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ID Review > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

Which Viral Hepatitis is not an RNA virus?

A

Hep B: DNA virus

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2
Q

Which Viral Hepatitis is a member of the Picorna Virus family?

A

Hep A (PERCH)
Non-enveloped, (+)ssRNA, linear, icosahedral
Synthesizes a large polypeptide that is cleaved to smaller viral proteins

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3
Q

Hep A incubation period

A

30 days

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4
Q

Acute disease

A

Anti-HAV IgM antibodies plus symptoms

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5
Q

Prior disease

A

Anti-HAV IgG antibodies

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6
Q

Hep E virus

A

Hepevirus
Non-enveloped, (+)ssRNA, linear, icosahedral
25% mortality rate in pregnancy

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7
Q

Hep B virus

A 
Hepadnavirus (DNA virus)
Enveloped, circular, icosahedral capsid
Partially double stranded DNA virus
Envelope from ER
Incubation period: 1-4 months
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8
Q

Immune Reconstitution

A

If HIV is treated w/o treating Hep B it can cause severe liver damage
Hep B is usually done prior to HIV therapy

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9
Q

Hep B Extrahepatic Manifestations

A

Polyarteritis nodosa

Glomerular disease

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10
Q

Hep B Surface Antigen

A

HBsAg
Hallmark of infection
Glycoprotein that forms spheres and tubules (EM)
From surface of envelope
Detectable weeks after exposure, prior to symptoms

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11
Q

Hep B Vaccine

A

Contains recombinant HBsAg
Contains (+) anti-HBsAg
All other antibodies (HBc, HBe) should be negative

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12
Q

Hep B Core Antigen

A 
HBcAg
IC ag (comes from w/n hepatocytes)
Capsid core protein
Expressed by infected hepatocytes
NOT detectable is serum
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13
Q

Window Period

A

Brief period where:
HbsAg undetectable
Anti-HBsAg not yet detectable
Can give false appearance of no infection
SOLE marker of infection is anti-HBc (IgM)

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14
Q

Hep B e Antigen

A 
HBeAg
Viral protein secreted by infected cells
Part of capsid core
Indicates significant viral rep
-Correlates well with levels of HBV DNA
-HBsAg indicates presence of virus, not necessarily replication
Highly infectious
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15
Q

Hep B DNA

A

Detectable with PCR

Major role is determining “viral load” for treatment

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16
Q

Acute Hep B

A

HBsAg (except window)
IgM Anti-HBc (even during window)
HBeAg (indicates infectivity)
HBV DNA

17
Q

Recovery after acute Hep B

A 
Anti-HBs
Anti-HBe
Anti-HBc (IgG)
Undetectable HBsAg
Absence of HBV DNA
18
Q

Prior Vaccination

A

Anti-HbsAg only

Not anti-HBc or anti-HBe

19
Q

Chronic Infection

A

HBsAg positive
If HBeAg = High infectivity
Anti-HBc positive
Viral DNA may be high, low depending on viral load

20
Q

(+) HBsAg

A

Pt infected

21
Q

(-) HBsAg

A

Pt not infected

22
Q

Acute Hep B

A

Supportive care

23
Q

Chronic Hep B

A

Interferon
Lamivudine (NRTI): also HIV drug, Hep B also uses reverse transcriptase
Other antiviral drugs

24
Q

Which Hep Virus is a Flavivirus?

A 
Hep C
(+) ssRNA, linear, icosahedral
High degree of antigenic variation
Envelope glycoproteins:
-Contains hypervariable region
-high mutation rate in genome
-Lack of proofreading by viral RNA polymerase
-Prone to frequent mutations so difficult for immune system to eradicate; becomes chronic
25
Q

Chronic Hep C

A

Often asymptomatic

Incidental finding on liver function test

26
Q

Hep C Dx

A 
HCV RNA by PCR
-elevated soon after exposure
Anti-HCV
-elevated by 12 weeks after exposure
Both elevated in chronic disease (common)
27
Q

Chronic Hep C Tx

A

Interferon (cytokine)
Ribiviron (anti-viral)
Others

28
Q

Hep D

A

Delta Agent
Small, enveloped, (-) RNA virus, circular genome
Defective virus
Lacks gene for envelope proteins so uses HBsAg for envelope protein
Genome encodes one protein: delta antigen (HDAg)
Virus particles carry HDAg

29
Q

Hep D Pathogenesis

A 
Invades hepatocytes
Travels to nucleus to replicate
Uses HBV to provide envelope
Virus particle coated with HBsAg
Uses host cell RNA polymerase to replicate genome
30
Q

Hep D Coinfection

A

Get Hep B and Hep D at same time

31
Q

Hep D Superinfection

A

Hep D infection on top of chronic Hep B infection. Often leads to hepatitis flare.

32
Q

Hep D dx

A

HDAg in serum
HDV RNA
Anti-HDV antibodies

ID Review (23 decks)

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