Limjoco - Hepatitis Flashcards
Hepatotropic viruses (A, B, C, D, E, G) have an affinity for the liver.
Name 5 other viruses (systemic) that can cause Viral Hepatitis?
- EBV (infectious mononucleosis)
- CMV
- HSV
- Adenovirus (neonates, immunosuppressed)
- Yellow Fever
Mnemonics for Viral Hepatitis
AcutE Hepatitis: A and E (never chronic)
*Note: HEV is bad in immunocompromised hosts, pregnant women
Consonants B, C, D: can cause Chronic Disease
Hepatitis B can be transmitted by Blood, Birthing and Bonking.
Which Hepatitis?
80% or more develop chronic hepatitis and 20% of these people develop cirrhosis
Hep C (Chronic and Cirrhosis)
Typical Course for What Condition?
Incubation period: asymptomatic
Symptomatic Pre-icteric period: malaise, fatigue, anorexia, nausea, fever
*2 weeks post-exposure
Acute Viral Hepatitis
Typical Course for What Condition?
Icteric Phase (1-2 weeks after prodrome, last up to 6 weeks)
jaundice, dark urine, clay-colored stools, hepatomegaly
Convalescence (6-8 weeks post-exposure): dinminishing jaundice
Acute Hepatitis
When is an individual with Viral Hepatitis most infectious?
Last asymptomatic days of Incubation Period
What do lab results look like for Viral Hepatitis?
- Liver Enzymes?
- ________bilirubinemia (hyper/hypo)
- Viral Serology; also RNA or DNA detection by PCR
High Levels of ALT, AST (>1000 U/L)
Hyperbilirubinemia
After how many months of infection, do you have chronic hepatitis?
6 months
Definition (Viral Hepatitis).
- harbors orgs without signs & symptoms
- either no liver damage or with liver damage –> reservoirs for future infection
Carrier State
During a Viral Hepatitis Infection, hepatocellular damage is due to the host’s ________ immune response to viral protein expressed by infected cells.
It is not due to direct viral cytopathic effect.
What immune cells are activated and what damage ensues?
adaptive
T Cells
- ->Necroinflammatory activity
- ->Apoptosis (“cell suicide” - elimination of infected/damaged cell)
Which Hepatitis?
- Family: Picornavirus
- Genus: Hepatovirus
- Small, naked +SS RNA
- Benign, self-limited course, rare relapse
- NO chronic or carrier state
- history of travel to endemic areas*
Hep A
Which Hepatitis?
- fecal-oral route
- ingested through contaminated water and food
- contaminated undercooked shellfish concentrates virus
- endemic in countries with poor sanitation
- in developed countries, better hygience but NO herd immunity
- older age group will be more symptomatic an severe
Hepatitis A
Serology for Hepatitis A.
_____ (what Ab): rises with onset of symptoms; marker of ACUTE infection
_____ (what Ab): rises on decline of IgM after months, persists
confers LIFELONG IMMUNITY AGAINST REINFECTIONS WITH
ALL STRAINS
NOTE: there is no direct detection for IgG. It is derived from [Total Ig - IgM]
IgM
IgG
Total Anti-HAV Antibody = Ig____ + Ig_____
IgM + IgG
How is HAV spread rapidly?
Fecal shedding of HAV Virus occurs _____ weeks before and ____ week after the start of jaundice.
2-3 weeks before
1 week after
Which Hepatitis?
- more sporadic than HAV
- **India, Asia, Africa, ME, China, mexico
- Developed world: pig farms
- High mortality rate in Pregnant Women
Hep E
Which Hepatitis?
Genus: Hepevirus
- naked +SS RNA
- virions shed during acute illness
- RNA and Virions detectable in stool/serum prior to symptoms appearing
CLINICAL: Inc. AST/ALT
Inc. IgM
-self-limited, resolves in 4-6 weeks
Hep E
Which Hepatitis?
Family: Flavivirus
- small +SS RNA virus
- RNA codes only for 1 polyprotein, processed into functional proteins
- RNA polymerase, poor fidelity in copying (Antigenic variation)
Hep C
Hepatitis C
_____ envelope glycoprotein (target of anti-HCV antibodies) is the MOST VARIABLE region of the genome.
New virus strains can escape neutralizing antibodies.
E2
Why no vaccine for Hep C?
Anti-HCV Ig____ produced after infection does NOT confer immunity –> HIGH RATE OF CHRONICITY
genomic instability, antigenic variation (Exonuclease lacks proofreading capacity in the 3’-5’ so the RNA is prone to frequent mutations)
IgG
What are the top 3 Risk factors for contracting Hep C?
- IV Drug use
- Multiple sex partners
- Undergoing surgery in the last 6 months
Others: Needle Sticks, Multiple contacts w/HCV-infected person, Work in medical/dental field, perinatal infections
True or False.
There is a higher risk for HCV than HIV by needle stick.
True!
Which Hepatitis?
Incubation period: 4-26 weeks (1-6 months)
Majority Asymptomatic
Best Diagnostic method: PCR to detect RNA in blood together with elevated AST, ALT levels
-milder clinical course than HBV
Hep C
Fact. Hepatitis C - Acute and Chronic Infection Serum HCV RNA Levels
