Hepatitis - Causes and Types

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Questions and Answers

What is the primary mode of transmission for Hepatitis A?

Blood transfusions

Person-to-person via faecal-oral route (correct)

Person-to-person via respiratory droplets

Contaminated food and water

Which of the following populations is most commonly affected by Hepatitis A in developed countries?

Alcoholics

Travellers to endemic countries (correct)

Infants

Healthcare workers

What type of food is associated with the transmission of Hepatitis E?

Fried chicken

Canned vegetables

Raw pork and game meat (correct)

Undercooked shellfish

How long is the incubation period for Hepatitis B?

1-6 months Signup and view all the answers

Which statement correctly describes Hepatitis C?

There is no vaccine available for it Signup and view all the answers

What does a positive Anti Hepatitis B surface antibody (Anti-HBs) usually indicate?

Initial infection resolved or vaccination Signup and view all the answers

Which of the following antibodies indicates an acute Hepatitis B infection?

HBcAb (IgM) Signup and view all the answers

In a serology test, which marker indicates the presence of replicating Hepatitis B virus?

Hepatitis B DNA Signup and view all the answers

What does a negative result for Anti Hep B core total (IgG) indicate in a person with positive HBsAg?

They have an acute infection Signup and view all the answers

Which serology results would most likely indicate a person who has cleared Hepatitis B infection?

Negative HBsAg and positive Anti HBs Signup and view all the answers

Which of the following viruses is responsible for hepatitis A?

RNA virus Signup and view all the answers

What is the primary function of the hepatitis B virus in hepatocytes?

Expresses viral proteins on the surface Signup and view all the answers

Which hepatitis virus is considered a defective virus that requires the presence of another virus to replicate?

Hepatitis D Signup and view all the answers

What type of virus is hepatitis C categorized as?

RNA virus Signup and view all the answers

Which of the following hepatitis viruses has multiple genotypes and does not offer cross-protection?

Hepatitis C Signup and view all the answers

In which type of infections is hepatitis E virus primarily classified?

RNA virus infections Signup and view all the answers

Which structures are part of the hepatitis B virus?

Spherical form, filaments, and Dane particle Signup and view all the answers

What is the primary complication associated with viral hepatitis infections?

Liver inflammation Signup and view all the answers

What is the appropriate course of treatment for Hepatitis A?

Supportive care Signup and view all the answers

Which antibody indicates a past infection with Hepatitis B?

Anti Hep B core total (IgG) Signup and view all the answers

What is crucial for effective post-exposure prophylaxis for Hepatitis A?

Receiving passive immunisation Signup and view all the answers

Which of the following markers would indicate a hepatitis C infection has been cleared?

Negative HCV antigen Signup and view all the answers

Which of the following is a preventive measure for Hepatitis A?

Vaccination Signup and view all the answers

In the diagnosis of chronic Hepatitis C, which laboratory result is expected?

HCV ag – Positive Signup and view all the answers

What type of vaccine is used for Hepatitis A?

Inactivated vaccine Signup and view all the answers

What is the timeframe for Hepatitis C antibodies to become positive after exposure?

2-6 months Signup and view all the answers

Which of the following populations is considered at risk for severe complications from hepatitis?

Chronic liver disease patients Signup and view all the answers

What is the primary treatment approach for acute hepatitis E infection?

Supportive therapy Signup and view all the answers

What is a key goal of chronic hepatitis B treatment?

Reduction of hepatitis B DNA to undetectable levels Signup and view all the answers

What immediate action is recommended for individuals experiencing a needle stick incident if they have inadequate vaccine protection?

Passive immunization with immunoglobulin Signup and view all the answers

What is one of the standard precautions recommended to prevent the spread of hepatitis B?

Safe disposal of sharps Signup and view all the answers

Which of the following is a part of the management for chronic hepatitis B?

Regular monitoring for liver cancer Signup and view all the answers

Which of the following groups is primarily recommended for hepatitis B vaccination?

