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MD3002 > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

Identify the main causes of hepatitis, and the pathogens involved with each.

A 
• Viral
• Non-viral
e.g. Toxoplasma gondii
• Drugs
e.g. paracetamol
• Alcohol
• Poisons
e.g. Aflatoxins 
e.g. Amanita phalloides (mushrooms)
• Other
e.g. Pregnancy
e.g. Circulatory insufficiency
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2
Q

Define hepatotropic. Which of the hepatitis viruses are hepatotropic ?

A

Demonstrate an ability to infect hepatocytes (liver cells)

All of them (A through E)

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3
Q

Identify all the main hepatitis viruses.

A 
Hepatitis A (HAV)
Hepatitis B (HBV)
Hepatitis C (HCV)
Hepatitis D (HDV)
Hepatitis E (HEV)
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4
Q

Which family do the hepatitis viruses belong to ?

A

All belong to different virus families (i.e. all possess entirely different properties)

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5
Q

Identify the main stages of viral replication.

A
  • Adsorption
  • Penetration
  • Uncoating
  • Replication of nucleic acid
  • Maturation / assembly
  • Release
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6
Q

HEPATITIS A

  • Family
  • Structure
  • Number of serotypes
A 
HEPATITIS A
-Family: Picornaviridae family
-Structure: 
Single-stranded RNA virus
Non-enveloped virus (naked)
-Number of serotypes: only 1 serotype
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7
Q

How does transmission of Hep A occur ?

A

• Spread by:
– Faecal-oral route
– Poor hand hygiene
– Contaminated food or water

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8
Q

What is the number of Hep A viruses present per gram of feces ?

A

100 million viruses present /gram faeces

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9
Q

How does shellfish lead to transmission of Hepatitis A virus ?

A
  • Sewage contaminated water
  • Filter action of shellfish leads to concentration of virus in flesh
  • Harvested shellfish carry high numbers of viruses
  • Eating raw or partly cooked shellfish leads to infection
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10
Q

Identify the main stages of HAV infection.

A
  • Incubation period of 2-4 weeks (prodromal phase)
  • Virus excreted in faeces for 1-2 weeks before symptoms
  • Translocation from GI tract to blood
  • Infection of liver cells
  • Passage to biliary tract and back to GI tract
  • Excretion in faeces
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11
Q

Identify the main clinical features of HAV.

A
  • Fever, anorexia
  • Nausea, vomiting
  • Jaundice
  • Dark urine, pale stools
  • Liver moderately enlarged
  • Spleen palpable in 10% patients
  • No chronic carriage
  • Diagnosed by presence of anti-HAV IgM
  • Prognosis excellent (mortality 0.1%) in young adults
  • Death if fulminant hepatic necrosis occurs
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12
Q

Describe the treatment of HAV.

A
  • No specific treatment
  • Maintain comfort and nutritional balance
  • Fluid and electrolyte replacement
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13
Q

Describe prevention of HAV.

A

• Vaccine
• Good hygiene
(Resistant to chlorination)
• Killed by boiling for 10 mins

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14
Q

HEPATITIS B

  • Family
  • Structure
A 
HEPATITIS B
-Family: Hepadnaviridae
-Structure: 
• Double-stranded DNA virus 
• Enveloped virus
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15
Q

Identify the main antigens involved with Hepatitis B, and explain their significance.

A

• HBsAg - surface antigen
– Indicates high transmissibility
– HBsAb provides immunity and appears late (not in carriers)

• HBcAg – core antigen
– HBcAb appears early in infection

• HBeAg - envelope antigen
– Derived from core
– Indicates high infectivity

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16
Q

How does transmission of Hepatitis B occur ?

A
  • Sexual intercourse
  • Intra-uterine, peri- and post-natal infection
  • Blood or blood products
  • Contaminated needles and equipment used by intravenous drug users
  • In association with tattooing, body piercing and acupuncture
  • Contaminated haemodialysis equipment
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17
Q

Who is at risk of Hepatitis B infection ?

A

• Anyone coming into contact with blood / body fluids from someone infected with HBV

• At greatest risk are those who:
– Have sex with an infected person
– Have multiple sex partners
– Have a sexually transmitted infection
– Are men who have sex with men
– Inject drugs or share needles, syringes, or other drug equipment
– Live with a person who has chronic hepatitis B
– Are infants born to infected mothers
– Are exposed to blood / body fluids in their job
– Are hemodialysis patients
– Stay for a prolonged period of time in areas of the world with moderate to high rates of hepatitis B

18
Q

Identify the main stages of HBV infection.

A

• Incubation period of 2-4 months

• 50% patients develop chronic active hepatitis
- 20% of these proceed to cirrhosis
1-4% of these risk developing liver cancer

19
Q

Identify the main stages of HBV acute infection, and state how long each one lasts.

A
  • Incubation period of 45 – 120 days
  • Pre-icteric (preceding appearance of jaundice) period of 1 – 7 days
  • Icteric period of 1 – 2 months
  • Convalescent period of 2 – 3 months in 80-90% of adult cases
20
Q

Describe the evolution of levels of Hepatitis B antigens, and of antibodies to those antigens, in both acute, and chronic hepatitis.

