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Micro 5 > Viral Inf Of GI > Flashcards

Viral Inf Of GI Flashcards

1
Q

Acute Viral Hepatitis Symptoms - symptoms

A
  • Jaundice: Yellowing of the skin and eyes due to increased bilirubin levels.
  • Dark Urine
  • Acholic Stool: Light or Clay-colored Stool due to reduction in bile production.
  • Prodrome: 1-2 weeks prior to jaundice
  • Headache, myalgia, arthralgia, fatigue, nausea, vomiting, pharyngitis, mild fever.
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2
Q

billirubin in urine means

A

liver disease

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3
Q

Two enzymes that are elevated with acute viral hep?

A 
Alanine aminotransferase (ALT) 
Aspartate aminotransferase (AST)
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4
Q

Chronic Viral Hepatitis

A
  • Hepatitis which does not resolve within 6 months.
  • Predisposes to hepatocellular carcinoma and cirrhosis
  • can catch it and liver may be able to regenerate but regeneratino = cell division and potential mutations = cancer
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5
Q

Fulminant Viral Hepatitis

A
  • Rapid, severe hepatitis == leads to severe CNS issues
  • Massive hepatic necrosis
  • Encephalopathy (TOO MUCH AMMONIA PRESENT): Confusion; Disorientation; Coma
  • Edema
  • Complications: Cerebral edema; Brainstem compression; GI Bleeding; Sepsis; Organ Failure
  • Liver Transplant can be lifesaving
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6
Q

Hep A - virus family, incubation, transmission, chronic?

A

Picornavirus - +ssRNA
2-4weeks
fecal oral
NO chronic

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7
Q

Hep B - virus family, incubation, transmission, chronic?

A

Hepadnavirus - dsDNA
6wks-6mo
bodily fluids
YES chronic

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8
Q

Hep C - virus family, incubation, transmission, chronic?

A

Flavivirus
2mo
bodily fluids
YES chronic

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9
Q

Hep D - virus family, incubation, transmission, chronic?

A

Deltavirus
2-12wks
bodily fluids
YES chronic

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10
Q

Hep E - virus family, incubation, transmission, chronic?

A

Hepevirus
6-8wks
fecal oral
NO chronic

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11
Q

Hep A details:

A 
-Picornavirus family
\+ ssRNA genome
-Fecal-oral transmission
-Seroprevalence 30%
-All age groups susceptible, children usually asymptomatic
-Incubation period ~28 days
-Resolution usually within 2 months
-Does not cause chronic hepatitis - resolves within 6mo
-Very rarely causes fulminant hepatitis
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12
Q

Hep A diagnosis

A
  • Acute infection = IgM antibodies against HAV

- Anti-HAV IgG antibodies protective immunity

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13
Q

Hep A prevention

A
  • Inactivated vaccine available since 1995
  • IM injection - 2 dose schedule
  • Since 2005, ACIP recommends universal vaccination for all infants (12 -23 months of age).
  • Other high risk adult groups also recommended for vaccination.
  • Post-exposure Prophylaxis
  • Vaccine or anti-HAV IgG antibodies
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14
Q

dane particles:

A

complete Hep B virions

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15
Q

tubes and spheres:

A

incomplete noninfectious particles of Hep B virions

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16
Q

Hep B details

A
  • Hepadnavirus family member
  • Partially dsDNA genome (NO REVERSE TRANSCRIPTASE-ITS DNA)
  • Reverse transcription is a part of life cycle
  • Incubation period median 90 days
  • Transmission route = body fluids=Sexual transmission, percutaneous needle stick (6-30%), perinatal transmission at birth (10 – 90%).
  • Half of infected adults are asymptomatic
  • Acute hepatitis symptoms often milder than HAV
  • Risk of chronic infection: correlated with age at infection. Chronically infected are carriers.
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17
Q

Heb B diagnosis

A
  • Viral antigens and anti-HBV antibodies are used for diagnosis.
  • -The presence of HBsAg within the blood is a marker for active infection.*
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18
Q

Hep B Status: Acute infection

A

HBsAg= +
anti-HBsAg= -
anti-HBc: total and IgM = +

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19
Q

Hep B Status: chronic infection

A

HBsAg= +
anti-HBsAg= -
anti-HBc: total=+ and IgM = - (no high levels of IgM bc IgM is primary response and then IgM productin drops off)

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20
Q

Hep B Status: vaccinated

A

HBsAg= -
anti-HBsAg= +
anti-HBc: total= -

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21
Q

Hep B Status: previous infection

A

HBsAg= -
anti-HBsAg= +
anti-HBc: total= +

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22
Q

Hep B Status: susceptible

A

HBsAg= -
anti-HBsAg= -
anti-HBc: total= -

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23
Q

Hep B treatment

A
  • None for acute infections
  • Chronic infections: -Lamivudine: reverse transcriptase inhibitor -Famcylovir/Adefovir dipivoxil: nucleoside inhibitor -Interferon-alpha
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24
Q

Most susceptible indiv to chronic hep B inf?