High-risk groups such as healthcare workers Signup and view all the answers

What is the recommended titre level for hepatitis B vaccination to be considered effective?

Ideally >100 IU/ml Signup and view all the answers

What transmission method is primarily associated with Hepatitis E in developing countries?

Faecally-contaminated water Signup and view all the answers

What is the incubation period range for Hepatitis A after infection?

15-50 days Signup and view all the answers

Among the following, which population is least likely to experience Hepatitis A infections in developed countries?

Individuals with regular access to clean water Signup and view all the answers

Which statement accurately describes Hepatitis B compared to Hepatitis C?

Hepatitis B has a vaccine available, but Hepatitis C does not. Signup and view all the answers

What is a major characteristic that differentiates the Hepatitis viruses from one another?

Hepatitis E infects both humans and animals, while Hepatitis A infects only humans. Signup and view all the answers

What mode of transmission is primarily associated with high prevalence areas for hepatitis B?

Close household contact and intrapartum spread Signup and view all the answers

What are the clinical features that might signify an infection with hepatitis A in adults?

Prodromal symptoms followed by dark urine and pale stools Signup and view all the answers

Which of the following best describes the typical laboratory findings in patients presenting with symptomatic viral hepatitis?

Increased levels of alanine aminotransferase and bilirubin Signup and view all the answers

What is true regarding patients infected with hepatitis B regarding liver function tests?

Elevations in liver function tests, particularly AST and ALT, are common Signup and view all the answers

During what timeframe is a hepatitis B e antigen (HBeAg) detectable?

When the virus is actively reproducing Signup and view all the answers

What factor increases the risk of symptomatic hepatitis A infection as individuals age?

Coinfection with hepatitis B Signup and view all the answers

Which practice significantly contributes to the parenteral transmission of hepatitis viruses?

Sharing of personal care items like razors Signup and view all the answers

What complication may arise in cases of fulminant disease related to hepatitis infections?

Acute liver failure although uncommon Signup and view all the answers

What is the primary goal of antiviral therapy in chronic Hepatitis B treatment?

To prevent the progression to cirrhosis and liver cancer Signup and view all the answers

In which scenario is passive immunisation specifically recommended?

For neonates born to Hepatitis B positive mothers Signup and view all the answers

Which method is most effective for monitoring liver cancer in patients with chronic Hepatitis B?

Ultrasound and Alpha Feta Protein test Signup and view all the answers

What factor is essential for determining who should receive the Hepatitis B vaccine?

Risk factors for transmission Signup and view all the answers

What is a significant complication of chronic Hepatitis E infection in transplant patients?

Reduced immunosuppression therapy Signup and view all the answers

Which intervention is included in standard precautions to prevent the spread of Hepatitis B?

Safe disposal of sharps and proper hygiene practices Signup and view all the answers

Which of the following statements about Hepatitis C management is accurate?

There is no recognized post-exposure prophylaxis following Hepatitis C exposure Signup and view all the answers

What is the significance of achieving a titre level of >10 IU/ml in Hepatitis B vaccination?

Indicates adequate immune response to protect against infection Signup and view all the answers

What does a negative result for Hepatitis C antibody (Anti-HCV) indicate in an individual with symptoms of an acute infection?

The individual is not infected with Hepatitis C. Signup and view all the answers

In the context of Hepatitis A prevention, what is the role of passive immunization?

It provides immediate but temporary protection post-exposure. Signup and view all the answers

Which laboratory marker is consistently positive in individuals with chronic Hepatitis C infection?

All of the above Signup and view all the answers

What is the correct post-exposure management for contacts of Hepatitis A cases?

Vaccination or passive immunization within two weeks. Signup and view all the answers

In the serological evaluation of Hepatitis B, which result would suggest a patient has an active infection?

Positive Hep BeAg (e antigen) with negative Anti-HBs. Signup and view all the answers

Which statement about Hepatitis C infection is true regarding antivirus antibodies?

Anti-HCV may remain positive even after the infection resolves. Signup and view all the answers

What is the primary preventive measure for reducing the acquisition of Hepatitis A?

