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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

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

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4
Q

What is the diagnostic test for hepatitis A?

A

Anti-hepatitis A IgM

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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

How is hepatitis B transmitted?

A
  • Sexually transmitted
  • Blood products
  • Mother-to-baby (e antigen is the biggest predictor)
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7
Q

What is the incubation period of hepatitis B?

A

2-6 months

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8
Q

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

A
  • 5-10% in adults
  • 95% in babies
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9
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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10
Q

Why do some antiretrovirals work on hepatitis B?

A

HBV uses reverse transcriptase to replicate

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11
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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12
Q

What serological feature is suggestive of recent HBV infection?

A

Anti-HBV IgM antibodies

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13
Q

What serological feature is suggestive of chronic HBV infection?

A

Prolonged presence of HBsAg (more than 6 months)

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14
Q

What are some possible consequences of HBV infection?

A
  • Hepatocellular carcinoma
  • Cirrhosis
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15
Q

List the HBV disease stages.

A
  • Immune tolerant
  • Immune reactive
  • Inactive HBV carrier state
  • HBeAg negative chronic HBV
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16
Q

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

A

HBV DNA level (copies/mL)

17
Q

List some treatment options for chronic HBV.

A
  • Interferon alpha
  • Lamivudine
  • Tenofovir
  • Entecavir
  • Emtricitabine
18
Q

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

A

Interferon alpha

19
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)

20
Q

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

A
  • MSM
  • IVDU
21
Q

Which phylogenetic family is HCV a part of?

A

Flaviviridae

22
Q

What components constitute the viral RNA genome of hepatitis C?

A
  • Core
  • Envelope
  • Non-structural components
23
Q

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

A
  • Protease inhibitors
  • Inhibitors of non-structural components
24
Q

What is the incubation period of HCV?

A

6-8 weeks

25
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)

26
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

27
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

28
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
29
Q

What is a key feature about hepatitis D virus?

A

Requires the presence of hepatitis B to replicate within the host

30
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
31
Q

Which phylogenetic family is heaptitis E a part of?

A

Herpeviridae

32
Q

How is hepatitis E transmitted?

A

Faecal-oral

33
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

34
Q

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

A

Pregnant women

NOTE: mainly associated with genotype 1

35
Q

What is the incubation period of hepatitis E?

A

3 - 8 weeks

36
Q

List some rare complications of hepatitis E.

A
  • CNS disease (e.g. Bell’s palsy)
  • Chronic infection
37
Q

Outline the treatment of hepatitis E.

A
  • Supportive
  • Ribavirin
38
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

39
Q

What is hepatitis G?

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

YEAR 5: MICRO (24 decks)

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