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YEAR 5: Microbiology and Infection AS > MI: Viral Hepatitis > Flashcards

MI: Viral Hepatitis Flashcards

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Biology 101 flashcards
1
Q

How is hepatitis A spread?

A

Faecal-oral

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2
Q

What is the incubation period for hepatitis A?

A

2-6 weeks

usually 4w

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3
Q

Describe the natural history of hepatitis A infection.

A
  • 2-6 weeks after the infection you will develop hepatitis (transaminitis)
  • This will be accompanied by a rise in IgM
  • A more gradual rise in IgG will follow
  • isolate for 7 days after onset

NOTE: hepatitis A infection is often subclinical

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4
Q

How long are you infectious with HAV

A

2w pre symptom onset to 1w after jaundice

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5
Q

What is the diagnostic test for hepatitis A?

A

Anti-hepatitis A IgM
HAV RNA PCR (lab)

if ALT>500u/L, may be negative in first few weeks

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6
Q

Which antibodies will be present if someone has received a hepatitis A vaccine?

A

High IgM and high IgG but NO transaminitis

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7
Q

Vaccine for Hep A?

A

yes 2 doses

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8
Q

How is hepatitis B transmitted?

A
  • Sexually transmitted
  • Blood products (parenteral)
  • Mother-to-baby (e antigen is the biggest predictor)

the only DNA virus of the hepatitides

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9
Q

What is the incubation period of hepatitis B?

A

2-6 months

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10
Q

What is the risk of chronic infection in adults and babies?

A
  • 5-10% in adults
  • 95% in babies
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11
Q

risk of chronic HBV in <5

A

90% progress to chronic HBV, only 10% progress to this in adults

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12
Q

how to define chronic HBV

A

HBsAg reactivity >6 months

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13
Q

complications of chronic HBV

A

cirrhosis
hepatocellular carcinomas
extra-hepatic complications

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14
Q

Describe the molecular organisation of hepatitis B virus.

A

DNA virus with four overlapping reading frames (core, X, polymerase and surface antigen)

NOTE: as they overlap, a mutation in one reading frame could affect others

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15
Q

Why do some antiretrovirals work on hepatitis B?

A

HBV uses reverse transcriptase to replicate

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16
Q

Where is the hepatitis e antigen found?

A

Pre-core part of the core reading frame

It’s a marker of active replication

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17
Q

What serological feature is suggestive of recent HBV infection?

A

Anti-HBV IgM antibodies

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18
Q

What serological feature is suggestive of chronic HBV infection?

A

Prolonged presence of HBsAg (more than 6 months)

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19
Q

What are some possible consequences of HBV infection?

A
  • Hepatocellular carcinoma
  • Cirrhosis
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20
Q

List the HBV disease stages.

A
  • Immune tolerant
  • Immune reactive
  • Inactive HBV carrier state
  • HBeAg negative chronic HBV
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21
Q

Symptoms of hepatitis

A

non specific
- fever
- malaise
- fatigue
- loss of appetite
- abdominal pain

high bili
- jaundice
- dark urine
- pale, gray, white stool
- pruritis

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22
Q

how is cirrhosis staged

A

child-pugh score

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23
Q

radiological findings of cirrhosis

A

coarse echotexture, nodularity, portal HTN- splenomegaly

24
Q

what imaging can be used for cirrhosis

A

transient elastography >12.5kPa
histopath GOLD standard

25
Q

how to check for hepatocellular carcinoma

A

alpha-fetoprotein
imaging

26
Q

What is a strong indicator of risk of cirrhosis in people with hepatitis B infection?

A

HBV DNA level (copies/mL)

27
Q

List some treatment options for chronic HBV.

A
  • Interferon alpha

nucleos/tide analogues
* Tenofovir
* Entecavir
* Adefovir
* Lamivudine

28
Q

how does IFN-a work in hbv

A

induces long term immune control: eAg, sAg loss

SC injection 48 weeks

29
Q

Which of these treatments should not be used in liver transplant patients?

