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microbiology > Viral Hepatitis- Exam IV > Flashcards

Viral Hepatitis- Exam IV Flashcards

1
Q

A clinical syndrome characterized by inflammation of the liver

A

hepatitis

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2
Q

In viral hepatitis, ____ cell death releases ____ which causes ____.

A

hepatocyte; bilirubin; jaundice

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3
Q

A byproduct of heme metabolism in the liver (where heme is detoxified)

A

bilirubin

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4
Q

Where is heme detoxified? What does this create?

A

liver; bilirubin

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5
Q

hepatitis viruses have a strong tropism for the liver and preferentially replicate in the ___.

A

hepatocyte

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6
Q

___% of liver cells are hepatocytes

A

85%

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7
Q

Hepatitis viruses primarily cause:

A

liver disease

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8
Q

Infectious hepatitis is caused by:

A

Hep A and Hep E

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9
Q

“Hit and Run” describes ____ hepatitis

“Hide and Infiltrate” describes ___ hepatitis

A

infectious (A & E)

serum (B, C & D)

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10
Q

How is infectious hepatitis (A&E) transmitted?

A

Fecal-oral

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11
Q

Serum Hepatitis is caused by:

A

Hep B, C, & D

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12
Q

How is serum hepatitis (B, C, & D) transmitted?

A

blood and sexual fluids

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13
Q

What is the nucleic acid composition of Hepatitis A?

A

linear + ssRNA

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14
Q

What virus family does Hepatitis A belong to?

A

picrornaviridae

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15
Q

Hepatitis A causes:

A

infectious hepatitis

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16
Q

Describe the characteristic shape and viral structure of HAV?

A
  • icosahedral, naked capside virus
  • positive strand linear RNA
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17
Q

How is HAV spread?

A

spread by fecal-oral contamination of food, drink, or shelfish

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18
Q

HAV is shed into ____ and into ___ and passes out of the body in ___.

A

bile ducts; intestine; feces

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19
Q

How does HAV kill hepatocytes?

A

DIRECTLY

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20
Q

What is the clinical manifestations of HAV?

A

Usually mild intestinal infectious, but occasionally viremia occurs, leading to liver infection and jaundice

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21
Q

Describe the vaccination for HAV:

A

Killed HAV vaccine, recommended for all in US, especially military, frequent travelers, and staff of care facilities

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22
Q

In highly endemic regions (HAV) , almost all children become:

A

infected in the first few years of life

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23
Q

In endemic regions most children infected with HAV in the first few years of life remain:

A

asymptomatic

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24
Q

Adults from non endemic regions (HAV) who become infected are more likely to:

A

display symptoms

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25
Q

Describe the nucleic acid composition of Hep B:

A

nicked circular, mostly double stranded DNA

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26
Q

What virus family does hep B belong to?

A

hepadnaviridae

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27
Q

Describe the viral genome structure of Hep B:

A
  • enveloped
  • smallest viral genome of 3200 nucleotides
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28
Q

How many nucleotides are present in the viral genome of Hep B?

A

3200

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29
Q

How many distinct viral particles does Hep B contain, describe:

A

3 distinct viral particles

  • 22 nm particles
  • variable tubular/ filamentous particle (22nm)
  • 42 nm Dane particle (infective form of virus)
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30
Q

Which viral particle of Hep B is the infective form of the virus?

A

Dane particle

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31
Q

List the Hep B surface antigens:

A

L, M, S

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32
Q

Which Hep B surface antigen is embedded into the lipid bilayer (envelope)?

A

S

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33
Q

What is the main component of the Hep B lipid bilayer/envelope/dane particle?

A

HGsAg-S

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34
Q

Core antigens of Hep B include:

A

HBe antigen & HBc antigen

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35
Q

Core antigen that is mostly secreted from infected cells and found in the bloodstream, making it a useful marker for HBV infection:

36
Q

The filaments of hep B are enriched for:

37
Q

In hep B, both types of 22nm particles are:

A

empty envelopes

38
Q

Most of the 22nm viral particles of Hep B are:

39
Q

Reverse transcription in seen in Hep B is performed by:

A

viral reverse transcriptase

40
Q

Unlike retroviruses, RT in hep B occurs during:

A

viral assembly

41
Q

Transcription of hep B occurs via:

A

Host RNA polymerase

42
Q

priming of reverse transcriptase by TP (terminal protein domain) of viral polymerase occurs by:

A

adding first nucleotide to a tyrosine residue of TP

43
Q

What determine the course of HBV infection?

A

Cell-mediated immune response

44
Q

What is responsible for killing hepatocytes infected with HBV?

A

Cytotoxic T-lymphocytes

45
Q

If a liver infected with HBV has an effective cell mediated immune response, what will the outcome be?

A

acute disease (jaundice and release of enzymes) with resolution

46
Q

If a liver infected with HBV has a limited cell mediated immune response, what will the outcome be?

A

Chronic disease with mild symptoms leading to either:
- fulminant hepatitis
- primary hepatocellular carcinoma
- cirrhosis

47
Q

What is the agent responsible for the progression of chronic hep B into fulminant hepatitis?

