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LMP301 > LMP301 Lecture 16: Viral Hepatitis > Flashcards

LMP301 Lecture 16: Viral Hepatitis Flashcards

1
Q

Causes of hepatitis

A
  1. drugs
  2. toxins
  3. bacteria
  4. viruses
  5. parasites
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2
Q

define: hepatitis

A

inflammation of the liver

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3
Q

drugs that may cause hepatitis

A
  • anticonvulsants
  • corticosteroids
  • alcohol
  • tylenol/asprin overdose
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4
Q

toxins that may cause hepatitis

A
  • DDT

- mushrooms

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5
Q

bacteria that may cause hepatitis

A
  • thyphoid fever
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6
Q

viruses that may cause hepatitis

A
  • hepatitis A, B, C, D, E, G
  • CMV
  • EBV
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7
Q

parasites that may cause hepatitis

A

tapeworm

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8
Q

clinical symptoms of viral hepatitis

A
  • enlarged liver
  • elevated liver enzymes
  • change colour of urine/feces
  • accumulation of biliburin (jaundice)
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9
Q

on a virus particle, what can be used to identify the strain?

A
  • ssDNA or RNA

- surface proteins (HBsAg)

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10
Q

define: antigen (Ag)

A

a substance (protein) that prompts the generation of antibodies -> immune response

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11
Q

define: antibody (Ab/IgG/IgM)

A

proteins produced by B-cells which play an immunological role; identify & neutralizes foreign particles through antigens

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12
Q

Which antibody is first released when there is an immune response? Which is released after?

A

IgM, then IgG

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13
Q

IgM indicates…

A

primary immune response

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14
Q

__ are produced during the primary immune response

A

memory lymphocytes

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15
Q

The virus particle is surrounded by…

A

capsule coat

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16
Q

The genetic material of virus is in the form of…

A

DNA or RNA (single or double stranded)

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17
Q

what is directly inside the capsule coat?

A

Viral nucleocapsid (HBcAg)

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18
Q

HBcAg

A

Viral nucleocapsid

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19
Q

HBeAg

A

particles associated with nucleocapsid

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20
Q

Where are HBeAg found?

A

inside the viral capsid (HBcAg)

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21
Q

When does the production change from IgM to IgG?

A

after mature B cells are formed

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22
Q

What is it called when IgG production begins and IgM production stops?

A

class-switching

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23
Q

class-switching is….

A

a stable change in the B-cell’s genome, and is transmitted to all progeny cells

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24
Q

Lifecycle of a virus

A
  1. enters hepatocyte (capsule coat removed), viral DNA moves to nucleus of host
  2. viral dsDNA -> cccDNA -> template for viral mRNA
  3. viral mRNA transcription & assembly of new viral particles
  4. viral proteins assemble around DNA core
  5. new viral particles released from outer membrane of the host
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25
Q

dsDNA -[?]-> cccDNA

A

cellular enzymes

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26
Q

___ can persist in the hepatocyte during chronic infection

A

cccDNA

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27
Q

cccDNA is genetic material of…

A

virus

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28
Q

Steps of viral reproduction

A
  1. Uncoating
  2. Repair (formation of cccDNA)
  3. Transcription
  4. Translation
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29
Q

How does release of viral particles determine host cell health?

A

If a little bit of the particle is released at a time, host lives
if all released, host dies

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30
Q

If the host cell dies, what happens to the viral production cycle?

A

it halts

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31
Q

Describe the Hep A virus

A
  • small
  • ssRNA (single protein core)
  • no surface proteins to identify
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32
Q

how is Hep A virus transmitted?

A

fecal-oral

  • person-to-person contact
  • contaminated water
  • poor hygiene & sanitation
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33
Q

Who is at high risk for Hep A?

A
  • children in daycare

- travelers to places where sanitation is bad

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34
Q

onset of symptoms for Hep A

A
  • very abrupt

- lasts 1 ~ 8 weeks

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35
Q

what is a common clinical symptom of Hep A? How many adults develop this symptom?

A

jaundice

70-80%

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36
Q

What is responsible for causing Hep A?

A

HAV

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37
Q

where does HAV replicate?

A

in liver

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38
Q

how does HAV leave the body?

A

through stool

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39
Q

when is HAV most infectious (found in stool)?

A

first 2 weeks of contracting disease, a lot of HAV will be found in the stool

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40
Q

When does [HAV] decline in the stool?

A

after jaundice appears

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41
Q

what happens to those people who have Hep A?

A

will recover, and develop immunity to HAV

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42
Q

what is a marker used for diagnosing/confirming recent/acute HAV infection?

A

anti-HAV IgM + ALT (liver enzyme)

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43
Q

what is a marker that indicates immunity to HAV?

A

anti-HAV IgG, and the absence of anti-HAV IgM in serum

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44
Q

clinical symptoms of Hep A appears about…

A

2 weeks after infection, and lasts until week 8 (duration: 6 weeks)

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45
Q

What anti-HAV IgG a marker off?

A

past or present infection; cannot make a definitive diagnosis of a recent infection

46
Q

genome of HBV

A

double stranded circular DNA

47
Q

What are the 2 antigens found on HBV?

A
  • Hep B surface antigen (HBsAg)

- Hep B core antigen (HBcAg)

48
Q

What is the structure that holds viral DNA?

A

central core nucleocapsid

49
Q

What is the main structural difference between HAV and HBV?

A

HBV has a coat over the capsid that contains surface proteins

50
Q

transmission of Hep B

A

exchange of body fluids

  • needle
  • transplant
  • sex
51
Q

individuals at risk for Hep B

A
  • injection drug users
  • unsafe sex
  • occupation working with blood
  • institutionalized populations (prisoners)
52
Q

incubation period for Hep B

A

60 - 90 days (2-3 months)

53
Q

Onset of Hep B is very…

54
Q

Less / More people develop jaundice when infected with HBV compared to HAV

A

less (only 30-50%)

55
Q

What happens to individuals infected with HBV?

