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197 Cards in this Set
- Front
- Back
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What type of Hepatitis is considered "Infectious"
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Hep A
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What two types of hep are considered "Serum" hep
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Hep B and D
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Which type of Hep is Enterically Transmitted?
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Hep E
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Which type of Hep is Parenterally transmitted
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Hep C
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Inflammation of the liver in which diffuse or patchy necrosis causes damage to the liver acini, resulting in destruction of the organ's architecture is defined as what
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Hepatitis
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What are the 6 primary causes of hepatitis
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Viral, Bacterial, Medication, Toxins, Alcohol, Obstruction
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What are the 4 Viral causes of Hep
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Hepatitis A-G and TTV, HIV, Cytomegalovirus, and Herpes Simplex Virus
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What are the 2 causes of Bacterial Hep
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Mycobacterium TB, and Bacterima
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What types of medications cause hep
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Rx meds: psychotropic agents, (analgesics) acetaminophen, (antibiotics) ampicillin, tetracycline, (antivirals) zidovudine
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What 3 toxins cause Hep
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Halothane, Isoniazid, Methyldopa
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What 2 Obstructions cause Hep
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Choangitis (biliary tract), and Cholecystitis (gallbladder)
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Flue-like symptoms such as Fever, nausea, vomiting, diarrhea, joint and muscle pain, anorexia, jaundice, hepatomegally, abdominal and gastric distention, dark urine, fatigue, bruising rash, and chills is indicative of Acute or Chronic Hep
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Acute Hep
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Hepatic inflammation, necrosis, and figrosis with elevated AST and ALT levels as well as Imaging studies and Liver Biopsy is indicative of (Acute or Chronic) hep
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Chronic
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Which type of test is the best way to follow the progression of chronic liver disease
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Liver biopsy
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What are the 8 types of hep
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A-G and TTV
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Which 5 types of hep can be both acute and chronic
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B, C, D, G, and TTV
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Which three types of Hep are only Acute
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A, E, and F
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Which types of hep can be tested for by Serologic means
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A-E, and G
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Which types of hep can NOT be tested for by Serologic means
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F and TTV
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Which types of hep are acquired throu contaminated water and food
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A, E, F
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Which types of Hep are Enterically Transmitted
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Hep A and E
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Which types of Hep are Parenterally Transmitted
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Hep B, C, D, and TTV
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Which types of Hep are Blood Born
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Hep B, C, D, and TTV
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Sjogren's Syndrome is associated with which type of Hep
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HCV
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Lichen Planus is associated with Acute/Chronic Hep
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Chronic
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In Hep pts, is the breath musty/sweet
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Yes, bc keto acidocis
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What does a loss of liver coagulation factors due to Hep cause in the mouth
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Gingival Bleeding, Mucosal ecchymosis, petechae, and delayed healing
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Can hep cause mucosal jaundice (yellow pigment) as well as jaundice in the sclera fo the eye
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Yes
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Alcoholic hep causes what in the oral cavity
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Glossitis and angular cheilitis
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What is currently the most prevelent form of hep
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Hep C
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What type of virus causes hep A
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A 27-nm RNA piconavirus
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Can Hep A be both asymptomatic or symptomatic
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Yes
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What is the average incubation period for HAV
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28-30 Days
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How long is induced protection against HAV subsequent to infection
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Lifelong
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How many different serotypes of HAV have been observed in the world
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Only One
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Have clinical trials proven HAV vaccine to provide long or short tierm protection against HAV
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Long Term
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What 2 etiological conditions are corrolated with high HAV infections
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Poor socioeconomic and hygienic conditions
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In industrialized contries what 2 groups have common outbreaks of HAV
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drug users and travelers to high endemic areas such as India, Africa, and Mexico
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Has HAV infections been increasing or decreasing since a HAV vaccine was licensed in 1995 and the ACIP recommendations for HAV made in 1999
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Decreasing
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Have incidence of HAV been reletively constant or on 10-15 year cycles over the past 50 years
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Cycicle in 10-15 year cycles
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Are the estimated number of Acute cases of HAV greater or lower than the reported # of Acute HAV cases
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much higher
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Before 1997 what part of the US had the greatest numbers of HAV
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The west Coast
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Is the incidence of HAV greater or lower now than in 2001
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The Incidence of HAV is the lowest now than ever recorded.
