Micro Hepatitis B and D
Terms in this set (75)
what is hepatitis?
inflammation of the liver caused by infectious or toxic agents and characterized by jaundice, fever, liver enlargement, and abdominal pain
is it possible to obtain hepatitis from a cause other than viral infection?
yes....yes it is
name the general progression of hepatitis (or alcohol toxicity) and its effects on the liver
healthy liver -> hepatitis (excessive alcohol) -> acute stage -> inflammation -> chronic inflammation -> diseased liver -> cirrhosis -> cancer
name the viruses that can cause hepatitis other than hep a, b, c, e, d, and g
EBV, CMV, Adeno, Yellow fever
which hepatitis viruses do not have vaccines?
Hepatitis C and G
what portion of the hepatitis b structure is important for treatment?
partially double stranded DNA
what are the associated diseases of Hepatitis B?
acute hepatitis, chronic hepatitis, and hepatic cancer
what would a hepatitis B surface antigen indicate during a hepatitis panel?
currently infected with virus
what would an antibody to hepB core antigen indicate in a hepatitis panel?
current infection or previous infection
a PCR portion of the hepatitis panel looks for what? and determines what?
the PCR looks for the E antigen to detect infection and determines the severity of the liver infection
how does the hepatitis B virus replicate?
what is the vaccine for Hepatitis B?
a vaccine against/to the Hepatitis B surface antigen
how is Hep B treatment similar to HIV treatment?
reverse transcriptase inhibitors with interferons
how do you treat a primary Hep B infection in clinic?
Hep B immunoglobulin
how is Hep B transmitted?
Person to Person: Birth (pregnant women can pass Hep B to child), blood (IV drug use, needlestick, and tattoos), and bimbos (unprotected sex)
is the hepatitis B envelope sensitive to chemicals?
NO...no it isn't
explain how the Hep B surface antigens evade immune systems
the envelope has surface antigens that project out of it and produce enough to outnumber the virions...the antibodies against the virions are occupied by the amount of surface antigens and the virus spreads
explain how the cell mediated is responsible for liver damage
there is replication in the liver and the T cells start to kill by recognizing the virally infected cells and destroy them and damage the liver...this leads to fibrotic state and cirrhosis
what do the non-infectious particles of Hep B do?
they contain only the Hep B surface antigen and bind and block the S antibodies and act as a decoy
what do antibodies to the surface antigen of Hep B do?
can confer lifelong immunity
what does the cell mediated response to Hep B results in?
CTL's against the surface (S) and internal (C and E) antigens
very briefly explain the steps of replication of Hep B virus
1) envelope fuses to surface and enters cell
2) Production of RNA off of dsDNA
3) Production of mRNA and entire genome code created
4) "reproduce" DNA from RNA with reverse transcriptase
two ways to describe Hep B virus replication:
very effective (HUGE amounts of very stable virus) and very contagious
name the three outcomes to a Hep B exposure
subclinical acute hepatitis, no effect, or clinical acute hepatitis
if you are infected with subclinical acute hepatitis what are the possible outcomes?
96% recovery or 4% are healthy carriers (chronic persistent hepatitis still transmittable)
if you are infected with clinical acute hepatitis what are the possible outcomes?
healthy carriers (chronic persistent hepatitis still transmittable); chronic active hepatitis; acute fulminating hepatitis; and 96% recovery
what are the two outcomes of clinical acute hepatitis that can lead to death?
chronic active hepatitis (after liver damage, cirrhosis, and cancer) and acute fulminating hepatitis (unchecked/uncontrollable replication)
what is the incubtion period of acute hep B
45 - 180 days
what are the symptoms of acute hep B?
tiredness, loss of appetite, abdominal pain, vomiting, joint pain, dark urine, clay colored stool, jaundice
the rate of symptoms of an acute hep B infection depends on?
the initial dose of infection
how long does it take for surface antibodies to be produced in serology of an acute hep B infection?
For an acute hep B infection, are symptoms seen before the body responds with antibody production?
No...the body responds to the surface antigen infection before symptoms are seen
which antibodies are expressed then taper off?
