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96 Cards in this Set
- Front
- Back
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WHAT IS HEPATITIS DEFINITION
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INFL OF LIVER
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What is presentation of hepatitis
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Jaundice, Fatigue, Nausea, Vomiting, Loss of Appetite, Joint Pain, Dark Urine, Light Stools, Abdominal Pain, Diarrhea, Fever (not always)
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what are etiologies of hepatitis
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Classic agents (Hep ABC...) as well as Yellow Fever, Cytomegalovirus, Epstein-Barr, Rubella, Mumps, ECHO viruses, others
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What cells affected in hepatitis
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Hepatocyte vs Kuppfer Cells
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Physiology of Jaundice
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Bile and Billirubin can't be metabolized so it comes out in skin/urine and stool as well.
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Hepatitis in Cell Culture (diagnostics)
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Hepatitis in Cell Culture (diagnostics)
cell culture - virus does not grow well ANIMALS - look at liver histology after infection SEROLOGY - ELISA, markers for aby and agn are hard to grow |
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Hepatitis A Family/Genus
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F Picornaviridae, G Hepatovirus
+RNA, 7.5 kb Inc - 2-6 wks low mortality(slightly higher in adults) ~15% prolonged or relapsing 6-9 months |
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Hepatitis A virus Epi
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F/O - conc in shellfish
WW distribution - 1/3 Americans have evidence of past infection vaccine greatly reduced cases in US some epidemics up to 35K cases |
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persons at risk for hep a
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-Household contacts of infected people -Sex contacts of infected people -Persons living in areas with increases rates (children) -Men who have sex with men -Drug users (IV and non-IV)
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HAV control
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Improve Sanitation Immunoglobulin-(pre or post exposure prophylaxis, short term) Vaccine
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HAV vaccine
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Licensed in 1995, No majors adverse effects Recommended for >2 year old who are travelers, men who have sex with men, drug users (IV or non-IV), clotting disorders (hemophilia), chronic liver disease, and children in high risk areas.
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HEP E VIRUS -I
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+RNA, 9.4 kb
FORMERLY CALICIVIRIDAE first documented in Dehli in 1955 Domestic animals reservoir F/O, probably WW |
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HEP E VIRUS - II
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adolescence or early adult
inc 2-6 wks acute hep w/o chronic carriage mortality low X pregnant women no TX or VACCINE more prev in north africa and SW asia |
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HEPADNAVIRIDAE FAMILY
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Hepatotrophic and DNA = hapadnavirus
Narrow host range determined by receptors |
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What are two genera of HEPADNAVIRIDAE
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Orthohepadnavirus Genus - mammals
Avihepadnavirus - Birds |
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Characteristics of Hep B virus
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ds DNA
circular genome enveloped - budding thru internal membranes - glycoproteins: HBV surface agn Icosahedral Nucleocapsid - core protein HBV core agn |
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Does genotypic variation in Hep V have clinical importance
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yes, maybe. Significant jgenotypic variation s exist
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HBV PATHOGENESIS
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Vigorous CTL - ACUTE HEP w/clearance
WEAK CTL - Asymptomatic Chronic Carrier INTERMEDIATE CTL - Chronic carriage and chronic hep |
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is HBV a cytolytic infection of hepatocytes?
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no
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What is recruited for clearance of infection of Hep B
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CTL response
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HEP B EPI
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WW DISTRIBUTION! - 350 mil chronic carriers
US - 1.2 mil CC highest rates in 20-49 age (drugs sex vertical) big decline since vaccine in 1980's |
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is there vertical and horizontal transmission in HBV
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yes, both - vertical mom-child is what makes SE Asia levels very high
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% of vertical transmission of HBV in SE Asia
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up to 50% of babies - birth canal or through breast feeding
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What kind of carriage does HBV vertical transmission result in
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CHRONIC CARRIAGE
90% - neonates 30% - kids 1-5 6% after age 5 MOST ASYMPTOMATIC |
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WHAT IS DEATH RATE IN CHRONIC LIVER DISEASE PATIENTS
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15-25% of chronically infected persons
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Is Hepatitis B immunizing?
