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Unit 4: Diagnostic Virology and Bacterial Serology > Section 2: Viral Hepatitis > Flashcards

Section 2: Viral Hepatitis Flashcards

1
Q

Hepatitis

A

-inflammation of the liver
-the specific cause can vary (viruses, alcohol, drugs, toxins, autoimmunity)

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2
Q

Hepatitis symptoms (physical)

A

-nausea
-abdominal pain
-fever
-malaise
-anorexia
-dark urine
-clay colored stool
-jaundice

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3
Q

jaundice

A

-yellowing of skin and whites of eyes

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4
Q

hepatitis with jaundice is called?

A

-icteric

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5
Q

hepatitis without jaundice is called?

A

-anicteric

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6
Q

Hepatitis lab results

A

-you have elevated levels of ALT, AST, Bilirubin, and PT (clotting time increased)
-can test for the presence of a variety of viruses that infect or affect the liver

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7
Q

hepatotropic viruses

A

-viruses that specifically seek out cells of the liver (tissue tropism)
-Hepatitis A, B, C, D, and E (similar names, but different viruses)

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8
Q

Nonhepatotropic viruses

A

-viruses that primarily infect other cells but can infect cells of the liver

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9
Q

Herpesviridae

A
  • Epstein-Barr Virus (EBV-Mono), varicella zoster (chicken pox), cytomegalovirus (CMV)
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10
Q

Tropism

A

-cells that express specific surface receptors, which make them permissive to infection by a particular virus or bacteria

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11
Q

Hepatotrophic viruses are spread through?

A
  1. Fecal-oral: A and E
  2. Blood-borne: B, C, and D
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12
Q

Hepatitis A (HAV): Family, Genome, and Transmission

A

Family: picornaviridae
Genome: ss(+) RNA- single-stranded positive-sense RNA
-Baltimore Classification IV
Transmission: fecal-oral

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13
Q

Risk groups: Hepatitis A

A

-men who have sex with men
-International travelers
-illegal drug users

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14
Q

HAV Infection

A

-acute hepatitis after an incubation of 28 days
-does not become chronic
-people cannot be re-infected
-35% of infected are hospitalized, with only an 0.8% mortality
-high levels of virus in the stool: 2 weeks prior to symptoms and 1 week post symptoms

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14
Q

HAV Infection

A

-acute hepatitis after an incubation of 28 days
-does not become chronic
-people cannot be re-infected
-35% of infected are hospitalized, with only an 0.8% mortality
-high levels of virus in the stool: 2 weeks prior to symptoms and 1 week post symptoms

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15
Q

HAV Clinical testing

A

-Hepatitis A is a reportable infection to the state health department making an accurate detection is important
-diagnosis usually involves anti-HAV IgM
-Total anti-HAV can be used to assess immune status

16
Q

List the immunoassays that exist for testing HAV

A
  1. Indirect enzyme immunoassays
  2. Competitive direct enzyme immunoassays
  3. Capture immunoassays
17
Q

Hepatitis E (HEV): Family, Genome, Transmission

A

Family: Hepeviridae
Genome: ss(+)RNA / BC IV
Transmission: Fecal-oral
-not spread person to person or sexually
-rare in the US usually associated with travel

18
Q

HEV Infection

A

-causes acute hepatitis 2 weeks to 2 months after infection
-40% of infected actual become ill
-does not become chronic
-1% of cases of the disease are fatal
-pregnant women infected in their third trimester have a nearly 30% mortality
-if a previous liver damage is present mortality can be up to 70% in infected people

19
Q

HEV clinical testing

A

-rarely performed in the US
- immunoassays to detect IgM and IgG
-RT-PCR (reverse transcriptase polymerase chain reaction for detection of viral genome)
-no vaccine or treatment is currently available

20
Q

Hepatitis B (HBV) : Family, Transmission, Genome

A

Family: hepadnaviridae
Genome: partial dsDNA/ BC VII
Transmission: blood borne/ body fluids
-1.5 cases per 100,000 US population- greatly reduced by vaccination program started in 1991
-2 billion people infected worldwide
-350 million develop chronic infection
-HBV tenth major cause of worldwide mortality

21
Q

HBV Risk groups

A

-having sex with an infected person
-MSM
-people with multiple sex partners
- healthcare workers
- hemodialysis patients
-travelers
-IV drug users
-Newborns from infected mother