IgM anti-Hep B core and anti-Hep B surface
Total Anti-Hep B core are continually expressed for protection
the infant and young age group show ____ clinical symptoms and _____ chance of chronic infection than older age groups
less (10%) and more (85-90%)
Younger patients more easily develop chronic Hep B because of
weak cell mediated immunity
with a Hep B infection, what are the chances that an older patient shows clinical symptoms and what are the chances of developing a chronic infection?
high (30-50%) and low (2-10%)
what are the percentages of chronic hepatitis leading to cirrhosis and death
25% lead to cirrhosis and 25% of cirrhosis lead to liver failure or cancer (hepatocellular carcinoma) and death
chronic hepatitis patients can be asymptomatic?
why yes! yes they can!
what is the difference in surface antigen expression in acute and chronic hepatitis?
in acute, there was a peak of surface antigens at 12 weeks and it dropped off. In chronice surface antigen produced continuously and sustained
in chronic hepatitis, what are the levels of core antibodies and surface antigen antibodies?
there are built up levels of core antigen antibodies but there is rarely surface antigen antibody production
is there protection to surface antigens in chronic hepatitis?
patients who carry _____ are at a much higher risk to develop hepatocellular carcinoma
Hepatitis B Surface antigen and Hep B E internal antigen
what is one way the liver can cause cancer within itself?
cells trying to repair the liver damage continuously divide and lead to hepatocellular carcinoma
How does hepatitis B virus lead to liver cancer?
a hep b virus protein X activates the SRC kinase and may interact with p53. also, hep b virus genome can integrate near myc gene
what enzymes are used to diagnose chronic hep b?
alanine aminotransferase (ALT) in the serum during symptomatic phase
how is chronic hep b diagnosed with a hepatitis panel (what is detected)?
detection of hepb surface and internal E antigens and detection of antibodies against surface antigens and internal E and C antigens
describe the histology of a biopsy in a chronic hep b patient
ground glass appearance of hepatocytes and cytoplasmic abnormalities cause by surface antigens
what is the hepatitis B interpretation: negative surface antigen, negative antibody for C and S
no previous exposure and not vaccinated
what is the hepatitis B interpretation: negative surface antigen, positive antibody for C and S
patient is immune to hep B as a result of previous exposure
what is the hepatitis B interpretation: negative surface antigen, negative C antibody, and positive S antibody
patient immune to Hep b because of vaccination
what is the hepatitis B interpretion: positive surface antigen, positive C antibody, positive IgM, negative S antibody
acute Hep B infection -- possible decoy particles by surface antigens making antibodies undetecable
what is the hepatitis B interpretation: positive surface antigen, positive C antibody, negative IgM, and negative S antibody
chronic Hep B infection -- IgM response has disappeared
what is the hepatitis B interpretation: negative surface antigen, positive C antibody, and negative S antibody
patient in recovery phase of acute infection or possible false positive
what is a pregnant women given if HBsAg positive?
vaccine and HBV immunoglobulin
vaccine is contraindicated for people with _________
if infected with hep B and not vaccinated what should you do?
Hep B immunoglobulin for post exposure and passive immunization or interferon alpha or pegylated interferon
reverse transcriptase inhibitors used why in Hep B infections?
Hep B replicates by using dsDNA to mRNA to DNA so reverse transcriptase could inhibit further replication
what associated viruse requires presence of hep B for further replication?
if you vaccinate for Hep B, you inadvertently vaccinate against what other disease?
describe the structure of Hep D?
very small, enveloped, circular, ssRNA
how is Hep D transmitted?
parental, IV drug use, sexually (less efficiently)
how do you diagnose Hep D?
delta antigen in liver and delta antigen in blood
describe the therapy for Hep D
NONE -- eliminate/control Hep B to eliminate/control Hep D
the outer envelope protein of Hep D is ______
the Hepatitis B surface antigen
Hep D can only infect a cell if it is?
coinfected with hep B
the inner core of Hep d contains _1_ associated with the delta antigen to target __2__to the nucleus
1 - extensively base-paired circular RNA genome
2 - RNA
why is hep d so small?
only one open reading frame with two proteins (small and large delta antigens). It only has one protease because it needs Hep B for everything else...
In hep d acute disease, are the antibodies produced before symptoms are seen?
NO - if you have a coinfection then you will get symptoms very early after infection
the elevation of what occurs at the same time of symptoms in acute hep d disease?
elevation of ALT
in an acute hep b and d coinfection, there is a brief appearance of __1__ in the blood and a brief appearance of __2__?
1 - delta antigen
2 - IgM with little or no IgG
what persists at high levels after clearance in an acute hep b and d coinfection?
anti-HBsantigen (surface antigen antibodies)
in a chronic hep b and d superinfection, what is the appears briefly?
IgM followed by high titers of anti-delta IgG
in a chronic hep b and d superinfection, you will see a peak in ALT around the same time of?
in a chronic hep b and d superinfection, what persists in the liver but is rapidly cleared from serum?
in a chronic hep b and d superinfection, what persists at high levels?
anti delta IgG
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