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Microbiology Exam III > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

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1
Q

Three main clinical presentations of Hepatitis

A

1) Acute
2) Chronic
3) Fulminant

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2
Q

Acute Viral Hepatitis Symptoms

A

1) Jaundice
2) Dark Urine
3) Acholic stool (light or clay-colored due to reduced bile production)
4) Prodrome (1-2 weeks prior to jaundice; Headache, myalgias, arthralgias, fatigue, nausea, vomiting, pharyngitis, mild fever)

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3
Q

Acute Viral Hepatitis Biochemistry

A

1) Bilirubin Levels
>3 mg/dL Jaundice
Commonly 5-20 mg/dL
Bilirubin in urine = liver disease

2) Liver Enzymes
- Alanine aminotransferase (ALT)
- Aspartate aminotransferase (AST)
- Elevation apparent as early as PRODROME PHASE
- Usually higher than that of other hepatitis causes
- May be up to 1000 U/L-ALT

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4
Q

Chronic Viral Hepatitis

A
  • Hepatitis which DOES NOT resolve within 6 months

- Predisposes to hepatocellular carcinoma and cirrhosis

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5
Q

Fulminant Viral Hepatitis

A
  • RAPID, SEVERE hepatitis
  • Massive hepatic NECROSIS
  • Encephalopathy (CNS EFFECTS): confusion, disorientation, coma
  • Edema
  • Complications: cerebral edema, brainstem compression, GI bleeding, sepsis, organ failure
  • LIVER TRANSPLANT can be lifesaving
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6
Q

Hepatitis A (Virus Family, Transmission, Chronic Infection)

A

Picornavirus, Fecal-Oral, No

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7
Q

Hepatitis B (Virus Family, Transmission, Chronic Infection)

A

Hepadnavirus, Body Fluids, Yes

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8
Q

Hepatitis C (Virus Family, Transmission, Chronic Infection)

A

Flavivirus, Body Fluids, Yes

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9
Q

Hepatitis D (Virus Family, Transmission, Chronic Infection)

A

Deltavirus, Body Fluids, Yes

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10
Q

Hepatitis E (Virus Family, Transmission, Chronic Infection)

A

Hepevirus, Fecal-Oral, No

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11
Q

Hepatitis A

A 
Picornavirus Family
\+ssRNA
Fecal oral transmission
Seroprevalence 30%
All age groups susceptible, children usually ASYMPTOMATIC
Incubation period ~28 days
Resolution usually within 2 months
***DOES NOT cause chronic hepatitis***
Very rarely causes fulminant hepatitis
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12
Q

Hepatitis A (Diagnosis)

A

Acute Infection = IgM antibodies against HAV

Anti-HAV IgG antibodies protective immunity (will be present in patients who were PREVIOUSLY exposed)

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13
Q

Hepatitis A (Prevention)

A
  • HAVRIX and VAQTA
  • IM injection (2 dose schedule)
  • Since 2005, ACIP recommends universal vaccination for all infants (12-23 months), as well as high risk adult groups
  • Post-exposure Prophylaxis* (Vaccine or anti-HAV IgG antibodies)
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14
Q

Hepatitis B (Appearance)

A

Tubes and Spheres: Incomplete, Noninfectious particles (Hepatitis B Surface Antigen - HBsAg)

Dane Particles: Complete Virions (HBsAg, Hepatitis B Core Antigen - HBcAg, and HBeAg)

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15
Q

Hepatitis B (Characteristics)

A

Hepadnavirus Family
Partially dsDNA genome
REVERSE TRANSCRIPTION (via reverse transcriptase) is part of life cycle

NOT a Retrovirus

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16
Q

Hepatitis B (Acute vs Chronic)

A

Acute:

  • HBsAg is cleared PRIOR TO 6 months
  • After this will see Anti-HBs
  • Early–> will see IgM
  • Late–> will see IgG

Chronic:

  • HBsAg is maintained for a long period of time
  • **DO NOT have Anti-HBs in this type because it is seen in RECOVERY and you are not having recovery in chronic infections
17
Q

Hepatitis B (Diagnosis)

A
  • Viral antigens and anti-HBV antibodies used for diagnosis

- Presence of HBsAg within the blood is a marker of ACTIVE INFECTION

18
Q

Hepatitis B (Acute vs Chronic Lab Tests)

A

Acute: Anti-HBc Total and IgM are POSITIVE

Chronic: Anti-HBc Total is POSITIVE and IgM is NEGATIVE

19
Q

How do you know if a patient is susceptible to HBV?

A

They will have a NEGATIVE Anti-HBc Total test

20
Q

How do you know if a patient has been previously infected with HBV?