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yes, only one infection
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Predominant mode of transmission in industrialized world
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sexual and parenteral (blood-borne)
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Infection to disease ration in Hep B
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10:1
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What is a high blood titer in Chronic Hep B carriers
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10 to the 10th/ml blood - blood is highly infectious
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Is virus resistant to drying
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pretty resistant, can last 1 week
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How is Hep B transmitted thru sex
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unprotected sex, especially if multiple partners
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What are other blood-borne routes for Hep B
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nosocomial exposure(hospital)
Household exposure(sharing razor, TB, etc with chronic carrier) blood transfusion - 1/200000 units of blood Hemodialysis Tatoos and piercings IVDU - IV drug use |
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What are possible results of Chronic HBV Infection
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life-long asymptomatic carriage w/o obvious adverse effect
Spontaneous clearance(small fraction, usually when infected as adult) Cirrhosis - hepatocytes replaced with necrotic tissue Hepatocellular carcinoma - destruction of hepatocytes and regrowth selects for tumors Integration into hepatocyte DNA with subsequent oncogenesis |
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What are antibodies to HBV infection and which are stronger
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surface and core antigens
CORE - appears at onset of symptoms and persist for life. indicates previous or ongoing infection SURFACE - previous infection or vaccination |
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When does HBV antigen show up
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during acute and chronic hep. Indicates infection
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What is the best correlate of infectivity in HBV
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Hep B e Antigen. Secreted product of the nucleocapsid gene found during acute and chronic hep B
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When is Hep B e antibody seen
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temporarily during acute inf or during and after a burst in viral replication.
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What does spontaneous conversion from e antigen to e antibody
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predictor of long-term clearance of HBV in patients undergoing antiviral therapy and indicates lower levels of HBV.
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What does IgM antibody to Hepatitis B core Antigen indicate
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acute or recent infection(less than 6mos)
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Describe multiple factors we need to assess for treatment
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Clinical status
Hepatocellular enzyme levels viral load Liver function enzymes Antibody and antigen status biopsy |
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Is there good treatment for chronic HB
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Treatments are experimental and still inadequate
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what is a rate of the clearance in one trial
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16 %
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What are treatment for chronic HB
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Pegylated alpha interferon(encapsulated)
Nucleoside or nucleotide analogues |
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Describe analogues(similar to the DNA, stops replication)
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lamivudine
adefovir entecavir telbivdine |
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Resistant in chronic HBV is concern
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yes(up to 10 % of cases in one study)
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Describe prevention and control
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Universal precautions in healthcare settings
Condoms Testing of pregnant women Hepatitis B immune globulin (HBIG) HBV vaccine |
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What is HBV vaccine based on
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S gene expressed in yeast
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advantages and disadvantages of HBV vaccine
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dis - 3 doses needed, can't clear in chronic carriers
adv - no major side effects, |
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Who/what is indicated for HBV vaccine
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all children 1st 18 months
HCWs IVDU Hi risk sexual exposure Living with chronic carrier Immediately, post exposure |
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what are subviral agents
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DEFECTIVE VIRUS
SATELLITE VIRUS VIROID VIRUSOID PRION |
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What is a DEFECTIVE VIRUS
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unable to replicate b/c of lack of complete genome. often competes with with complete virions for cell resources
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what is SATELLITE VIRUS
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depends on helper virus to provide some factor for replication
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what is VIROID
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Circular RNA molecule, contains no protein, too little NA to encode for replication.
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what is VIRUSOID
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ssRNA satellite virus
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what is PRION
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only protein!
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Describe the Hepatitis D
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Satellite HBV(cannot replicate in the absence of HBV)
Negative stranded RNA, Covalently closed circular genome 1.7 kb Genome encodes for a single polypeptide(hepatitis delta agent) |
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How % of people co-infected HBV and HDV
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5-60 %
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Describe the characteristics of transmission
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Parenteral transimssion most efficient
Sexual transmission less efficient Perinatal transmission rare |
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Describe coinfection in HDV
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transmission w/ B virus and D virus simultaneously
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Describe desease w/ coinfection B and D
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Severe acute
Not chronic Very aggressive desease (Fulminant- 2-20%) |
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Describe the superinfection
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~80 % develop chronic HDV infection
~80 % develop cirrhosis(compare w/ 15~30% w/ HBV alone) |
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Explain about serological characteristics of HBV-HDV coinfection
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Symptoms and elevating ALT occur same time
anti-IgM rises w/ total anti- HDV Total anti-HDV decreases slower than IgM See the material anti-HBs shows up after Ig M anti-HDV and total anti-HDV |
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Explain about serological characteristics of HBV-HDV superinfection
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Jaundice occurs as a one of the symptoms.
HBsAg can see right after exposure See the material Symptoms are milder and total anti-HDV level stays high Under superinfection HDV RNA is present throughout course(compared to coninfection which has short duration of RNA and HBs Ag) |
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Describe the prevention of HBV-HDV coinfection
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pre- or post- exposure prophylaxis to prevent HBV infection
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Describe the prevention of HBV-HDV superinfection
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Education to reduce risk behaviors among persons w/ chronic HBV.
