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Viral Hepatitis Flashcards

1
Q

What family is hepatitis A virus from? Describe its structure.

A

The family Picornaviridae, genus hepatovirus
Single-stranded, positive sense RNA genome
Quasi-enveloped virions

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2
Q

How is it transmitted and what is the incubation period?

A

Faeco-oral versus blood-borne transmission
Incubation period of 15-50 days

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3
Q

Describe the epidemiology of HAV?

A
  • o More common in countries in which access to clean water is poor - Sub Saharan Africa and India
  • Approx. 1.5 millions of cases worldwide annually
  • Developing countries with poor socio-economic conditions
  • 300-500 cases annually in the UK
  • Mostly among age 15-34 and non-travellers
  • Outbreaks among MSM (2016/17) & IVDU (2001 & 2017)
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4
Q

What is the Clinical manifestation of HAV?

A
  • Wide disease spectrum from asymptomatic to fulminant hepatitis
  • Strong correlation with age: <10% symptomatic among children <6 years old versus 70% in adults
  • Typical symptoms: fever, malaise, anorexia/nausea, abdominal discomfort, diarrhoea, jaundice
  • Extra-hepatic diseases
  • Acute presentation; 99% resolution

•NOT an aetiology for chronic hepatitis

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5
Q

Describe the natural history of HAV infection/vaccine.

A
  • 2-6 weeks after the infection you get hepatitis
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6
Q

What is the diagnostic test for HAV?

A

•Diagnostics based on HAV serology

Acute infection: IgM reactive; unlikely if bilirubin level < 30umol/L

Past infection: IgM non-reactive, IgG reactive

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7
Q

What is the tx for HAV?

A

Supportive

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8
Q

What are the public health implications of HAV infection?

A
  • Notifiable disease in the UK – must alert HPT immediately upon diagnosis•
  • Infectious period of index case: two weeks before onset of first symptoms and until one week after the onset of jaundice
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9
Q

What is pre and post exposure prophylaxis forHAV?

A
  • Pre-exposure immunisation among population at risk
  • Post-exposure prophylaxis
  • Within 14 days of exposure to index case: HAV vaccine +/- HNIG (for 60 years and above, chronic liver diseases incCHB/CHC, immunocompromised contact)
  • Over 14 days: HAV vaccine +/- HNIG (for chronic liverdiseases inc CHB/CHC, immunocompromised contact)
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10
Q
A

Acute HAV infection

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11
Q

What family his hepatitis B from? Describe the structure.

A
  • The family Hepadnaviridae
  • Double-strained DNA with reverse transcriptase
  • Enveloped virions
  • 10 genotypes (A-J) with distinctive geographic distribution
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12
Q

Hw is HBV transmitted? What is the incubation period?

A
  • Blood-borne transmission: horizontal & vertical
  • Incubation period of 40-160 days
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13
Q

What is the clinical manifestation of acute HBV infection?

A

•Age related presentation & prognosis in acute hepatitis B

  • Neonates & children: mostly asymptomatic or anicteric; 90% HBV-infected neonates develop CHB, and 30% among children age <5 years
  • Adult: 30-50% icteric hepatitis; 10% become CHB•
  • 0.1-0.05% risk of fulminant hepatitis; related to co-infection with HCV/HDV
  • Maternal HBeAg/Ab status & HBV viral load
  • HBeAg as the most important risk predictor for vertical transmission
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14
Q

Describe the natural history of acute hepatitis B infection.

A
  • Incubation period: 2-6 months
  • Presence of IgM anti-HBc = recent infection
  • The symptoms and rise in ALT will probably subside after around 6 months
  • They will eventually clear HBsAg and HBeAg
  • Prolonged presence of HBsAg is suggestive of chronic infection
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15
Q

What is chronic HBV infection? What are the complications?

