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55 Cards in this Set
- Front
- Back
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What is the cause of hepatocyte damage in viral-induced hepatitis?
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Cytotoxic lymphocytes trying to get rid of the virus
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What systemic viruses can cause hepatitis?
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EBV
CMV Yellow Fever |
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What will LFTs show with hepatitis?
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Really elevated ALT
Elevated AST Alk phos normal |
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What type of virus causes Hep A?
What is the main route of transmission? How does replication happen? |
Single serotype picorna (+RNA naked)
-is stable at pretty low pH since naked Fecal-oral is main route of transmission - SHELLFISH! Immediately translates viral RNA into polyprotein which is cleaved |
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T/F Replication of hepatitus viruses is generally non-cytolytic
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True
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Where will the concentration of Hep A virus be highest?
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In the stool (not in the blood)
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What is the temporal relationship between viral shedding and symptoms?
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Virus is shed ~10 days before symptoms appear (can infect others before you know you have it)
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T/F Chronic shedding does not occur in Hep A
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True
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What response is protective against Hep A?
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Humoral - antibodies confer lifelong immunity
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Who is more likely to show worse symptoms when infected with Hep A - young adults or children?
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Young adults - symptoms mostly due to immune response against the virus
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What are the symptoms of the prodrome phase of Hep A?
The icteric phase? |
Mild flu-like symptoms
5-6 days later, get dark urine and jaundice as well as itching and abdominal pain |
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What is the timeline of the clinical disease of Hep A?
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Symptoms start 3 weeks to a month after exposure
Prodrome first, then 5-6 days later get ichteric phase Symptoms last about 3 weeks, complete recovery in 2-6 months |
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How is Hep A and E diagnosed?
What is ordered for acute infection? For old infection? |
Serology (there are ABs by the time you see symptoms)
IgM for acute Total for past (IgM + IgG) |
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What does IgM negative and total negative for Hep A or E mean?
IgM positive and total positive? IgM negative and total positive? |
No Hep A/E
Acute Hep A/E Past Hep A or past vaccination |
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Is there any prophylactic treatment for HepA?
What type of vaccine is available? |
Yes, immune globulins
Inactivated whole virus vaccine available |
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What is the treatment for Hep A?
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None - symptomatic only
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What type of virus is Hep E?
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Hepeviridae (only member, noro-like)
+RNA, nonenveloped |
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How many types of Hep E are there?
Distinguish the types. |
One serotype and 4 genotypes
Genotypes 1 and 2 are responsible for most outbreaks in humans Genotype 3 affects swine Genotype 4 affects humans and swine, is common in Asia, and is a more serious disease than that caused by genotype 3 |
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What are some differences in the clinical features of Hep E and Hep A?
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Incubation period a little longer for Hep E (40 days as opposed to a month)
Mortality rate is slightly higher in Hep E (1.5% as opposed to 0.5%) Severity of illness very high in pregnant women with this (esp third trimester) --- fulminant hepatitis with mortality rate of 20% |
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Complications rarely assoc. with Hep A or Hep E - describe them:
Fulminant hepatitis Cholestatic hepatitis Relapsing hepatitis |
Fulminant hep - leads to liver failure and requires a transplant
Cholestatic hep - obstruction of biliary duct Relapsing hep - more likely to occur in immunocompromised |
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What is the difference between Hep A and Hep E in age at which people are typically affected?
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Hep A is when very young in areas with poor sanitation
Hep E is more likely in young adulthood |
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Which is more likely to be spread person-to-person, Hep A or Hep E?
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Hep A
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What is the main way that Hep E is transmitted?
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Fecal-contaminated water
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What type of virus causes Hep B?
What is often seen in blood? |
Hepadnavirus
DNA virus with reverse transcriptase See Dane particles (complete virion) but these are outnumbered by surface antigen-containing particles |
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What is the role of HBsAG (Hep B surface antigen)?
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Stimulates neutralizing antibody production (HBsAb) - produced in excess which protects virus from antibodies during active infection
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Describe HBcAg and HBeAg and their roles.
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HBcAg is the core antigen of Hep B that is the primary core antigen and is part of the nucleocapsid.
HBeAg is the E antigen and is also part of the nucleocapsid and is produced in excess and secreted into the blood like HBsAg HBeAg is the most potent marker of ongoing viral replication |
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Describe the replication of Hep B briefly and what translation of the mRNA yields.