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Are there currently more cases of HAV from low incidence or high incidence states.
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Cases from low incidence states now account for the majority of cases nationwide.
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Does the RNA Picornavirus have an acute disease or asymptomatic infection that progresses to a chronic infection
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No, HAV has NO chronic infection because of protective antibodies that confer lifelong immunity
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Which age group of <5, 6-14, and >14 yrs has the greatest percent of Jaundice due to HAV
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>14 yrs has the highest percent of Jaundice due to HAV, <10%, 40-50%, and 70-80%
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What are the 3 Rare complications of HAV
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Fulminant hepatitis (die within 1 month), Cholestatic Hep, and Relapsing Hep
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Are there any Chronic long term effects from HAV
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There are NO long term effects from HAV
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Is more HAV found in the stool or in the blood of infected pts
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In the Stool
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What liver serum enzyme spikes during the 2-6 weeks of HAV infection
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ALT enzyme
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What weeks is HAV clinical illness exibited
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3-9 weeks
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Which IG increases rapidly and then declines during a HAV infection
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IgM
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Which IG slowly increases and remains long term present in a HAV infection
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IgG
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What is the correct order from greatest to lowest concentration of HAV in oral cavity, feces, saliva, and serum
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Fecal>serum>oral cavity>urine (steril)
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What is the most common route of HAV transmission
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Fecal-oral due to close personal contact
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What are the most common methods of HAV transmission
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Fecal-oral, Close personal contact (household contact, sex contact, day care), Contaminated food/water (infected food handlers and pools), and Blood exposures/viremia (RARE, IV drug use and B Transfusions)
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What is the greatest risk factor associated with HAV
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Unknown, 46% or reported cases cannot associate a risk factor to their infection.
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Of known risk factor associated with HAV, what is the % breakdown
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Sexual or household contact - 14%, Other Contact - 8%, Men haveing Sex with Men - 10%, Contact of day-care child/employees - 8%, IV drug use - 6%, Food or water borne - 4%
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What are the 4 methods to prevent HAV
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1, Vaccination (pre-exposure prevention)
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What 6 groups of people does the ACIP recomment recieve HAV vaccinations
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1. Travelers to intermediate and high HAV-endemic countries
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5. persons with chronic liver disease
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6. Communities with historically high rates of hepatitis A -routine childhood vaccination
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What 2 racial groups have high endemic rates of HAV Infection and periodic HAV out breaks
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Alask Natives and American Indians
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How long does HAV vaccine antibodies last
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At least 5-8 years with predictions of protective antibody levels for at least 20 years
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Is there currently any recommendations for followup boosters of HAV vaccine after the second dose
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NO
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After 1 and 2 doses of HAV vaccine, what percent of people have Immunogenicity
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94-100% positive 1 month after dose 1 and 99-100% positive after dose 2
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What are the most common side effects of HAV vaccine
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1. Sore injection site (50%), headache (15%), malaise (7%)
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After what age can HAV vaccine be administered
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After age 1 year
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Is post HAV vaccine testing reccommended.
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NO, Post HAV vaccination testing is NOT recommended because of the high response rate among vaccinees
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If there is <4 week before a non-HAV vaccinated person is to travel to an endemic region, what should be done to protect that individual
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Addminister IG (80-90% effectie in preventing hep A.
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If exposed, within how many days should post Hep A IG prophylaxis be administered
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Within 14 days to be effective
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Who should recieve Post-exposure HAV IG
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Routine
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Among what groups is HAV rates increasing
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Occurring among adults in high risk groups (e.g. MSM, drug users)
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What is the major etiologic agent of enterically transmitted no-A, non-B hep worldwide
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hep E Virus HEV
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What form of hep is a spherical, nonenveloped, single stranded RNA virus that is approximately 32 to 34 nm in diameter.
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HEV
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What fimily is HEV Classified in
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The Caliciverdae family
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What goegraphic areas is ourbreaks of HEV common
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Primarily in developing countries with inadequate environmental sanitation
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What is the prevalence of anti-HEV in healthy populations (US)
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<2%
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In the US what is the source for HEV infection
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Nearly all Hep E from traveling to India and contaminated water.
