Viral Hepatitis Overview and HAV Details
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Questions and Answers

What is the primary mode of transmission for HAV infection?

  • Fecal-oral transmission (correct)
  • Vector-borne transmission
  • Airborne transmission
  • Bloodborne transmission
  • How long can HAV be detected in feces after the initial infective contact?

  • 12 weeks
  • 1 week
  • 8 weeks (correct)
  • 2 weeks
  • Which group of individuals is NOT considered at risk for HAV infection?

  • Family contacts of an infected person
  • Vaccinated travelers (correct)
  • Intravenous drug users
  • Homosexuals
  • What is the period during which humans are most susceptible to HAV infection?

    <p>During and following the clinical onset (A)</p> Signup and view all the answers

    What is unique about the cytopathic effect of HAV?

    <p>It lacks cytopathic effects. (A)</p> Signup and view all the answers

    What type of immunity is developed after an HAV infection?

    <p>Life-long immunity (A)</p> Signup and view all the answers

    What characteristic is associated with asymptomatic HAV infections?

    <p>They are more common in children. (D)</p> Signup and view all the answers

    Once HAV enters the body, where does the first round of replication occur?

    <p>In the bowel and oropharynx (B)</p> Signup and view all the answers

    What role do NK cells and cytotoxic T cells play in the context of viral hepatitis?

    <p>They help in viral clearance through cytokine and interferon action. (A)</p> Signup and view all the answers

    Which of the following accurately describes the production of IgM antibodies in hepatitis A?

    <p>They serve as a marker for current or recent infection. (D)</p> Signup and view all the answers

    During which period do IgG antibodies become predominant after an HAV infection?

    <p>After the onset of jaundice. (D)</p> Signup and view all the answers

    What is the average incubation period for hepatitis A virus infection?

    <p>21 days (B)</p> Signup and view all the answers

    Which of the following metabolic processes is affected by hepatic injury in hepatitis A?

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

    What symptom is most frequently associated with the non-specific digestive syndrome in HAV infection?

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

    What type of hepatitis A infection form is more common in children?

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

    Which factor contributes to hepatic lesions observed in hepatitis A?

    <p>Immunologic mechanisms induced by viral antigens (B)</p> Signup and view all the answers

    What is often observed in hepatocytolysis syndrome prior to jaundice?

    <p>Increase in transaminases (AST, ALT) (C)</p> Signup and view all the answers

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

    <p>Lower in hepatitis A (C)</p> Signup and view all the answers

    What does a significant increase in bilirubin levels typically indicate in a patient with jaundice?

    <p>Severe forms of liver disease (D)</p> Signup and view all the answers

    What aspect of hematological syndrome is not commonly found?

    <p>Elevated leukocyte count (B)</p> Signup and view all the answers

    What is indicated by a reduced prothrombin index (PI) and increased INR?

    <p>Severe liver injury (A)</p> Signup and view all the answers

    Which of the following is NOT a function affected by liver failure?

    <p>Hormonal regulation (A)</p> Signup and view all the answers

    What does a significant elevation of GGT and alkaline phosphatase suggest?

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

    In the context of liver disease, what can high levels of serum ammonium indicate?

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

    What characterizes the prolonged form of hepatitis A?

    <p>Persistence of clinical and/or biological changes for several weeks or months (D)</p> Signup and view all the answers

    What percentage of adults experience cholestatic hepatitis A?

    <p>4-10% (A)</p> Signup and view all the answers

    Which feature is NOT associated with fulminant hepatitis A?

    <p>High incidence in children (C)</p> Signup and view all the answers

    What specific risk does acute hepatitis A pose to pregnant women and their fetuses?

    <p>Longer elimination of HAV in feces if infected in late pregnancy (A)</p> Signup and view all the answers

    How does HIV infection affect the progression of acute hepatitis A?

    <p>Can cause persistent elevations in transaminases (A)</p> Signup and view all the answers

    What is a key aspect of the laboratory diagnosis of acute hepatitis A?

    <p>Epidemiological and clinical data (D)</p> Signup and view all the answers

    What distinguishes the non-specific laboratory data in acute hepatitis A?

    <p>It shares similarities across different types of acute hepatitis (A)</p> Signup and view all the answers

    What vaccination recommendation is advised for patients with chronic liver diseases regarding hepatitis A?

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

    What is the main site of replication for HBV in the human body?

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

    During which stage of HBV infection does the immune system actively clear the virus?