Practicing good hygiene and sanitation. Signup and view all the answers

For whom is the Hepatitis A vaccine particularly recommended?

Travellers to endemic countries and at-risk groups. Signup and view all the answers

Which of the following accurately describes the hepatitis B virus?

It triggers the immune response by expressing viral proteins on hepatocytes. Signup and view all the answers

What is the primary role of the hepatitis D virus?

It requires hepatitis B surface antigen for replication. Signup and view all the answers

Which of the following is characteristic of hepatitis C genotypes?

At least six distinct genotypes are recognized. Signup and view all the answers

Which hepatitis virus is classified as a non-cytopathic virus?

Hepatitis A Signup and view all the answers

How is hepatitis E primarily classified?

As an enterovirus. Signup and view all the answers

Which of the following indicates the presence of excess hepatitis B virus envelope proteins?

Filaments Signup and view all the answers

Which hepatitis viruses can co-infect with each other?

Hepatitis B and D Signup and view all the answers

What distinguishes hepatitis B from other hepatitis viruses?

It is the only hepatitis virus known to trigger liver cancer. Signup and view all the answers

Study Notes

Hepatitis - Causes

Inflammation of the liver
Can be caused by both infectious and non-infectious agents.
Infectious causes include bacteria, viruses, and other organisms.
Non-infectious causes include drug use, alcohol consumption, vascular issues, autoimmune disorders, and metabolic conditions.
Viral infections included Hepatitis A, B, C, and E.
Other viral infections include Cytomegalovirus, Epstein-Barr virus, Rubella, and Yellow Fever.

Hepatitis A

RNA virus that infects the liver
Transmitted via the fecal-oral route, often through contaminated food or water.
Incubation period of 30 days (range 15-50).
Infectious for two weeks before to one week after the onset of symptoms.
Primarily found in developing countries.
In developed countries it is most commonly found in travellers to endemic countries, households with confirmed cases, sexual contacts of confirmed cases, and occasional foodborne outbreaks.

Hepatitis B

DNA virus that infects hepatocytes (liver cells)
Hepatitis B core, surface, and envelope antigens are produced.
There are three virus forms: Dane particle, Spherical form, and filaments.
Dane particles contain the entire viral genome and are the only infectious form.
Spherical and filamentous forms lack DNA but have the virus envelope that contains the Hepatitis B surface antigen (HBsAg).

Hepatitis C

RNA virus in the Flaviviridae family.
At least 6 distinct genotypes (1-6) with no cross-protection.
Transmission through blood-to-blood contact, primarily via contaminated needles, infected blood products, and sexual intercourse.
Incubation period of 8 weeks (average).

Hepatitis D

Incomplete viral particle
Defective RNA virus.
Requires Hepatitis B surface antigen (HBsAg) for propagation.

Hepatitis E

RNA virus with four genotypes.
Found predominantly in developing countries.
Transmitted via contaminated water and food.
Incubation period of 30-40 days.

Hepatitis B Serology

Antibodies and antigens detected in serum
Hepatitis B surface antigen (HBsAg): present in acute and chronic infections, indicates infectivity
Hepatitis B e antigen (HBeAg): present in acute and chronic infections; high levels indicate high viral replication
Hepatitis B e antibody (HBeAb): indicates the body is controlling infection & viral replication is decreasing
Anti-Hepatitis B core IgM (HBcAb IgM): appears in acute infection, indicating recent infection
Anti-Hepatitis B core total (IgG) (HBcAb IgG): usually positive for life, indicating prior exposure to the virus.
Anti-Hepatitis B surface antibody (Anti-HBs): usually appears after the initial infection has resolved; can indicate vaccination.

Hepatitis B Serology Interpretation

Patient A: Acute Hepatitis B infection.
Patient B: Chronic Hepatitis B infection, with declining viral activity.
Patient C: Resolved Hepatitis B infection.
Patient D: Resolved Hepatitis B infection with immunity due to vaccination.

