Acute Viral Hepatitis Overview
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Questions and Answers

What characterizes the prolonged form of hepatitis A?

  • Fulminant liver necrosis within the first week
  • Presence of severe neurological disturbances
  • Rapid recovery without any specific treatment
  • Persistent clinical and/or biological changes for several weeks or months (correct)
  • In what percentage of adults does the cholestatic form of hepatitis A typically occur?

  • 4-10% (correct)
  • 1-2%
  • 15-20%
  • 25-30%
  • What is a defining characteristic of fulminant hepatitis A?

  • Rapid onset recovery within days
  • Severe dyshomeostasis and coagulation disorders (correct)
  • Common occurrence in pediatric cases
  • A mild asymptomatic course of illness
  • What is the teratogenic risk of acute hepatitis A in pregnant women?

    <p>No teratogenic risk for the fetus (A)</p> Signup and view all the answers

    How do patients with HIV respond to acute hepatitis A compared to the general population?

    <p>They may show prolonged elevation of transaminases (B)</p> Signup and view all the answers

    What should patients with chronic liver diseases do concerning hepatitis A?

    <p>Be vaccinated against hepatitis A and B (B)</p> Signup and view all the answers

    What type of data is crucial for the positive diagnosis of hepatitis A?

    <p>Epidemiological, clinical, and paraclinical data (C)</p> Signup and view all the answers

    Which of the following laboratory changes are noted in acute viral hepatitis A?

    <p>Non-specific laboratory changes similar to other acute hepatitis (C)</p> Signup and view all the answers

    Which component of the Hepatitis B virus is strictly localized in hepatocytes and is not detectable in the blood?

    <p>HBc Ag (C)</p> Signup and view all the answers

    What is indicated by the persistence of HBe Ag for more than 3 months?

    <p>Chronic evolution of the infection (D)</p> Signup and view all the answers

    What does the presence of HBV DNA in blood signify?

    <p>Contamination risk (C)</p> Signup and view all the answers

    Which genotype of Hepatitis B virus predominates in Europe?

    <p>Genotype A (adw) (A)</p> Signup and view all the answers

    What is the size of the viral nucleocapsid (core) of the Hepatitis B virus?

    <p>27 nm (C)</p> Signup and view all the answers

    Which protein product of HBV is involved in hepatocyte apoptosis and activation of cytolytic T cells?

    <p>HbxAg (D)</p> Signup and view all the answers

    What characteristic of the DNA polymerase of Hepatitis B virus makes it unique among DNA viruses?

    <p>It requires an RNA intermediate for replication. (D)</p> Signup and view all the answers

    How long can Hepatitis B virus survive on inorganic surfaces without visible blood traces and still maintain its infectious potential?

    <p>7 days (D)</p> Signup and view all the answers

    What condition is characterized by an increase of transaminases (AST, ALT) that can reach 20-30 times the normal range?

    <p>Hepatocytolysis syndrome (C)</p> Signup and view all the answers

    Which syndrome is most likely not to be associated with acute viral hepatitis if its effects are more significant than those of hepatocytolysis?

    <p>Cholestatic syndrome (D)</p> Signup and view all the answers

    What laboratory finding is a severe prognosis marker associated with liver failure?

    <p>Decrease in prothrombin index (D)</p> Signup and view all the answers

    Which type of bilirubin predominates when bilirubin levels increase to more than 4-5 mg/dl, indicating jaundice?

    <p>Direct bilirubin (A)</p> Signup and view all the answers

    In cases of acute hepatitis A, how do the serum bilirubin levels compare to those in acute hepatitis B?

    <p>Lower in A than B (A)</p> Signup and view all the answers

    What does an increase in serum ammonium indicate in the context of liver failure?

    <p>Detoxification impairment (C)</p> Signup and view all the answers

    Which hematological finding may indicate a complication of hepatitis?

    <p>Thrombocytopenia (C)</p> Signup and view all the answers

    Which clinical sign is typically observed with significant levels of bilirubinemia greater than 20 mg/dl?

    <p>Obvious jaundice (C)</p> Signup and view all the answers

    What is a significant laboratory finding in diagnosing autoimmune hepatitis?

    <p>Presence of antinuclear antibodies (A)</p> Signup and view all the answers

    Which of the following factors is a predisposing factor for a more severe evolution in patients with recurrent jaundice during pregnancy?