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DNA --> RNA --> DNA
Translation of mRNA yields HBsAg, core proteins, and reverse transcriptase |
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T/F Neutralizing antibodies can resolve an established Hep B infection but cannot prevent an initial infection
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F (opposite)
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How is a chronic Hep B infection defined? How many of these people will have signs?
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6 or more months of titers found in blood
About half will have signs |
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How is Hep B spread?
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Through blood, saliva, unprotected intercourse.
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What is given prophylactically to infants born to infective mothers or those that may have been exposed?
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Hep B Immune globulins
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What type of vaccine is available for Hep B?
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Recombinant - universally given to all infants in the U.S.
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What is used to monitor therapy of HBV?
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molecular assays (e.g. viral load assays)
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What treatment is sometimes given in Hep B (not hugely effective, is costly, and has lots of side effects though)
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Interferon
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What marker indicates overall infection with HepB?
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HbsAg
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What marker indicates high level of replication of Hep B?
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HbeAg
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What marker indicates recovery from Hep B?
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HbsAb
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What marker is used to detect someone in the window phase of Hep B (when there is no more surface antigen but not surface antibody yet)?
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HbcAb - IgM
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What does Hep D look like and what does it require to complete its life cycle?
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Small ss circular RNA with delta antigen and HBsAg on envelope
Requires HBV to complete its life cycle |
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What is coinfection of Hep D and Hep B? What is superinfection?
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Coinfection if the were acquired at the same time
Superinfection if Hep D was acquired later |
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What is responsible for ~40% of fulminant cases of hepatitis?
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Hep B/Hep D combo
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Which is less severe, coinfection with Hep B/D or superinfection?
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Coinfection
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How is Hep D spread and how does it cause damage?
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Through blood and body fluids
Direct cell death and immune-mediated damage |
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Describe the virus that causes Hep C.
Which serotypes are most common in the U.S. and Western Europe? |
Hepacivirus from flaviviridae family
Enveloped, +RNA Types 1a and 1b most common |
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In which condition do most patients have persistent viremia, variable degrees of hepatic inflammation or fibrosis and also inadequate T cell response to control the inflammation but damage due to cytokine elaboration in the liver?
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Hep C
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What are some factors that make a person with Hep C less likely to develop severe cirrhosis or cancer (or at least delay the time it takes this to develop)?
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Being female, young, and not using alcohol or drugs (in this case, it may take 30 or more years for the disease to progress)
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What is the main way that people get Hep C?
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Infected blood (in U.S., it is injection drug use and used to be transfusions)
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What are the symptoms of Hep C in the acute phase?
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Normally there are none or very mild symptoms
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T/F Hodgkin's lymphoma is an extrahepatic manifestation of Hep C
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True
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What is the most common screening test for Hep C?
What is the limitation? |
Serology (this can be confirmed with Western Blot or viral nucleic acid)
Does not tell you if it is acute or chronic so need to look for the viral RNA |
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What is the treatment for Hep C?
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Interferon-alpha and ribavirin combination used for 24-48 weeks
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What kind of vaccine is available for Hep C?
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None
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While this organism usually causes asymptomatic infection, occasionally someone will present with hepatic necrosis, fibrosis, and jaundice. The source is often infected fish and the offender lives in the gall bladder and bile ducts. What is this and how is it diagnosed and treated?
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Clonorchis sinensis (Chinese liver fluke)
ID ova in feces Treat with praziquantel |
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What fluke inhabits the hepatic parenchyma and infects humans through plants with metacercaria (and have sheep involved in life cycle). How is is treated?
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Fasciola hepatica
Praziquantel not effective |
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Patient presents with flu-like symptoms that worsens into headache, myalgia, chills, abdominal pain, conjunctival reddening, vascular collapse, thrombocytopenia, hepatic and renal dysfunction.
What is the cause? How did infection happen? What is this secondary set of symptoms called? What causes the damage? How is this diagnosed? |
Leptospirosis (spirochete bacteria that are zoonotic - humans are accidental host)
Penetrates skin through minor breaks, gets into bloodstream and causes endothelial damage to spread Weil's disease Organism and immune reactions (e.g. immune complexes) Diagnosed through serology |
