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Viral Hepatitis Flashcards

1
Q

Clinical manifestations of Acute viral hepatitis

A
  • Fever
  • Malaise
  • Anorexia
  • Nausea
  • Vomiting
  • Jaundice
  • Abdominal/RUQ pain
  • Hepatomegaly
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2
Q

Understand Hep A virus serology

A

refer to image

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3
Q

When do you have symptoms with Hep A virus?

Where do you see virus in body?

A

Symptoms peak at 1 month post exposure with high ALT

fecal HAV high

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4
Q

What lab is ordered if pt is suspected of HAV infeciton?

A

Order Hep A IgG test~ if comes back +, run for IgM to tell if it’s acute or old infection of over 6 months

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5
Q

When does IgM anti HAV peak?

IgG anti-HAV?

A

peaks at 3 months, then goes down

IgG starts to rise as 1 month and stays elevated= IMMUNITY

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6
Q

How do you prevent HAV

A
  • Hygiene (e.g., hand washing)
  • Sanitation (e.g., clean water sources)
  • Immune globulin (pre- and post-exposure)
  • Hepatitis A vaccine (pre-exposure)
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7
Q

Who do we recommend to recieve the Hep A vaccine?

A

Recommended for:
– Infants
– People working in or traveling to areas with high incidence of HAV
– People with chronic liver disease
– People working with HAV

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8
Q

Hep A:

____virus

____transmission

infection and serotypes:

Incubation period:

A

Hep A

RNA virus

fecal-oral transmission

inucbates for about 4 weeks

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9
Q
A
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10
Q

A patient of yours is going to an HAV infected area, what do you do for your pt?

A

Give patient the hepatitis A immunoglobulin; better then vaccine and you would need booster in 6 months

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11
Q

A pt of yours works at a daycare and just found out several of her kids have Hep A

What do you recommend?

A

Give pt the Hep A immunoglobulin if it’s w/in 14 days

recommend all her contants get it too

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12
Q

Area of HAV prevealance

is it chronic?

is it symptomatic?

A

Prevelant in S. America, Africa, Asia

not chonic

more sypmtomatic in adults (70%) and only 10% in children

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13
Q

What body fluids is HepA concentrated in?

A

Feces

Serum

Saliva

NOT urine

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14
Q

Understand Serology of Hep E virus

A

Understand serology

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15
Q

Transmission of Hep E:

Incubation period:

Case-Fatality:

A

Transmission: fecal-oral, contaminated water, minimal person-person contact, recent travel to endemic area

Incubates 40 days

Case fatality: ovearll 1-3% pregnant women 15-45%

no chronicity

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16
Q

When do we see Symptoms in Hep E pts?

A

Symtpoms when ALT rises during 5 months post exposure

see virus in stool

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17
Q

When do we see increase in IgG and IgM in Hep E infection

A

IgG increases at 2 months and stays elevated

IgM rises and goes back down after 6 months and is present during acute infection

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18
Q

How do you diagnose Hep E?

A

• Hep E ab (there is no tx for Hep E)
• Hep E IgM = acute (<6 months)
• Hep E IgG = previous exposure (>6months) and now immune
***protective antibody

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19
Q

Acute Hep B:

describe HBeAg and anti-HBe

A

in acute; HBeAg elevated and then there is seroconversion to anti-HBe

this is spontaneous and generally occurs around week 12

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20
Q

In the pt that clears Hep B virus, when do we see the peak in HBsAg

A

peaks at week 12 then goes back down

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21
Q

In acute Hep B what does the total anti-HBc stand for?

A

its teh core antigen for IgM and IgG

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22
Q

what is the sign that you are immune to hep B?

A

At 32 weeks there is increase in anti-HBs which means you are immune

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23
Q

Hep B is a _____virus

who does it infect?

Incubation period?

Acute-fatality:

A

DNA virus

infects humans and some primates

incubation is 60-90 days

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24
Q

Hep B

  • Acute case-fatality :
  • Chronicity determined by :
  • Premature mortality from chronic disease 15%-25%
  • Leading cause of ________worldwide
A

