Viral Hepatitis Flashcards
Where is hepA commonly transmitted?
daycare, prison, travelers etc
Where is HepA most commonly found?
S America, Africa, SE Asia
How is HepA transmitted?
fecal oral, very high content in feces
What is the incubation period for HepA?
4 wks (2-6)
What type of genetic material does HepA have?
RNA
What are the symptoms of acute HepA?
fever, malaise, anorexia, nausea, vomiting, jaundice, abdominal/RLQ pain, hepatomegaly
Are adults or children at higher risk for infection? do adults or children get more symptoms?
adults get more symptoms but are at lower risk of infection
Is a hepA infection usually acute or chronic?
acute
What is seen in serology with a hepA infection?
ALT spike from 1-2mo, overlaps wtih symptoms
Anti-HAV IgM-indicates active infection (acute <6mo)
Anit-HAV IgG-indicates previous exposure and reocvery//immunity/vaccination
How can HepA be prevented?
hygeine/sanitation
immune globulin pre and post exposure
HepA vaccine
Who is the Hep A vaccine recommended for?
infants
ppl who work or are traveling to areas with high incidence of HAV
ppl w/chronic liver disease
When in HAV immune globulin given?
pre exposure to travelers going to high HAV region post exposure (w/i 14 days) of exposure to household/intimate contact, daycare centers w/outbreak
Who is at greatest risk of death from a HepE infection?
pregnant women (15-45% mortality)
Is a HepE infection usually acute or chronic?
acute
Where is HEV most commonly found?
N Africa, SE Asia, likely underreported due to lack of monitoring in many countires
Is there and HEV vaccine?
no
What are the signs/symptoms of an acute HEV infection?
fever, malaise, anorexia, nausea, vomiting, jaundice, abdominal/RLQ pain, hepatomegaly
What serology findings are found in a patient w/HEV?
ALT spike 1-2 mo, overlaps w/symptoms, overlaps w/onset of HgM and IgG response
Anti-HEV IgM-indicates active infection (acute <6mo)
Anti-HEV IgG-indicates recovery/immunity (protective)
Is HepB usually an acute or chronic infection?
chronic
Is HepC usually an acute or chronic infection?
chronic
What is HepD?
incomplete RNA virus that requires HBsAg to replicate
How is HepD transmitted?
sexual, blood
What serology is seen in HBV/HDV COinfection?
ALT spikes w/symptoms, then disappears HBsAg/HDV RNA;present briefly Anti-HDV IgM-acute infection Anti-HDV IgG Anti-HBs
What is unique about anti-HDV IgG?
disappears and is not protective!
What does Anti-HBs indicate?
ability to clear the infection (HBsAg required for replication)
Does coinfection or superinfection have a greater chance of causing chronicity?
superinfection
Does coinfection or superinfection cause more severe symptoms?
coinfection
What serology is seen with HBV/HDV SUPERinfection?
ALT-fluctuates HBsAg/HDV RNA-persists Anti-HDV IgM-acute infection Anti-HDV IgG-persists No Anti-HBs
What does coinfection mean?
simultaneous acquisition
What does superinfection mean?
HBV then HDV
What is HepB?
chronic DNA virus
How is HepB transmitted?
sexually or via IVDU
Is HBV more likely to become chronic in kids or adults?
more chrnoic in newborns
Does HBV cause more symptoms in adults or kids?
adults
Where is HBV most commonly found?
Africa, SE Asia, Alaska, Canada
What is the incubation period for HBV?
60-90 days
Where is HBV concentration highest in infected persons?
highest: blood, serum, wounds
mod: semen, vaginal, saliva
low: breastmilk, feces
What is the natural progression of HBV infection?
- acute infection
- chronic infection
- cirrhosis
- liver faulture/liver CA (go directly to liver CA w/o cirrhosis)
- liver transplant or death
What are the goals of HBV therapy?
- eleiminate/suppress HBV replication
- prevent progression to cirrhosis and HCC
- ALT normalizaiton
- histological improvement
- Loss of HBeAg, development of HBeAb
- Loss of HBsAG
What is seroconversion?
loss of HBeAg and development of HBeAb
spontaneous immune response against envelope protein
What is the best time to give HBV IVIG?
w/in 24hrs of exposure preferrably, but up to a week)
Who gets the HBV vaccine?
all infants and previously unvaccinated children by age 11
those exposed to HepB in last 24hrs-wk
What is the treament for a newborn of a HBsAg positive mother?
HBIG and vaccine
What are the chronic therapy drugs?
interferon
PEG-IFN (works in low viral load, High ALT/AST pts) provides best chance of eradication
Nucleotide/nucleoside inhibitors Ientecavir/tenofovir)
What are the side effects of IFNs?
flu-like sx
bone marrow depression
neuropsych sx
What are the serologic findings in acute HBV infection?
HBsAg: appears 2-8wks post exposure, last up to 4mo
HBeAg/HBV DNA-after HBsAg but before HBsAb
Anti-HBe
Anti-HBc Igm
Anti-HBc IgG
Anti-HBs
What does anti-HBcIgM indicate?
acute HBV infection
What does anti-HBc IgG inidcate?
previous exposrue to HBV (lifelong)
What does Anti-HBs indicate?
PROTECTION!
marker of immunization or recovered from natural infection
What serology findings in chronic HBV infection?
HBsAg-lasts longer than 6mo (def of chronic)
HBeAg/HBV DNA: persists longer than in acute
Anti-HBe-develops in a small amt of pts (seroconversion)
Anti-HBc IgM
Anti-HBc IgG
***Anti-HBs never develops in chronic infection
What is an important differences in HBeAg/HBV DNA duration in acute vs chronic HBV?
lasts longer in chronic, differentiates healthy chronic carrier from infective chronic carrier
What type of infxn does a person with HBsAg have?
current HepB (acute or chronic)
What does anti-HBc indicate?
natural exposure (IgM-recent IgG-old exposure)
What is HCV?
chronic RNA virus
*HUGE virion production (10^12 daily)
How is HCV transmitted?
IVDU, sexual, potentially blood transfusions before 1992
Where is HCV most commonly found?
high in US, E Europe, W Pacific, SE Asia
What is the normal progression of HCV?
- exposure and acute phase
- chronic
- cirrhosis
- ESLD or HCC
- Transplant or death
What is the incubation period of HCV?
6-7 wks
What are the most common HCV genotypes in the US
1A, 1B, 2, 3
What is an important clincial presentation of HCV?
fibrosis
-variable rates of progression (slow w/low LT complications, fast w/high LT complications)
What increases the likelyhood of a fast fibrotic progression in pts w/HCV?
EtOH
obesity
other liver disease
What serology is seen in chronic HCV?
ALT-spike 2-4mo, stays elevated but fluctuates
HCV RNA- confirms chronic infection/viral load (2-4 wk)
Anti HCV IgM
Anti HCV IgG-indicates active infection or recovery, non protective
What changes in serology occur during acute HCV reaction?
no change anti-HCV, HCV RNA goes away (<6mo)
ALT normalizes
How is HCV diagnosed?
HepC Ab in all exposures, even thought that spontaneously clear virus/have successful tx
HepC viral RNA-those who are viremic only
How is HCV treated?
Interferon therapy
Polymerase Inh, Protease Inh
What evidence suggests that HCV has been eradicated?
undetectable virus 6mo after completion of therapy