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What are the 3 Epidemiologic features of HEV infection and US HEV infection
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Most outbreaks associated with fecally contaminated drinking water
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Is HEV transmitted readily by peron to person contact
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NO
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What is the average Incubation period for HEV
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40 days (Range 15-60 days)
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What are the typical signs of HEV
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abdominal pain anorexia, dark urine, fever, hepatomegaly, jaundice, malaise, nausea, and vomiting.
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What are the less common symptoms associated with HEV
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arthralgia, diarrhea, pruritus, and urticarial rash.
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Is there any evident of chronic infection from HEV
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No evidence of chronic infection has been detected in long‑term follow‑up of patients with hepatitis E.
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What is the case-fatality rate for HEV
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Overall, 1%-3% Pregnant women, 15%-25%
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Is HEV illness more or less severe with increasing age
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Increased illness severity with increased age
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Where are HEVs found 3-7 weeks after infection
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In Stool
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What liver enzyme is elevated 4‑5 weeks after oral ingestion and persisted for 20‑90 days
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ALT liver enzyme
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Elevated levels of which Antibodies are detectible subsequent to a HEV infection
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Both IgM and IgG antibody to HEV (anti‑HEV) are elicited following HEV infection. The titer of IgM anti‑HEV declines rapidly during early convalescence
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Are there any commersially available serologic tests to diagnose HEV infection in the US
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NO because there is very low levels of HEV in the US
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What Prevention and Control Measures for Travelers to HEV – Endemic Regions are available
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Avoid drinking water (and beverages with ice) of unknown purity, uncooked shellfish, and uncooked fruit/vegetables not peeled or prepared by traveler IG prepared from donors in Western countries does not prevent infection. Unknown efficacy of IG prepared from donors in endemic areas. Future vaccine (?)
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What % of the global population live in areas with a High prevalence of chronic HBV infection
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Approximately 45% (> 8% of the population is HBsAg‑positive)
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What % of the global population live in areas with a moderage prevalence of chronic HBV infection
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43% in areas with a moderate prevalence (2%‑7% of the population is HBsAg‑positive)
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What % of the global population live in areas with a Low prevalence of chronic HBV infection
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and 12% in areas with a low prevalence (< 2% of the population is HBsAg‑positive).
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What are the respective lifetime risks for HBV in High, Moderate, and Low HEV Prevelances
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>60%, 20-60%, and <20%
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What is the Relative prevelance of HBV in the US
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LOW
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What has 6 things has contibuted to a decline in HBV infections since the late 1980s
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1. behavioral changes of MSM and IV drug users in responce to AIDS, 2. HBsAg screening of pregnant women, 3. Infant immunization, 4. OSHA Rule enacted, 5. Adolescent Immunization, 6. acceptance in a new non-serum derived HBV vaccine
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is the incidense of asymptomatic HBV cases high or Low
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High
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What is the Average Incubation period for HBV
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Average 60-90 days, Range 45-180 days
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What is the incidence of Clinical Illness (jaundice) form HBV <5yrs and >5yrs
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<5 yrs, <10%
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What is the Acute case-fatality rate for HBV:
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0.5%-1%
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What is the rate of Chronic Infection from HBV for <5yrs and >5yrs
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<5 yrs, 30%-90%
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What is the % Premature mortality from chronic liver disease due to HBV
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15%-25%
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What is the outcomes for both Asymptomatic and Symptomatic acute HBV infection
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What is the total percentage of those infected with HBV that become chronic carriers
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5-10%
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What % of Acute hepatitis infections become Fulminant Hep and cause death
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<1%
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What % of those who develop Cirrhosis due to HBV develop Hepatocellular Cancer and/or Die
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10% for each
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What are the different Serologic Markers for HBV
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HBsAg (HB surface Antigen) HBsAb (anti-HBs) This stands for (anti-HB surface Antibody)
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Which serologic marker is teh first to appear following acute HBV infection
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HBsAG which can be detected as early as 1 or 2 weeks and as late as 11 or 12 weeks avg 3 months
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Diagnosis of acute HBV infection can be made based on which IG
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on the basis of the detection of IgM class antibody to hepatitis B core antigen (IgM anti‑HBc) in serum
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Which IG persists indefinately as a marker of past HBV infection
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IgG
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Which serologic marker for HBV persists indefinately after the disappearance of HBsAg in patients who do not progress to chronic infection
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The presence of anti‑HBs following acute infection generally indicates recovery and immunity from reinfection. Anti‑HBs is what you look for to tell if a pt is immune.
