Viral Hepatitis Flashcards
Causes of infectious hepatitis
primary
Hep A-E
Secondary
EBV
CMV
HIV
Adenovirus
…
ASDFGHJKL;P’;’[PL./’PL./P./PL./’L./PTransmission of Hep A
Face oral route
person to person contact
contaminated food or drink
incubation period of Hep A
4w - check
6-8
Sx of acute hep
fever
malaise
fatigue
anorexia
abdo pain
jaundice
dark urine
pale stool
pruritus
Hep A lab Ix
Anti HAV IgM (if ALT >500 u/L
may be negative in week 1 of sx
When should you request Hep A IgM?
if ALT > 500 u/L
in that phase it is too early and would not be detectable -> false reassurance
How long should people isolate for with Hep A?
7d from Sx onset
should you report Hep A?
yes
should you report Hep A?
yes
Complications
XXXXXX
- cirrhosis (child-push score) - transient elasticity? shows amount of fibrosis
- HCC (APF and imaging)
- polyarteritis nodosa????
Incubation period of Hep B
2-6m
Transmission of Hep B
parental
sex
materno fetal
Acute Hep A inf
if <5yo 90% are asyx but 90% progress to chronic hep B inf
adults 20-40% ssxx, 10% progress to chronic hep B
Hep B serology
HBsAg - current HBV infection
HBeAg - high viral replicaation/high infectivity
HBcIgM - acute infection <3m
AntiHBc - exposure to HBV, past or present HBV infection
AntiHBe - immune control, imminent or already achieved eAg clearance
AantiHBs - immunity (natural or induced via vaccination)
What Hb serology marker shows current infection?
HBsAg
Wich HepB antibody is positive if someone had vaccine but never infection?
ANti-HBs
What drives considerations for treatment of Hep B?
viral load
Mx of Hep B
- pegylated IFN-a (bad flue like sx)
- neucleos(t)ide analogues (entecavir, tenofovir, long term oral treatment)
prevention of Hep B
vaccination
screening in pregnancy
Mum has Hep B in pregnancy Mx
HbsAG + EAG - VACCINE AT BRTH
OTHER WITH HBIG AT BIRTH AND VACCINE
Hep C global prevalence
1%
Transmission of Hep C
blood products
sharing needles
sharing bank notes tto insufflate reacreational drugs
incubation period for Hep C
2w-6m
acute Hep C infection
mostly asymptomatic
20-40$ spsontenoussly clear inf
40-60% progress to chronic infection
complications of Hep C infection
Tests for Hep B
Anti HCV
HCV PCR
Management of HepC
now curable disease - every pt should be considered for treatment (1 pill/day for 12 weeks), very good against all genotypes.//
direct-acting antivirals
every p
Prevention of Hep C///o
no vaccine
screening of blood products
Pt has anti-HCV reactive , HCV RNA not detected, no fibrosis on fibroscan
no hep C (because no RNA)
no treatment required
pt spontaneously cleared the infection and did not develop a chronic infection and no damage to the liver so they do not need any FU
Hep D - what does it need to function?
needs Hep B co-infection to function
then goes on to destroy hepatocytes
Hep D - course of diseaes
severe acute disease
low risk of chronic infection
if already infected with Hep B: get chronic Hep D superinfection and this triggers accelerated liver damage and cirrhosis
How do we prevent Hep D?
prevent Her B
PEP
educate pts with hep B about risky behaviours such as sharing needles, UPSI
Hep E - incubation period
2-8 w
Hep E - disease course
mild disease
30% mortality in pregnant women (high ALT and unwell)
chronic infection only if immunocompromised
diagnostic assays in Hep E
HEV IgM and IgG (immunocompetent)
HEV RNA (immunocompromised - HEV Ab often undetectable)
extra hepatic manifestations of viral hepatitis E
thrombocytopenia
red cell aplasia
proximal myopathy
necrotising myositis
encephalitis s
ataxia
brachial neuritis
GBS
IgA nephropathy
membranoproliferative glomerulonephritis
Is treatment of acute and chronic Hep C differnet/
no its the same, 1 pill every day for 3m/12w
Hep B - extrahepatic manifestations
polyartereritis nodosa
vassculitis
Hep C - extra hep manifestatons
cryoglobulineamia
what is cryoglobulinaemia an extra hep manifestation of?
Hep C