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Describe the characteristics of Hepatitis C virus
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Family Flaviviridae
Genus Hepacivirus Positive-stranded RNA Genome 9.4 kb Six major genotypes or clades w/ no cross-protection |
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which symptoms are milder, super of coinfection
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Super-chronic-cirrohsis
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Describe the characteristics of WW distribution
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~3 % of the world chronically infected
~2.7 million chronically infected in the U.S 19% population in Egypt(from schistosomiasis vaccine) |
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Is initial HCV infection mild and what are the long term problems
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mild or asymptomatic
chronic carriage more than 50 % Cirrhosis and Hepatocellular carcinoma |
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What are the risk factors for HCV
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IVDU
Transfusion Transplant Needle stick/ iatrogenic Birth to HCV-infected mother Sex w/ infected partner |
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What are the % of biggest risk factor of HCV infection
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60% IVDU
50% Sexual Male>Female Hemophilia has high level in blood transmission HCV |
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What behavioral change happened early 2000 to reduce the incidence of HCV
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reduced IVDU- moved on to crack smoking
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What is cause of non A non B hepatitis
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HCV- Late 80's discovery
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What is prevalence of HCV following IVDU
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rapidly acquired 30% - 3 yrs
50% - 5 yrs 4 X more common that HIV Highly efficient |
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Post-transfussion HCV
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See the material
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Describe occupational transmission of HCV
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Inefficient
Hollow bore needles 10 times lower than for HBV infection |
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What kind of people has a possibility of perinatal transmission
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Women HCV-RNA positive at delivery
Average rate of infection -6% If women co-infected w/ HIV -17% Severe hepatitis in infant is rare No relation w/ breast feeding and delivery method |
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Describe characteristics of Sexual transmission of HCV
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efficiency is low
(rare btwn long-term steady partners) MSM no higher risk than heterosexuals Male to female>Female to male transmission |
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What are risk factors of HCV sexual transmission
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Infected partner
multiple partners early sex non-use of condoms other STDs sex w/ trauma |
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Through what kind of things is household transmission occur in HCV
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Through percutaneous/ mucosal exposures to blood
(contained equipment used for home therapies; IV therapy, injections) Theoretically through sharing of contaminated personal articles(razors, toothbrushes) Household transmission-rare |
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What are other potential exposures to blood
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No or insufficient data showing increase risk relate to,
Intranasal cocaine use Tattooing Body piercing Acupuncture |
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What will happen after HCV Infection and describe % of each of these
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Chronic infection- 60-85%
Chronic hepatitis- 10-70%(most asymptomatic) Cirrhosis 5-20% Mortality from chronic liver disease- 1-5 % |
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What are factors promoting HCV progression or severity
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Increased alcohol intake
Male gender Age>40 years at time of infection HIV co-infection Chronic HBV co-infection |
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What are characteristics of HCV clinical
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Incubation period; 6-7 weeks(range2-26w)
Acute illness less than 20% symptomatic Case fatality rate low |
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Describe characteristics of serologic pattern of Acute HCV infection w/ recovery
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ALT elevates around 1 month, and decreases around 6 months.
anti-HCV gets high HCV RNA shows up from 1months after exposure and disappears less than 1 year. Symptoms + or - |
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Describe characteristics of Acute HCV infection w/ progression to chronic Infection
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Symptoms; +/-
Anti-HCV; high increase from 1 month, from 6 months starts wax and waning for ALT and HCV RNA |
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How evaluate chronic HCV infection
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Same process for HBV,
liver function enzymes Assess severity and possible treatment depending on, Clinical status Viral load Antibody and antigen status Biopsy varies from Dr to Dr. |
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Describe characteristics of management of chronic HCV infection
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Treatments; experimental and inadequate
Clearance of infection; <50 % Involve combinations of ; Pegylated alpha interferon Nucleoside or nucleotide analogues(ribavirin) |
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Describe the name of nucleoside analogues
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Lamivudine, adefovir, entecavir, telbivudine
(all drugs block some form of replication) |
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What is a biggest concern in management of chronic HCV infection
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Emergence of resistant viruses
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Describe ways for prevention and control of HCV
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Screen and blood donors
Virus inactivation of plasma-derived products Safe injection and infections control practices |
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Describe the risk-reduction counseling and services
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Obtain history of high-risk drug and sex behaviors
Provide information on minimizing risky behavior, including referral to other services Vaccinate against hepatitis A and/or hepatitis B |
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Who should take HCV test
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<Risk of infection>
Ever injected illegal drugs Received clotting factors made before 1987 Received blood.organs before July 1992 Ever on chronic hemodialysis Evidence of liver disease <Risk of exposure> Healthcare, emergency, public safety workers after needle stick/ mucosal exposures to HCV-positive blood Children born to HCV-positive women |
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What are ways for reducing harm to liver
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Limit or abstain from alcohol
Vaccinate against hepatitis A and B Refer to support group |
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What routes of transmission of HCV to others should be used to prevent
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Direct exposure to blood
Perinatal exposure Sexual exposure |
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What viruses have first and second highest risk of needle stick infection
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1 HBV(HBs Ag+, HBeAg+);20-30% clinical hepatitis, 37-62% Seroconversion
2 HBV(HBsAg+, HBeAg-); 1-6% clinical hepatitis, 23-37% Seroconversion (eAg=more infectious sAg=less infective) HCV 0-7%, HIV-1 0.3% |