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if a pt develops chronic HBV infection, which serologic marker remain detectable for life
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HBsAg and IgG anti‑HBc
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What does a negative test for IgM anti‑HBc together with a positive test for HBsAg in a single serum specimen usually indicate
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A chronic HBV infection.
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What are the 3 modes of HBV transmission
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Sexual
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In what body fluids is the concentration of HBV high
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Blood, serum, Wound Exudates
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In what body fluids is the concentration of HBV Moderate
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Semen, Vaginal Fluid, Saliva
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In what body fluids is the concentration of HBV Low
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Urine, Feces, Sweat, Tears, Breast milk
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What % of HBV infections had a sexual risk factor
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36% (>1 sex partner during the previous 6 months, sex contact with a person with hepatitis, or men who have sex with men)
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What is the medical employee associated risk factor for HBV
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1%
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What is the associated risk factor for HBV Unknown, Other factors, and IV drug Use
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32%, 18%, and 14% respectively
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What is the typical schedule for a 3 dose HBV Vaccine
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3 dose series, typical schedule 0, 1-2, 4-6 months - no maximum time between doses (no need to repeat missed doses or restart)
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What is the typical schedule for a 2 dose HBV Vaccine
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2 dose series (adult dose) licensed by FDA for 11-15 year olds (Merck)
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What is the percent immunization/protection after dose 1, 2 3
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Protection ~30-50% dose 1
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Who will have lower rates of conversion after using the HBV
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lower in older, immunosuppressive illnesses (e.g., HIV, chronic liver diseases, diabetes), obese, smokers
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What is the rate of Anaphylaxis for HBV vaccines
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1/600,000
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Is there scientific data to link hep B vaccine with MS, autism, or other autoimmune diseases
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NO
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Who does the AICP Recommend be administered HBV vaccine
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Basically Everyone, Routine infant
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Is post-vaccination testing recommended after HBV vaccination
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Yes, 1-2 months after last shot
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What type of hep virus is enveloped, single‑stranded RNA virus, approximately 50 nm in diameter
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Hep C
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What genous is Hep C part of
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Flavivirdae
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What genetic property of HCV allow it to escape immune surveilance
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HCV undergoes rapid mutation in a hypervariable region(s) of the genome coding for envelope protein. Ths allows it to escape immune surveilance
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Are most HCV infections Acute or chronic
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Chronic
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What is the most common blood borne pathogen in the US
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HCV
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What countries have the lowest incidence of HCV.
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UK and Scandinavia <0.1%
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What country has the highest rate of HCV
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Egypt 20%
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Is the prevalence of HCV in the US High, Intermediate, Low, or Very Low
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Low, 0.2%-1%
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Donated blood is screened for HCV
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True
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What accounts for the >80% decline in HCV infections between 1989 and 1995
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Anti-HCV test 1st and 2nd gen - decline in trasnfusion recipients and a decline among IV drug users
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What are the 2 largest population groups for + HCV
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hemophilia and IV drug users
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What is the Incubation period for HCV
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Average 6 - 7 wks
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What % of HCV infections are acute illness (jaundice)
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<20% and mild
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What is the case fatality rate for HCV
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Low
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What % of HCV infections develop into chronic infection
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Very large %, 60%-80%
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What % of HCV infections develop into chronic hepatitis
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70%
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What % of HCV infection develop into Cirrhosis
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5%-20%
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What is the mortality rat from HCV
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3%
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How long does it take to develop symptoms form chronic Hep C
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10-20yrs
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When is cronic Hep C usually diagnosed
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When symptoms of fatigue appear with advanced liver disease
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Can HCV RNA disappear and reappear later
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Yes
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What liver enzyme is characteristic of accute hep C
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ALT (allanine aminotransferase)
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Normalization of ALT may occur and suggest what
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full recovery
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What increases the severity of chronic Hep C infection
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Increased alcohol intake
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In the US, how many new HCV infection/yr are there
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currently 25,000/yr used to be 240,000/yr
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in the US, how many death from chronic HCV desease/yr
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8,000-10,000
