Gi_Pm_Micro_Viral Hepatitis

Front 1

Which Viral Hepatitis (VH) is "infectious"?
Serum?

Back 1

A, HAV

Serum: B&D, HBV, HDV

Front 2

What sort is Hep E?

Back 2

Enteric Transmission
HEV

What are the Non-A and Non-B (NANB) Viruses (name 4)

Hint 2

Hep C
Hep G
SEN
TTT
-others

Front 3

In 80s-90s which virus caused maj VH?

What about today?

Back 3

Hep A

Hep B today

What helped hep C decline?

Hint 3

The HCV Ab Test
-inc sensitivity increased awareness so it went down

Front 4

Epidem of Hep A and Hep B

Back 4

42k cases per year in US
~1/2 are asymptomatic

-A and B are most reported caccine preventable dzz

Front 5

Clinical Manifestions of VH?
Physical

Back 5

RUQ ab pain, Nausea, anorexia, fatiguq, fever

Physical: Jaundice, Hepatomegaly

Front 6

Regarding Hep A, HAV
Family, Group?
Nucleic Acid?
Tough?
Sx?
Transmission?
Nickname?

Back 6

+ssRNA virus
Picornaviridae fam, Enterovirus group
-Very stable in envronemt
-Acute OR ASx Infx
-Fecal Oral
=Infectious nickname

Immunity after Infxn?

Hint 6

Lifelong immunity due to Abs

Front 7

Ways for HAV Transmission

Back 7

Crowding and poor hygiene
-sporadic cases more common than single source outbreaks
-Community Outbreaks: contaminated water, food, shellfish

Who is source of New Infections?

Hint 7

ASx individuals

Front 8

HAV Features:
Incubation
Complications
chronic Sequelae

Back 8

Average 30 Days,
Fulminant Hep, cholestatic hep
NO chronic seq.

What is typical dz?

Hint 8

Acute for weeks; gradual recovery

Jaundice is 70-80% in >14yrs
40-50% in 6-14yrs
<10% in <6years

NOTE: Primary is Fecal ORal--but pretty much any transmission is possible

Front 9

Pathogenesis of HAV
What is point of entry?
Replication?
Damage from What?
Shedding?

Back 9

Enters in GIT & replicates at LOW Levels-->Blood-->Liver
Replicates in Hepatocytes
--MonoNuc Cell Inflamm in Response in Liver
--Damage from Immune Resp + Damage from Virus
--Leaves Via bile duct--shed in feces

Front 10

When is viral shedding highest?

What liver enzyme is increased?

Back 10

Maximal shed before Onset of Sx
-ALT- Liver Alanine Transferase

What is present in Blood once Virus is Cleared?

Hint 10

a-HAV IgG -- gives lifelong proection--shoots up fairly early to clear infxn
-IgM goes up earliest, and down earliest--IgM tells you you have ACTIVE/ACUTE infxn

Front 11

What if IgM for HAV is positive , but IgG is negative

Back 11

You're right in middle of active/acute infxn

Front 12

Treatment for HAV?
Vac?

Back 12

No Antiviral Treatment

Vac for HAV: inactived-- routine for children 1yrs
-for travelers,

Immuinty with HAV?

Hint 12

Lifelong

Front 13

Moving on to what

Back 13

Hep B, HBV

What is family?
Nucleic Acid?
Envelope?

Hint 13

Hepadnaviridae Family
partially dsDNA virus
Enveloped --not nearly as stable as Hep A

Front 14

What is used for HBV to replicate

Back 14

thought its partially dsDNA, it replicates via RNA intermediate?

What is resevoir for HBV?

Hint 14

Humans are only resevoir

Front 15

How is HBV best transmitted?
Causes?

Back 15

Blood and Body Fluids
-Causes Acute (usually) an Chronic Infections

Front 16

What are the 5 Items serum CAN contain from HBV

Back 16

HBsAg --surface
HBcAg --nucleocapsid
HBeAG --deep
Viral DNA

Who's at greatest risk for Hep B
Virus Particles

Hint 16

Men>
Acute infections usually ONLY in Adults

-Gay Men
-IV Drug Use

~1/3 Unknown Transmission, similar to HAV

Front 17

What is typical outcome from Acute Infection in adults?
Chronic?

Back 17

90% recover completely

Chronic: chronic persistent (ASx Hept)
OR Chronic Activ (Sx Hep)

What are worse things that can occur?

