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SA infections > S8) Blood Borne Viruses – Hepatitis > Flashcards

S8) Blood Borne Viruses – Hepatitis Flashcards

1
Q

What is hepatitis?

A

Hepatitis is the inflammation of the liver due to cell injury or viruses (hepatotropic) which can cause collateral liver damage e.g. EBV, CMV, VZV

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2
Q

Outline Hepatitis B and C in terms of transmission, incubation and affirmation of chronic illness

A
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3
Q

Outine the viral structure of different types of hepatitis

A
  • Hepatitis B: dsDNA, enveloped
  • Hepatitis C: ssRNA, positive, enveloped, icosahedral
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4
Q

Outline the production and excretion of bilirubin

A
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5
Q

Identify the different types of jaundice and their causes

A
  • Prehepatic – caused by haemolysis
  • Intrahepatic – caused by viral hepatitis, drugs, alcohol hepatitis, cirrhosis
  • Extrahepatic – caused by common duct stones and carcinoma
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6
Q

Identify some liver function tests (LFTs)

A
  • Bilirubin
  • Albumin
  • ALT & AST
  • Alkaline phosphatase (ALP)
  • Coagulation tests – INR & PT
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7
Q

How can Hepatitis B be transmitted?

A
  • Vertical transmission
  • Sexual contact
  • Contaminated needles (IVDU, HCW)
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8
Q

What are the symptoms of acute Hep B?

A
  • Jaundice
  • Fatigue
  • Abdominal pain
  • Anorexia / nausea / vomiting
  • Arthralgia
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9
Q

What are the microbiological findings of Acute Hep B?

A

AST/ALT in 1000s

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10
Q

Describe the complications of Acute Hep B

A
  • Up to 50% – no/vague symptoms & clear infection within 6 months
  • <1% – fulminant hepatic failure
  • <10% – becomes chronic (if adult)
  • Up to 90% – becomes chronic (if infant)
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11
Q

Outline the 6 steps in Hepatitis B serology

A

⇒ Surface antigen, within 6 weeks (HBsAg)

⇒ Highly infectious e-antigen (HBeAg)

⇒ Core antibody appears first (IgM)

⇒ e-antibody appears, less infectious now (HBeAb)

⇒ Surface antibody appears last, clears virus (HBsAb)

⇒ Core antibody persists for life (IgG)

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12
Q

What is a chronic Hep B infection and what are its consequences?

A

A chronic Hep B infection is the persistence of HBsAg after 6 months:

  • 25% chronic infection leads to cirrhosis
  • ~5% will develop hepatocellular carcinoma
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13
Q

What is the treatment for chronic Hepatitis B?

A
  • NO CURE – integrates into host genome
  • Life-long anti-virals required to suppress viral replication
  • Not required for everyone e.g. “inactive” carrier (Low VL / normal LFTs / no liver damage)
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14
Q

Describe the composition and effective response of the Hepatitis B vaccination

A
  • The vaccination consists of a genetically engineered surface antigen (3 doses + boosters if required)
  • Produces surface antibody response:

I. >10 adequate

II. >100 long-term protection

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15
Q

What’s the status (HBsAg, HBsAb, HBcAb) for Hepatitis B in terms of:

  • Acute infection
  • Cleared infection
  • Chronic infection
  • Vaccinated
A
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16
Q

Who is at risk of Hep C transmission?

A
  • IVDU
  • Sexual contact
  • Infants born to HCV positive mothers
  • Blood transfusion prior to 1991
  • HCW via needlestick injuries
17
Q

Outline the disease progression of Hepatitis C

A
  • ~80% become chronically infected
  • Of these some will develop chronic liver disease/cirrhosis
18
Q

What are the complications of chronic liver disease/cirrhosis due to a chronic Hepatitis C infection?

A
  • Decompensated liver disease
  • Hepatocellular carcinoma (primary liver cancer)
  • Transplant
  • Death
19
Q

What are the symptoms of Hepatitis C?

A
  • 80% have no symptoms (acute or chronic)
  • 20% have vague symptoms:

I. Fatigue

II. Anorexia

III. Nausea

IV. Abdominal pain

20
Q

Identify and describe the blood tests involved in Hepatitis C

A
  • Serology – anti-Hep C antibody as it remains positive throughout life, even after clearance/cure (not protective, can get reinfected)
  • Viral PCR – if positive, confirms on-going / chronic infection
21
Q

Discuss the treatment for Hepatitis C

A
  • Cure/but no vaccine
  • Directly acting antiviral drug combo:

I. 8-12 weeks

II. >90% chance of cure

III. £20,000 - £60,000 per course

IV. Can get re-infected

22
Q

Discuss the risk of transmission of HIV, Hep B and C from needlestick injury

A
  • Hep B – 1/3 (much lower if recipient has been vaccinated)
  • Hep C – 1/30
  • HIV – 1/300 (much lower if patient is on ARVs / VL undetectable)
23
Q

Distinguish between HIV, Hep B and Hep C in terms of:

  • Acute infection
  • Prevention
  • Outcome of untreated infection
  • Treatment
A

SA infections (19 decks)

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