A

Interferon alpha

30
Q

When do you NOT give Hep B immunoglobulin to babies born to mothers with Hep B

A

If the mother has anti-HBe (this confers protection to the baby, but you still give the accelerated vaccine)

31
Q

Which patient populations are particularly at risk of hepatitis C virus infection?

A
  • MSM
  • IVDU
32
Q

Which phylogenetic family is HCV a part of?

A

Flaviviridae

33
Q

What components constitute the viral RNA genome of hepatitis C?

A
  • Core
  • Envelope
  • Non-structural components
34
Q

What class of drugs are most antivirals used for hepatitis C?

A
  • Protease inhibitors
  • Inhibitors of non-structural components
35
Q

What is the incubation period of HCV?

A

6-8 weeks

36
Q

Outline the serological changes that take place following HCV infection.

A

Anti-HCV antibodies develop after the acute infection has resolved (i.e. ALT has returned to normal)

37
Q

How is HCV treated?

A

Early treatment with peginterferon alfa

NOTE: peginterferon alfa 2b is interferon alpha with polyethelene glycol attached which improved its pharmacokinetics and turns it into a depot preparation

38
Q

How is the response to treatment with peginterferon-alfa assessed in HCV infection?

A

Sustained viral response (SVR12) - no HCV RNA 12 weeks after stopping treatment

39
Q

What is the main difference in the treatment of genotype 1 and non-genotype 1 HCV?

A
  • Genotype 1 - high-dose long-lasting ribavirin is required for high cure rates
  • Non-genotype 1 - ribavirin does NOT increase cure rates
40
Q

What is a key feature about hepatitis D virus?

A

Requires the presence of hepatitis B to replicate within the host

41
Q

What is the difference between hepatitis D co-infection and superinfection?

A

Co-infection:

  • This happens when you are inoculated with HBV and HDV at the same time (e.g. sharing a needle with someone infected by both viruses)
  • Anti-HDV IgM will rise after inoculation causing hepatitis

Superinfection:

  • This happens when someone with chronic hepatitis B infection is inoculated by HDV
  • This is more severe than coinfection
  • Patients can develop cirrhosis within 2-3 years
42
Q

Which phylogenetic family is heaptitis E a part of?

A

Herpeviridae

43
Q

How is hepatitis E transmitted?

A

Faecal-oral

44
Q

What are the genotypes of hepatitis E?

A
  • 1 + 2 = human
  • 3 + 4 = animals (mainly pigs)

NOTE: there is very little person-to-person transmission

45
Q

Which patient group has a high mortality if infected by hepatitis E?

A

Pregnant women

NOTE: mainly associated with genotype 1

46
Q

What is the incubation period of hepatitis E?

A

3 - 8 weeks

47
Q

List some rare complications of hepatitis E.

A
  • CNS disease (e.g. Bell’s palsy)
  • Chronic infection
48
Q

Outline the treatment of hepatitis E.

A
  • Supportive
  • Ribavirin
49
Q

Outline the serological changes that take place in hepatitis E infection.

A
  • Acute infection is accompanied by a rise in IgM anti-HEV antibody
  • Rarely you can get persistently high levels of HEV RNA

NOTE: it generally responds well to ribavirin

50
Q

What is hepatitis G?

A
  • Pegivirus
  • Simian virus
  • May cause higher CD4 counts in HIV-positive patients
51
Q

incubation period of hepatitis C

A

2-6weeks

52
Q

acute vs chronic infection HCV- % which progress

A

20-40% spontaneously clear
40-60% progress to chronicity

53
Q

chronic infection risks of HCV

A

incidental finding
CLD/ cirrhosis
hepatocellular carcinoma

54
Q

how long does it take for anti-HCV Ab to become reactive

A

4 weeks after infection so request HCV RNA

55
Q

treatment of HCV

A

direct acting antivirals: 12w treatment with daily pill
-previr (boceprevir)
-asvir (velpasvir)
- buvir (sofosbuvir)

56
Q

HBV screening in pregnancy

A

HBsAg positive, eAg negative: vaccine at birth + routine schedule

HBsAg positive, eAg positive: vaccine at birth, PLUS HBIg within 48 hours

YEAR 5: Microbiology and Infection AS (25 decks)

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