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51 Cards in this Set
- Front
- Back
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What is the general clinical presentation of hepatitis?
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fever, nausea, jaundice, itching wheals on trunk, arthralgia, prodrome, Dark urine, light feces (clay colored)
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What strain of hepatitis virus historically has been the primary cause of serum hepatitis?
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HBV
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What is the structure of HBV?
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circular DNA
partially ds, partially ss replicates with reverse transcriptase (DNA -> RNA -> DNA) icosahedral capsid enveloped (from ER) |
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What is the unique name given to the HBV infectious particle?
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DANE
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What is the HBsAg?
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Hep B surface Antigen that is the collective name for the three viral glycoproteins extending from the surface of the HBV envelope and the target for vaccines. the detection of HBsAg is indicative of HBV infection
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What does the HBeAg indicate?
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pt is infectious, there is whole virus in the blood.
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What does HBcAg indicate?
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core antigen makes up capsid, just before active disease occurs, you can see this. this is the last Ag to appear
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How does HBV spread?
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semen, menstrual fluid, saliva, nasopharyngeal fluid, blood, sexual contact, perinatal, breast milk
NO respiratory, NO fecal/oral |
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What is the concern of perinatal infection?
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must higher chance of becoming a chronic infection
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Where does HBV replicate in the body?
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liver, duh.
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When do liver symptoms appear?
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immune mediate inflammatory response as a response do the virus is what causes it. the viral incubation period is about 100 days
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What two common types of immune responses occur in HBV infection?
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1. Strong CTL expression -> acute HBV
2. Weak CTL expression because of reduction of MHC-I expression because of poor IFN production -> chronic HBV infection |
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What is the correlation between age group and chronic vs. acute prognosis?
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young age = chronic
older age = acute |
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What is usually the cause of fulminate HBV infection?
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super infection of HBV and HDV both!
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What is qualitatively a chronic HBV infection?
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HBsAg in the blood for more than 6 mos
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What are two names of chronic HBV infection?
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MCH - minimal chronic hepatitis
CPH - chronic persistent hepatitis or CAH - chronic active hepatitis SCH - severe chronic hepatitis |
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What is a classic HBV profile for a chronically infected MCH/CPH pt?
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is infectious. no major liver damage.
HBsAg+, HBeAg-, Anti-HBcAg+, Anti-HBeAg-/+ some can be occult infections where asymptomatic and no Ag |
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What is the classic HBV profile for a chronically infected CAH/SCH pt?
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high liver damage maybe even liver cancer, intermittent symptoms, death usually in 1 year
HBsAg+, HBeAg+ Anti-HBcAg+, Anti-HBeAg- |
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What does HBV DNA and DNA polymerase in the serum indicate?
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HBV DNA means that there is active viral replication occurring
HBV DNA polymerase means that there is so much viral replication that your immune system can't keep up with it = poor prognosis indicator |
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What is tx for acute HBV?
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bed rest and whatever the pt is comfortable doing. no therapy. do not use corticosteroids. can cause post treatment HBV flare up.
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What is preventative tx for HBV acute?
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safe sex
vaccine |
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What is tx for chronic HBV?
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INF-alpha tx to upregulate MHC-1 and increase CTL response
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What is tx for perinatal infection?
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bolus of HBV Ig and active vaccination simultaneously
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What are the two forms of the HBV vaccine?
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1. recombinant vaccine - 3 doses of purified HBsAg
2. plasma-derived - not used because risks of plasma-derived |
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What is significant about HDV?
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It is not a complete virus. It is a subviral particle, so it has to coinfect cells that are already infected by HBV. It cannot infect on its own.
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What is the structure of HDV?
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negative ssRNA (ribosome, so self cleaves and self ligates)
endcodes for a single delta antigen helical capsid envelope from HBV replication so it uses the HBsAg as its surface antigen |
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So considering the structure of HDV, what is the preventative tx for HDV?
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HBV vaccination
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What is the most concerning disease involving HDV?
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chronic HDV which results in a superinfection and pushing from chronic persistant to chronic acute with exacerbating liver damage. bad news.
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How can you detect HDV?
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delta antigen in the serum
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What has restricted the science community's knowledge of HCV?
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HCV cannot be grown in culture. a lot unknown about HCV. more chronic cases of HCV than of HBV.
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What is the structure of HCV?
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linear positive ssRNA
helical capsid enveloped contains E1 and E2 glycoproteins in the envelope E2 contains a neutralization epitope, but also contains a hypervariable mutating region, so neutralization can cause mutation! |
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What demographic is most commonly infected with HCV?
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blood transfusion
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What is a distinguishing clinical presentation of HCV?
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upper right quadrant pain,
elevated liver enzymes |
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What is the long term effect of HCV?
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cirrhosis/liver destruction, since very very long 10 - 30 yr chronic persistent infection, pt is infectious during the whole time!
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How is HCV clinically dx?
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ELISA to look for HCV Ab. HCV produces fatty liver, bile duct lesions and lymphoid follicles which are different than HBV.
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What is HCV tx?
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none, no vaccine, can give INF-alpha which will reduce HCV in the blood, BUT it HCV will relapse. can use Ribavirin (but is a teratogen = no preggos)
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What family is HAV in?
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Picornovirus
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What is the structure of HAV?
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non-enveloped
icosahedral capsid EXTREMELY stable. no effect by autoclaving, standard chemical tx, pH1 |
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Where are common food sources of HAV?
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sea water, soil, fresh water, live oysters, cream filled cookies
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How does HAV effect the liver?
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replication occurs in the hepatocytes, but there is not a lot of bad liver damage. liver damage occurs because of immune response to hepatocyte infection
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What types of acute and chronic HAV infection is caused?
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just acute, no chronic
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What clinically symptoms appear with HAV?
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same as most other hepatitis.
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What is the best way to prevent HAV?
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wash hands after you poop
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How is HAV treated?
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Ig or ISG (immune serum globulin) but is commonly self-limiting. use a vaccine Havrix or Vaqta to prevent. great vaccine.
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What is the family of HEV?
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Calicivirus
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What is the structure of HEV?
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positive ssRNA
icosahedral capsid no envelope not quite as stable as HAV |
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What is the HEV route of infection?
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infected water, fecal-oral
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How is HEV dx?
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exclusion dx
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What is the most dangerous demographic of infection of HEV?
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pregnant women - 20% mortality
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What is HEV tx?
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supportive, no vaccine
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What is the blood borne hepatitis dx of exclusion?
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HGV
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