    <p>Previous liver disease (D)</p> Signup and view all the answers

    What constitutes non-specific prophylaxis for preventing hepatitis A?

    <p>Ensuring potable water (D)</p> Signup and view all the answers

    What is the composition of hepatitis B vaccine?

    <p>Inactivated virus (C)</p> Signup and view all the answers

    Which characteristic is true for hepatitis B virus (HBV)?

    <p>It is a DNA virus belonging to the Hepadnaviridae family (B)</p> Signup and view all the answers

    Which of the following best describes the structure of the Dane particle?

    <p>Small virus with an outer shell and viral core (D)</p> Signup and view all the answers

    What is the primary role of passive pre-exposure prophylaxis for hepatitis A?

    <p>To provide immediate immunity against hepatitis A (A)</p> Signup and view all the answers

    Which of the following best describes the anti-HAV vaccine's eligibility for post-exposure prophylaxis?

    <p>For immunocompetent individuals aged 1 to 40 years (C)</p> Signup and view all the answers

    What percentage of HBV prevalence is typical in Western Europe?

    <p>0.5-1% (C)</p> Signup and view all the answers

    Which group is considered to have the highest risk of acquiring HBV infection through vertical transmission?

    <p>Children born from HBsAg carriers (D)</p> Signup and view all the answers

    What aspect of immunity is associated with recovery from HBV infection?

    <p>Durable and life-long immunity (D)</p> Signup and view all the answers

    Which transmission route is the most frequent for perinatal infection of HBV?

    <p>Intrapartum transmission during delivery (D)</p> Signup and view all the answers

    What is the correlation between HBeAg presence and the risk of vertical transmission of HBV during pregnancy?

    <p>Higher risk when HBeAg is present (B)</p> Signup and view all the answers

    Which of the following is NOT a parenteral route of HBV transmission?

    <p>Genital secretions (B)</p> Signup and view all the answers

    Which risk group has the lowest probability of acquiring HBV through multiple transfusions?

    <p>Patients on dialysis (C)</p> Signup and view all the answers

    Which immune response is primarily responsible for mediating cytotoxicity during HBV infection?

    <p>Cellular immunity (C)</p> Signup and view all the answers

    Which of the following body fluids does NOT typically contain HBV?

    <p>Urine (C)</p> Signup and view all the answers

    What determines the duration of the incubation period for HBV infection?

    <p>Viral pathogenicity (C)</p> Signup and view all the answers

    Which syndrome is specifically associated with the onset of acute hepatitis B?

    <p>Pseudorheumatoid syndrome (C)</p> Signup and view all the answers

    What symptom can be observed 1-5 days prior to the clinical appearance of jaundice in HBV infection?

    <p>Dark urine (B)</p> Signup and view all the answers

    Which phase of HBV infection is characterized by a decrease in constitutional symptoms alongside persistent hepatomegaly?

    <p>Convalescent phase (C)</p> Signup and view all the answers

    What percentage of acute HBV cases is known to have a favorable self-limiting evolution?

    <p>90% (B)</p> Signup and view all the answers

    Which condition is described specifically in children as a symptom of HBV infection?

    <p>Erythematous-papular rash (B)</p> Signup and view all the answers

    What factor contributes to significant variations in the symptoms of HBV infection?

    <p>Coinfection with other viruses (C)</p> Signup and view all the answers

    Flashcards

    Prolonged Hepatitis A

    Persistence of acute hepatitis A symptoms and/or biological changes for weeks or months.

    Cholestatic Hepatitis A

    A severe form characterized by prolonged, intense jaundice with a greenish tint.

    Fulminant Hepatitis A

    Extremely rare, characterized by massive liver damage and severe complications.

    Hepatitis A in Pregnancy

    Does not pose a risk to the fetus.

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    Hepatitis A in HIV

    HIV patients may show elevated transaminases, but not more severe disease than others.

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    Hepatitis A in Chronic Liver Disease

    Potentially more severe, with a higher chance of fulminant hepatitis compared to those without chronic liver conditions.

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    Diagnosis of Hepatitis A

    Based on epidemiological (contact, travel), clinical (symptoms), and paraclinical (lab tests) evidence.

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    Non-Specific Lab Tests in Hepatitis

    Similar lab changes occur in different types of acute hepatitis (A, B, C, D, E).

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    HBV Prevalence

    The percentage of people in a population infected with the Hepatitis B virus.

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    HBV Transmission Routes

    The ways in which HBV can spread from one person to another.