    <p>Replicative with immunological clearance (A)</p> Signup and view all the answers

    What is a potential outcome if the host's immune response is particularly active after HBV infection?

    <p>HBs seroconversion (A)</p> Signup and view all the answers

    What is the role of CD8 lymphocytes in HBV infection?

    <p>Recognizing infected hepatocytes and mediating cytolysis (C)</p> Signup and view all the answers

    What happens to HBV DNA levels during the integrative stage after a strong immune response?

    <p>They become undetectable in serum but remain detectable in liver (A)</p> Signup and view all the answers

    What facilitates cytolytic aggression in HBV infection?

    <p>Cytotoxic T lymphocytes and macrophages (A)</p> Signup and view all the answers

    Which stage of HBV infection is characterized by minimal cytolysis and no symptoms?

    <p>Replicative with immune tolerance (B)</p> Signup and view all the answers

    What can serve as a reservoir for HBV despite not causing inflammatory lesions?

    <p>Lymph nodes and circulating lymphocytes (A)</p> Signup and view all the answers

    What is the average incubation period for HBV infection?

    <p>60-90 days (B)</p> Signup and view all the answers

    Which antibodies are considered protective against HBV?

    <p>HBV surface antibodies (A)</p> Signup and view all the answers

    During which period of HBV infection do symptoms like hyperchromic urine and discolored stools typically occur?

    <p>Prodromal period (B)</p> Signup and view all the answers

    What symptom is NOT commonly associated with the onset of acute hepatitis B?

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

    What characterizes the convalescent period of HBV infection?

    <p>Persistence of hepatomegaly (C)</p> Signup and view all the answers

    Which syndrome is specifically described in children during HBV infection?

    <p>Gianotti-Crosti syndrome (D)</p> Signup and view all the answers

    What is the typical evolution of HBV infection in most cases?

    <p>Self-limiting and favorable (C)</p> Signup and view all the answers

    What is a common feature of jaundice during the evolution of HBV infection?

    <p>It is typically intense and prolonged (B)</p> Signup and view all the answers

    Flashcards

    HAV Infection Transmission

    Spread through fecal-oral route, direct contact, or contaminated water/food.

    HAV Infection Source

    Infected individuals (with or without symptoms).

    HAV Fecal Excretion

    Virus found in feces two weeks after infection until two weeks after symptoms appear, but decreases after jaundice appears.

    HAV Infectivity Duration

    Virus is most infectious in the weeks before jaundice and decreases sharply after jaundice.

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    HAV Replication Sites

    Orpharynx, salivary glands, intestines, and liver hepatocytes.

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    HAV Clinical Symptoms

    Less frequent and milder in children than adults; 40-50% infected with no symptoms.

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    HAV Viral Proteins

    Proteins assembled into capsids that create new virions.

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    HAV Route of Transmission

    Fecal-oral route, meaning contamination of food or water.

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    Intrahepatic Replication

    Viral replication within the liver cells.

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    Viremia Duration

    Viral presence in the blood (viremia) from 2 weeks post-infection to 2 weeks after symptom onset.

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    Hepatic Lesions Cause

    Immune response to viral antigens on the liver cells leads to damage.

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    Immune Response (HAV)

    The immune system combats the infection, with IgM antibodies appearing during infection/excretion and lasting 6 months ; IgG appears later and protects against reinfection.

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    Incubation Period (HAV)

    The time between infection and the appearance of symptoms (15-45 days, average 21 days).

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    Prodromal Period (HAV)

    The period before jaundice, showing nonspecific symptoms (3-5 days).

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    Clinical HAV Presentation

    Most HAV infections are asymptomatic; symptomatic cases may present non-specific symptoms (fever, body aches).

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    Hepatic Injury Effects

    Liver damage affects metabolic processes-lipids, proteins, carbohydrates, and electrolytes.

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    Hepatitis A Prognosis

    Generally good with no risk of becoming chronic. The virus usually clears within a few weeks or months.

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    Cholestatic Hepatitis A

    A rare form of hepatitis A characterized by intense, prolonged jaundice with a green tint. Occurs in 4-10% of adult cases.

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    Fulminant Hepatitis A

    Extremely rare, more common in adults, characterized by massive liver necrosis, coagulation disorders, and neuropsychiatric disturbances.

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    Hepatitis A In Pregnancy

    No known teratogenic risk for the fetus. Infection in the last trimester may infect the fetus but usually without symptoms.

