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Viral Causes of Hepatitis Flashcards

1
Q

What viral family is HAV?

A

Picornavirus

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2
Q

What viral family is HEV?

A

Hepevirus

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3
Q

What viral family is HBV?

A

Hepadnavirus

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4
Q

What viral family is HCV?

A

Flavivirus

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5
Q

What is the transmission route of HAV?

A

Fecal-oral

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6
Q

What is the transmission route of HEV?

A

fecal-oral

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7
Q

What is the transmission route of HBV?

A

Parenteral

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8
Q

What is the transmission route of HCV?

A

Parenteral

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9
Q

What viruses other than hepatitis viruses cause liver infections? (6)

A 
Epstein barr
CMV
Rubella
Mumps
ECHO viruses
Yellow Fever
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10
Q

What is the structure of HAV?

A

icosahedral capsid that is enveloped in faeces and can be enveloped or non-enveloped in blood

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11
Q

Why is HAV enveloped in the blood but non-enveloped in the environment?

A

Budding allows for exit without lysis, immune escape in the body - confers resistance to neutralising antibodies,
no envelope outside the body in faeces confers stability and transmission of virus

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12
Q

How many serotypes does HAV have?

A

one serotype based on structural proteins VP1 and VP3

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13
Q

How many genotypes of HAV are there?

A

4 genotypes in humans (1, 2, 3, 7)

3 genotypes in monkeys (4, 5, 6)

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14
Q

HAV genomic RNA is translated into a. . ?

A

polyprotein which is cleaved into structural proteins and replicative proteins

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15
Q

How does HAV infection spread through the body?

A

HAV enters via the oral cavity, crosses the intestines and enters the blood where it can spread to the liver, enter the bile and enter the stool

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16
Q

What is the incubation period for hepatitis A?

A

2-6 weeks

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17
Q

What are the symptoms during the prodromal phase of HAV infection (1-7 days)? (7)

A
  1. Fever
  2. Fatigue
  3. Malaise
  4. Loss of appetite
  5. abdominal pain
  6. nausea
  7. vomiting
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18
Q

What are the symptoms of the symptomatic phase of HAV infection? (3 weeks) (4)

A
  1. Bilirubinuria
  2. Pale/clay coloured faeces
  3. Jaundice
  4. Liver enlargement
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19
Q

What are the complications of HAV infection? (3)

A
  1. cholestatic hepatitis
  2. relapsing hepatitis
  3. fulminant hepatic failure
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20
Q

How does HAV cause liver damage?

A

Immunopathology mediated liver damage

Cytotoxic T cells

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21
Q

What are the characteristics of HAV in regions of high endemicity? (2)

A
  1. disease rates are low as most people are infected at an age when infection is asymptomatic
  2. transmission mainly from person to person but also contaminated food/water
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22
Q

What are the characteristics of HAV in regions of intermediate endemicity? (2)

A
  1. disease rates are high as the age of infection is older

2. person to person transmission and large common source outbreaks

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23
Q

What are the characteristics of HAV in regions of low endemicity? (2)

A
  1. disease rates are low due to lack of exposure but large numbers of children and adults are susceptible
  2. person to person and occasionally food/water transmission
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24
Q

What are the characteristics of HAV in regions of very low endemicity?

A
  1. disease is limited to adults in defined risk groups such as international travellers
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25
Q

How is HAV diagnosed in a lab? (2)

A
  1. liver function tests eg ALT
  2. Serology
    IgM anti-HAV
    Total anti-HAV
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26
Q

How can HAV be prevented?

A
  1. improved standards of hygiene and sanitation
  2. immunization
    passive - immune serum globulin
    active - inactivated whole virus vaccines
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27
Q

What is the host range of HEV genotype 1 and 2?

A

Humans

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28
Q

What is the host range of HEV genotype 3?

A

Human
Pig
Rabbit
Deer

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29
Q

What is the host range of HEV genotype 4?

A

Human

Pig

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30
Q

What is the host range of HEV genotype 5 and 6?

A

Wild boar

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31
Q

What is the host range of HEV genotype 7?

A

Camel

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32
Q

What happens to HEV’s envelope?

A

Non-enveloped in the faeces, enveloped in the body

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33
Q

What is HEV’s genome?

A

positive sense ssRNA

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34
Q

What is the incubation period for HEV?

A

2-6 weeks

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35
Q

What type of infection can HEV cause? (3)

A
  1. asymptomatic
  2. icteric
  3. fulminant
36
Q

What are the symptoms of HEV? (6)

A
  1. fever
  2. nausea
  3. abdominal pain
  4. jaundice
  5. long periods of viraemia
  6. faecal shedding
37
Q

What is the mortality rate of pregnant women infected with HEV1 and HEV2?

A

20-25% mortality rate

38
Q

What genotypes of HEV cause chronic infections in immunocompromised people?

A

HEV3 and HEV4

39
Q

What are neurological complications of infection with HEV1 and acute and chronic HEV3? (4)

A
  1. Guillain-Barre
  2. Bell’s Palsy
  3. Acute transverse myelitis
  4. Acute meningoencephalitis
40
Q

What are renal complications of HEV infection?

A

membranoproliferative glomerulonephritis (MPGN)

41
Q

What are the muscular complications of HEV infection? (2)

A
  1. athralgia

2. myalgia

42
Q

What are the haematological complications of HEV infection? (2)

A
  1. thrombocytopaenia

2. aplastic anaemia

43
Q

What is the route of transmission of HEV1 and HEV2?

A

Faecal oral route in developing countries

44
Q

What is the route of transmission of HEV3 and HEV4?

