Viral Hepatitis

Question 1

Hepatitis A

Answer 1

Hep. A: stable for weeks or months in a moist environment.

• RNA virus
• Transmission: Fecal oral route, food and water born disease. Good hygienehelps a lot!
• Incubation Period: Lasts for 10-50 days
• Long Term Sequelae: Flu like illness with elevated liver enzymes

Question 2

Hepatitis B

Answer 2

• DNA virus (hepadnaviruses)
• Mode of transmission: Source is only human carriers.. if someone infected at birth HIGH CHANCE TO BECOME CHRONIC CARRIER. Two times of Transmission.
  - Horizontal: blood products, IV drug use sharing needles, sexual transmission
  - Vertical: Mother to infant at birth. At time of birth blood from mother (if carrier) although small amount of blood contact can transmit disease!
• Incubation Period: 6 weeks-6months
• Long Term Sequelae: Chronic inflammation of the liver, which can lead to cirrhosis and cancer in the liver. Longer the patient carries the virus, the more likely they are to develop cancer!

Question 3

Hepatitis C

Answer 3

• RNA virus, Many genotypes.. thus VACCINE IS VERY HARD TO DEVELOP! And when you create HCV antibodies.. might not protect you from other genotypes!
• Mode of transmission:
  
  1. Blood and blood products
  2. Contact with blood through illicit drug use most common
  3. Sexual Transmission
  4. Vertical Transmission
• Incubation Period: 6-7 weeks
• Long Term Sequelae:
• Clinical: fatigue, spider nevi (disappears completely when pushing on it, but then when you take your finger off it fills up from inside out!). Redness in thumbs. Spleen and liver palpable.

Question 4

Hepatitis D

Answer 4

• Circular RNA virus
• Mode of transmission: Similar to Hep B. Blood/fluids!
• More aggressive than Hep B
• Needs Hep B surface antigens for its envelope.. thus only HBV infected individuals get Hep D!
• Look for HDAg or HDV-RNA in serum
• No treatment

Question 5

Hepatitis E

Answer 5

• RNA Virus
• Mode of transmission: Like Hep. A, oral fecal!
• Incubation Period: 2 weeks to 2 months
• Diagnosis: IgM to HEV
• Higher mortality in pregnancy
• Found in Asia, middle east, and africa… 50% of acute hepatitis to young adults is due to Hep E in these areas…
• 2 vaccines exist

Question 6

Clinical features of Acute Viral Hepatitis

Answer 6

• Flu-like illness
• Darkening of urine
• Stool becoming pale
• Yellow discoloration of the sclera or skin (jaundice)
• Increased liver enzymes (transaminases)

Question 7

DO QUIZLET!

Answer 7

DO QUIZLET FLASHCARDS

Question 8

How to interpret Hepatitis B serology and Hep C

Answer 8

HEP B: Right after infection first marker of Hep. B infection which is Hep B surface Antigen (HBsAg) appears in the serum. This will peak after period of several weeks and disappear if patient does not become chronic carrier. This is then followed by the appearance of Hepatitis B surface antibody (HBsAb). Often prior to the antibody appearing Hepatitis core antibody (HBcAB) appears in serum. If you are a chronic carrier, then HBeAG (surrogate marker for HBcAg) will remains in serum. BUT!!! HEP B VIRUS DNA IS THE MOST IMPORTANT MARKER OF THE INFECTOIUS VIRUS THAT CAN BE DETECTED IN THE SERUM. If you have HBsAg… you then look at HBV-DNA. If you have HBV-DNA then you are a carrier and are infectious. Otherwise.. not infectious!
HEP C: Antibody to HEP C, once infected… remained positive even if virus eliminated. HEP C PCR for HCV RNA. Viral Genotype… assessment for treatment.. which genotype is causing the disease!

Question 9

Hepatitis B Treatment

Answer 9

Hep B:- Treat when in Immune reactive phase! That is… HBeAg positive and HBV-DNA high! These patients need therapy. Usually if HBV-DNA is low or undetected… don’t need therapy.. give therapy if High HBV-DNA! Therapy is prolonged or life-long and thus VERY EXPENSIVE.

- Antiviral Agents:
	1. Pegylated interon - helps in 30% of treated patients.. usually for younger patients. Only therapy for 6 months and better chance to be gone forever.
	2. Nucleoside analogues - direct acting antivirals. Antiviral agents: Entevavir or Tenofovir. These decrease HBV-DNA, normalize liver enzymes and prevent cirrhosis and hepatocellular carcinoma. Oral administration, once per day, minimal side effects. Although life long use!

Question 10

Hepatitis C Treatment

Answer 10

• Direct Acting Antivirals.

- NS3/4A protease inhibitors, NS5B Rna polymerase inhibitors, NS5A inhibitors. Use NS5A and NS5B in combination!

Question 11

Primary and Secondary methods of prevention of hepatitis Infections

Answer 11

Primary:

1. Universal precausing..
2. Screening of blood and blood products
3. Hepatitis B Immunoglobulin … given to an infant or unimmunized individual.
4. Vaccine… both before someone gets it, and infants born to carrier mothers get vaccine and Hep B immunoglobulin at birth!

Secondary:
- Antivirals