-6 months after infection

Question 28

HBeAg=

Answer 28

Hepatitis B e antigen -correlates with higher levels of HBV in serum and increased infectivity

Question 29

Anti-HBe=

Answer 29

antibody to HBeAg -presence in serum of HBsAg carrier indicates lower titer of HBV

Question 30

My notes from hepatitis table:

Answer 30

Anyone who has an infection will have HBsAg -Anti-HBs or Anti HBs AB= indicates previous infection (WILL NOT Be positive in someone with a chronic infection. This one indicates immunity (so vaccine or someone cleared the infection) -core antigen is only positive is IgG -core IgM indicates a more recent infection For Boards: need to know the first 5!!!! In this chart. -core antigen= ignore!! Core antibody= anti-HBc KNOW this !!! -anti-Hbe- don’t need to rlly know rn If Hep B e antigen is present that correlates to high levels of HBV (higher levels of virus)

Question 31

Acute Hepatitis B Virus Infection with Recovery: Review Slide 34

Answer 31

-Acute Hepatitis B Virus Infection with Recovery: Typical Serologic Course IGNORE the pink bar!!! HBsAg is the first one to become positive after initial infection (peaks around 10-12 week mark and then starts to come down. HBsAg will go back to negative if the Pt clears the infection. Anti-HBs (surface antibody)–> starts to become positive 32 weeks after being infected, and stays positive forever (for Pts that naturally clear the infection). Yellow= IgM, will turn positive around week 6 after exposure and peaks at week 16, and reverts back to negative at 32 weeks. Total anti-HBc= core antibody, positive at week 6 and peaks at week 22 and stays positive always Anti-Hbs and IGM presentat 36 weeks SO they are immune now after clearing the infection Serologic markers of HBV infection vary depending on whether the infection is acute or chronic. The first serologic marker to appear following acute infection is HBsAg, which can be detected as early as 1 or 2 weeks and as late as 11 or 12 weeks (mode, 30‑60 days) after exposure to HBV. In persons who recover, HBsAg is no longer detectable in serum after an average period of about 3 months. HBeAg is generally detectable in patients with acute infection; the presence of HBeAg in serum correlates with higher titers of HBV and greater infectivity. A diagnosis of acute HBV infection can be made on the basis of the detection of IgM class antibody to hepatitis B core antigen (IgM anti‑HBc) in serum; IgM anti‑HBc is generally detectable at the time of clinical onset and declines to subdetectable levels within 6 months. IgG anti‑HBc persists indefinitely as a marker of past infection. Anti‑HBs becomes detectable during convalescence after the disappearance of HBsAg in patients who do not progress to chronic infection. The presence of anti‑HBs following acute infection generally indicates recovery and immunity from reinfection.

Question 32

Review slide 26 and 28: -Progression to Chronic Hepatitis B Virus Infection Typical Serologic Course

Answer 32

In patients with chronic HBV infection, both HBsAg and IgG anti‑HBc remain persistently detectable, generally for life. HBeAg is variably present in these patients. The presence of HBsAg for 6 months or more is generally indicative of chronic infection. In addition, a negative test for IgM anti‑HBc together with a positive test for HBsAg in a single serum specimen usually indicates that an individual has chronic HBV infection. Chronic infection Pts: they will have HBsAg positive and a core antibody present= chronic infection

Question 33

Review Slide 29

Answer 33

slide 29

Question 34

Test: -HbsAg: negative -anti-HBc: negative -anti-HBs: negative Interpretation?

Answer 34

Interpretation: susceptible to HBV Action: vaccinate for HBV

Question 35

Test: -HbsAg: negative -anti-HBc: negative -anti-HBs: positive

Answer 35

Hepatitis B: -Immune to HBV due to vaccination Action: none required

Question 36

Test: -HbsAg: negative -anti-HBc: positive -anti-HBs: positive

Answer 36

Interpretation: -immune to HBV due to infection Action: Counsel and treat as clinically indicated

Question 37

Test: -HbsAg: positive -anti-HBc: Positive -IgM anti-HBc: positive -anti-HBs: negative

Answer 37

=Acute HBV infection -Report and counsel Pt My notes: If Pt has anti-HBs: immunity due to vaccination!!! GOOD -KNOW THESE: -HbsAG (hep B surface antigen) positive= acute or chronic infection depending on IgG or IgM -don’t need to know the bottom rows -hep B= DNA -Hep C= RNA)