A

zoonotic transmission in developed countries

45
Q

Which HEV genotype can be transmitted via blood?

46
Q

Which HEV genotype can be transmitted vertically from mother to child?

47
Q

How is HEV diagnosed in a lab?

A

serology - anti-HEV IgM

48
Q

How can HEV be prevented?

A

improved sanitation

two commercial vaccines

49
Q

How many genotypes of HBV are there?

A

HBVA-J (10)

50
Q

What are the transmission routes of HBV? (3)

A
  1. Blood and Blood products
  2. Sexual contact
  3. Perinatal
51
Q

What is the main mode of transmission of HBV in regions of high endemicity?

A

perinatal transmission

52
Q

What is the main mode of transmission of HBV in regions of medium endemicity?

A

childhood and percutaneous transmission

53
Q

What is the main mode of transmission of HBV in regions of low endemicity?

A

adult, sexual and percutaneous transmission

54
Q

What are the HBV proteins? (4)

A
  1. S - surface proteins (HBsAg)
  2. C - core proteins (HBeAg, HBcAg)
  3. P - polymerase, reverse transcriptase
  4. X - HbX
55
Q

What percent of adults have complete recovery from HBV within 1-3 months?

56
Q

What is the incubation period of HBV?

A

1-4 months

57
Q

What are the characteristics of the immune tolerant phase (phase 1) of HBV infection? (4)

A
  1. HBeAg+
  2. High HBV DNA
  3. ALT normal
  4. Minimum or no inflammation
58
Q

What are the characteristics of the immune active/clearance phase (phase 2) of HBV infection? (4)

A
  1. HBeAg+
  2. High/declining HBV DNA levels
  3. ALT high
  4. moderate to severe liver inflammation
59
Q

What are the characteristics of the inactive phase (phase 3) of HBV infection? (5)

A
  1. HBe negative/anti-HBe positive
  2. ALT levels normal
  3. Low HBV DNA
  4. minimum inflammation in liver
  5. low risk of cirrhosis or HCC
60
Q

What are the characteristics of the reactivation phase (phase 4) of HBV infection?

A
  1. HBe negative/ anti-HBe positive
  2. High HBV DNA and ALT levels
  3. Inflammation and fibrosis
  4. pre core mutations
61
Q

increased risk of cirrhosis is associated with which HBV mutant?

A

HBe negative HBV mutant

62
Q

What are the characteristics of occult HBV (phase 5)?

A
  1. unexplained liver disease in HBsAg negative, anti-HBc positive
  2. normal ALT levels
  3. detectable HBV DNA in blood or liver by sensitive molecular methods
63
Q

How can severity of HBV liver disease be assessed through biochemical parameters? (7)

A
  1. liver enzymes
  2. alkaline phosphatase
  3. bilirubin levels
  4. albumin levels
  5. gamma globulins
  6. full blood count
  7. prothrombin time
64
Q

How can severity of HBV liver disease be assessed through physical examination? (3)

A
  1. abdominal ultrasound is recommended for all patients
  2. liver biopsy
  3. transient elastography
65
Q

What are the indications for treatment of chronic HBV?

A
  1. serum HBV levels > 2000 IU/mL
  2. Serum ALT levels > ~40 IU/mL
  3. moderate necroinflammation and/or moderate fibrosis or cirrhosis
66
Q

What are the treatment strategies for HBV? (2)

A
  1. pegylated interferon

2. nucleoside analogues: lamivudine, entecavir, tenofovir

67
Q

How is HBV monitored?

A
  1. HBV viral load assays
  2. genotyping assays
  3. drug resistance mutation assays
  4. liver enzymes
  5. serology for HBeAg and anti-HBeAg
68
Q

How is an acute infection of HBV diagnosed?

A

IgM and anti-HBcAg

69
Q

How can HBV be prevented?

A

vaccination

70
Q

How can vertical transmission from mother to child be prevented?

A

HB Ig and vaccine should be given to infants born to HBV positive mothers

71
Q

How many different genotypes of HCV are there

A

7 genotypes 1-7

72
Q

What are the clinical manifestations of acute HCV?

A
  1. malaise
  2. nausea
  3. dark urine
  4. jaundice
73
Q

What is the incubation period of acute HCV?

74
Q

What percentage of HCV infections become chronic?

75
Q

What percentage of chronic HCV infections become cirrhosis?

76
Q

What are the skin complications of HCV infection? (2)

A
  1. porphyria cutanea tarda

2. lichen planus

77
Q

What are the renal complications of HCV?

A
  1. membranoproliferative glomerulonephritis (MPGN)
78
Q

What are the haematological complications?

A

cryoglobulinaemia

79
Q

What are the CNS complications of HCV infection?

A

Depression

80
Q

What are the neuromuscular complications of HCV infection? (2)

A
  1. arthritis

2. peripheral neuropathy

81
Q

What are the vascular complications of HCV infection?

A

polyarteritis nodosa

82
Q

What does “sustained virological response” mean?

A

refers to the absence of HCV RNA in serum 12 weeks after stopping treatment

83
Q

What does “non-responder” refer to?

A

people in whom HCV RNA levels remain stable during treatment

84
Q

What does “rapid virological response” mean?

A

undetectable HCV RNA at 4 weeks

85
Q

What does “early virological response” refer to?

A

undetectable HCV RNA at 12 weeks

86
Q

How is HCV diagnosed?

A

serology
ELISA measures antibodies against NS4, core, NS3, NS5
6-8 weeks after exposure

87
Q

How is HCV monitored?

A

viral load

GI/GU Illness (15 decks)

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