Block 3 Micro Exam -- Hepatitis Viruses (#13)

Front 1

Virus family of Hep A

Back 1

Picornaviridae

Front 2

Virus family for Hep B

Back 2

Hepadnaviridae

Front 3

Virus family for Hep C

Back 3

Flaviviridae

Front 4

Virus family for Hep E

Back 4

Caliciviridae

Front 5

Type of virus Hep D is

Back 5

Defective ssRNA virus

Front 6

What causes cellular damage in hepatitis?

Back 6

The Immune Response

Actual virus growth is relatively benign for hepatocytes

Front 7

% of Hep B carriers that develop chronic, active hepatitis

Back 7

25%

Front 8

Predominant Hep B serotype in the U.S.

Back 8

adw

Front 9

HBV can be disinfected by

Back 9

Bleach
Acid

Front 10

Unlike most enveloped viruses, HBV CANNOT be inactivated by these

Back 10

Detergent
Ether

Front 11

Dane particle

Back 11

Name for the infectious virion of HBV

Front 12

Size of the two particles that accompany Dane particle

Back 12

20 nm

One is a rod, one is a sphere

Front 13

What are the two particles that accompany the Dane particle made of?

Back 13

Composed entirely of S glycoprotein (HBsAg)

Front 14

Unique characteristic of Hepatitis virus

Back 14

PARTIALLY double stranded

Full length minus strand
50-80% complete positive strand

Front 15

What are the four proteins encoded by HBV?

Back 15

HBsAg
HBcAg
Polymerase
Protein X (function unknown)

Front 16

What is special about HBV polymerase?

Back 16

Has BOTH RNA-dependent and DNA-dependent (reverse) polymerase activities

Front 17

Three forms of HBsAg

Back 17

Small
Medium
Large

ALL are present in virions

Front 18

Predominant form of HBsAg in Dane, spherical and rod-shaped particles

Back 18

Small form

Front 19

HBeAg

Back 19

Truncated form of HBcAg that is secreted by infected cells
Function is unknown

Front 20

In what cells does HBV replication take place?

Back 20

Hepatocytes

Front 21

Where in the cell does HBV replication take place?

Back 21

Nucleus

Front 22

cccDNA

Back 22

Covalently Closed Circular DNA

This is what HBV DNA becomes after missing nucleotides of + strand are added

Front 23

Where is the + strand of the DNA made complete?

Back 23

In the nucleus

Front 24

What is packed in the initial capsid with the full-length transcript?

Back 24

Core protein
HBV Polymerase

NOTE: remember that the transcript is RNA

Front 25

Inside the capsid, what is done with the transcript?

Back 25

Complete MINUS DNA strand is synthesized from it

Minus strand DNS is template for incomplete PLUS strand DNA

Front 26

What does HBV bud through?

Back 26

Cytoplasmic VESICLE

Front 27

How does HBV exit the host cell?

Back 27

Exocytosis

Front 28

How is HBV transmitted?

Back 28

Parenterally (needles, sex, birth, etc.)

HBV present in all body fluids, including mother's milk

Front 29

Is rate of progression to chronic infection higher in children or adults?

Back 29

Children (80-95%)

In adults, it is only 5-10%

Front 30

Incubation period for HBV

Back 30

Two months or more

Front 31

Are there more virions or 20 nm particles in blood?

Back 31

20 nm particles

Front 32

"Window period" of HBV infection

Back 32

When neither HBsAg nor anti-HBs can be detected

After HBsAg has largely disappeared
Before anti-HBs has shown up

NOTE: Abs for HBc and HBe are detectable in this period

Front 33

Serology of HBV chronic carriers key characteristics

Back 33

HBsAg does NOT go away
Anti-HBs never shows up

Front 34

In what order do the following show up?

Anti-HBs, Anti-HBc, Anti-HBe

Back 34

Anti-HBc --> Anti-HBe --> Anti-HBs

NOTE: in chronic carrier state, Anti-HBs never shows up

Front 35

When (what period) does Ab for HBsAg show up?

Back 35

During the recovery period

SO, it doesn't contribute significantly to clearing

Front 36

In an HBV infection, what do CD8 T cells recognize?

Back 36

Fragments of HBcAg

Front 37

Where (in the world) is HBV carrier rate high?

