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Review of Infectious Diseases > Viral hepatitis > Flashcards

Viral hepatitis Flashcards

1
Q

What is unique about Hepatitis D?

A

It requires co-infection with HBV to replicate.

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2
Q

Spectrum of clinical presentations

A
  1. Asymptomatic
  2. Symptomatic without jaundice (anicteric)
  3. Symptomatic with jaundice + mild flu-like symptoms
  4. Jaundice with abdominal pain
  5. Liver failure
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3
Q

What is the 1st line diagnostic test in viral hepatitis?

A

Serology

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4
Q

Route of transmission of HepA

A

Faeco-oral route

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5
Q

Sources of infection of HepA

A

Contaminated food and water

+ Person-to-person spread

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6
Q

When is the most infectious period of HepA?

A

One week prior to onset of symptoms.

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7
Q

Clinical presentation of children <4 yrs

A

Asymptomatic without jaundice

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8
Q

Clinical presentation of children 4-6 yrs

A

Symptomatic without jaundice

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9
Q

Clinical presentation of children >15 yrs and adults

A

Symptomatic + jaundice

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10
Q

HAV: Risk factors for a poor outcome

A

Age >40

Previous liver disease

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11
Q

Immunological response to acute HAV

A

Immune after first infection i.e. NO CHRONIC INFECTION or risk of liver Ca

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12
Q

T/F: HAV is a benign disease

A

True- it is a mild-moderately severe disease with a low risk of liver failure

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13
Q

HAV: Serological findings

A

Anti-HAV IgM= acute infection

Anti-HAV IgG= immune i.e. previous infection or vaccination

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14
Q

HAV: Liver enzymes

A

AST and ALT are 10-100x the ULN

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15
Q

Indications for HAV vaccine

A 
Pre-exposure
HIV 
Chronic liver disease 
Travel to high-risk countries 
High-risk occupational exposure
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16
Q

Which viral hepatitis is the leading cause of chronic liver damage worldwide?

A

Hepatitis B, followed by Hepatitis C

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17
Q

HBV: Routes of transmission in developing countries

A

Perinatal

Child-to-child

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18
Q

HBV: Routes of transmission in developed countries

A

Blood borne

Sexual transmission

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19
Q

Spectrum of liver damage in chronic HBV

A
  1. Inflammation
  2. Fibrosis
  3. Cirrhosis
  4. Liver failure
  5. HCC
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20
Q

Will neonates predominantly be symptomatic or asymptomatic?

A

Asymptomatic

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21
Q

Are children more likely to recover from acute HBV?

A

No, 70-95% of children develop chronic HBV/ become carriers

22
Q

What does + HBsAg mean?

A

Current infection (acute or chronic)

23
Q

HBeAg

A

Active DNA replication (+++ infectious)

24
Q

Anti-HBsAg

A

Immune due to previous infection/ vaccination

25
Q

Anti-HBcAb

A

Current infection (acute or chronic) or previous infection

26
Q

Anti-HBcAb IgM

A

Acute infection or flare

27
Q

Anti-HBeAb

A

Resolved infection (sAg neg) or less infectious chronic infection (sAg pos)

28
Q

Why should you do a viral load?

A

To quantify the severity of infection and decide on therapy

29
Q

What are the 3 effects of anti-HBV viral agents?

A
  1. Delay progression of cirrhosis
  2. Reduce incidence of HCC
  3. Improve long-term survival
30
Q

What nucleotide analogues are used in HBV treatment?

A

Tenofovir

Entecavir (if tenofovir not tolerated)

31
Q

Which two classes of drugs are used in the treatment of HBV?

A

Nucleotide analogues

+ Interferon

32
Q

What is meant by functional immunological cure?

A

Sustained DNA viral load suppression + loss of HBsAg

33
Q

Between INF and NA, which one is more likely to cure HBV infection?

A

INF

34
Q

Indications for HBV vaccination

A

Newborn babies
Children
Non-immune adults
Babies born from mothers with untreated HBsAg infection

35
Q

What is the definition of fulminant hepatitis?

A

Fulminant hepatitis, or fulminant hepatic failure, is defined as a clinical syndrome of severe liver function impairment, which causes hepatic coma and the decrease in synthesizing capacity of liver, and develops within eight weeks of the onset of hepatitis.

36
Q

What are the other 3 viral co-infections with HBV?

A
  1. HIV
  2. HCV
  3. HDV
37
Q

Transmission of HCV

A

Same as for HBV:
Intravenous drug use&raquo_space;> blood transfusions
MSM
Body piercings

38
Q

Is there a vaccine for HCV?

A

No vaccine, but there is a cure (expensive).

39
Q

Who is screened for HCV?

A

IV drug users
MSM
Unexplained elevated AST ad ALT

40
Q

What special investigations are used to diagnose HCV?

A

Serology (IgM) + confirm with PCR

41
Q

How is chronic HCV infection diagnosed with PCR?

A

If there is persistence of HCV RNA for 6 months after acute infection

42
Q

What is the most common cause of acute hepatitis and jaundice in the world, especially in East-Asia?

A

Hepatitis E virus

43
Q

What is the incubation period of HEV?

A

3-8 weeks?

44
Q

Which genotypes are the epidemic type?

A

Genotype 1+2

45
Q

Which genotypes are the sporadic type?

A

Genotype 3+4

46
Q

Route of transmission of HEV (genotype 1 and 2)

A

Faeco-oral contamination

47
Q

Route of transmission of HEV (genotype 3-4)

A

Exposure to infected animals + consumption of undercooked pork/ game

48
Q

What is acute-on-chronic hepatitis?

A

When a patient has pre-existing liver disease and now presents with sudden fulminant liver failure

49
Q

Which genotype of HEV is known to precipitate acute-on-chronic hepatitis?

A

Genotype 3

50
Q

Which genotype of HEV is associated with fulminant hepatitis and high mortality in PREGNANT woman?

A

Genotype 1

51
Q

T/F: The sporadic type f HEV does not cause severe disease?

A

True, unless acute-on-chronic phenomenon is seen

Review of Infectious Diseases (7 decks)

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