Hepatitis C Serology

Anti-HCV: Indicates prior or current exposure to hepatitis C.
HCVag: Indicates active infection.
HCV RNA: Indicates active infection.
Acute infection (infectious): Anti-HCV may be negative or positive, HCVag is positive, and HCV RNA is positive.
Chronic infection (infectious): Anti-HCV is positive, HCVag is positive, and HCV RNA is positive.
Infection cleared (non-infectious): Anti-HCV is positive, HCVag is negative, and HCV RNA is negative.

Hepatitis A Prevention

Hygiene: Good handwashing practices and sanitation
Traveller Advice: Educate travellers about potential risks and recommend vaccination or immunoglobulin if needed.
Vaccination: Inactivated vaccine available
- Post-exposure: Given to contacts of cases and for outbreak control.
- Pre-exposure: Recommended for travellers to endemic countries, people with chronic liver disease, injecting drug users, gbMSM, and workers exposed to raw untreated sewage.

Hepatitis A Immunoglobulin (Passive Immunization)

Given as post-exposure prophylaxis
Needs to be given within 2 weeks of exposure to be effective.
Recommended for:
- Individuals over 60 years old
- Those at risk of severe complications (e.g., chronic liver disease, chronic hepatitis B or C infection)

Hepatitis B Prevention

Standard Precautions: Hand hygiene, use of personal protective equipment, safe disposal of sharps.
Safe Injections: Use of clean needles and disposable syringes.
Blood Screening: Screen blood products to prevent transmission.
Safe Sex: Safer sex practices to reduce the risk of transmission.
Passive Immunization: Immunoglobulin given for post-exposure prophylaxis.
- Recommended for:
  - Neonates (at birth)
  - Needle stick injuries in unvaccinated individuals or those with inadequate antibodies
  - After high-risk sexual exposure
- Vaccine is also recommended along with immunoglobulin.

Hepatitis B Vaccination

Pre-exposure prophylaxis using cloned Hepatitis B surface antigen (HBsAg).
Vaccine Course: Three doses.
Antibody Titers: Ideally > 100 IU/mL of anti-HBs.
High Risk Groups: Healthcare workers, part of national immunisation program.

Hepatitis - Causes

Hepatitis is inflammation of the liver.
It can be caused by infectious or non-infectious agents.
Infectious causes include bacterial, other, and viral agents.
Viral subtypes include Hepatitis A, B, C, D, and E.
Non-infectious causes include drugs, alcohol, vascular, autoimmune, and metabolic factors.

Hepatitis A

It is an RNA virus, an enterovirus (picornavirus).
It is not cytopathic in itself; cellular immunity is thought to cause liver damage.
It is transmitted primarily person-to-person via the fecal-oral route.
Transmission can also occur through contaminated food and water.
The incubation period is 30 days (range 15-50).
Period of infectiousness is 2 weeks before to 1 week after onset of symptoms.

Hepatitis B

It is a DNA virus that infects hepatocytes.
Viral proteins are expressed on the surface, triggering the cellular immune response.
There are three virus forms: Dane particle, spherical form, and filaments.
The Dane particle is the infectious particle.

Hepatitis C

It is an RNA virus (flavivirus).
There are at least six distinct genotypes (1-6).
There is no cross-protection; individuals can be reinfected with another genotype.

Hepatitis D

It is a defective RNA virus.
Uses hepatitis B surface antigen for propagation.

Hepatitis E

It infects both animals and humans.
There are four genotypes with different geographic distributions and epidemiology.
Genotypes 1 and 2 are transmitted via fecally-contaminated water in developing countries.
Genotypes 3 and 4 are found in humans, pigs, and other mammals.
Transmission to humans occurs through undercooked or raw pig and game meat, processed pork, shellfish (genotype 3), handling animals (particularly pigs), and contaminated water.
Incubation period is 30-40 days post exposure.

