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Viral Hepatitis
GI System (Blue)
| Question | Answer |
|---|---|
| What is another name for hepatitis A virus? | infectious hepatitis |
| True or false: Once a person has been infected with the hepatitis A virus, you have lifetime immunity. | true! this is b/c there is a single serotype |
| What are the symptoms of pre-icteric hepatitis A? | gastroenteritis! patients begin to experience symptoms when the immune response occurs. patients are capable of infection during this time |
| Describe the pathogenesis of hepatitis A infection: | ingestion of infected material -> absorption from stomach or small intestine -> replication in the liver -> secretion into bile -> excretion in stool or reabsorption |
| Do all patients infected with hepatitis A show signs of jaundice? | jaundice is prevalent in adults, but less so in children. children are infected more often than adults. when they are, they can be asymptomatic or have milder GI-illness w/o jaundice. |
| What's the prognosis for a patient infected with hepatitis A? | good! mortality rate is <1% in the US, and there is no chronicity. |
| How is hepatitis A transmitted? | via FECAL-ORAL route (person to person), food (esp. shellfish), and water |
| How long do patients infected with hepatitis A shed virus? | most shed virus for 2 weeks, but some shed virus for up to 12 months |
| B/c hepatitis A is most common in children, and b/c it is spread via the fecal-oral route... | small epidemics can occur |
| How do you treat and prevent hepatitis A infection? | no antivirals. inactivated vaccines are available (HAVRIX and VAQTA) and recommended for children and anyone traveling to endemic areas. Passive immunization with Ig (Gammagard) is also available. |
| What is another name for hepatitis B virus? | serum hepatitis |
| What do you expect to see in the blood if a patient is infected with hepatitis B? | Dane particles (these are excess outer capsid; rod-like protein products) |
| What are the different kinds of antigens associated with hepatitis B? | Hbs-antigen, HBc-antigen, and HBe-antigen |
| What is Hbs-antigen? | hepatitis B surface antigen aka "AUSTRALIA ANTIGEN" that is outer capsid. this appears in large quantities in the blood |
| What is HBc-antigen? | hepatitis B inner capsid; NOT detectable in blood |
| What is HBe-antigen? | non-structural antigen that IS detectable in the blood |
| What is DNA pol? | a reverse transcriptase of hepatitis B (ds DNA -> ss RNA -> ds DNA); note: RT inhibitors for HIV can be used against this |
| What is Hbx gene? | an inhibitor of p53 that's associated with hepatitis B. it also inhibits GSK-3b tumor suppressor. it may promote oncogene activation |
| Does hepatitis B have pre-icteric and icteric phases like hepatitis A? | yes |
| How long is the incubation period for hepatitis B? | 30-180 days (compared to 14 days w/hepatitis A) |
| Describe the prognosis of hepatitis B: | the morality rate is higher. hep B can include acute fulminant persistence leading to cirrhosis and/or hepatocellular carcinoma |
| Patients with hepatitis A often recover without sequelae, in contrast, patients with hepatitis B... | take longer to reach recovery. some patients enter a carrier state, and chronicity can develop |
| What determines a particular patients outcome once they are infected with hepatitis B? | the immune response! if there's a strong response, patients may have subclinical infection w/eventual viral elimination and immunity. if it's a weak response, patients are more likely to become a chronic carrier with persistent infection and symptoms |
| What is one reason that some patients infected with hepatitis B may become chronically infected? What immune response are they lacking? | although they produce anti-HBc, they never produce anti-HBs. anti-HBc isn't sufficient to clear the virus b/c HBc is an inner capsid protein. as a result, HBsAg persists. |
| Your patient tests positive for HBsAg and HBeAg, but there are no antibodies present. What is their hepatitis status? | they are in the incubation period of the hepatitis infection |
| Your patient tests positive for HBsAg and HBeAg. They also test positive for anti-HBc IgM and anti-HBc IgG. Anti-HBe and anti-HBs are negative. Hepatitis status? | they either have acute hepatitis B or they are a persistent carrier |
