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YEAR 5: MICRO > MI: Viral Hepatitis > Flashcards

MI: Viral Hepatitis Flashcards

1
Q

How is hepatitis A spread?

A

Faecal-oral

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2
Q

general blood tests results of viral hepatitis

A

transaminitis - raised AST/ALT

high bilrubin

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3
Q

viruses which can cause hepaitits

A

Hepatotrophic - specifically affect liver
* Hep A,B (D+),C, E

Non-heptatotrophic - causes hepatitis as part of wider disease syndrome
* Most common - CMV, EBV
* Adenovirus
* HSV

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4
Q

what virus specifcally affects paediatric liver transplant patients

A

adenovirus

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5
Q

how lonf after infection are IgM and IgG detectable

A

IgM - 3 months
IgG - years/life

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6
Q

What is the incubation period for hepatitis A?

A

2-6 weeks

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7
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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8
Q

Hep A presentation

A

fever
Jaundice - 80% of adults, 10% of children
dark urine
pale stool

infection more severe with age, in children can be sub-clinical

acute liver failure (fulminant hepatitis) <1%

self-limiting, low mortality

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9
Q

Hep E presentaiton

A

majority subclinical

fever
jaundice
pale stool
dark urine

More severe in 3rd trimester women and immunocompromised

self-limiting, low mortality

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10
Q

What are diagnostic tests for hepatitis A?
current, recent, past infection, immunisation

A

Anti-hepatitis A IgM and IgG antibodies

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11
Q

What are diagnostic tests for hepatitis E?
current, recent, past infection

A

Anti-hepatitis E IgM and IgG

Hepatitis E RNA detection PCR - blood, stool

PCR tells you active infection or not

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12
Q

define diagnostic window period

A

time between infection and +ve test result

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13
Q

relevance of diagnostic window in viral hepatitis

A

mainly important for Hep A and Hep C

Longer diagnostic window than incubation period –> patient presents symptomatically but tests -ve

Hep A –> repeat serology tests at least 10 days after symptom onset

Hep C –> PCR can be +ve first but antibodies -ve in acute infection as they can take up to 9 months to develop

Hep B and E can be detected before patient presents clincally

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14
Q

in what patients with acute Hep B infection can antibody test be negative?

A

HIV+Ve or immunocompromised

check PCR screen - this will become +ve earlier that antibodies, confirm acute infection

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15
Q

How is hepatitis B transmitted?

A
  • Sexually transmitted
  • Blood products
  • Mother-to-baby (e antigen is the biggest predictor)
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16
Q

Chronic Hepatitis complications

A

Cirrhosis
Liver failure
HCC

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17
Q

Hep C diagnostic tests
acute, chronic, past

A

1st. Anti-Hep C antibodies
if Ab+ve –> Plasma Hep C RNA PCR

Acute/chronic infection = Ab and PCR +ve
Past resolved infection = Ab+ve and PCR-ve

If early on in infection or immunocomprised –> may be Ab-ve despite currrently infected

PCR tells you active infection

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18
Q

in what % of infected people is Hep B vs Hep C symptomatic

A

Hep B - 50%
Hep C - 20% (majority are subclinical, will only know they have had once get chronic disease)

acute symptoms - fever, jaundice, dark stool, pale urine

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19
Q

What is the incubation period of hepatitis B?

A

2-6 months

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20
Q

What is the risk of chronic infection for Hep B vs Hep C

A

Hep B:
* 5-10% in adults
* 95% in babies

Hep C:
* 70% in adults

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21
Q

definition of hepatitis carrier/chronic infection

A

persistence of infection for >6 months

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22
Q

Hep B and C extra hepatic manifestations

A

arthropathy, vasculitis

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23
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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24
Q

Why do some antiretrovirals work on hepatitis B?