A

recover within six months and develop immunity

56
Q

2-10% of infected individuals with Hep B will progress to…

A

chronic infection

57
Q

15-50% of people with chronic Hep B…

A

die prematurely as a result of chronic liver disease

58
Q

Markers of Hep B

A
  • HBsAg
  • HBeAg
  • anti-HBc (IgM)
  • anti-HBe (IgG)
  • anti-HBs (IgG)
59
Q

HBsAg

A

Hep B surface antigen

60
Q

HBeAg

A

Hep B envelope antigen

61
Q

What can be used to identify the strain of Hep B?

A

type of HBsAg and HBeAg that can be found in serum

62
Q

Anti-HBc (IgM)

A

IgM antibody to the core antigen

63
Q

Anti-Hbe (IgG)

A

antibody to HBe antigen

64
Q

Anti-Hbs (IgG)

A

antibody to HBs antigen

65
Q

What can be used to identify the stage of hepatitis infection?

A

see which antibody is secreted by the body (IgM or IgG)

66
Q

What is used to follow patient progress throughout hepatitis infection?

A

serial testing: follow patient’s progress using markers (HBsAg, HBeAg, anti-HBe, anti-HBs)

67
Q

What markers can be seen for acute hepatitis?

A
  • HBsAg = there are surface antigens
  • HBeAg = there are envelop antigens
  • anti-HBc (IgM) = there is a core

(the viral parts, mostly)

68
Q

duration of an acute Hep B infection

A

2 weeks - 3 months

69
Q

what markers appear during early recovery and recovery phase of Hep B?

A

anti-HBs & anti-HBe

the antigens

70
Q

duration of early recovery period for Hep B

A

3-6 months

71
Q

duration of recovery for Hep B

A

6-12 months / years

72
Q

what is the last marker to appear for Hep B?

73
Q

What does the presence of anti-HBs and anti-HBe indicate?

A
  • Hep B is resolving (leaves acute stage)

- establishment of immunity

74
Q

individual is considered chronically infected if…

A

HBsAg is present for more than six months

75
Q

what markers can be seen for chronic hep B infection?

A
  • HBsAg and HBeAg are elevated even at later stage

- antibodies to those viral particles are also constantly present

76
Q

Hep B: indicator of disease resolution

77
Q

Hep B: indicator of recovery & immunity

78
Q

Hep B: indicator of acute infection (unique to this category)

A

Anti-HBc (IgM)

79
Q

genomic material of HCV

A

ssRNA encased by nucleocapsid (core)

80
Q

difference between envelope of HBV and HCV

A

HCV has an envelope proteins, but they can’t be used to identify the strain

81
Q

HCV is encased by…

A

lipid envelope

82
Q

size of HCV

A

< 50 nm

very small

83
Q

transmission of HCV

A

blood

  • needle
  • transfusion
  • perinatal
84
Q

individuals at risk for Hep C

A
  • injection drug users
  • occupational hazard
  • transfusions before 1992
  • institutionalized populations (prisoners)
85
Q

60-70% of people with Hep C have what symptom?

A

asymptomatic!

86
Q

20-30% of people with acute Hep C have what symptom?

87
Q

___% of Hep C patients become chronically infected

88
Q

10-20% of people with chronic Hep C develop _____

89
Q

1-5% of people with chronic Hep C develop _____

A

hepatocellular carcinoma

90
Q

hepatocellular carcinoma occurs over…

A

20-30 years (latent infection)

91
Q

HCV is a leading cause of….

A

liver transplants

92
Q

HCV reacts differently depending on…

A 
what other "factors" you have
- alcohol use
- HIV
- drugs
...
93
Q

duration of incubation for HCV

A

2-26 weeks

avg: 6-7 weeks

94
Q

when do people infected with HCV develop symptoms?

95
Q

define: seroconversion

A

development of antibodies in response to disease states

96
Q

how long does it take before seroconversion occurs for Hep C?

97
Q

What individuals are considered infectious for Hep C?

A
  • positive for HCV antibody

liver enzymes could still be normal

98
Q

why might there not be an elevation in liver enzymes for those with Hep C?

A

slow infection cycle allows liver to slowly adjust to the increasing strain

99
Q

how is HCV diagnosed?

A
  1. detecting antibodies specific to HCV (anti-HCV)

2. ruling out HAV or HBV

100
Q

symptoms of Hep C appears during…

A

week 1 - week 5 of infection period

101
Q

downside of using anti-HCV as marker for diagnosis

A
  • may not appear if tested early
  • can take >2 months to become positive
  • does not distinguish between acute & chronic
  • can’t tell when they got the disease
102
Q

what can be found at a constant level for those infected with HCV?

103
Q

what liver enzyme is abnormal in Hep C individuals, and what is the serologic pattern like?

A
  • ALT
  • more abundant than normal (peak about week 2-3)
  • decreases and goes fluctuates, slightly above normal range later on
104
Q

serologic pattern for anti-HCV

A

increase as duration of Hep C increases (exponential)

105
Q

HCV RNA measure…

A

level of circulating virus = “viral load”

106
Q

high viral load means that…

A

the virus is replicating a lot

107
Q

Why is HCV RNA testing used?

A
  • detect HCV before anti-HCV may be formed
  • access viral load before and after treatment
  • detect HCV infection in cases with ambiguous serology (blood test)
108
Q

which viral hepatitis has abrupt onset

109
Q

which hep virus has the shortest incubation time?

110
Q

which hep virus will most likely cause a chronic infection?

111
Q

which hep virus has the highest mortality rate?

LMP301 (18 decks)

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