22
Q

HBV virion

A

-enveloped virus- viral nucleocapsid surrounded by lipoprotein envelope derived from host cell
-nucleocapsid core protein: HBc/HBcAg
-envelope surface antigen: HBsAg
-structural E antigen: HBeAg
Excess HBsAg is produced and forms particles called Australian antigens

23
Q

HBV Infection

A

-causes acute hepatitis 90 days after infection
-most people are asymptomatic
-symptoms are similar to other hepatitis infections with the addition of rash and joint pain
-40% of reported symptomatic patients need hospitalization with a mortality of 0.5-1.0
-infection can become chronic (-5%)

24
Q

Chronic HBV Infection

A

-after acute infection is cleared virus persist
-patients can be asymptomatic for 20-30 years
-chronic infection leads to liver scarring (cirrhosis)
-hepatoma (liver cancer) results in 15-25% of chronically infected
-both cirrhosis and hepatoma can lead to death

25
Q

HBV Clinical testing

A

-the levels of antibody are different in acute resolving patients and acute becoming chronic patients
-both antigens and antibodies are detected and have distinct clinical outcomes
HBsAg
-Anti-HBs+ (anti-HBsAg)
HBcAg
-Anti-HBc+ (anti-HBcAg)
HBeAg
-Anti-HBe+ (anti-HBeAg)

26
Q

HBV treatment

A

-no treatment is given for acute HBV infection due to spontaneous recovery
-antivirals are given to severely ill patients but little to no evidence they work
-chronic infection with active replication is treated with interferon A, reverse transcriptase inhibitors,
-severely causes cancerous or cirrhosis can be treated with a liver transplant along with anti-HBV immunoglobulin
-five vaccines available in the US

27
Q

Hepatitis D (HDV)

A

-also called hepatitis delta virus
-circular ssRNA (only known animal virus): only codes for two proteins (long and small delta antigens)
-required co-infection with HBV: uses HBV surface antigens to make viral envelope, and sub viral satellite
-transmission similar to HBV
-can be detected by antibody product to HDV antigens and RT-PCR
-can prevented with HBV vaccine

28
Q

Hepatitis C (HCV): Family, Genome, Transmission

A

Family: flavivirdae
Genome: ss(+)RNA / BC IV
Transmission: blood born/ body fluids
-4 million chronically infected in the US

29
Q

Risk group: Hepatitis C

A

-IV drug use
-Blood transfusion prior to implementation of standard testing in 1992
-sexual

30
Q

HCV Infection

A

-70% of acutely infected patients are asymptomatic
-symptoms occur 6-7 weeks after infection
-symptomatic patients are less likely to progress to chronic infection (like HBV)

chronically infected patients
-75 to 85% develop chronic infection
- 60-70% will progress to chronic liver disease
- 5-20% will progress to liver cirrhosis or hepatoma (20 years)

31
Q

Mixed essential cryoglobulinemia

A

-HCV infection is the most common cause of this disease (1-2%)
-immune complexes form with viruses, antibody, complement, and rheumatoid factor
-cause symptoms of type III hypersensitivity (rashes and joint pain)
-if exposed to the cold patients can develop Raynaud’s phenomena (pain, numbness, and tingling of the fingers and toes)

32
Q

CV Clinical testing

A

-diagnosed with a group of immunoassays and molecular techniques
-immunoassays measure antibody in two different ways: screening test and confirmatory test
-molecular testing for HCV RNA are both qualitative and quantitative
-after positive molecular test, genotyping is performed because different types respond differently to treatment
-liver biopsy is performed to assess cirrhosis and hepatoma

33
Q

screening test

A

-third generation indirect enzyme immunoassays using a mixture of viral antigens on microbeads
-measures structural and nonstructural antigens qualitatively

34
Q

confirmatory test

A

-after a positive screen recombinant immunoblot assay (RIBA) is performed

35
Q

RIBA

A

-similar to western blot
-uses synthetic antigens placed on nitrocellulose strip: C33c, NS5, 5-1-1, c100, and c22 peptides
-indirect immunoassay is performed with enzyme labeled secondary antibodies

36
Q

HCV Treatment

A

-no postexposure prophylaxis is available
-no vaccine is available
-PEGylated interferon-a ribavirin is effective in 55% of patients
-patients with cirrhosis do not respond to treatment
-transplantation can be performed in liver failure `

Unit 4: Diagnostic Virology and Bacterial Serology (2 decks)

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