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High Yield Path - Micro > MI: Viral Hepatitis > Flashcards

MI: Viral Hepatitis Flashcards

1
Q

How is hepatitis A spread?

A

Faecal-oral
(food/water + MSM sex)

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2
Q

What is the incubation period for hepatitis A?

A

2-6 weeks

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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

NOTE: hepatitis A infection is often subclinical unless underlying disease: nausea, D+V, fecer, jaundice, malaise, abdo pain

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4
Q

What is the diagnostic test for hepatitis A?

A

Anti-hepatitis A IgM (shows acute infection)

presence of IgG shows infection has passed or at recovery phase

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5
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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6
Q

Treatment for Hepatitis A

A

Supportive

mortality increases with age

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7
Q

How is hepatitis B transmitted?

A
  • Sexually transmitted
  • Blood products
  • Mother-to-baby (e antigen is the biggest predictor)
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8
Q

What is the incubation period of hepatitis B?

A

2-6 months

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9
Q

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

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

Why do some antiretrovirals work on hepatitis B?

A

HBV uses reverse transcriptase to replicate

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12
Q

Where is the hepatitis e antigen found?

A

Pre-core part of the core reading frame

It’s a marker of active replication and therefore infectivity

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13
Q

What does the presence of the HBV core antigen in serum reflect

A

It reflects infection with the virus - may it be a present infection or a past infection.

Therefore only patients that have been infected with HBV will have antibodies to the core antigen.

+ve IgM HBc —-> acute infection
-ve IgM HBc and +ve IgG HBc —-> chronic infection (if HbsAg present) or past infection (HbsAg not present)

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14
Q

What does the presence of HBs Antigen in serum reflect

A

HBeAg reflects active viral infection

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15
Q

What serological feature is suggestive of recent HBV infection?

A

Anti-HBV IgM antibodies

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16
Q

What serological feature is suggestive of chronic HBV infection?

A

Prolonged presence of HBsAg (more than 6 months)
and
Anti-HBV IgG antibodies

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17
Q

FIll in the following table

A
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18
Q

What are some possible consequences of HBV infection?

A
  • Hepatic fibrosis –> Cirrhosis –> Hepatocellular carcinoma

Tumour marker: alpha fetoprotein

19
Q

List the HBV disease stages.

A
20
Q

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

A

HBV DNA level (copies/mL)

21
Q

List some treatment options for HBV.

A

Acute –> Supporitve
Chronic –> Anti-viral therapy

Complications may require liver transplantation

22
Q

Which treatment of HBV should not be used in liver transplant patients?

A

Interferon alpha

23
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)

24
Q

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

A
  • MSM
  • IVDU
25
Q

Which phylogenetic family is HCV a part of?

A

Flaviviridae

26
Q

What components constitute the viral RNA genome of hepatitis C?

A
  • Core
  • Envelope
  • Non-structural components
27
Q

What is the incubation period of HCV?

A

6-8 weeks

  • 20-40% clear infection spontaneously (90% asymptomatic)
  • 60-80% progress to chronicity (many asymptomatic - incidental finding of elevated ALT) - highest chronicity of all Hep viruses.
28
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)

29
Q

What class of drugs are most antivirals used for hepatitis C

A

Direct Acting Anti-virals:
* Protease inhibitors
* Inhibitors of non-structural components

30
Q

How is HCV treated?

A

Early treatment with Direct Acting Anti-virals (DAAs): e.g. peginterferon alfa

12 week treatment course with daily pill.

31
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

32
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
33
Q

What is a key feature about hepatitis D virus?

A

Requires the presence of hepatitis B to replicate within the host - requires HBV surface antigen to invade liver cells.

34
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 acute 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
35
Q

Which phylogenetic family is heaptitis E a part of?

A

Herpeviridae

36
Q

How is hepatitis E transmitted?

A

Faecal-oral

37
Q

Clinical Picture of HEV infection

A

Commonly asympatomatic but can cause acute hepatitis symptoms: jaundice, RUQ, fever, D+V

Commonly occuring in immunocompromised patients.

Note - HEV is one of the most common causes of acute hepatitis .

38
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

39
Q

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

A

Pregnant women (esp in 3rd trimester)

NOTE: mainly associated with genotype 1

40
Q

What is the incubation period of hepatitis E?

A

3 - 8 weeks

41
Q

List some rare complications of hepatitis E.

A
  • CNS disease (e.g. Bell’s palsy)
  • Chronic infection
42
Q

Outline the treatment of hepatitis E.

A
  • Supportive
  • Ribavirin
43
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
  • HEV RNA detectable in serum and stool during incubation period.

NOTE: it generally responds well to ribavirin

High Yield Path - Micro (6 decks)

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