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MI: Viral Hepatitis Flashcards

1
Q

Name some primary and secondary hepatotropic viruses?

A

Primary - hepatitis A, B, C, D, E
Secondary - EBV, CMV, HIV, parovirus B19

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2
Q

What type of virus is hepatitis A?How is hepatitis A spread?

A

Single-stranded RNA virus

Faecal-oral
- Person-to-person (sex)
- Contaminated food/drink

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3
Q

What is the incubation period for hepatitis A?

A

2-6 weeks (usually 4 weeks)

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4
Q

What are symptoms of hepatitis A infection?

A

Symptoms of acute hepatitis
- Non-specific - fever, fatigue, abdominal pain, malaise, loss of appetite
- Elevated bilirubin - jaundice, pale stools + dark urine, pruritius

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5
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

NOTE: hepatitis A infection is often subclinical

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6
Q

What is the diagnostic test for acute hepatitis A?

A

Anti-hepatitis A IgM
- Only request if symptomatic patient has if ALT >500u/L)
- If <500 may get false negative because antibody titres have not risen enough

may be negative in 1st week

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7
Q

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

A

Anti-HAV IgG
(if infected, they will have high IgM and IgM, but no transaminitis)

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8
Q

When are those with hepatitis A infectious?

A

2 weeks before until 1 week after onset of jaundice

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9
Q

How is HAV treated?

A

Supportive, no chronicity

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10
Q

What type of virus is hepatitis B?How is hepatitis B transmitted?

A

DNA virus
* Sexually transmitted
* Blood products
* Mother-to-baby (eAg is the biggest predictor)

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11
Q

What is the incubation period of hepatitis B?

A

2-6 months

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12
Q

What are 3 possible courses of hepatitis B infection in adults?

A
  • Clearance (90%)
  • Chronic infection (10%)
  • Fulminant liver failure (0.5-1%)

40% are symptomatic

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13
Q

What is the course of HBV infection in children under 5 ?

A

Asymptomatic, 90% develop chronic infection

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14
Q

What the biochemical definition of chronic HBV infection?

A

HBsAg positive > 6 months

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15
Q

What do the presence of the following antigen/antibodies indicate:
- HBsAg
- HBeAg
- Anti-HBc IgM
- Anti-HBc IgG
- Anti-HBe IgG
- Anti-HBs IgG

A
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16
Q

What are some possible consequences of chronic HBV infection?

A
  • Hepatocellular carcinoma
  • Cirrhosis
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17
Q

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

A

HBV DNA level (copies/mL)

Scored with Child-Pugh score, diagnosed fibroscan

18
Q

List some treatment options for chronic HBV.

A

Pegylated IFN-a - aim is to induce long term immune control
* 48 weeks
* Low tolerability, lots of contraindications

Nucleoside analogues - aim is to inhibit viral replication
* Tenofovir
* Entecavir
* Lamivudine
* Adefovir

19
Q

What is the mechanism of action of nucleoside analogues?

A

Inhibit viral reverse transcriptase

20
Q

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

A

Interferon alpha

21
Q

What is the management of babies born to mothers with chronic HBV?

A

Depends on HBeAg status
- HBsAg positive, HBeAg negative - give vaccine at birth
- HBsAg positive, HBeAg positive - give vaccine at birth PLUS HBIG

Give HBIG also if HBV DNA >1 x 10^6 IU/ml

22
Q

What type of virus is HCV and how many genotypes are there? How is it transmitted?

A

Single-stranded RNA virus (6 genotypes)
- Sexually transmitted (MSM)
- Blood products (IVDU)

23
Q

What is the incubation period of HCV?

A

2 weeks - 6 months

24
Q

Describe the course of acute HCV infection

A

Most asymptomatic
- 30% will clear vrius
- 70% progress to chronic infection

25
What is the presentation of chronic HCV?
- Incidental finding - CLD/cirrhosis - Hepatocellular carcinoma
26
Diagnosis of HCV infection?
**HCV RNA** should be requested if acute infection is suspected Anti-HCV antibodies - develop 4 weeks post infection
27
How is HCV treated?
**Direct acting antivirals** for 12 weeks - 12 week treatment course with daily pill - Very effective against all genotypes - Development of DAA means that HCV is now curable
28
What do HCV DAAs target and give an example of a drug regimen
DAAs target HCV-encoded proteins responsible for viral replication Ledipasvir PLUS sofosbuvir
29
How can HCV infection be prevented?
No vaccine - Screen blood, organ, and tissue products - Needle exchange programs
30
What type of virus is hepatitis D? What is a key feature about HDV?
Incomplete RNA virus Requires the presence of **HBV** to replicate within the host
31
How is HDV transmitted?
Same way as hepatitis B (sexual, parenteral, vertical)
32
What is the difference between hepatitis D co-infection and superinfection?
**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 * Causes more severe acute disease, but low-risk chronic infection **Superinfection:** * This happens when someone with chronic HBV is inoculated by HDV * Leads to accelarated chronic infection and patients can develop cirrhosis within 2-3 years * **This is more serious than co-infection**
33
How can HDV be prevented?
- Prevent HBV infection - vaccination, post-exposure prophylaxis - Educate HBV patients about risky behaviours (sexual, parenteral)
34
What type of virus is hepatitis E and how many genotypes? How is it transmitted?
- Single-stranded RNA virus (4 genotypes) - Fa**e**cal-oral and eating undercooked pig/boar
35
In which group of people is HEV infection very dangerous and which genotype is responsible?
HEV genotype 1 infection in **pregnant women** can have a mortality of 30%
36
What are the natural courses of HEV infection?
Most asymptomatic - Acute infection - brief and self-limiting - Chronic infection (ONLY IN IMMUNOCOMPROMISED) - also mild disease and can be cleared by reducing immunosuppression
37
What is the incubation period of hepatitis E?
2 - 8 weeks
38
How is HEV diagnosed? How is chronic infection classified?
- Immunocompetent - HEV IgM and IgG - Immunocompromised - HEV RNA (Ab often undetectable) Chronic infection classified as HEV RNA positive >3 months
39
Outline the treatment of hepatitis E.
**Supportive** * Severe acute hepatitis - consdier ribavirin * Chronic hepatitis - reduce immunosuppression
40
What are some extrahepatic manifestations of HEV infection?
41
What viruses can cause chronic hepatitis?
B, C, D, E (only in IMMUNOCOMPROMISED)

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