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    Hepatitis A In HIV+

    Individuals with HIV do not seem to develop more severe symptoms compared to the general population, but may experience persistent elevated transaminases.

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    Hepatitis A In Chronic Liver Disease

    May have a more severe course compared to individuals without pre-existing liver disease. Fulminant hepatitis is more common in this group.

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    Hepatitis A Diagnosis

    Based on epidemiological, clinical, and laboratory data. This includes contact history, absence of prior infection, vaccination status, travel history, clinical symptoms, and laboratory tests.

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    Non-Specific Laboratory Changes

    Similar across various types of acute hepatitis. These changes are more extensively discussed for hepatitis A, with only specific differences highlighted for other types of hepatitis.

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    What is hepatocytolysis syndrome?

    A syndrome characterized by damage to liver cells, often seen in hepatitis A and B, leading to increased transaminases (ALT and AST) in the blood.

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    How is ALT level in hepatitis A?

    ALT levels are significantly higher in acute hepatitis A compared to other hepatitis types (B, C, or E).

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    What is biliary retention syndrome?

    A syndrome characterized by the buildup of bilirubin in the blood due to problems with bile flow, leading to jaundice.

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    What changes in bilirubin levels are seen?

    Increased bilirubin levels (both direct and indirect) in the blood, with jaundice being obvious at levels above 4-5 mg/dl.

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    What is cholestatic syndrome?

    A syndrome characterized by impaired bile flow, leading to high levels of bilirubin, GGT, ALP, and cholesterol in the blood.

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    How does cholestatic syndrome relate to acute viral hepatitis?

    A predominantly cholestatic syndrome suggests a non-viral cause, as it implies a blockage in bile flow rather than cell damage.

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    What are the common hematological changes in hepatitis?

    Leukocyte count can be normal or low with lymphocytosis and neutropenia. In rare cases, atypical lymphocytes can be present in blood.

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    How does liver failure manifest in hepatitis?

    Severe damage to the liver affecting its functions, including protein synthesis, detoxification, and metabolism, resulting in decreased serum protein levels, increased ammonium, and impaired bilirubin conjugation.

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    Immune Tolerance Stage

    The initial stage of HBV infection characterized by active viral replication within the liver, but with minimal damage to liver cells and no noticeable symptoms.

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    Immune Clearance Stage

    The immune system recognizes HBV proteins and attacks infected liver cells, leading to symptoms like jaundice and inflammation.

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    HBV Cytolysis

    Destruction of infected liver cells due to the immune response. This process is mediated by cytotoxic T lymphocytes (CTLs) and NK cells.

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    Chronic HBV Carrier

    A person who has persistent HBV infection, often with ongoing viral replication and the potential for liver damage.

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    HBV Integration

    The process where HBV DNA becomes incorporated into the host's genome, potentially leading to viral reactivation later.

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    Extrahepatic HBV Replication

    Replication of HBV can occur in tissues and organs outside the liver, but these sites typically do not result in inflammation.

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    Immune Response Impact

    The type of immune response determines the severity of the infection and the likelihood of chronic HBV infection.

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    Protective HBV Antibodies

    The only antibodies that offer protection against Hepatitis B infection are those directed against the Hepatitis B surface antigen (HBsAg).

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    Pre-Core Mutations and HBV Severity

    Certain mutations in the pre-core region of the HBV genome are associated with a higher likelihood of severe and rapid forms of the disease, including fulminant hepatitis.

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    Incubation Period of HBV

    The time between HBV infection and the appearance of symptoms is typically 60-90 days, but can range from 45-180 days. Factors influencing the duration include the amount of virus received, the transmission route, other infections, and the virus's properties.

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    Prodromal Phase of HBV

    This phase precedes jaundice and lasts for 2-3 weeks. Symptoms are usually similar to other types of acute viral hepatitis. Specific signs include pseudorheumatoid syndrome and skin syndrome.

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    Pseudoinfluenza Syndrome

    Symptoms like fever, cough, headache, muscle aches, and weakness are rarely seen at the beginning of HBV infection. It is more typical of the onset of hepatitis A.

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    Gianotti-Crosti Syndrome

    This syndrome, also known as papular acrodermatitis, is commonly observed in children with HBV infection. It involves a rash of red-pink bumps (papules) primarily on the face, trunk, and generalized lymph node swelling.