Hint 17

Fulminant Hep --rare

Hepatoma: hepatocellular carcinoma

Front 18

Regarding HBV:
Incubation
Clincal Illness (jaundice

Back 18

Average 100 Days

FINISH slide 30 & 31

Who gets chronic more often?

Hint 18

If kids get it, they're more likely to get crhonic

Front 19

skp

Back 19

skp

Front 20

HBV Pathogenesis
-Travels to Liver HOw?
Replication ?
Cause of Damage?

Back 20

Viral entry via blood or sement to liver. Also Perinatal Trans
-Replication in Liver
--No Sx, but HBsAg in Serume
-DAMGE From CTLs--NOT from virus

Who is more likely to get crhonic infection

Hint 20

Those who dont' /cant have good CTL immune response. Ie this is why babies c get chronic

-ie inefficient CTL response --> cjronic

Front 21

What is incubation for HBV?

Back 21

100 days

Front 22

33

Back 22

33

Front 23

34

Back 23

34

Front 24

Where is chronic Hep B typically high?

Back 24

Hihg in 45% of Global Pop
Africa and Asia

Front 25

Slide 37

alpha means anti

Back 25

37

Front 26

37

Back 26

37

Front 27

38 quesiton 1

Back 27

38 quesiton 1

Front 28

38 quesiton 2

Back 28

38 quesiton 2

Front 29

38 quesiton 3

Back 29

38 quesiton 3

Front 30

38 quesiton 4

Back 30

38 quesiton 4

Front 31

Whos is the Active Recombinant Vac indic for?

Back 31

Routine for all infants and children
--Vacc of high risk adults

Hint 31

Though babies won't be having sex and using needles, this vac is indicated because of the Chronic Nature of Hep B in children IF they get infected.

Front 32

Whos is the Passive Vac given to

Back 32

HBIG for post-exosure along with Active Vaccine
--health care workers, infants born to HBV-infected mothers

Front 33

Moving onto Hepatitis D (delta) Virus?

Not really a virus, jsut pieces of one

What is Helper Virus for HDV to infect?

Back 33

Hep B is delta viruses helper
--Need HBV as a helper to code its surface protein

Therefore, what sort of infxn is this?

Hint 33

Coinfection or SuperInfection

Front 34

What sort of nucleic acid does HDV have?

What are its 2 important Antigens?

Back 34

ssRNA

HDV Ag: derived from HDV
HBsAg; surface Ag; derived from HBV

Front 35

Modes of Transmission for HDV

Back 35

Percutaneous - Injections
Permucosal Exposures: sex

WHo is risk group

Hint 35

iV drug abusers and their fuckbuddies

Front 36

What is likely if you contract B and D at same time

Back 36

Coinfection= Severe Acute Dzz
---90% revocer fully
--Low risk of Chronic Infection

Who gets Super-Infection?

Hint 36

--If already have HBV (usually chronic)
can Develop Chronic HDV infection

Front 37

What are those with Super-Infection at high risk for?

Back 37

Chronic Active OR
Fulminant Hepatitis

Front 38

44

Back 38

44

Front 39

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Back 39

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Front 40

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Back 40

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Front 41

How is HDV best diagnosed?
name 3

Back 41

a-HDV IgM: acute; high titers in chronic during time of reactivation
-HDV Ag: acute & chronic
-a-HDV IgG: late in acute; high titres in chronic

Hint 41

Note: always suspect HDV infection in high risk Pts with Chronic or Acute HBV infxn

Front 42

Moving on to NANB Hep Viruse

Hepatitis E (HEV) is related to what?

Back 42

Related to Norwalk types/Calciviruses

Nucleic Acid?
Envelope?
ReplicatioN?

Hint 42

HEV is +RNA
NON-enveloped
-Replication mech is not completely understood

Front 43

Transmission of HEV?
Person to PErsoN?

Back 43

Fecal Oral Route via Contaminated Water
-NO Person to Person

Are there outbraks?

Hint 43

Acute Sporadic Outbreaks in areas where the virus is present
--2% of US pop is seropositive for Hep E
-

Front 44

What are Dz with HEV

Back 44

Acute ONLy
NO evidence for Chronic Infections

Front 45

50

Back 45

50

Hint 45

51

Front 46

52

Back 46

52

Hint 46

52

Front 47

Diagnosis and Tx for HEV

Back 47

NO Commercially available Test
--Can do sero on a-HEV IgG, a-HEV IgM
--or Direct Virus Detection

Is there a Vac?

Hint 47

NO Vac
-

Front 48

Moving on to Hep G
Family? aka? (2)
Nucleic Acid?