A
  • Definition: persistence of HBsAg for 6 months or more after acute HBV infection•
  • Complications
  • Cirrhosis: 8-20% untreated CHB in 5 years;
  • Hepatocellular carcinoma: the annual risk of 2-5% among CHB cirrhotic patients; affected by host (e.g. alcohol abuse) and viral factors (e.g. high HBV viral load & qHBsAg)
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16
Q

Describe the epidemiology go chronic hepatitis B.

A

•Approximately 296 million people are living with CHB worldwide;

CHB-related mortality at roughly 820,000 people per year

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17
Q

Describe the natural history of chronic hep B infection.

A

e antigen - marker for replication

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18
Q

How do we interpret HBV serology?

A
  • HBsAg: infection
  • HBsAb: immunity through either immunisation or past infection
  • HBcAb: exposure

IgM: acute infection

  • HbeAg: replication activity
  • HBeAB - not replicating as frequently
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19
Q
A

IgM might be negative in acute hep B infection - very early in infection

20
Q

What are the treatment options for CHB?

A
  • Chronic HBV Treatment
    • Interferon Alpha (used in a subset of patients who look like they are clearing the virus by themselves)
      • Do not use in patients who may require a liver transplant
    • Lamivudine
    • Tenofovir
    • Entecavir

Emtricitabine

21
Q

What is the public health implication in HBV?

A

•Acute hepatitis B: a notifiable disease

22
Q

What is the pre and post exposure prophylaxis for HBV?

25
Q
A

Previous Vaccination

26
Q
A

Acute infection

28
Q
A

Hepatocellular carcinoma

29
Q

Describe the structure of HDV? How is it transmitted? What is the incubation period?

A
  • Single-stranded, circular RNA genome•
  • A defective virus that relies on HBV for propagation
  • Blood-borne transmission
  • Incubation period: 3-6 weeks
30
Q

How does HBV/HDV infection present? How likely is it to become chronic infection? What is HDV super infection?

31
Q

How do we diagnose HDV infection? What is the treatment and prevention?

A
  • Anti-HDV serology; other HDV investigations rarely used•
  • PEG-interferon alpha licensed for HDV superinfection in CHB•
  • Pre-exposure HBV immunisation•
  • Acute HDV infection: notifiable disease
32
Q

What family is HCV from? Describe the structure.

A

•The family Flaviviridae, genus Hepacivirus•

Single-stranded, positive sense RNA genome

33
Q

How is HCV transmitted what is the incubation period?

A
  • Blood borne transmission
  • Incubation period: 2-6 weeks
34
Q

Describe the epidemiology of HCV infection.

35
Q

How common is HCV chronic infection? What is the clinical manifestation? What are the complications?

36
Q

What is the natural history of HCV infection? How is it diagnosed?

37
Q

How do we treat HCV infection?

A

CURABLE DISEASE NOW

3 types:

  • protease inhibitors
  • NS5A inhibitors
  • NS5B inhibitors
    *
38
Q

What are the public health implications of HCV?

A

•notifiable disease in the UK

39
Q

What is the prevention of HCV infection?

A
  • Nil vaccine available
  • Nil post-prophylaxis available•
  • Active HCV screening•

Risk reduction (e.g. safe handling and disposal of sharps, protected sex)

40
Q

What family is HEV from? Describe the structure.

A

•The family Hepeviridae, genus Orthohepevirus; species A strains (8 genotypoes) infect humans

  • G1 & G2: obligate human pathogens
  • G3 & G4: zoonotic; pigs & wild boar are natural hosts
  • •Single-stranded, positive sense RNA genome
  • •Quasi-enveloped HEV
41
Q

How is HEV transmitted? What is the incubation period?

A
  • Faeco-oral versus blood-borne transmission
  • Incubation period: 15-60 days
42
Q

Describe the epidemiology of HEV?

43
Q

What are the clinical manifestations of HEV? Who is the at risk population?

44
Q

What are the extrahepatic manifestations of HEV?

45
Q

Describe the natural history of HEV infection? How do we diagnose it?

46
Q

How do we treat and prevent HEV infection?

Microbiology (19 decks)

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