A

NEWBORNS MOST susceptible… with age risk declines

25
Q

Hep B vaccine:

A
  • Vaccine composed of purified HBsAg protein
  • IM injection – 3 dose schedule
  • Recommended for all infants (1st dose soon after delivery.
  • Premature infants born to mothers of unknown or HBsAg positive receive vaccine and Hepatitis B immunoglobin (HBIG) within 12 hrs of birth.
  • Full term infant born to HBsAg positive receive vaccine and HBIG within 12 hrs of birth.
26
Q

Hep C details and transmission

A

-Flavivirus Family Member
-Enveloped
+ ssRNA genome
-Transmission is Bloodborne and through Body Fluids: Injection Drug Use; Tattoos; Accidental Needle Stick (1.8%); Sexual; Perinatal (4%)

27
Q

Hep C diagnosis

A
  • Screening test: antibody-based test for anti-HCV antibodies
  • Confirmatory test: nucleic acid based tests for detection of the viral genome
28
Q

Hep C compared to Hep A and HepB

A

Hep C has milder acute symptoms but chronic infection super common

29
Q

Hep C treatment

A
  • Chronic genotype 1 HCV —> Pegylated Interferon-alpha + Ribavirin + NS 3/4 A protease inhibitor (boceprevir or telaprevir).
  • Chronic HCV (other genotypes)—> Pegylated interferon-alpha + ribavirin
30
Q

Hep C prevention:

A
  • No vaccine available
  • Reduce high risk behaviors, e.g., IV drug use or unprotected sexual activities.
  • Screening of blood supply
31
Q

Hep D details:

A
  • Small circular ssRNA genome
  • Encodes two proteins (Delta-short and Delta-Long antigens) that cover the virion.
  • Unique helper-dependent virus
  • Hepatitis B surface antigen forms the external surface of the virion. (NEEDS PRIOR INF WITH HEP B)
  • Replication requires HBV proteins: Only infects cells that have been previously or concurrently infected with Hepatitis B virus
  • Hepatitis D virus is the only hepatitis virus that directly injures hepatocytes.
  • Chronic infection can occur = carriers
32
Q

Hep D transmission:

A

bodily fluids

33
Q

Hep D diagnosis, treatment and prevention:

A
  • Diagnosis: ELISA to detect anti-HDV antibodies or the delta antigens.
  • Treatment: No specific antiviral treatments
  • Prevention: Since HBV infection is absolutely required for HDV to infect and cause disease, vaccination against HBV prevents HDV disease.
34
Q

Hep E details

A

-Hepevirus
+ssRNA genome
-Transmitted through fecal-oral route
-Does not cause chronic infection
-Most cases in US are travel related.
-Epidemics: India, Pakistan, Nepal, Burma, North Africa, and Mexico
-High Risk of death due to infection in pregnant women (~20% mortality rate).

35
Q

Hep E treatment and prevention:

A
  • Treatment: To alleviate symptoms

- Prevention: Prevent spread by providing clean water and proper food handling.

36
Q

Poliovirus virology/details:

A
  • Picornaviridae family member
  • RNA genome
  • Virions stable at acidic pH
37
Q

Poliovirus: clinical info:

A
  • Three serotypes (P1, P2, P3)
  • Transmission primarily through fecal-oral route.
  • Incubation period between 6 and 20 days.
  • ~95% of infections are asymptomatic
  • Shed in stool for weeks following infection.
38
Q

Poliovirus: manifestations/symptoms

A
  • Asymptomatic (95% of infections)
  • Abortive Poliomyelitis: Sore throat; Fever; Vomiting and abdominal pain; Constipation
  • Nonparalytic aseptic meningitis: 1-2% infections; Nonspecific prodromal symptoms; Stiffness in back, neck, or legs; Last 2-10 days
  • most severe: Flaccid Paralysis in less than 1% of infections.
39
Q

Poliovirus diagnosis

A
  • Virus can be isolated from stool of patients.

- Any isolates must be sequenced to determine if originated from wild type or vaccine strain.

40
Q

Polio vaccines:

A
  • first one was inactivated vaccine
  • next: trivalent, live attenuated oral polio vaccine (OPV) –> some strains reverted to neurotropic strain caused Vaccine-Associated-Paralytic-Poliomyelitis (VAPP)
  • NOW have inactivated polio vaccine w/ no risk for VAPP
41
Q

viral gastroenteritis which visues/details/symptoms/transmission

A
  • Inflammation of the stomach and intestines
  • Nausea
  • Diarrhea
  • Vomiting
  • Viral Causes
  • Fecal Oral Transmission
  • Non-enveloped
  • Types= Rotaviruses; Noroviruses; Adenoviruses; Astroviruses
42
Q

