Microbiology - Hepatitis viruses - Rebecca Greenblatt Flashcards by Mary Slome

Phylogeny: Hepatitis A

Human-restricted 
naked 
picornavirus;
enterovirus 72;
RNA virus

How well did you know this?

Not at all

Perfectly

How is Hep A diagnosed?

Enzyme Immunoassay (EIA) for Anti-HepA IgM –> acute infection

EIA for Anti-Hep A IgG –> past infection, vaccination

Alanine aminotransferase (ALT) level: high –> ongoing liver damage

How well did you know this?

Not at all

Perfectly

Mode of transmission: Hepatitis A

Human to human

How well did you know this?

Not at all

Perfectly

Phylogeny of Hep E

\+ssRNA virus;
Small, 
naked
icosahedral;
hepeviridae

How well did you know this?

Not at all

Perfectly

Where is Hep E endemic?

China

How well did you know this?

Not at all

Perfectly

Mortality in pregnant patients is higher in Hep A or E?

How well did you know this?

Not at all

Perfectly

Mode of transmission: Hep E

fecal-oral

How well did you know this?

Not at all

Perfectly

Hep A and E are DNA or RNA viruses?

RNA

How well did you know this?

Not at all

Perfectly

Phylogeny: Hepatitis B

Hepadnavirus
DNA
Small, enveloped, partially double-stranded

How well did you know this?

Not at all

Perfectly

How many serotypes exist for Hep B?

Only one serotype, HBsAb protective against reinfection;

Effective vaccine available.

How well did you know this?

Not at all

Perfectly

Where in the body does Hep B replicate?

Liver hepatocytes, leaves behind integrated copies of viral DNA

How well did you know this?

Not at all

Perfectly

What is Heb B Surface antigen?

HBsAg

Surface Antigen appears early, ceases being detectable as surface antibody is produced, resumes being detectable in chronic

How well did you know this?

Not at all

Perfectly

What is Heb B Surface antibody?

Surface Antibody becomes detectable as surface antigen levels fall, raised by both vaccine and infection

How well did you know this?

Not at all

Perfectly

What is Hep B Core Antibody?

Core Antibody arises a little later, stays: IgM for acute, IgG for resolved or chronic infection – not raised by vaccine

How well did you know this?

Not at all

Perfectly

When is E antigen of Hep B detectable?

E Antigen detectable when virus most transmissible

How well did you know this?

Not at all

Perfectly

What causes the cirrhosis in Hep B?

Ongoing cytotoxic T-cell response against infected hepatocytes causes permanent cirrhosis – virus itself is not hepatotoxic

Accumulation of Hep antigen-antibody complexes leads to kidney damage & arthritis (membranous glomerulonephritis, mostly peds)

What is the pathogenesis of Hep B cancer?

Virus genome integration, expression of viral transcriptional transactivators, and chronic inflammation can lead to cancer (primary hepatocellular carcinoma)

How does Hep B look under the microscope?

“Ground-glass” cytopathology

What is the treatment for Hep B?

1 year of polymerase inhibitors (lamivudine, adefovir entecavir, telbivudine)
PLUS
4 months of pegylated alpha-interferon (PEG-Intron, Pegasys) Significantly toxic, will cause heavy side effects (neutropenia, thrombocytopenia, disturbances of memory, concentration, vision, headaches, depression, irritability, hypo- or hyperthyroidism, nausea, vomiting, weight loss, alopecia, interstitial fibrosis)

Same drugs may be used to treat HepB-induced glomerulonephritis.

What is Hep D?

Helper virus
NOT A COMPLETE VIRUS: a “defective” virus or “viriod”
Cannot replicate by itself, only in cells co-infected with HepB
1700 nucleotide circular -RNA “genome” encodes one protein: delta antigen

Mode of transmission: Hep D

Blood and sex

How does Hep D exacerbate Hep B?

Delta antigen IS cytotoxic
Dramatically increases the incidence of fulminant hepatitis
Affects ~5% of HepB carriers

How is Hep D diagnosed?

Primary screening with EIA for anti-delta antibodies

Phylogeny: Hep C

Human-restricted
Flavivirus
enveloped
+RNA genome

Coinfection with Hep C is common with:

HIV

Which virus, Hep B or C, has a higher potential for causing cancer?

Much higher potential for chronic infection than HepB, thus a stronger association with primary hepatocellular carcinoma (11-19%)

Which hepatitis virus presents with the mildest initial infection?

Hep C - trying to stay under the immune radar

What Hep C genotype is the most common in the U.S.?

Genotype 1

How is Hep C diagnosed?

Serology: Liver function tests including ALT levels, albumin, bilirubin EIA followed by RIBA If positive, HCV genotyping RT-PCR for viral RNA levels to assess success of therapy

What are the goals of Hep C treatment?

Goal of treatment is sustained viral response (SVR) – like remission. “Failed” treatment may still reduce risk of hepatocellular carcinoma.

What is the current Hep C treatment?

Simeprevir (inhibits protease) manufacturer claims can cure (not just SVR) serotype 1 by combined therapy with IFN and ribavirin Sofosbuvir (inhibits polymerase) manufacturer claims can induce SVR in combined therapy with Ledipasvir (inhibits NS5A) without IFN or ribavirin Sofosbuvir in combination with ribavirin is active against Genotypes 2&3

Where is Hep A endemic?

A is endemic in Mexico and South America

Where is Hep E endemic?

Asia and Mexico

What is the second generation treatment for Hep C?

Second-generation protease inhibitors combined with IFN improve SVR rates for HepC serotype 1

What is the basic pathogenesis of Hep B, if it is not asymptomatically cleared?

B produces a large number of immune decoys composed of its surface antigen alone. Antigen-antibody complex disease may follow (ex glomerulonephritis)