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MICRO ADYA > Microbiology 11 - Viral Hepatitis > Flashcards

Microbiology 11 - Viral Hepatitis Flashcards

1
Q

What type of virus is HepA?

A

Unenveloped
picornavirus, positive sense ssRNA genome

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2
Q

Recall 2 RFs for Hep A transmission

A
  1. Drinking from dodgy water supply
  2. MSM
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3
Q

HepA clinical course:

a) Incubation period
b) How long are you symptomatic for?
c) How long are you infectious for?
d) Is it acute or chronic?

A

Incubation period: 2-6 weeks

Symptomatic: 3-10 days prodrome of flu like illness –> 1-3 weeks of icteric state (jaundice, hepatomegaly, dark urine and pale stools)

Infectious: 2 weeks before symptom onset to 1 week after resolution of symptoms

–> advise to stay off work for a week after starting showing symptoms

ONLY ACUTE- can’t become chronic. Self-limiting.

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4
Q

Hep A vaccine

A

HAV- Havrix. Need 2 doses of vaccine for full protection.

Type of vaccine: live attenuated and inactivated vaccines are available

Only available for certain at risk groups:

  • GUM clinics- MSM are currently offered vaccinations
  • Travel to high risk country
  • Chronic liver disease - higher chance of severe disease
  • Haemophilia
  • People who inject drugs ‘PWID’
  • Occupational risk:
    • lab
    • residential facilities
    • sewage work
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5
Q

What is IgM positivity in HepA indicative of?

A

Current infection (or recent vaccination- but in thsi case ALT would not be raised)

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6
Q

What is IgG positivity in HepA infection indicative of?

A

Past infection or vaccination

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7
Q

What test is used to identify acute hepatitis A?

A

Anti-hepatitis A virus IgM

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8
Q

What type of virus is HepB?

What is HBeAg?

A

DNA virus

Marker of infectivity

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9
Q

How is HBV transmitted?

Is it more or less transmissible than HCV?

A
  1. Sexual transmission
  2. Parenteral:
  • Blood products
  • Blood transfusions
  • IVDU
  • tattoos
  • needle stick
  1. Vertical- Mother to baby

*MORE TRANSMISSIBLE than HCV (B is a B*tch)

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10
Q

For how long does hepatitis B infection have to persist to be considered “chronic”?

What percentage of adults and children go on to develop chronic hepatitis if they have acute hepatitis?

A

6 months

Adults- 5-10% (because they have better immune system so can clear the infection more easily)

Children- 95%

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11
Q

What is the incubation period for hepatitis B?

A

2-6 months - much longer than HepC

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12
Q

What are the complications of chronic hepatitis B?

A

Cirrhosis
Hepatocellular carcinoma- high AFP

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13
Q

Recall the stages of hepatitis B infection

A
  1. Immune tolerant
  2. Immune reactive
  3. Inactive HBV carrier state
  4. HBe antigen negative chronic HBV
  5. HBs antigen negative phase
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14
Q

What treatments are available for chronic hepatitis B? What is the main goal of treatment of Hepatitis B?

A
  1. Interferon alpha

Pegylated Interferon (INF) Alpha 2a (subcut) – Direct antiviral effect + upregulates expression of MHC on cell surfaces

  1. Lamivudine (nucleoside analogue)
  2. Entecavir
    (nucleoside analogue)
  3. Telbivudine
    (nucleoside analogue)
  4. Tenofovir
    (nucleoTide analogue)

main goal of treatment is to prevent the progression to cirrhosis and HCC

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15
Q

HepB serology table

A
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16
Q

What does the hepatitis B vaccine contain?

A

Surface antigen

17
Q

Prevention of HepB

A

1. Vaccine

  • routine immunisation at 2,3 and 4 months (6 in 1 vaccine)
  • pre-exposure prophylaxis
  • post exposure prophylaxis (eg following needle stick injury)
  • pre and post exposure prophylaxis (accelerated schedule)

2. PMTCT

  • If mom is HBsAg+ but HBeAg- : give baby HBV birth dose vaccine –> routine schedule
  • If mom is HBsAg+ and HBeAg+ : give baby HBV birth dose vaccine + HBIG within 48 hours + routine HBV vaccine schedule
18
Q

What are the main routes of transmission of hepatitis C?