A

ACUTE HEPATITIS
• HBsAg and HBeAg appear during incubation period (then levels go back down)
• Viral DNA becomes detectable
• Antibodies to core antigen (HBcAg) appear concomitantly with rise in liver transaminases
• Antibodies to HBeAg and HBsAg only appear during convalescence

CHRONIC HEPATITIS
• Continued presence of HBsAg and absence of antibodies to it indicate that infection has become chronic

21
Q

Describe the clinical features of the

1) Pre-icteric Period of HBV
2) Icteric Period

A 
1) Pre-icteric period
• Malaise
• Anorexia
• Nausea
• Pain in right upper quadrant (tender liver)
2) Icteric period
• Yellowish pigmentation (caused by hyperbilirubaemia)
– Skin
– Sclerae
– Other mucous membranes
22
Q

Identify the clinical outcomes of acute HBV infection.

A

• Fulminant hepatitis (“patient’s condition rapidly deteriorates, with hepatic encephalopathy, necrosis of the hepatic parenchyma, coagulopathy, renal failure, and coma”)
• Chronic hepatitis or asymptomatic carrier
state
• Resolution of infection

23
Q

Describe the treatment for HBV.

A

• Pegylated interferon (peginterferon): superior
compared to α-interferon alone
• Nucleoside analogues such as oral lamivudine

24
Q

Describe the prevention for HBV.

A
  • Vaccination: 3 injections over 6 months
  • HBV immunoglobulin (prophylactic drug)
  • Blood screening
  • Needle exchange programmes
  • Sexual health education
25
Q

HEPATITIS C

  • Family
  • Structure
  • Number of genotypes
A 
HEPATITIS C
-Family: Flaviviridae
-Structure: 
• Single-stranded RNA
• Enveloped virus
-Number of genotypes: 6 virus types (from nucleotide sequences)
26
Q

Identify the main clinical features of HCV infection.

A
  • Usually asymptomatic
  • Fatigue
  • Nausea
  • Weight loss
  • May rarely progresses to cirrhosis
  • Small proportion of patients may develop hepatocellular carcinoma many years after primary infection
27
Q

How does HCV transmission occur ?

A
  • Blood and blood products (current incidence of transfusion-associated HCV is low)
  • Blood contaminated needles
  • Tattooing, body piercing, acupuncture
  • Haemodialysis
28
Q

Describe the main stages of HCV infection.

A
  • Virus replicates mainly in hepatocytes

* Incubation period 2 weeks to 6 months

29
Q

Which of the hepatitis viruses can we screen for ? How so ?

A

Hepatitis C

Blood test available for HCV based on NAAT

30
Q

Describe the treatment for HCV.

A

INTERFERON

  • Reduces liver transaminases in 80% of patients
  • Ribavirin works well in combination with pegylated α-interferon
COMBINATION THERAPY 
-Often one of these in addition to ribavirin and pegylated α-interferon 
Sofosbuvir (nucleotide analogue) 
Boceprevir (protease inhibitor) 
Telaprivir (nucleotide analogue) 
Daclatasvir (inhibits NS5A)
31
Q

How is prevention of Hep C achieved ?

A
  • No vaccine currently available

* Preventing transmission

32
Q

HEPATITIS D

-Structure

A

HEPATITIS D
-Structure:
Small (35nm) circular single-stranded RNA virus
HDV picks up HBsAg as it buds from liver cell

33
Q

Define a defective virus. Which of the hepatitis viruses is a defective virus ?

A

“Viruses which lack a complete genome so that they cannot completely replicate or cannot form a protein coat.”

Hepatitis D

34
Q

HDV

  • Transmission
  • Risk factors for infection
  • Treatment
A

HDV
-Transmission: Transmitted percutaneously, sexually, from infected blood

  • Risk factors for infection: Chronic HBV carriers are at risk for infection with HDV (HDV is found as co-infection with HBV; HBV serves as helper virus for infectious HDV production)
  • Treatment: No specific treatment is available
35
Q

HEPATITIS E

  • Family
  • Structure
A 
HEPATITIS E
-Family: Caliciviridae
-Structure: 
• Single-stranded RNA 
• Non-enveloped virus
36
Q

How does HEV transmission occur ?

A

• Waterborne disease

37
Q

Describe the epidemiology of HEV.

A

• Peak incidence in young adults

38
Q

State the incubation period, signs and symptoms of HEV infection.

A

HEV

  • Incubation period 3-8 weeks (but HEV usually self-limiting)
  • Signs and symptoms are similar to other acute forms of hepatitis (BUT can be life-threatening in pregnant woman)
39
Q

Describe prevention of HEV infection.

A
  • Good sanitation and hygiene

* Vaccine (Hecolin)

40
Q

Identify other viruses (besides the hepatitis viruses) which can cause viral hepatitis.

A
  • Epstein-Barr virus
  • Cytomegalovirus
  • Yellow fever virus
  • Adenoviruses
  • Bunyaviruses
  • Flaviviruses

MD3002 (95 decks)

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