Viral Hepatitis

Question 1

What does Surface antigen (HBsAg) show?

Answer 1

An active infection

Question 2

What does E antigen (HBeAg) show?

Answer 2

Marker of viral replication and implies high infectivity

Question 3

What do core antibodies (HBcAB) show?

Answer 3

Implies past or current infection

Question 4

What does surface antibody (HBsAb) show?

Answer 4

Implies vaccination or past or current infection

Question 5

What does Hepatitis B virus DNA (HBV DNA) show?

Answer 5

This is a direct count of the viral load

Question 6

What is an incubation period?

Answer 6

The time from the moment of exposure to an infectious agent until signs and symptoms of the disease appear

Question 7

What does IgM indicate?

Answer 7

Acute infection

Question 8

What does IgG indicate?

Answer 8

Previous infection or memory

Question 9

What does the development of Hepatitis A look like?

Answer 9

Either recover (most common) or have fulminant hepatitis (1-2%)

• Hepatitis A and E cause AcutE hepatitis

Question 10

How is Hepatitis A spread?

Answer 10

• Faeco-oral

- Shellfish

Question 11

Where is Hepatitis A most prevalent?

Answer 11

• Endemic in Africa and S America

Common in Children

Question 12

What is the serology for Hepatitis A?

Answer 12

• Hepatitis A viral RNA appears in stool after 1 week
• Transaminases rise 22-40 days after exposure
• IgM rises from day 25
• IgG detectable for life

Question 13

What is the preventative treatment for Hepatitis A?

Answer 13

• Vaccination
  1st dose: 1yr immunity
  2nd dose: 20yr immunity

Question 14

Can hepatitis A be treated?

Answer 14

Usually doesn’t need treatment as is self-limiting

Question 15

What is the incubation period for Hepatitis A?

Answer 15

2-6 weeks

Question 16

What determines progression of Hepatitis B to a chronic infection?

Answer 16

- Age 
      <1 year 90% chronic
      1-5 years 30% chronic
      >5 years 1-5% chronic
- Immunosuppression
- Route of infection
- Genotype

Question 17

What does Hepatitis B have a strong association with?

Answer 17

Liver cancer

Question 18

How is Hepatitis B spread?

Answer 18

• Vertical transmission from mother to child
• Sexual
• Blood
  IV drug users (IVDU), medical
• Sharing contaminated household products

Question 19

What is the serology for an acute Hepatitis B infection?

Answer 19

• Anti-core IgM
  Early rise
• HBsAg
  Present for 1-6months

Question 20

What does anti-HBc imply?

Answer 20

Past infection

Question 21

What does anti-HBs alone imply?

Answer 21

Vaccination

Question 22

What is the preventative treatment for Hepatitis B?

Answer 22

• Immunisation
  3 doses
  Immunise all sexual partners

Question 23

Can acute hepatitis B be treated?

Answer 23

Most people fully recover without treatment

Question 24

What is the serology for an chronic Hepatitis B infection?

Answer 24

• HbsAg > 6 months

HBeAg +ve = high viral load, infection, normal LFTs, few liver problems

HBeAb +ve = low viral load, raised transaminases, liver fibrosis and cirrhosis

Question 25

Can chronic hepatitis B be treated?

Answer 25

- Antivirals - Interferons Give to HBeAg +ve

Question 26

What is the incubation period for hepatitis B?

Answer 26

1-6 months

Question 27

What does the development of Hepatitis C look like?

Answer 27

- 25% Recover | - 75% Chronic hepatitis

Question 28

How is Hepatitis C spread?

Answer 28

- Blood - Sexual - Vertical

Question 29

What is the serology for an acute Hepatitis C infection?

Answer 29

- Anti-HCV - HVC-PCR RNA -ve Have been exposed to, but now cleared the virus

Question 30

Can chronic hepatitis C be treated?

Answer 30

- Inferferon Ribavirin - Protease inhibitors Can be re-infected after treatment

Question 31

What does the development of Hepatitis E look like?

Answer 31

Same as hepatitis A

Question 32

How is Hepatitis E spread?

Answer 32

- Faecal-oral route | - Undercooked pork, wild boar and deer

Question 33

When may Hepatitis E cause severe disease?

Answer 33

2nd trimester of pregnancy

Question 34

What is the serology for a Hepatitis E infection?

Answer 34

- HEV IgM = active infection | - HEV IgG = recovery

Question 35

What does the development of Hepatitis Delta look like?

Answer 35

- Requires co-infection with Hepatitis B | - Worsens prognosis of Hepatitis B

Question 36

What is the serology for a Hepatitis Delta infection?

Answer 36

- Anti-HDV antibody | Only ask if HBsAg +ve