A

HBV uses reverse transcriptase to replicate

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25
Where is the hepatitis e antigen found?
Pre-core part of the core reading frame *It's a marker of active replication*
26
Hep B diagnostic tests
Hep b surface antigen (HBsAg) - acute or chronic infeciton Hep b surface antibody (HBsAb) - immunisation or past resolved infection Hep b core antibody (HBcAg) - current or past infection * Hep b core IgM antibody (HBcIgM) - acute infection or reactivation HbV DNA via PCR
27
Acute vs chronic vs resolved infection vs immunised Hep B serology What is the test you would do first when susecting Hep B infection
Hep B surface antigen - you know if its -ve there is no acute or chronic Hep infection
28
Relevance of e markers in Hep B serology
determine how infective patient is Hep B “e” antigen (HBeAg): Acute or chronic infection of “high infectivity” Hep B “e” antibody (HBeAb): Current or past infection | don't focus on
29
What serological feature is suggestive of recent HBV infection?
Anti-Hep B IgM antibodies
30
What serological feature is suggestive of chronic HBV infection?
Prolonged presence of HBsAg (more than 6 months)
31
What is a strong indicator of risk of cirrhosis in people with hepatitis B infection?
HBV DNA level (copies/mL)
32
List some treatment options for chronic HBV.
* Interferon alpha - 48 weeks Nucleoside/nucleotide analogues - likely lifelong * Lamivudine * Tenofovir * Entecavir * Emtricitabine
33
what is goal of chronic Hep B treatment
reduce viral replication --> to reduce risk of complications e.g. cirrhosis, HCC alpha interferon - boots host immune response to virus nucleoside/nucleotide analogues - inhibt viral replication very unlikely to clear infection and become Hb surface antigen -ve (only in about 5%)
34
Which chronic hep B treatment should not be used in liver transplant patients?
Interferon alpha
35
When do you NOT give Hep B immunoglobulin to babies born to mothers with Hep B
If the mother has anti-HBe (this confers protection to the baby, but you still give the accelerated vaccine)
36
Which patient populations are particularly at risk of hepatitis C virus infection?
* MSM * IVDU
37
Which phylogenetic family is HCV a part of?
Flaviviridae
38
What components constitute the viral RNA genome of hepatitis C?
* Core * Envelope * Non-structural components
39
What class of drugs are most antivirals used for hepatitis C?
* Protease inhibitors * Inhibitors of non-structural components
40
What is the incubation period of HCV?
6-8 weeks
41
extra hepatic complications of hep A
Rare: rash transient arthropthay vasculitis glomerulonephritis
42
extra hepatic complications of hep E
neurological in 5%: GBS Brachcal neuritis Meningoencephalitis melitis Glomerulonephritis Cryoglobulinaemia
43
hepatitis D diagnostic tests
screen all newly diagnosed Hep B for Hep D antibodies If +Ve --> PCR for Hep D DNA
44
Outline the serological changes that take place following HCV infection.
Anti-HCV antibodies develop after the acute infection has resolved (i.e. ALT has returned to normal)
45
transmission of viral hepatitis
Primary: hep A and E - faecal oral Hep B, C, D - blood borne, bodily fluids - IVDU, sexual Hep B very infectious - much more likley for bodily fluid transmission (sex) whereas Hep C would need to be direct contact with blood (IVDU) Hep E - contaminated blood products + transfusion + transplant ## Footnote Hep C and Hep E are RNA
46
acute or chronic viral hepatitis infection
A + E - acute B, C, D - acute + chronic E can cause chronic infection in immunocompromised (transplant patients) | chronic infection - carrier
47
How is HCV treated?
direct acting antivirals 95% are cured of infection select regime according to genotype (pan-genotypic regimens are available but are more expensive)
48
How is the response to treatment with peginterferon-alfa assessed in HCV infection?
Sustained viral response (SVR12) - no HCV RNA 12 weeks after stopping treatment
49
What is the main difference in the treatment of genotype 1 and non-genotype 1 HCV?
* **Genotype 1** - high-dose long-lasting ribavirin is required for high cure rates * **Non-genotype 1** - ribavirin does NOT increase cure rates
50
What is a key feature about hepatitis D virus?
Requires the presence of hepatitis B to replicate within the host
51
what is effect of Hep D infection
worsens Hep B infection, accelerates complications
52
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 **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
53
How is hepatitis D treated?
interferon alpha - at least 48 weeks Bulevertide - subcut injection
54
Which phylogenetic family is heaptitis E a part of?
Herpeviridae
55
How is hepatitis E transmitted?
Faecal-oral
56
What are the genotypes of hepatitis E?
* 1 + 2 = human * 3 + 4 = animals (mainly pigs) NOTE: there is very little person-to-person transmission
57
Which patient group has a high mortality if infected by hepatitis E?
Pregnant women NOTE: mainly associated with genotype 1
58
What is the incubation period of hepatitis E?
3 - 8 weeks
59
Outline the treatment of hepatitis E.
* Supportive - acute infection self-resolves (like Hepatitis A) Chronic infection in immunocompromised: * Ribavirin + reduce immunosuppression * Monitor treatment response with RNA PCR in blood and stool
60
Outline the serological changes that take place in hepatitis E infection.
* 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
61
what viral hepatitides have vaccines how do you assess response to these
Hep A - anti-hep A IgG antibody Hep B - anti-hep B surface antigen antibody | also post-exposure prophylaxis for these
62
investigations for CMV what patients are most at risk
serology - IgM and IgG PCR - blood, stool, CSF - in immunocompromised and neonates transplant
63
investigations for EBV
EBV VCA IgM and IgG EBNA antibody - not +ve until at least 2 months after infection, used as indicator of non-recent infection
64
CMV prevention methods
Regular screening post-transplant Antiviral prophylaxis post-transplant Leucodepleted blood products CMV seronegative blood products (Seronegative donor) Neonatal screen
65
general rule of testing for testing for viral hepatides in immunocompromised
rely more on PCR tests as they may not produce enough antibody to test +ve
66
which is DNA hepatitis virus
Hep B A,C,D,E = RNA Adenovirus, EBV, CMV = DNA

YEAR 5: MICRO (24 decks)

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