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Out of every 100 people who are infected with HCV how many will die from cirrhosis
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4
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What is the leading indication for liver transplant
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HCV infection
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Of the approx 80-85 % of individuals who develop Chronic Hep C, what % will develop Cirrhosis
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20%
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Of those who develop HCV cirrhosis, what % will die
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50%
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What are the Major Risk Factors Associated with Transmission of HCV
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Illegal injection drug use
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Greater than 60% individuals receiving transfusion for transplantation from an infected donor become + for anti-hCV
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True
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What is the rate of transmission of HCV following a needle stick
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1.8%
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What 2 risk factor groups have increasing HCV trasmission
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health workers and Sexual transmission
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What accounts for the largest incidence of HCV transmission 60%
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drug use
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What is the second highest risk factor for HCV
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Sexual transmission
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IV drug use as a means of HCV transmission is _______ efficient, ________acquired after initiation, and ____ times more common than HIV transmission
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Highly efficient, Rapidly acquiired, and 4x mor commmon than HIV
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Sexual Transmission of HCV Occurs, but efficiencey is ____ and Accounts for ______% of acute and chronic infections in the US
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Low, 15-20%,
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Can HCV be transmitted by a blood splash to the eye
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yes
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The prevalene among health care workers is greater/lower than the general pop
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Lower, 1-2% and 10x lower than for HBV infection
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When should Health Care Workers or infants be tested for HCV
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After needle sticks and if born to HCV + mother
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Who should be routinely HCV tested
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Individuals with Identified Risk factors
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What is the Post-exposure Prophylaxis for HCV
|
There is none
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What protective antibody has been identified for HCV
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No protective antibody has been ID
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Are prior studies of IG use for Post-HCV exposure relevent
|
Probalbly not due to research methods
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IG prepared from high anti-HCV titer plasma did prevent infection in chimpanzees
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FALSE, IG in chmips did not prevent infection
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What are the predominate HCV genotypes
|
United States
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Who is at greater risk for developing infection after a needle stick, HCV or HIV exposure
|
HCV needle stick. 0-7% (AVE 1.8%) after unintentional exposures to known contaminated needles/sharps (HIV 0.25%)
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What methods are available for HCV Prevention
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No IV drugs, no hanky panky, and no needle sticks, Through primary means
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Which Hep virus is an obligate parasite, defective single-stranded RNA virus that requires the ehlper function of HBV to replicate
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HDV
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What does hDV need HBV for
|
for synthesis of envelope protein composed of HBsAn, which is used to encapsulate the HDV genome
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Generally, what is the global prevelance of HDV
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It corresponds to the prevalence of Chronic HBV infection
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In countries with a low prevalence of HBV, what is the rate of HDV among both asymptomatic and chronic HBV pts
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<10% and <25% occurs mostly among IV drug users and hemophiliacs.
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In countries with moderate and high levels of chronic HBV prevalence, is the prevalence of HDV infection is constant or highly variable.
|
Highly variable
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in most of Southeast Asia and China, where the prevalence of chronic HBV infection is very high, is the HDV infection correspondingly very high or uncommon.
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Uncommon
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What is distinct about HDV infections in South america
|
HDV outbreaks in South America come in periodic epidemics that are very severe, rappidly progressing to fulminant hep with 10-20% mortality
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What are the 2 typs of clinical features of HDV with HBV
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Coinfection with HBV
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What liver enzyme is elevated in a HBV-HDV coinfection
|
ALT Enzyme
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In a HBV-HDV Coinfection which 2 anti-HDV IG are detectable during eh course of eh infection
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IgM and IgG
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What IG is used as a commercial test in the US to detect HDV infection
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IgG
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What % of HBV-HDV Coinfections Recover with immunity
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90%
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What % of HBV-HDV Coinfections end in Death by Fulminate Hep
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3-4%
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In a HBV-HDV Coinfection what does the dissappearance of HDAg and HDsAg indicate
|
Resolution/immunity without the development of chronic infection
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In pts with chronic HBV infectionwho are superinfected with HDV, what 3 characteristic serologic fetures generally occur
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the titer of HBsAg declines at the time HDAg appears in the serum,
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What % of Hep D superinfections end in Death by Fulminant Hep
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7-10% (2-3x the deaths in a Coinfection)
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What % of Hep D superinfections end in Recovery
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10-15%
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What % of Hep D superinfections become Chronic HBV/HDV ending in Cirrhosis
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80%
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How is HDV transmitted
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Percutanous exposures
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