A

Blood products
MSM

19
Q

What % of people who get infected with hepatitis C go on to have chronic hep C?

A

60-80%

So much more than HepB!!

20
Q

What is the incubation period of hepatitis C?

A

2 - 6 weeks

21
Q

When do you make antibodies against HCV? What does anti-HCV positive mean?

A

*You only start making anti-HCV 4 weeks after the acute infection so it can take a while for them to show up + if you’re immunocompromised you might never make antibodies –> NOT RELIABLE marker of infection

If positive- you might have chronic HCV infection

If you see this, you should measure HCV RNA and viral load to see if they still have the infection as 20% of people might have cleared the infection!!

22
Q

What test is used to diagnose hep C infection?

A

HCV RNA

23
Q

What treatments are available for hepatitis C?

A

Initially interferon therapy (Peg INF ⍺ 2b/2a)

Now highly effective directly acting antivirals–> curative

  1. NS3/4 protease inhibitors (-previrs, block translation): telaprevir, boceprevir, simeprevir, asunaprevir (learn one or two)
  2. NS5A inhibitors (-asvirs, block release):
    ledipasvir, daclatasvir
  3. Direct polymerase inhibitors (-buvirs,
    block replication): Sofosbuvir, dasabuvir
24
Q

Hepatitis D infection is always superimposed upon which type of infection?

A

Hepatitis B

25
Q

What is one particularly risky food for hepatitis E infection?

A

Wild boar

**undercooked pork**

**also associated with shellfish**

26
Q

What are the possible complications of hepatitis E infection?

A

Bell’s palsy
Guillain Barre

27
Q

What does HBV/HDV co-infection mean for the clinical course of infection?

A

Causes severe, acute infection, but very low chance of becoming chronic

28
Q

HepE genotypes

A

Genotype 1+2

  • ony human host
  • Genotype 1 can cause severe infection/high mortality in pregnant women
  • faeco-oral transmission
  • often contracted on holiday
  • brief, self-limiting

Genotype 3+4

  • natural host is in swine, boar but humans are accidental hosts
  • can be contracted from eating dodgy sausages/meat on holiday
  • mostly asymptomatic
29
Q

Clinical course of HepE

A

immunocompetent people: acute and self limiting

immunocompromised patients: 60% become chronic

30
Q

Which Hep virus is dangerous for pregnant women?

what extra intestinal manifestation?

A

Hep E genotype 1 can cause severe fulminant liver failure in pregnant women

thrombocytopaenia - can look similar to helpp syndrome

31
Q

Diagnosis of HepE

A

Immunocompetent

  • HepE IgM and IgG

Immunocompromised

  • HepE RNA- as they may not mount a full immune response for it to be detected
32
Q

Which hepatitis virus is at risk of reactivating and when?

A

HepB is at risk of reactivating in immunocompromised individuals

especially in those taking B cell depleting therapies such as rituximab

33
Q

What type of virus is hepatitis C?

A

Enveloped flavivirus,
positive sense ssRNA genome

34
Q

Genotypes of HepC virus

A 
Genotypes 1 (40-50% of HCV UK burden), 4, 5, and 6 –
Treatment less successful

Genotypes 2 and 3 – (40-50% of HCV UK burden) Treatment
more successful

Most common in UK: 1,2,3

35
Q

What type of virus is Hep D virus?

A

Deltavirus, enveloped virus, negative sense, single-stranded circular RNA

36
Q

What type of virus is Hep E virus?

A

Unenveloped positive
sense ssRNA genome

37
Q

What antibodies can be made in response to hepatitis B virus?

A
  • IgM core antibody - only present in acute infection
  • IgG core antibody - present in acute and chronic infection (**not sure why in acute…_
  • anti-HbS - only present if a) infection cleared or b) previous vaccination

MICRO ADYA (22 decks)

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