0.5%-1%

age at exposure

hepatocellular carcinoma

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25
Understand chronic Hep B
know figure
26
Why do we have chronic hep B?
there is no seroconversion from HBeAg to anti-HBe the E antibody never develops and viral load never gets cleared
27
What is the window period in Hep B?
The HBsAg will increase at week 4 adn then goes back down at 24 weeks the anti-HB IgG will start to rise at 32: there is an 8 week window to detect Hep B core antigen
28
• Hep B Surface ag+ =
current hep B (acute or chronic)
29
• Hep B surface ab+ =
immune (recovered from natural infection, vaccine)
30
Hep B • Core antibody = \_\_\_\_\_\_\_ IgM= recent exposure ( IgG= old exposure (\> 6 months)
natural exposure
31
Candidates for HBV vaccine
• Routine immunization • All infants and previously unvaccinated children by age 11 • Increased risk for HBV  People with multiple sexual partners  Sexual partners or household contacts of HBsAg-positive people  Homosexually active men  Users of illicit drugs  Travelers to regions of endemic disease ( \> 6 months)  People occupationally exposed to blood or body fluids  Clients or staffs of institutions for developmentally disabled persons  Patients with chronic renal failure  Patients receiving clotting-factor concentrates
32
Chronic Hep B virus is more common in adults or children
children, adults that get Hep B usually have acute infection Hep B infection is done via vertical transmission
33
You have pt with Hep B exposure in unvaccinated patients, what can you do for them?
• Give hepatitis B immune globulin **(HBIG)**, within 24 hours or up to a week after  Second HBIG dose 1 month after first -or- • Hepatitis **B vaccine,** preferably within 24 hours but can be given _up to a week after_  Second dose of vaccine 1 month after first  Third dose of vaccine 6 months after first
34
• In Hepatitis B surface antigen positive mothers, give newborn
both HBIG and vaccine
35
CHRONIC HEPATITIS B: GOALS OF THERAPY
* Eliminate or significantly suppress HBV replication * Prevent progression to cirrhosis and possibly hepatocellular carcinoma (HCC) * ALT normalization * Histological improvement * Loss of HBeAg, development of HBeAb (seroconversion) * Loss of HBsAg
36
What are modes of intervention in the treatement of chornic hepatits B infection
Antiviral therapy; works by smoking out virus or blocking DNA/RNA synthesis Immune response targeted such as immunomodulatorys or antiviral therapy to rev up immune system; these are interfeurons.
37
How does chronic Hep B Interferon work?
• Interferon  proteins (cytokines)  released by host cells when infected by viruses  activate immune system.
38
Chronic Hep B therapy works with nucleotide/nucleoside analogues:
block reverse transcriptase thats necessary for HBV replication; this is enough to acocmpish seroconversion, if you don't achieve seroconversion, need to stay on drugs
39
Two recommended Hep B treatments that are nucleotide/nucleoside analogues
Entecavir; nucleoside no resistance Tenofovir; nucleotide, no resistance develops These are both 1st line therapies Peg-IFN has potential in specific population (low viral load, high ALT/AST) gives chance for eradication
40
Side effect of Peg-INF
 flu-like symptoms  neuropsychiatric symptoms/depression  bone marrow depression
41
Goal of Hep B therapy: * Eliminate or significantly suppress HBV replication: * Prevent progression to :
approx. 30% after therapy discontinuation cirrhosis and possibly HCC
42
Therapy: for HBV • ALT normalization: approx. \_\_\_ • Histological improvement • Loss of HBeAg, development of HBeAb (seroconversion): approx. \_\_\_% • Loss of HBsAg: approx. \_\_\_%
• ALT normalization: approx. 30% • Histological improvement • Loss of HBeAg, development of HBeAb (seroconversion): approx. 30% • Loss of HBsAg: approx. 5-7%
43
Understand serology of Hep B/D coeinfection
person exposed to both at the same time. Pt clears Hep B and will still have anti-HB but anti-HD goes down
44
Concentration of HBV in various body fluids
High in blood, serum, wound exudates some in semen, vaginal fluid but low in urine, feces, sweat, tears Hetero/homosexual men at high rish
45
What does a Hep B-D Superinfection look like on serology?
Pt will have chronic Hep B, later time will get Hep D and will have chroinc infection of both Ig-M from Hep D will go back down but IgG for Hep D don't decrease Have chronic levels of HDV RNA and HBsAg
46
Diagnosis Hep D with antigens
• Hep D IgM = acute infection (\< 6 months) • Hep D IgG= previous exposure (\> 6 months)  IgG is not protective antibody
47
Natural history of HBV infection: starting with acute
acute--\> chronic in 90% children, 10% adults Chronic--\> cirrhosis 30% time Chronic--\> Liver cancer without going to cirrhosis 5-10% Cirrhosis--\> liver fail
48
Hep C is what kind of virus?
RNA, spherical Half-life = 2.7 hours Daily production= 10 to 12 virions some in US, all over the world with wide genotype distribution 1a most common in US
49
Hep C antibody seen in all exposures and remains present in all patients including those who spontaneously clear the virus or undergo successful treatment; what is present in only people that are viremic?
• Hepatitis C viral RNA is present only in those who are viremic
50
Understand Hep C serology
know this diagram
51
When do we see anti-HCV in pts?
starts to rise at 2 months, peaks at 6 months and stays elevated \*have HCV RNA present in blood w/in two weeks
52
Pattern of Hep C from acute to chronic infection
HCV RNA levels persist
53
What antivirals are there for Hep C?
Sofosbuvir/Ledipasvir
54
Cuase of Hep C
IVdrug use
55
How does fibrosis progress in Hepatits pts?
variable progression of fibrosis over time
56
HBsAg: negative anti-HBc : negative anti-HBs: negative
Susceptible to Hep B
57
HBsAg : negative: anti-HBc positive anti-HBs positive
Immune due to natural infection
58
HBsAg negative anti-HBc negative anti-HBs positive
Immune due to hepatitis B vaccination
59
HBsAg positive anti-HBc positive IgM anti-HBc positive anti-HBs negative
Acutely infected
60
HBsAg positive anti-HBc positive IgM anti-HBc negative anti-HBs negative
Chronically infected
61
Hepatitis B surface antibody (anti-HBs):
The presence of anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B virus infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B
62
``` IgM antibody to hepatitis B core antigen (IgM anti-HBc): ```
Positivity indicates recent infection with hepatitis B virus (\<6 mos). Its presence indicates acute infection.
63
Total hepatitis B core antibody (anti-HBc):
Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefi ned time frame
64
Hepatitis B surface antigen (HBsAg):
A protein on the surface of hepatitis B virus; it can be detected in high levels in serum during acute or chronic hepatitis B virus infection. The presence of HBsAg indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection.HBsAg is the antigen used to make hepatitis B vaccine.
65
Hep B window period
both serological markers HBsAg (Hepatitis B surface antigen) and Anti-HBs (antibodyagainst HBsAg) are negative (which is due to the fact that, although there are Anti-HBs antibodies present, they are actively bound to the HBsAg). Other serological markers, IgM (antibody) against HBc can be positive at this point but person wont be infective

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