Viral Hepatitis Flashcards

Question

What are the genotypes of HEV?

Answer 1

Genotype 1 and 2 – human, epidemic Genotype 3 and 4 – swine and other (humans accidental host = zoonosis) Very little person to person spread Case reports Shellfish consumption, blood transfusion Sausages, pig liver consumption

Answer 2

supportive ? ribavirin

Answer 3

Incubation period 3-8 weeks High mortality rate in pregnancy ( genotype 1) RARE COMPLICATIONS CNS disease – Bell’s palsy, Guillain Barre, other neuropathy Chronic infection

Answer 4

VACCINE – EFFECTIVE - trials with recombinant HEVg1 In Nepalese military and Chinese (100 000)

Answer 5

* Approx. 1.5 millions of cases worldwide annually * Developing countries with poor socio-economic conditions * 300-500 cases annually in the UK * Mostly among age 15-34 and non-travellers * Outbreaks among MSM (2016/17) & IVDU (2001 & 2017)

Answer 6

* Wide disease spectrum from asymptomatic to fulminant hepatitis * Strong correlation with age: \<10% symptomatic among children \<6 years old versus 70% in adults * Typical symptoms: fever, malaise, anorexia/nausea, abdominal discomfort, diarrhoea, jaundice * Extra-hepatic diseases * Acute presentation; 99% resolution * NOT an aetiology for chronic hepatitis

Answer 7

•Diagnostics based on HAV serology ØAcute infection: IgM reactive; unlikely if bilirubin level \< 30umol/L ØPast infection: IgM non-reactive, IgG reactive •Supportive treatment

Answer 8

•Notifiable disease in the UK – must alert HPT immediately upon diagnosis • * Infectious period of index case: two weeks before onset of first symptoms and until one week after the onset of jaundice * Pre-exposure immunisation among population at risk * Post-exposure prophylaxis ØWithin 14 days of exposure to index case: HAV vaccine +/- HNIG (for 60 years and above, chronic liver diseases inc CHB/CHC, immunocompromised contact) ØOver 14 days: HAV vaccine +/- HNIG (for chronic liver diseases inc CHB/CHC, immunocompromised contact)

Answer 9

•Age related presentation & prognosis in acute hepatitis B ØNeonates & children: mostly asymptomatic or anicteric; 90% HBV-infected neonates develop CHB, and 30% among children age \<5 years ØAdult: 30-50% icteric hepatitis; 10% become CHB * 0.1-0.05% risk of fulminant hepatitis; related to co-infection with HCV/HDV * Maternal HBeAg/Ab status & HBV viral load ØHBeAg as the most important risk predictor for vertical transmission

Answer 10

* Definition: persistence of HBsAg for 6 months or more after acute HBV infection * Complications ØCirrhosis: 8-20% untreated CHB in 5 years; ØHepatocellular carcinoma: the annual risk of 2-5% among CHB cirrhotic patients; affected by host (e.g. alcohol abuse) and viral factors (e.g. high HBV viral load & qHBsAg)

Answer 11

Approximately 296 million people are living with CHB worldwide; CHB-related mortality at roughly 820,000 people per year

Answer 12

* HBsAg: infection * HBsAb: immunity through either immunisation or past infection * HBcAb: exposure ØIgM: acute infection * HbeAg: replication activity * HBeAB

Answer 13

* Acute hepatitis B: a notifiable disease * Pre-exposure prophylaxis ØRoutine childhood immunisation in the UK since 2017 ØHigh risk population •Post-exposure prophylaxis ØNeonate born to mother living with hepatitis B ØSexual partner: HBV vaccine +/- HBIG (within one week from the contact) ØNeedle stick injury

Answer 14

* Single-stranded, circular RNA genome * A defective virus that relies on HBV for propagation * Blood-borne transmission * Incubation period: 3-6 weeks

Answer 15

•HBV/HDV simultaneous co-infection ØSimilar to classic acute hepatitis B; mostly self-limited Ø\<5% chronic infection •HDV super-infection in CHB Ø80% chronic infection ØIncreased risk of cirrhosis and HCC than CHB alone

Answer 16

* Anti-HDV serology; other HDV investigations rarely used * PEG-interferon alpha licensed for HDV superinfection in CHB * Pre-exposure HBV immunisation * Acute HDV infection: notifiable disease

Answer 17

* The family Flaviviridae, genus Hepacivirus * Single-stranded, positive sense RNA genome * Blood borne transmission * Incubation period: 2-6 weeks * 58 million people living with chronic hepatitis C worldwide * 1.5 million new cases every year

Answer 18

•Acute infection Ø30% spontaneous clearance Ø70% become chronic hepatitis C (CHC) * Hepatic versus extra-hepatic manifestation * Cirrhosis (15-30% in 20 years) & HCC as complication of CHC

Answer 19

* Revolutionised the treatment for acute/chronic HCV infection * Any HCV cases should be considered * 8 or 12 weeks * Sustained virological response (SVR) at week 12 * Pan-genotypic regimen * Single-tablet regimen * Drug-drug interaction

Answer 20

* Acute hepatitis C: notifiable disease in the UK * Nil vaccine available * Nil post-prophylaxis available * Active HCV screening * Risk reduction (e.g. safe handling and disposal of sharps, protected sex)

Answer 21

•The family Hepeviridae, genus Orthohepevirus; species A strains (8 genotypoes) infect humans ØG1 & G2: obligate human pathogens ØG3 & G4: zoonotic; pigs & wild boar are natural hosts * Single-stranded, positive sense RNA genome * Quasi-enveloped HEV * Faeco-oral versus blood-borne transmission * Incubation period: 15-60 days * Approximately 20 million new HEV cases worldwide annually * 3.3m symptomatic hepatitis E * 44,000 mortality annually * UK is a HEV G3 endemic country

Answer 22

* Mostly self-limited; advised against alcohol during the course * At risk population ØPregnant women: G1; fulminant hepatic failure and obstetric complications (e.g. eclampsia and haemorrhage); 25% maternal mortality & high perinatal infant mortality ØChronic liver disease patients ØImmunocompromised patients: may develop chronic hepatitis E (G3 & G4) •Hepatic versus extra-hepatic manifestations

Answer 23

* Immunocompetent: HEV serology * Immunocompromised: HEV PCR

Answer 24

* Only indicated in chronic hepatitis E as most acute HEV infection are self-limited * Acute HEV infection: a notifiable disease * HEV patient should avoid prepping food during the first 2 weeks * Immunocompromised and chronic liver disease patients should avoid consumption of undercooked meat (pork, wild boar and venison) and shellfish ØHEV vaccination: only licensed in China

Viral Hepatitis Flashcards

(53 cards)