Viral Hepatitis Flashcards
What three non-hepatitis viruses can cause hepatitis?
CMV, EBV, HSV
all in the herpes family
What is the course and presentation of CMV hepatitis?
Generally causes hepatitis in children, or immunosuppressed adults.
Anicteric hepatitis with no chronic phase propensity, may be lethal in immunosuppressed
What atypical hepatitis occurs in immunosuppressed individuals and is associated with high mortality? How is it seen? What is the treatment?
HSV -> seen by inclusion bodies on light microscope
Treatment is acyclovir or vidarabine
What is the relative incubation period of all the hepatitis?
Vowels hit the bowels = short incubation (A/E)
Long incubation = B,C,D
D will be short if its a superinfection
Who tends to get jaundice in Hepatitis A?
Tends to be the adults -> think of the adult puking in sketchy. This leads to higher mortality.
In children it’s an anicteric disease
What lab test indicates acute hepatitis A infection, and does it become chronic?
HAV IgM antibody
Does not become chronic -> may wax and wane in LFTs, but ultimately always resolves.
Can cause acute liver failure in some folks
Is Hepatitis B virus very contagious? How is it transmitted?
Sex, drugs, and rock and roll
-> sex, sharing needles, personal items
Most common route of transmission: Vertical transmission
It is considered more contagious than HIV -> doesn’t take very much, can even be spread by sharing personal items like razors
Who is considered at highest risk for HBV?
Men who have sex with men (trauma during sex), people born in areas with high rates of chronic HBV (especially Asia), and those with multiple sex partners
What immune marker is ordered to confirm acute hepatitis B?
IgM anti-HBc - core antigen
What would be the markers for chronic HBV infection vs exposure and clearance of HBV infection vs evidence of immunization?
Chronic HBV: HBsAg, anti-HBc, no anti-HBs
Exposure and clearance: no HBsAg, anti-HBc, anti-HBs
Immuzation: no HBsAg, no anti-HBc (Formed in fighting virus), anti-HBs
Who tends to develop chronic hepatitis B? Is jaundice common?
Neonates - 90% of cookie eaten
Adults - 10% of cookie eaten
Jaundice is relatively uncommon
What asserts the highest risk of cirrhosis, HCC, and chronic carrier state with HBV?
Integration of HBV genome into liver cell DNA
Is acute liver failure common in HBV? What drugs are used to treat chronic infection?
No -> chronic carrier state can be though.
Drugs: Think NRTI wielding mace and lamb (lamivudine), as well as IFN-alpha antenna
Most commonly used are entecavir and tenofovir, suppressing virus
What is used for HBV prophylaxis in possibly exposed infants?
Combination of HB Ig and HB vaccination (active and passive immunization within 12 hours)
Who is at particular risk of HDV? What type of infection is worst?
Injection drug users
Worse: superinfection (acute HDV on chronic HBV) -> uses HBV coat to replication, causes chronic liver disease in 90%
Better: Co-infection (acute + acute) - usually self-limited
Who is the largest group to get Hepatitis C?
Prior to 1990, major mode of transmission was blood transfusion
-> baby boomers constitute 70% of infection, and largest group at risk for infection are IV drug users
How does acute HCV compare to HAV or HBV? Chronicity?
HCV - less severe, often subclinical - acute liver failure is very rare
Chronicity - C= chronic, develops chronic hepatitis / cirrhosis in 80% of patients. When symptoms have emerged, end stage liver disease is common.
What is the gold standard for detecting HCV?
PCR which detects HCV RNA
-> antibodies take months to be detectable
How is hepatitis E virus transmitted and why is it unique? What type of virus is it?
Fecal-oral, especially from contaminated water
RNA hepevirus
Unique - only human hepatitis virus with an animal reservoir (swine)
What is the clinical course for HEV in regular people?
Mild, uncommonly associated with jaundice
No carrier state or chronic liver disease (like hepatitis A) unless immunosuppressed
Who is at greatest risk for severe disease with HEV? How is the virus detected?
Expectant (pregnant) women
-> high mortality
Virus is detected via PCR for HEV-RNA, like HCV
What is the treatment for HCV?
Direct Acting Antivirals - especially protease inhibitors (think of cleaver in the tree)
Ribavirin and interferon alpha (bones and antenna in sketchy) are old treatments
What is the treatment for HCV?
Direct Acting Antivirals - especially protease inhibitors (think of cleaver in the tree)
Ribavirin and interferon alpha (bones and antenna in sketchy) are old treatments
