L5: Viral Hepatitis Flashcards
The hepatitis D virus can only infect a person if they are co-infected with…?
Hepatitis B
The hepatitis D virus uses what to aid in its propagation?
Hepatitis B surface antigen - HBsAg
What is the main transmission method(s) of Hepatitis A?
- person to person via faecal oral route
- contaminated food and water
- MSM
- travelers to endemic countries
- household or sexual contacts of known cases
What is the incubation period for Hepatitis A?
range: 15 - 50 (30 days)
What is the period of infectiousness for hepatitis A?
2 weeks before onset of symptoms and
1 week after onset of symptoms
What is the main transmission method(s) of Hepatitis E?
- via food (UNDERCOOKED meats)
- directly through handling animals
- contaminated water (poor sanitation - e.g. faecally contaminated water)
similar to HAV - faecal oral route
What is the incubation period for Hepatitis E?
range: 15 to 60 days (40 days)
Genotypes 1 + 2 of Hepatitis E are prevalent where in the world? What are they associated with?
- developing countries
- transmitted via faecally-contaminated water
Genotypes 3 + 4 of Hepatitis E are prevalent where in the world? What are they associated with?
- genotype 3 prevalent in Europe
- genotype 3 infections food-borne
generally, 3 and 4 are a/w contact with humans, pigs and other mammals
What are the main transmission methods of Hepatitis B?
- perinatally
- sexually
- parenterally (blood-borne virus)
What is the incubation period of Hepatitis B?
1 to 6 months
In high prevalence areas of hepatitis B, what is the main mechanism of spread?
intrapartum or close household contact (vertical + horizontal transmission)
think of developing countries
In low prevalence areas of hepatitis B, what is the main mechanism of spread?
sexually/parenterally
think of Western countries
What are the main transmission methods of Hepatitis C?
- perinatally
- sexually
- parenterally (blood-borne virus)
What is the incubation period of Hepatitis C?
8 weeks (average)
If a patient is symptomatic with a viral hepatitis, how would they present?
Conjugated Hyperbilirubinaemia
- prodromal symptoms (fever, nausea, fatigue)
- dark urine
- pale stools
- jaundice
What is the clinical course for hepatitis A?
acute infection
- no chronic state
- no carrier state
- acute hepatitis failure may occur (<1%)
What is the clinical course for hepatitis E?
- acute infection
- chronic infection (very rarely - usually in immunosuppressed pts e.g. transplant pts, HIV…)
An acute infection of hepatitis E may lead to fulminant hepatitis in which population? Which genotype is life-threatening in this population?
Genotype 1 is life-threatening to mum + fetus
pregnant women at risk of fulminant hepatitis
A chronic infection of hepatitis E may lead to mortality in which population? Which genotype is life-threatening in this population?
immunosuppressed patients - liver transplant recipients
genotype 3
What are the 3 outcomes of a hepatitis B acute infection?
- resolution
- chronic infection
- fulminant hepatic failure (1% of cases)
What is the definition of a chronic hepatitis B infection?
infections persisting for more than 6 months with detection of HBsAg (surface antigen)
What are the main transmission methods for hepatitis D?
- perinatally
- sexually
- parenterally (blood-borne virus)
What is the clinical course for hepatitis C?
- acute infection (most develop into chronic)
- chronic infection
Which hepatitis is it most common to have extrahepatic features in?
Hepatitis C
What are some risk factors that may lead to an increased risk of progression of a hepatitis C infection?
- ALCOHOL*
- co-infection with HBV or HIV (a superinfection)
What are some extra-hepatic features that are common in hepatitis C?
Haemotological - mixed cryoglobulinaemia
Endocrine - diabetes, thyroiditis
Rheumatological - PAN
Dermatological
What is the significance of HbcAb (IgG) [antibody to core antigen] in regards to hepatitis B?
usually POSITIVE FOR LIFE - can check if anyone has EVER been infected with hep B
What is the last hepatitis B antibody to appear and which indicates that the infection is resolved?
Anti-HBs (antibody to s antigen)
When will the hepatitis C antibody appear on serology? What does this suggest?
positive 2-6 months after exposure - this means that it may not show up on serology if the patient has an acute infection
What is the main treatment of Hepatitis A?
supportive care
When is PEP given for hepatitis A? What populations may it be given to?
within 2 weeks of exposure to be effective
persons aged over 60
children more than 12 months and at risk of severe complications
What is the main treatment for an ACUTE hepatitis E infection?
symptomatic treatment
What is the main treatment for a CHRONIC hepatitis E infection?
chronic infections often occur in transplant patients!
- reduce immunosuppression
- antivirals
What is the main treatment for an ACUTE hepatitis B infection?
supportive therapy
What is the main treatment strategies for treating a chronic hepatitis B infection?
- Antiviral Therapy (+ Pegylated Interferon Alpha)
- Monitor for Liver Cancer
- Transplant
- Patient Education
- Vaccination
What is the main treatment for an ACUTE hepatitis C infection?
no PEP
- see if spontaneous clearance
What is the main treatment for a CHRONIC hepatitis C infection?
trying to achieve a Sustained Virological Response
depends on genotype and other co-infections but…
- Directly Acting Antivirals ± Interferon
- give Hep A and B Vaccine
Which forms of viral hepatitis are there vaccines for? Which ones are there no vaccines for?
Vaccine = A + B (D is inadvertently covered)
No Vaccine = C, E
Are the hepatitis viruses RNA or DNA viruses?
everything RNA except for hepatitis B (which is a DNA virus)
Which 2 hepatitis viruses are considered blood-borne viruses?
Hepatitis B and Hepatitis C
List some of the complications of a hepatitis B infection
- cirrhosis
- hepatocellular cancer
- reactivation of a hepatitis B infection (if immunosuppressed)
If a person is given the hepatitis B vaccine, which HBV marker would be the only one positive?
Anti-HBs
What is Alpha Fetoprotein a tumour marker for?
Hepatocellular Cancer
How many doses of the Hepatitis B vaccine are administered?
3 doses
Why should the hepatitis A and B vaccine be given when treating someone with a chronic hepatitis C infection?
to minimize the # of insults to the liver