A

Positive Anti-HBsAg and Positive Anti-HBc Total test

21
Q

How do you know if a patient has been vaccinated against HBV?

A

Will have Positive Anti-HBsAg

22
Q

Hepatitis B (Characteristics)

A
  • Incubation period median 90 days
  • Transmission route = Bodily Fluids (e.g. sexual transmission, percutaneous needle stick (6-30%), perinatal transmission at birth (10-90%)
  • Half of infected adults are ASYMPTOMATIC
  • Acute symptoms are often MILDER than HAV

Younger you are, the more likely you are to develop a chronic HBV infection
Birth = 90% ; Over 5 years old = 10%

23
Q

Hepatitis B (Treatment)

A
  • None for acute infections
  • Chronic infections
    a) Lamivudine —> REVERSE TRANSCRIPTION INHIBITOR
    b) Famcyclovir/Adefovir dipivoxil: NUCLEOSIDE INHIBITOR
    c) Interferon alpha

Usually a combo of either A and C or B and C

24
Q

Hepatitis B (Vaccine)

A

IM injection - 3 dose schedule
Currently use Recombinant HBV vaccine produce in YEAST CELLS (Recombinvax HB and Engerix B)
-Recommended for all infants (1st dose soon after delivery)

25
Q

Hepatitis B (Post-Exposure Prophylaxis)

A
  • Premature infants born to mothers of unknown or HBsAg positive receive VACCINE and HEPATITIS B IMMUNOGLOBIN (HBIG) within 12 hours of birth
  • Full term infants born of HBsAg positive receive VACCINE and HBIG within 12 hours of birth
  • Percutaneous exposure of healthcare workers
26
Q

Hepatitis C (Characteristics)

A

Flavivirus Family
ENVELOPED
+ssRNA genome

27
Q

Hepatitis C (Transmission)

A
  • INJECTION DRUG USE
  • Tattoos
  • Accidental needle stick (1.8%)
  • Perinatal (4%)
  • Sexual (VERY UNCOMMON)
28
Q

Hepatitis C (Diagnosis)

A

Chronic infection suspected
Two-Step Test:
1) Screening test–> antibody-based test for anti-HCV antibodies
2) Confirmatory test–> Nucleic acid based tests for detection of the viral genome

29
Q

Hepatitis C (Symptoms)

A

MILDER acute symptoms than HAV or HBV

Disease outcomes (across all age groups):

  • 15% acute only
  • 15% rapid progression to CIRRHOSIS
  • 70% CHRONIC INFECTION
30
Q

Hepatitis C (Treatment)

A
  • Only treat CHRONIC infections*
  • All treatments include SOFOSBUVIR (an RNA-Dependent RNA Polymerase Inhibitor)
  • Very expensive; newest way to treat Hep C
31
Q

Hepatitis C (Prevention)

A

NO VACCINE AVAILABLE

  • Reduce high risk behaviors (e.g. IV drug use or unprotected sex)
  • Screening of bloody supply
32
Q

Hepatitis D (Characteristics)

A
  • Small circular ssRNA genome
  • Encodes TWO PROTEINS (Delta-Short and Delta-Long long) that cover antigen*
  • Unique helper-dependent virus* (e.g. RELIES ON ANOTHER VIRUS (Hepatitis B))
  • Hepatitis B surface antigen forms the external surface of virion
  • Replication REQUIRES HBV proteins*

KNOW: only infects cells that have been previously or concurrently infected with HBV

33
Q

Hepatitis D (Disease)

A

FULMINANT HEPATITIS is a more likely outcome of HBV and HDV double infection than any other single hepatitis virus infection

Hepatitis D virus is the ONLY hepatitis virus that DIRECTLY INJURES HEPATOCYTES

Chronic infection can occur = carriers

34
Q

Hepatitis D (Diagnosis, Treatment, Prevention)

A

Diagnosis:
-ELISA to detect anti-HDV antibodies or the delta antigens

Treatment:
NO SPECIFIC ANTIVIRAL TREATMENTS

Preventions:
Since HBV infection is ABSOLUTELY required for HDV to infect and cause disease, vaccination against HBV prevents HDV disease

35
Q

Hepatitis E (Characteristics)

A

-Hepevirus family
+ssRNA genome
-Fecal oral transmission
DOES NOT cause chronic infection
-Most cases in US are travel-related
-Epidemics: India, Pakistan, Nepal, Burma, North Africa, and Mexico
-High risk of death due to infection in PREGNANT WOMEN (~20% mortality rate)

36
Q

Hepatitis E (Treatment and Prevention)

A

Treatment:
-Alleviate symptoms

Prevention:
-Prevent spread by providing clean water and proper food handling

Microbiology Exam III (9 decks)

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