Hepatitis B and C

Hepatitis B is vaccine-preventable, while Hepatitis C is not.
The incubation period for Hepatitis B is 1-6 months, compared to 8 weeks (average) for Hepatitis C.
Transmission to humans for both Hepatitis B and C includes perinatal, sexual, and parenteral routes.

Hepatitis B - Epidemiology:

In low prevalence areas, acute infection is sporadic in adults.
Spread is primarily through sex and parenteral routes.
In high prevalence areas, acute infection is found in infants and young children.
Spread is through intrapartum and close household contact.

Clinical Presentation of Viral Hepatitis

Patients may be asymptomatic or symptomatic.
Symptomatic infections are often preceded by prodromal symptoms (fever, loss of appetite, nausea, fatigue, right upper quadrant abdominal pain).
Other symptoms include dark urine, pale greasy stools, and jaundice (build-up of bilirubin).
Abnormal liver function tests (LFTs) are seen in cases of viral hepatitis.

Hepatitis A Clinical Course

Acute infection is generally asymptomatic in children.
Risk of symptomatic infection increases with age and coinfection (e.g., hepatitis B).
Fulminant disease (acute hepatitis failure) is unusual.
It takes 6 months for chronic infection to develop.

Hepatitis B - Laboratory Diagnosis

HBsAg (surface antigen) is positive in acute and chronic infection.
Hep BeAg (e antigen) is detectable when the virus is actively reproducing.
Hep Be Ab (e antibody) and anti Hep B core IgM are positive in current hepatitis B infection.
Anti Hep B core total (IgG) and anti HBs (surface antibody) are positive in cleared infection.

Hepatitis C - Laboratory Diagnosis

Hepatitis C antibody (Anti-HCV) is positive 2-6 months after exposure to hepatitis C.
It remains positive even if infection has cleared.
Hepatitis C antigen (HCV ag) is positive in acute and chronic infection.
Hepatitis C virus (HCV) RNA is positive in acute and chronic infection.

Hepatitis A Treatment and Prevention

Treatment is supportive care.
Prevention includes hygiene, advice to travelers, sanitation, and vaccination.

Hepatitis A Vaccination

It is an inactivated (not live) vaccine.
Post-exposure: It is used for management of contacts of cases and outbreak control.
Pre-exposure: It is recommended for travelers to endemic countries, at-risk individuals (chronic liver disease, injecting drug users, men who have sex with men, workers exposed to raw untreated sewage), and those over 60 years of age.
Passive immunization (immunoglobulin) is a post-exposure prophylaxis option.

Hepatitis E Management and Prevention

Acute infection is usually self-limiting; treatment is symptomatic.
Chronic infection in transplant patients may require reducing immunosuppression and using antivirals.

Hepatitis B Treatment

Acute infection requires supportive therapy.
Chronic infection management includes patient education, vaccination, and antiviral therapy.
Antiviral therapy aims to prevent progression to cirrhosis, liver failure, and cancer but cannot eradicate the virus.
Goal of antiviral therapy is to reduce hepatitis B DNA below detectable levels and achieve seroconversion of e antigen to e antibody.
Liver cancer monitoring (ultrasound, Alpha Feta Protein) is important.
Transplantation is considered for fulminant hepatitis and end-stage chronic hepatitis.

Hepatitis B Prevention

Strategies vary based on high and low prevalence areas.
Prevention includes standard precautions (safe sex, screening blood products, clean needles/disposable equipment, hand hygiene, gloves, goggles, aprons, safe disposal of sharps), avoiding risk factors, and passive immunization (immunoglobulin) for post-exposure prophylaxis.
Pre-exposure prophylaxis includes vaccination.
Hepatitis B vaccine uses a cloned surface antigen (HBsAg) and induces antibodies to HBsAg (Anti-HBs).

Hepatitis C Management

There is no post-exposure prophylaxis for acute infection.

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Description

This quiz covers the causes and types of hepatitis, focusing on both infectious and non-infectious agents. Learn about the various viruses, such as Hepatitis A and B, along with their transmission methods and characteristics. Test your knowledge about how these viruses affect the liver and their global prevalence.