Viral hepatitis Flashcards
which of the hepatitis viruses are rna and which are DNA?
All are RNA apart from hep B
hep a virus is of which family?
Picornaviridae
which hep viruses are of feace-oral contact?
Hep A and E
the first and the last
an image of a table is very helpful
patient comes back from India, 6 weeks later they develop, jaundice, RUQ discomfort.
diagnosis?
hep a
come from an endemic area
Incubation period: 2-6 weeks
which hepatitis produce chronic infection and which don’t?
Chronic: B, C, E
No chronicity: Hep A
Which liver marker do we look at with hepatitis serology?
how does it change?
ALT - usually raised
2-3x normal - not in thousands!
patient has Anti-HAV IgM in serology. meaning?
acute infection
patient has Anti-HAV IgG in serology. meaning?
past infection OR vaccination
what advice would you give to hep A patient regards to work?
Advice for patient: stay off work for 7 days from onset symptoms
BECAUSE are infectious 2 wks before symptoms start
when are people given a hep A vaccine?:
for pre-exposure prophylaxis or recent exposure:
Travel to high risk country Chronic liver disease Haemophilia People who inject drugs ‘PWID’ MSM - men who have sex with men Occupational risk: lab, residential facilities, sewage work
treatment for some1 with confirmed hep A?
no cure
supportive care
liver transplant if deteriorate
in those with hep a, which group are most likely to present with jaundice
adults / over 14s
which virus is of the hepadnavirus family?
Hep B
which hep viruses are transmitted via:
sexual, parenteral, vertical
Hep B
characterise chronic infection in
- Hep B
- Hep E
B: HBsAg positive > 6 months
E: HEV RNA positive > 3 months
which hep virus has the longest incubation period?
Hep B - 2-6 months
hep c can also be 6 months but can start in weeks too
how many under 5s develop hep B?
90%
how many adults develop hep b?
10%
kids with acute hepatitis infection present how?
no symptoms
what part of the hep b drug structure is a target?
dna polymerase
what is the order of hep b structural components from outside to in?
surface antigen
e antigen
core antigen
ds DNA and dna polymerase
HBsAb: marker of _____ ?
IMMUNITY
core+envelope Ab positive denotes?
past infection
core+envelope Ab negative, SAb + denotes?
vaccination
SAg-
EAg -
Core Ab-
Sab +
denotes?
vaccination
mnemonic of decreasing order of abundance igs?
GAMED
g most abundant because for long term immunity
Anti-HBc IgM (core IgM) means?
acute infection
what components of the hep b can’t you have in vaccine?
e and core antigen
which is the marker of active replication i.e. infectiousness
e antigen
HBeAg
Anti-HBe means?
past/chronic
HBV DNA means?
active replication
SAg+ EAg+ Core Ab +
denotes?
Acute infection - if IgM
Chronic infection - if IgG. high risk
SAg+ EAg- Core Ab +
Resolving acute
chronic low risk
SAg- EAg-
Core Ab +
resolved infection
reactivation risk - latency
NOT a vaccine because its CORE antibody not surface
SAg- EAg-
Core Ab -
SAb -
no exposure - not immune
vaccinate risk groups
how long after infection are Anti-HBs (HBsAb positive)
made? in acute infection
8 months / 32 weeks
what does serology look like in acute hep b with recovery?
RECOVERY:
HBsAg loss
Anti-HBs (HBsAb positive)
what does serology look ini in chronic hep b?
NO surface antibody
BUT you get core antibody: Igm + igg
LOTS of HBsAg
what’s the gold standard card in cirrhosis diagnostics?
histopath
ivx for hcc : hepatocellular carcinoma?
AFP - also high in pregnancy
imaging : ULTRASOUND
patient with test signs:
Radiology:
coarse echotexture, nodularity,
portal HTN – splenomegaly
which condition?
cirrhosis
who with Hep B should be treated?
HBeAg +
HBV DNA > 20k & ALT x2
Cirrhosis + HBV DNA detectable
- the greater the load of hbv dna, the gr8er risk of cirrhosis and HCC
what do you want from hbv treatment?
REDUCE HBV DNA load!!
also SAg , eAg too.
ALT normalization
mmemonic for HEP B treatment?
TILE
T- Tenofovir*
I - pegylated interferon alpha
L- lamivudine
E- Entacavir*
*NRTI
what is the MOA of NRTIs?
inhibit DNA polymerase
high genetic barrier to resistance - tenfovir and entecavir
which hep b drugs indue eAg, sAg loss
pegylated interferon alpha
sc injections
bad side effects
how long to take tenfovir and entecavir for?
until HBsAg loss
how is hep b prevented in UK?
Routine Vaccination:
2 months, 3 months, 4 months
is baby is HBsAg positive, eAg negative how to treat?
vaccine at birth + routine schedule
HBsAg positive, eAg positive how to treat?
vaccine at birth PLUS HBIG within 48 hours
what does the hep b vaccine consist of?
Recombinant vaccine (HBsAg)
can you get hep c from sex?
NO
when can one get hep e?
range but
chronic infection - post transplant and immunosuppresed
which is the only non-vaccine preventable hep virus?
hep c
hep c is acquired from?
blood products
what marker is used to diagnose hep c?
problems?
what to measure instead ?
Anti-HCV antibody
rises after 4 weeks. -ALT rises first!
measure - HCV RNA
treatment for hep c?
everyone who has it gets treatment with:
Direct acting antivirals - NS3,4,5 inhibitors
(serine) Protease inhibitors
which hep virus can you get only if you have hep b?
hep d
if one has hep b and d co-infection, can this become chronic?
no
if one has hep b and d SUPER infection, can this become chronic?
yes
happens in people who already have hep b
how to prevent hep d?
hep b vaccine + post exposure prophylaxis
which hep b genotypes affect humans?
GT 1 and 2 directly
3 and 4 only IF humans eat undercooked meat
which hep virus are pregnanct women at risk of death from?
hep e
how to diagnose hep e in
- immunocompetent
- immunocompromised
?
- immunocompetent : anti-hep e antibodies
2. immunocompromised: hep e RNA
which hep virus is associated with extra hepatic manifestation of which neurological signs most important?
hep e
treatment/prevention for hep e?
supportive
RIBAVIRIN
RARE COMPLICATIONS:
CNS disease – Bell’s palsy, Guillain Barre, other neuropathy
are found in?
hep e