Compare viral and bacterial gastroenteritis: setting, incubation, vomiting, diarrhea, and diagnosis:

A
  • —VIRAL:
  • setting: Incidence similar in developing and developed countries
  • incub: 1–3 days for most agents; can be shorter for norovirus
  • vomit: Prominent and can be the only presenting feature, especially in children
  • diarrhea: Common; nonbloody in almost all cases
  • diagn: This is often a diagnosis of exclusion in clinical practice. Commercial enzyme immunoassays are for rotavirus and adenovirus.
  • —BACTERIAL:
  • setting: More common in settings with poor hygiene and sanitation
  • incub: A few hours to 7days
  • vomit: Common with bacteria producing preformed toxins; less prominent in diarrhea due to other agents
  • diarrhea: Prominent and frequently bloody with agents causing inflammatory diarrhea
  • diagn: Culture of stool specimens, sometimes on special media, can identify several pathogens
43
Q

Signs of severe dehydration: (viral gastroenteritis)

A

-rapid, weak pulse, sunken eyes, tears absent, skin tenting, lack of urination
MILD Treatment: oral rehydration
SEVERE: IV rehydration

44
Q

Rotavirus details:

A
  • most severe disease among 3-24mo children
  • most common children 3-35mo
  • segmented genome which remain in “core” particle during infection: turrets exchange stuff into cell once inside
  • G1 and G2 are first two most prevalent
45
Q

rotavirus clinical/symptoms:

A
  • Incubation period 1-3 days
  • Vomiting and Diarrhea duration 4-7 days, occasional cough and coryza.
  • 1/3 patients have fever >102º F
  • Risk for life threatening complications in very young, immunodeficient, or malnourished.
46
Q

rotavirus pathology:

A
  • 10 billion particles released/g stool
  • Malabsorptive diarrhea
  • Additionally, Rotavirus produces a toxin (NSP4) that causes Ca2+ release.
  • virus gets into vili and replicates in the vili = shortening o vili = vili blunting = less SA = malabsorption
47
Q

rotavirus daignosis, treatment, prevention/vaccines

A
  • Diagnosis: EIA from stool sample; Less commonly: EM, RT-PCR
  • Treatment: Oral Rehydration Therapy; IV Rehydration Therapy with Severe Dehydration
  • Prevention: Prevent fecal-oral transmission Sanitize fomites, e.g., toys; Handwashing; IgA in colostrums
  • Vaccines = Two live attenuated , oral vaccines; universal vaccination of infants before 12 wks.; No increase risk of intussusceptions.
48
Q

Noroviruses - details and virology

A

-#1 cause of nonbacterial gastroenteritic
-Caliciviridea family
-Non-Enveloped
+ ssRNA genome
-Norwalk virus founding member.
-Bind to histo blood-group antigens which are also found on vlli tips –> THIS VIRUS LIKES TO BIND TO H AND A ANTIGENS PRESENT ON CELLS (NOT B)
-As little as 100 virions can cause infection.

49
Q

Noroviruses-symptoms

A
  • Incubation period 24-48 h
  • Nausea, vomiting, diarrhea for 24-60 hrs
  • Low grade fever in about half of patients.
  • Afflicts all age groups
  • Pathology similar to Rotavirus
50
Q

Noroviruses - transmission:

A
  • Fecal-Oral
  • Person-to-person: Close personal contact & Droplets from Vomitus
  • Fomites
  • Waterborne
  • Contaminated Food: Food Handler & Contamination prior to preparation & SHELLFISH!
51
Q

Noroviruses major route of spread and where?

A
  • FOODBORNE MOST COMMON

- FOUND IN LONG TERM CARE FACILITIES AND CRUISE SHIPS

52
Q

Adenoviruses - details:

A
  • dsDNA genome
  • Naked Capsid
  • Fiber Protein at vertices - directly toxic to cells
  • Serotypes 40 and 41 cause gastroenteritis
  • Shed from the GI tract
  • Primarily in children.
  • Incubation Period 8-10 days
  • Watery, non-bloody diarrhea 7-8 days
  • May be accompanied by vomiting and fever
  • No seasonal variation
53
Q

Adenoviruses - dagnosis

A

antibody based-serology

54
Q

Sapoviruses

A

-Another Caliciviridea family member

55
Q

AStroviruses details:

A

-Star-shaped viruses
+ ssRNA genomes
-Susceptible: infants, young children, elderly, or healthy adults exposed to contaminated food and drink.

56
Q

e-antigen present in patient means?

A

Virus is currently highly infective and replicating! Measure of viral replication
-determines if chronic replicative or chronic non-replicative

57
Q

How does a Hepatitis infection (except hEp D) destroy the liver?

A

Trick question mofo– Hep doesnt directly destroy anything … its the CTL mediated immune repsonse that effs thing up for the liver.

58
Q

Hep B vaccine has what? What kind of immunity?

A

HBsAg = humoral immmunity

Micro 5 (5 decks)

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