Back 48

HGV is Flavivirus family, aka
-GB Virus-C
-GBV-C

+ssRNA

Front 49

end of Hep G slide

Back 49

end of Hep G slide

Front 50

Begin of 2nd Viral Hep Lecture

Back 50

Hepatitis C

Front 51

for Hep C (main NANB Hep Virus)
Nucleic Acid?
Resevoirs?

Back 51

Flavivirus
+ssRNA
-90% of NANBH infxn
-Resevoirs humans AND Chimps

-mjaor cause of post-transfusion heppatitis before routine screeing of blood supplies

Front 52

Transmission of HCV?

Back 52

Percutaneous Route: IV drugs --90% will acquire HCV within 1st 5 yrs of Using
---Needle Stick Injuries -in health care
-Blood transfusions before 1990

Other major mode of Transmission?

Hint 52

Permucosal Rougte:
perinatal
Sexual--high risk practices

Front 53

What sort of infx doe HCV cause and why

Back 53

Chronic Infections
--Virus mutates WITHIN individual, like HIV--rapid Ag variation of quasispecies

-note: 6 clades and +100 subtypes worldwide-

Front 54

Impact of HCV in US
current ifxn?
New annually
death?
proportion f chronic liver dzz?

Back 54

4mill in US
30K per year
8k-10k death per year
-40% of Chronic Liver Dz
-Leading cause of Liver Transplant

What country has 16% infected?

Hint 54

Japan
Egyptis 15

Front 55

What is common to HAV and HBV regarding HCV transmission

Back 55

High proportion of UNKONW transmission
-39%

unusual mode of transmission?

Hint 55

Tattoos, body piercings
--NOTE: NO evidence of transmission via breast milk

Front 56

Incubation for HCV?

What is acute illness?
What is typical?

Back 56

Average 8-9weeks = long (range is 2-26weeks)

Acute: Jaundice-mild 25% cases
Chronic is TYpical: 70-85%
---what are results of chronic dz?

Hint 56

Chronic Hep
Cirrhosis
Mortality for CLD

Front 57

Does Sx or ASx infection matter for whether it becomes chronic infxn?

Back 57

No, either way, 75% get Chronic

What prop of Chronic get Cirrhosis and Hepatoma?

Hint 57

~65% get these within 10-20 ear due to chronic infxn

Front 58

What are some variables for HCV infectivity?

Back 58

Innoculum Size
-genotype of HCV
-Age
-Strength of initial imm response
-Route of infxn

Front 59

Name some factors that promote Progression or Severity of Chronic HCV infxn

Back 59

Increased ETOH intake
>40 years at time of infxn
-HIV Co-infection
-Male Gender
-Chronic HBV Co-Infection

Front 60

Describe Serologic Pattern for HCV in Acute

Back 60

HCV RNA early/before Sx -->
IgG Abs

Front 61

Describe Serologic Pattern for HCV in Chronic

Back 61

HCV RNA early/before Sx then INtermittantly (undulates above an below detection)
--IgG rises and stays throughout course

Front 62

What determines ability to clear virus?

What causes the Damage?

Back 62

efficacy of T Cell Response
-Genetic Variants arise rapidly
-Iiver Injury due to Inflammatory Cells and Cytokines

Front 63

Note: some genotypes may NOT be detected serologically and SOme can Escape Immune and Tx

Back 63

Genotype 1 is most resistant to IFN Tx and MOST common in US!!!

Front 64

what are the 5 viral Ag for HCV diagnostics?

Back 64

C Protein (core)
E1 and E2 -- enveloped---harder to find= ag shift??
NS3,4,5

Front 65

What is Riba test

Back 65

Recombinant Immunoblot assay
--test for presence of 1+ Ags of Virus

Front 66

Slide 23

Back 66

23

Front 67

What are 2 molecular Diag Tests for HCV

Genotype Test used for what?

Back 67

RT-PCR for HCV RNA in serum

-q-PCR for Viral Load

_Genotype Test predicts Tx Response

Front 68

Last slide

Back 68

Sucked

Front 69

Note on ALl Hep Viruses:
All are reportable

Back 69

Hep A: acute
B: acut or perinatal or chronic
Hep c: acute or chronic

Front 70

Which Heps are routinely screened in blood transfusions

Back 70

HBV and HCV

Front 71

Which Hep is the only DNA virus?

Which Virus is the only (-) RNA virus?

Back 71

Hep B

Hep D is (-) RNA

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