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    HBV Jaundice

    Clinically, the jaundice (yellowing of the skin and whites of the eyes) associated with HBV is typically more intense, longer lasting, and fluctuates in severity. It often comes with other symptoms like tender liver enlargement, right upper abdominal discomfort, and sometimes spleen swelling and lymph node enlargement.

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    Study Notes

    Acute Viral Hepatitis

    • Acute viral hepatitis are systemic infections primarily affecting the liver.
    • They are a significant public health concern due to high morbidity, mortality and significant healthcare costs.
    • Five viruses account for over 90% of hepatitis infections: HAV, HBV, HCV, HDV, and HEV.
    • HAV is an RNA virus, while HBV is a DNA virus. Other viruses, HCV, HDV and HEV are RNA viruses.

    Viral Hepatitis A (HAV)

    • HAV is a spherical RNA virus (27nm).
    • It lacks an envelope.
    • It is antigenically unitary.
    • It replicates in the liver, bile and feces.
    • It is thermostable and resistant to acid and organic solvents.
    • HAV is inactivated by boiling, intense chlorination, autoclaving, UV exposure, and formaldehyde.
    • It is transmitted enterally.
    • Clinical manifestation can range from asymptomatic to severe.

    HAV Epidemiology

    • HAV is spread worldwide, with seasonal outbreaks.
    • The source of infection is a diseased patient, either symptomatic or asymptomatic.
    • Infectivity period is two weeks before to two weeks after the onset of clinical symptoms.
    • Transmission is fecal-oral, through contact or contaminated water/food.
    • Risk groups include: Close contacts, healthcare workers, travelers to high-endemic regions, people with risk of infection.

    HAV pathogenesis

    • HAV is ingested and replicates in the oropharynx and gut.
    • Replication in the small intestines, followed by transportation via the portal vein to the liver.
    • HAV does not cause direct cell damage in vitro or in vivo.
    • Hepatocellular damage is cause by an immune response.
    • Virus is excreted in feces.

    HAV Clinical Picture

    • The incubation period is 15-45 days.
    • Prodromal (preicteric) phase (3-5 days), with general symptoms such as fever malaise and myalgias.
    • Icteric phase (duration variable 4-21 days), with jaundice (and hyperchromic urine and acholic stools).
    • Convalescent period (2-6 months): recovery and return to normal.
    • Anicteric form: most frequent in children, with no jaundice.
    • Fulminant form: Extremely rare, severe and rapidly progressing.
    • Cholestatic form: Prolonged jaundice.

    HAV Laboratory Diagnosis

    • Elevated transaminases (AST, ALT).
    • Increased bilirubin (direct and indirect).
    • Detection of IgM antibodies during acute infection.
    • Detection IgG antibodies after recovery (for immunity).
    • Fecal detection.

    Hepatitis B (HBV)

    • HBV is a DNA virus belonging to the Hepadnaviridae family.
    • The complete HBV particle is known as Dane particle (42nm), consisting of outer shell and inner core.
    • Envelop with proteins like HBs Ag.
    • Core contains DNA polymerase.

    HBV Epidemiology

    • HBV is a global health concern.
    • It is transmitted through parenteral routes (transfusions, IV drug use), non-parenteral routes.
    • Risk groups include IV drug users, healthcare workers, patients on dialysis, and people with multiple sexual partners.
    • Vertical transmission is possible from mother to child.
    • Transmission mostly occurs via blood-to-blood contact.

    HBV Pathogenesis

    • HBV enters the body and replicates within the liver.
    • The body mounts an immune response against the virus, causing inflammation and cell death in the liver.
    • Chronic infection can develop with potential complications such as cirrhosis and liver cancer.
    • The HBV genome is partially double stranded DNA that has multiple open reading frames.
    • HBV-DNA polymerase mediates the DNA replication in reverse transcription.

    HBV Clinical Picture

    • Incubation period: 60-90 days.
    • Prodromal period (1-3 weeks): nonspecific symptoms (fatigue, low-grade fever).
    • Icteric period (2-6 months): jaundice followed by resolution of symptoms.
    • Fulminant hepatitis is a severe form characterized by rapidly progressing liver failure.
    • Chronic or prolonged infection is characterized by persistence of symptoms and inflammation for months to years.

    HBV Laboratory Diagnosis

    • Detection of HBsAg: surface antigen, early marker.
    • Detection of Anti-HBs: antibody, indicates previous infection.
    • Detection of Anti-HBc: antibody, appears early in infection.
    • Detection of Anti-HBe: Antibody, indicates remission.
    • HBV-DNA: Indicates the viral replication

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