| Your patient tests positive for HBsAg, HBeAg, and anti-HBc IgG. Anti-HBe, anti-HBc IgM, and anti-HBs are all negative. Hepatitis status? | persistent carrier state |
| Your patient tests positive for anti-HBc IgG and anti-HBs. Hepatitis status? | they no longer have antigen, and they developed the anti-HBs antibody so you know that they were infected at one point, but they have recovered. |
| There are (blank) carriers of hepatitis B worldwide. | 350,000,000 |
| How is hepatitis B transmitted in the US? | blood products, infected needles, syringes, sexually, and mom to fetus...basically transmitted the same as HIV |
| Is hepatitis B more common in adults or children? | adults (this is b/c of the nature of transmission) |
| 90% of the time, perinatal hepatitis B transmission results in... | chronic HBV |
| How can we prevent infection with hepatitis B? | vaccinate! this is routinely given to infants as a series of 3 vaccinations. |
| What are the subunit vaccines available for hepatitis B? | Energix-B and Recombivax HB |
| What should you give to an infant born to an HBV-infected mother? | HBIG w/in 12 hours of birth |
| What is the name of the HBV vaccine that is combination killed HAV/recombinant HBV? | TwinRix |
| How do you treat hepatitis B? | interferon alpha and nucleoside analogs that inhibit reverse transcriptase (ex: lamivudine) |
| What's special about hepatitis D virus? | it's a defective satellite virus that uses outer coat protein of HBV as its capsid. B/c of this, you can't have hepatitis D alone. It has to be in combo with HBV. the RNA genome is a RIBOZYME. |
| Hepatitis D is acquired by co-infection or super-infection with HBV. Does this alter the patients prognosis? | it increases the severity of the HBV infection and increases the likelihood of fulminant hepatitis and chronicity |
| Hepatitis C is a high (blank) | REPLICATION rate...there are 10 BILLION new viral particles/day. it also has a high MUTATION rate. b/c of this we call it a "quasispecies" that forms a mutant swarm that the immune system can't keep up with |
| True or false: Hepatitis C results in widespread liver infection. | true; up to 50% of hepatocytes are affected in those w/chronic infection |
| How is hepatitis C transmitted? | IV drug abuse and sexual contact |
| Like with hepatitis B, infection with hepatitis C incites a variable immune response from person to person. What percentage can be expected to recover? | 20%...this means that 80% will have persistent infection |
| Just because a patient with hepatitis C has persistent infection, they are not doomed to a severe outcome. Overall (including those who recover), what percentage of hepatitis C patients can be expected to have a favorable outcome? | 64%; although not all of these patients fully recover, some experience stable chronic hepatitis, variable progression, or a sustained response. |
| What percentage of hepatitis C patients can be expected to have a severe outcome? What are some of the possible severe outcomes? | 36%; a severe outcome could include treatment failure or severe progressive hepatitis |
| What is one thing that patients with hepatitis C must abstain from using? Why? | alcohol! If a patient with HCV is an alcohol abuser, their risk of liver loss increases by 150x |
| How many people worldwide have a chronic hepatitis C infection? | 3.2 million; there are 4.5 million total with infection |
| Incidence of HCV has dramatically declined in the US. Why? | we developed a way to screen our blood supply for HCV |
| Before 1990 (the year we came up with a way to screen donated blood for HCV), what population most commonly became infected with HCV? | patients with hemophilia |
| After 1990, what population is most commonly infected with HCV? | illegal drug users |
| True or false: There is a very effective vaccine for HCV, but patients often refuse it b/c the side-effects are debilitating. | false! there is NO vaccine for HCV |
| How do we treat HCV? | we used to use interferon, but we now use PEG-interferon with ribavirin and protease inhibitors (telaprevir and boceprevir) |
| Where do we find hepatitis E? | in developing countries |
| Hepatitis E is the leading worldwide cause of... | waterborne hepatitis; disease and transmission is similar to that of hepatitis A (fecal-oral) |
| Hepatitis G virus info... | discovered in 1995; it's a flavivirus related to hepatitis C |
Created by:
smuncy