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    Parenteral Transmission

    HBV transmission through blood or contaminated blood products, often via medical procedures or sharing needles.

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    Non-Parenteral Transmission

    HBV transmission through bodily fluids like saliva and genital secretions, primarily via sexual contact.

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    Vertical Transmission

    HBV transmission from a mother to her baby during pregnancy, birth, or breastfeeding.

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    Individuals at Increased Risk for HBV

    People with a higher chance of contracting HBV due to their lifestyle, medical conditions, or exposure.

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    HBV Immunity

    Protection from HBV infection due to the presence of antibodies, either from previous infection or vaccination.

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    Anti-HBs Antibodies

    Antibodies that provide immunity against HBV, produced after either infection or vaccination.

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    Hepatocytolysis Syndrome

    A condition where liver cells are breaking down, leading to increased transaminases (AST, ALT).

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    Bilirubin Increase (Jaundice)

    Elevated bilirubin levels, sometimes with a predominance of direct bilirubin, leading to jaundice (yellowing of skin/eyes).

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    Cholestasis

    A condition where bile flow is blocked, leading to increased serum bilirubin, GGT, ALP, and cholesterol.

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    Hematological Syndrome

    Blood abnormalities sometimes seen in severe liver disease, including leukocyte changes and possible blood disorders (thrombocytopenia, anemia).

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    Prothrombin Time (INR)

    A blood test showing the time it takes blood to clot. Reduced prothrombin index or increased INR is an early marker of severe liver disease.

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    Liver Failure

    Severe liver damage affecting liver functions like protein synthesis, detoxification, and metabolism.

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    ALT Levels

    Elevated levels indicate liver injury, with significantly higher values seen with hepatitis A than other types.

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    Biliary Obstruction

    Blockage of bile ducts; detected by ultrasound.

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    HBV Genotypes

    Different HBV subtypes classified by specific combinations of epitopes, resulting in distinct geographical distribution and varied disease progression.

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    HBsAg Location

    HBsAg (hepatitis B surface antigen) can be found in the blood and within infected liver cells.

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    HBcAg Location

    HBcAg (hepatitis B core antigen) is found exclusively within the infected liver cell, not detectable in the blood.

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    HBeAg Function

    HBeAg (hepatitis B e antigen) is a soluble form of HBcAg, indicating active viral replication and high infectivity.

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    HBV DNA Structure

    The HBV genome is a small, circular, partially double-stranded DNA molecule, coding for various viral proteins.

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    HBV DNA Polymerase

    A unique enzyme in HBV that mediates viral replication through a process similar to retroviruses, including reverse transcription of RNA.

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    HbxAg Function

    HbxAg (hepatitis B x antigen) is a protein involved in liver cell death and activation of immune cells.

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    HBV Survival

    HBV can remain infectious for 7 days on surfaces even without visible blood, and is resistant to some common disinfectants.

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    Hepatitis A Prognosis

    Most healthy individuals fully recover from Hepatitis A with no lasting effects. However, older adults, those with existing liver disease, and individuals with weakened immune systems may experience more severe complications and a mortality rate of 0.1-1%.

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    Hepatitis A Prevention

    Preventing Hepatitis A involves ensuring clean water, proper sanitation, practicing food hygiene, and using immunoglobulins or vaccines for pre- and post-exposure prophylaxis.

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    Hepatitis A Vaccine

    Multiple commercially available vaccines contain inactivated hepatitis A virus. These are administered by injection and can be monovalent or bivalent, including protection against other diseases like hepatitis B or typhoid fever.

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    Hepatitis B Virus (HBV)

    Hepatitis B virus is a DNA virus, unlike other types of hepatitis. It belongs to the Hepadnaviridae family and has three distinct forms of surface antigen: large (″L″), medium (″M″), and small (″S″).

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    Dane particle

    The complete form of HBV, a small (42 nm) particle consisting of an outer envelope and a viral core (nucleocapsid).

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    HBsAg (Hepatitis B Surface Antigen)

    The surface antigen present on the envelope of HBV, existing in three forms: large (″L″), medium (″M″), and small (″S″).

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    Acute Hepatitis A Treatment

    The treatment for acute hepatitis A is similar to that of acute hepatitis B, C, and E.

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    Acute Hepatitis B Treatment

    The treatment of acute hepatitis A is similar to that of acute hepatitis B, C and E (see the subsection Treatment of acute hepatitis B).

