Viral Hepatitis

Question 1

What three non-hepatitis viruses can cause hepatitis?

Answer 1

CMV, EBV, HSV

all in the herpes family

Question 2

What is the course and presentation of CMV hepatitis?

Answer 2

Generally causes hepatitis in children, or immunosuppressed adults.

Anicteric hepatitis with no chronic phase propensity, may be lethal in immunosuppressed

Question 3

What atypical hepatitis occurs in immunosuppressed individuals and is associated with high mortality? How is it seen? What is the treatment?

Answer 3

HSV -> seen by inclusion bodies on light microscope

Treatment is acyclovir or vidarabine

Question 4

What is the relative incubation period of all the hepatitis?

Answer 4

Vowels hit the bowels = short incubation (A/E)

Long incubation = B,C,D

D will be short if its a superinfection

Question 5

Who tends to get jaundice in Hepatitis A?

Answer 5

Tends to be the adults -> think of the adult puking in sketchy. This leads to higher mortality.

In children it’s an anicteric disease

Question 6

What lab test indicates acute hepatitis A infection, and does it become chronic?

Answer 6

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

Question 7

Is Hepatitis B virus very contagious? How is it transmitted?

Answer 7

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

Question 8

Who is considered at highest risk for HBV?

Answer 8

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

Question 9

What immune marker is ordered to confirm acute hepatitis B?

Answer 9

IgM anti-HBc - core antigen

Question 10

What would be the markers for chronic HBV infection vs exposure and clearance of HBV infection vs evidence of immunization?

Answer 10

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

Question 11

Who tends to develop chronic hepatitis B? Is jaundice common?

Answer 11

Neonates - 90% of cookie eaten

Adults - 10% of cookie eaten

Jaundice is relatively uncommon

Question 12

What asserts the highest risk of cirrhosis, HCC, and chronic carrier state with HBV?

Answer 12

Integration of HBV genome into liver cell DNA

Question 13

Is acute liver failure common in HBV? What drugs are used to treat chronic infection?

Answer 13

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

Question 14

What is used for HBV prophylaxis in possibly exposed infants?

Answer 14

Combination of HB Ig and HB vaccination (active and passive immunization within 12 hours)

Question 15

Who is at particular risk of HDV? What type of infection is worst?

Answer 15

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

Question 16

Who is the largest group to get Hepatitis C?

Answer 16

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

Question 17

How does acute HCV compare to HAV or HBV? Chronicity?

Answer 17

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.

Question 18

What is the gold standard for detecting HCV?

Answer 18

PCR which detects HCV RNA

-> antibodies take months to be detectable

Question 19

How is hepatitis E virus transmitted and why is it unique? What type of virus is it?

Answer 19

Fecal-oral, especially from contaminated water

RNA hepevirus

Unique - only human hepatitis virus with an animal reservoir (swine)

Question 20

What is the clinical course for HEV in regular people?

Answer 20

Mild, uncommonly associated with jaundice

No carrier state or chronic liver disease (like hepatitis A) unless immunosuppressed

Question 21

Who is at greatest risk for severe disease with HEV? How is the virus detected?

Answer 21

Expectant (pregnant) women
-> high mortality

Virus is detected via PCR for HEV-RNA, like HCV

Question 22

What is the treatment for HCV?

Answer 22

Direct Acting Antivirals - especially protease inhibitors (think of cleaver in the tree)

Ribavirin and interferon alpha (bones and antenna in sketchy) are old treatments

Question 23

What is the treatment for HCV?

Answer 23

Direct Acting Antivirals - especially protease inhibitors (think of cleaver in the tree)

Ribavirin and interferon alpha (bones and antenna in sketchy) are old treatments