Back 37

Southeast Asia
Africa

Front 38

Type of vaccine for HBV

Back 38

Subunit vaccine consisting of HBsAg

Given in three doses

Front 39

Most widely used drug against HBV

Back 39

Lamivudine

Front 40

Timeline of HBV dosage

Back 40

1st dose is time 0
2nd dose 1 month after first
3rd dose 6 months after first

Front 41

What is given to babies right after birth to prevent HBV?

Back 41

HB immune globulin

Front 42

HDV is also known as what?

Back 42

Delta agent

Front 43

HDV requires what other virus in order to propagate?

Back 43

HBV

Front 44

When is disease more severe?

HDV and HBV simultaneous co-infection

OR

HDV super-infection in an HBV carrier

Back 44

HDV super-infection in an HBV carrier

Rate of fulminant hepatitis is greater
Progression to carrier state occurs to greater extent

Front 45

Characteristics of HDV genome

Back 45

MINUS sense
ssRNA

Enclosed in capsid of Delta antigen
Wrapped in membrane containing HBsAg

Front 46

What one protein does HDV genome encode?

Back 46

Delta antigen

Front 47

How is HDV transmitted?

Back 47

Same as HBV
EXCEPT, NOT by sexual route

Front 48

What is the only real method to control HDV?

Back 48

Vaccination for HBV

Front 49

What is the etiological agent for "acute" (infectious) hepatitis?

Back 49

Hepatitis A

Front 50

How many serotypes of HAV are there?

Back 50

Only ONE

Front 51

How is HAV transmitted?

Back 51

Fecal-oral route

Front 52

HAV is inactivated by... (5)

Back 52

Bleach
Formalin
Beta-propriolactone
UV radiation

Routine chlorination of drinking water

Front 53

Large quantities of HAV can be found where (in/from body)?

Back 53

In bile
In stool

Front 54

Onset of symptoms in HBV is described as

Back 54

Insidious

Front 55

Onset of symptoms in HAV is described as

Back 55

Acute

Front 56

Incubation period for HAV

Back 56

Approximately 4 weeks

Front 57

After recovery from infection, what is HAV immune status of pt.?

Back 57

Life-long immunity

There are NO CHRONIC CARRIERS

Front 58

What is the course of HAV hepatitis?

Back 58

Symptoms last for 3-4 weeks
Infection resolves completely

Front 59

How is HAV diagnosed?

Back 59

Analyzing stool w/ PCR or immunoassay
ELISA assay for anti-HAV in blood

Front 60

Is HAV more symptomatic in adults or children?

Back 60

Adults (3:1, symptomatic:asymptomatic)

Children (1:12)

Front 61

Type of vaccine for HAV

Back 61

Killed

Front 62

In the U.S. are there more carriers for HBV or HCV?

Back 62

3x as many HCV carriers

Front 63

HCV-encoded proteins do what to the immune response?

Back 63

Antagonize it
Inhibit apoptosis
Antagonize effect of interferon

Front 64

How is HCV transmitted?

Back 64

Parenterally (Sex, blood, needles)

Front 65

Incubation period for HCV

Back 65

1 - 2 months

Front 66

When can viremia be detected in an HCV-infected pt.?

Back 66

After 1 - 3 WEEKS

Lasts 4-6 months in those who clear infection
Last for life in chronically infected

Front 67

How long does it take for most pts. to become anti-HCV positive?

Back 67

Usually happens within 5 MONTHS (7 - 31 weeks)

Front 68

% of people who become HCV chronic carriers

Back 68

85%

Front 69

This enhances the progression of HCV chronic carriers to liver disease

Back 69

Alcohol abuse

Front 70

% of deaths from chronic liver disease attributed to HCV

Back 70

40%

Front 71

This has been successful in clearing carrier state of HCV in some pts.

Back 71

Combo of interferon and ribavirin

Front 72

Pt. group at risk for severe HEV infection

Back 72

Pregnant women

20% mortality in this group

Front 73

Hepatitis viruses with parenteral transmission

Back 73

HBV
HCV
HDV

Front 74

Hepatitis viruses with fecal-oral transmission

Back 74

HAV
HEV

Front 75

Hepatitis C genotype that is most common in U.S.

Back 75

Genotype I

Shows poor response to treatment