A

Delta agent

48
Q

The outcomes of acute hepatitis B include:

90% ___
9% ___
1% ___

A

90% resolution
9% HBsAg + for greater than 6 months
1% fulminant hepatitis

49
Q

From the individuals who have had acute HBV infection that results in HBsAg+ antibodies for greater than 6 months, what are the possible outcomes:

A
  1. resolution
  2. chronic active hepatitis
50
Q

If a hep B infection progresses to chronic active hepatitis, what are the possible outcomes?

A
  1. cirrhosis
  2. hepatic cell carcinoma
51
Q

How does HBV kill hepatocytes?

A

INDIRECTLY

52
Q

Describe how HBV indirectly kills hepatocytes:

A

Cytotoxic T-lymphocytes directed against MHC class I proteins bound to viral antigens on hepatocyte surface

53
Q

In addition to cytotoxic T-lymphocytes being directed against MHC class I proteins bound to viral antigens on hepatocyte surface, killing of hepatocytes also occurs by:

A

cytokine release that promotes inflammation and tissue damage

54
Q

% of infants infected with HBV that becomes chronically infected:

55
Q

Why do 90% of infants become chronically infected with HBV?

A

immature cell-mediated immune response

56
Q

Why do some cases of chronic HBV progress to hepatocellulr carcinoma?

A
  1. Increased cell division due to regeneration which increases the chances of mutations
  2. peroxides and free radicals from CTL killng
57
Q

Increased cell division due to regeneration (increasing the changes of mutation), and peroxides and free radicals from CTL killing may result in:

A

hepatocellular carcinoma

58
Q

Interpretation of serologic assays for hepatitis B virus:

HbsAg: neg
Anti-HBs: neg
Anti-HBc: neg
Anti-Hbe: neg
HbeAg: neg

Interpretation=

A

No prior exposure

59
Q

Interpretation of serologic assays for hepatitis B virus:

HbsAg: N
Anti-HBs: P
Anti-HBc: N
Anti-Hbe: N
HbeAg: N

Interpretation=

A

prior vaccination

60
Q

Interpretation of serologic assays for hepatitis B virus:

HbsAg: N
Anti-HBs: P
Anti-HBc: P
Anti-Hbe:P
HbeAg: N

Interpretation=

A

prior acute infection, resolved

61
Q

Interpretation of serologic assays for hepatitis B virus:

HbsAg: P
Anti-HBs: N
Anti-HBc: P
Anti-Hbe: N
HbeAg: P

Interpretation=

A

acute or chronic infection

62
Q

Interpretation of serologic assays for hepatitis B virus:

HbsAg: P
Anti-HBs: N
Anti-HBc: P
Anti-Hbe:P
HbeAg: N

Interpretation=

A

later stage in chronic infection

63
Q

Discuss the vaccination for Hep B:

A

vaccination recommended for all infants in US; HbsAg particles produced in yeast

64
Q

Following vaccination, discuss immunity:

A

passive immunotherapy within 7 days of exposure

65
Q

What may be used as a treatment for Hep B infection?

A

reverse transcriptase inhibitors (originally anti-HIV drugs)

66
Q

Describe the nucleic acid composition of Hep D:

A

circular negative sense ss RNA

67
Q

What virus family does hep D belong to?

A

deltaviridae

68
Q

HDV depends on ____ to replicate

69
Q

Chronic HBV infection is exacerbated by:

A

infection with HDV

70
Q

What is the nucleic acid composition of Hep C?

A

linear + ss RNA

71
Q

What family of viruses does Hep C belong to?

A

Flaviviridae

72
Q

Is hep C enveloped or non-enveloped?

73
Q

Discuss all the modes of transmission of Hep C:

A
  1. blood & sexual fluid
  2. mother to fetus via fecal oral route
  3. organ transplants
74
Q

How does HCV kill hepatocytes?

A

INDIRECTLY

75
Q

HCV kills hepatocytes indirectly by:

A
  1. Cytotoxic T lymphocytes directed against MHC class I proteins bound to viral antigens on hepatocyte surface
  2. By cytokine release that promotes inflammation and tissue damage
76
Q

Immune complex disease of kidney and other sites- disease outside liver caused by hep C:

A

mixed cyroglobulinemia

77
Q

Mixed cryglobulinemia is caused by what virus?

78
Q

In mixed cryglobulinemia, inflammation and blockage of small and medium blood vessels is caused by:

A

cryoglobulin deposition

79
Q

Hepatitis C virus acute infection possible outcomes:

15% __
15% __
70% __

A

15% recovery and clearance
15% cirrhosis and rapid onset
70% persistant infection

80
Q

If Hep C virus acute infection results in persistent infection (70%), what next will occur?

A

chronic hepatitis

81
Q

What are the outcomes of chronic hepatitis caused by Hep C?

6% ___
20% ___
4% ___

A

6% liver failure
20% cirrhosis
4% hepatocellular carcinoma

82
Q

Describe the nucleic acid composition of Hepatitis E:

A

linear + ssRNA

83
Q

What virus family does Hep E belong to?

A

Calciviridae

84
Q

How is Hep E virus release?

A

Not by budding; released as a naked capsid virus

85
Q

Describes the modes of transmission of Hep E:

A
  1. spread in contaminated food & drink (like hep A)
  2. human-to-human transmission
  3. animal-to-human transmission (zoonosis)
86
Q

For animal to human transmission of Hep E, what is a common source?

microbiology (24 decks)

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