Hepatitis Viridae

Question 0

How are Hep A and E transmitted?

Answer 0

By the fecal-oral route. The rest parenterally.

Question 1

How many viruses that primarily infect the liver exist?

Answer 1

Six:
5 RNA–> Hep A,C,D,E,G
1 DNA–> HepB

Question 2

What hep viruses can cause acute hep?

Answer 2

All of them.

Question 3

What hep viruses can cause chronic hep?

Answer 3

HepB,C,D

Question 4

What is the time usually needed for jaundice to occur in acute hep?

Answer 4

One to two weeks.

Question 5

Give a basic description of HAV.

Answer 5

1. Naked icosahedral capsid with a positive single-stranded RNA.
2. It is in the family Picornaviridae and as it is the case with most of this family it is transmitted by the fecal to oral route (HAV = Anus).

Question 6

What is the incubation period of HAV?

Answer 6

About 15-40 days.

Question 7

What is the morphology of HepA?

Answer 7

Picorna viridae

1. Positive single stranded RNA.
2. No envelope (naked)
3. Icosahedral capsid

Question 8

How is HepA transmitted?

Answer 8

Fecal-oral.

Question 9

What characterizes acute viral hepatitis caused by HAV?

Answer 9

1. Fever
2. Jaundice
3. Painful enlarged liver –> 1% develop fulminant hepatitis.
4. HepA never becomes chronic.

Question 10

What is the serology in HepA?

Answer 10

1. Anti-HAV IgM –> Active disease.

2. Anti-HAV IgG –> Old, not active disease. Protected against repeated infection.

Question 11

What is the morphology of HBV?

Answer 11

Hepadna viridae.

1. Double-stranded circular DNA.
2. Envelope
3. Icosahedral capsid
4. Dane particle (intact virus)
5. HBsAg (envelope, capsid proteins)
6. HBcAg
7. HBeAg

Question 12

What does the Dane particle include?

Answer 12

1. Envelope
2. Capsid associated proteins
3. Capsid
4. Core (DNA + protein enzymes)

Question 13

What includes the HBcAg?

Answer 13

1. Double stranded DNA
2. DNA polymerase enzyme
3. Capsid

Question 14

What does dissociation of the Dane particle leaves?

Answer 14

HBsAg and HBcAg.

Question 15

What is the HBeAg?

Answer 15

Soluble component of the core, which is a marker for active disease.

Question 16

How is HBV transmitted?

Answer 16

1. Blood transfusion
2. Needle sticks
3. Sexual
4. Across the placenta

Question 17

What can HBV cause?

Answer 17

1. Acute viral hepatitis
2. Fulminant hepatitis
3. Chronic hep (10%)
4. Coinfection with HDV.
5. Risk for cirrhosis and HCC.

Question 18

What is the serology of HBV?

Answer 18

HBsAg --> Disease (acute or chronic).
Anti-HBsAg --> Immunity: provides protection against repeat infection.
IgM anti-HBcAg --> new infection.
IgG anti-HBcAg --> old infection.
HBeAg --> High infectivity 
Anti-HBeAg --> Low infectivity

Question 19

What is useful to keep in mind about HBV?

Answer 19

1. Only HepB carries a DNA polymerase enzyme within the virion.
2. Liver injury occurs from a cell-mediated immune system attack on HBV.

Question 20

What is the morphology of HCV?

Answer 20

1. Propably a flavovirus
2. Single-stranded RNA
3. Enveloped icosahedral capsid

Question 21

How is HCV transmitted?

Answer 21

Same way as HBV.

Question 22

What can HCV cause?

Answer 22

Acute viral hep.

1. Up to 85% develop chronic hep.
2. 20% will develop cirrhosis.
3. Increased risk of developing primary HCC.

Question 23

What is the serology of HCV?

Answer 23

Anti-HCV antibodies.

Question 24

What is important to remember about HCV?

Answer 24

1. It is the leading cause for liver transplantation.2 | 2. Genotype 1 most common in US.

Question 25

What is the morphology of the HDV?

Answer 25

1. Incomplete RNA virus - only infective with the help of HBV. 2. Helical nucleocapsid that requires the hepB envelope (HBsAg) to be infectious.

Question 26

How is HDV transmitted?

Answer 26

Same way as HBV.

Question 27

What can HDV cause as a coinfection?

Answer 27

Acute hep together with HBV.

Question 28

What can HDV cause as a superinfection?

Answer 28

HDV infects patient with chronic HepB who cannot make Anti-HBsAg antibodies ---> Fulminant hep and cirrhosis.

Question 29

Is serology helpful in HDV infection?

Answer 29

No, since detectable titers of IgM and IgG anti-HDV are not so high.

Question 30

What is the morphology of HEV?

Answer 30

Hepeviridae family. 1. Single stranded RNA. 2. No envelope.

Question 31

How is HepE transmitted?

Answer 31

Fecal-oral.

Question 32

What can hepE cause?

Answer 32

Hepatitis like hepA.

Question 33

What is important to remember about HEV?

Answer 33

Responsible for epidemics of hep in Asia. Very rare in the US.

Question 34

What is the morphology of HGV?

Answer 34

The one of a flavivirus.

Question 35

How is HGV transmitted?

Answer 35

Transfusion and needle sticks.

Question 36

What can HGV cause?

Answer 36

It is not conclusively shown to cause liver disease.

Question 37

What is interesting to remember about HGV?

Answer 37

Some studies have shown that co-infection with HGV might actually slow the progression of HIV disease. (!)