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    HBV's Direct Impact

    The virus itself can directly damage liver cells, suggesting that mutations in the viral pre-core region can lead to more severe liver disease.

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    What is the incubation period for HBV?

    The incubation period for hepatitis B typically ranges from 60 to 90 days, but can vary from 45 to 180 days.

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    Prodromal Period

    The prodromal period, lasting 2-3 weeks, is the pre-jaundice stage featuring symptoms similar to other viral hepatitis forms.

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    Pseudorheumatoid syndrome

    This syndrome is a specific symptom at the onset of acute hepatitis B, characterized by joint pain and inflammation.

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    Pseudoinfluenza Syndrome

    Symptoms like fever, cough, headache, muscle aches, and weakness are rarely seen in acute HBV. They are more common in acute hepatitis A.

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    Jaundice in Hepatitis B

    Clinically, jaundice in HBV is usually more intense, longer-lasting, and often has a fluctuating pattern, accompanied by liver pain and enlargement.

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    Convalescent Period

    This period marks the gradual recovery from HBV, with the disappearance of general symptoms but ongoing liver enlargement and mild liver cell damage.

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    Self-limiting Hepatitis B

    In 90% of cases, the HBV infection resolves on its own within a few weeks.

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    Study Notes

    Acute Viral Hepatitis

    • Acute viral hepatitis is a systemic infection primarily affecting the liver through inflammation
    • It remains a major public health concern due to high morbidity and mortality rates
    • Five main viruses account for over 90% of hepatitis infections: HAV, HBV, HCV, HDV, and HEV
    • HBV is a DNA virus, while the others are RNA viruses
    • This diversity of causative agents leads to variations in clinical presentation, pathologies, and evolution
    • The clinical spectrum ranges from asymptomatic forms to severe, rapid cases
    • The major public health concern lies in the possibility of progression to chronic infections (with B, C, and D viruses) and the potential development of hepatocellular carcinoma
    • HAV is a spherical RNA virus (27nm) with icosahedral symmetry. It lacks an envelope and has a single reading frame (ORF) with 3 regions (P1, P2, P3)
    • There is only one HAV serotype and one antigenic determinant (HAV Ag)
    • HAV does not induce cytopathic effects and replicates strictly in the liver
    • It is detected in the liver, bile, and feces at the end of the incubation period
    • HAV is resistant to acids, organic solvents, and remains viable for several hours at room temperature
    • It is inactivated by boiling for one minute, intense chlorination, autoclaving, UV exposure, and formaldehyde
    • HAV is transmitted via the fecal-oral route, mostly through direct contact or contaminated food/water sources
    • The source of infection is the diseased patient (with or without symptoms)
    • HAV is thermostable, with infectivity lasting up to 16 weeks in the feces

    Viral Hepatitis A

    • Acute viral hepatitis type A is an infectious and contagious disease transmitted via the enteral route
    • Clinical symptoms include general infectious and digestive phenomena, along with potential jaundice
    • HAV is detectable in feces from two weeks after the infective contact until two weeks after the appearance of symptoms.
    • A period of approximately 8 weeks and potentially even longer in children and those with compromised immune systems
    • Infections are mostly mild/asymptomatic in children
    • Individuals at high risk include: family contacts of HAV-infected individuals, medical staff, unvaccinated travelers, homosexuals, intravenous drug users, individuals from disaster areas, or institutionalized children
    • HAV replicates in the oropharynx, salivary glands, and bowel before being transported via the portal vein to the liver, leading to replication in hepatocytes and Kupffer cells
    • The replication process does not result in cell destruction

    Clinical Presentation of HAV

    • Incubation period: 15-45 days (average 21 days)
    • Prodromal period (preicteric): 3-5 days, with fever, headache, myalgias, anorexia, nausea, vomiting/diarrhea.
    • Icterus (jaundice) period: 4-21 days, with variable intensity, accompanied by acholic stools (pale) and hyperchromic urine, with jaundice intensity as a sign of severity
    • Convalescent period: 2-6 months, with complete clinical and biochemical remission and histological normalization

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    Description

    This quiz provides an in-depth look at acute viral hepatitis, focusing on its systemic effects on the liver, major viral causes, and clinical presentations. Learn about the five primary viruses responsible for the majority of hepatitis infections and the implications for public health. Understand their differences in pathology and the risk of chronic infections leading to more serious conditions.

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