Term
| INFECTIONS OF CIRCULATORY AND LYMPHORETICULAR SYSTEM |
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Definition
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Term
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Definition
General term for inflammation of liver - can be caused by variety of agents
extent of liver damage ranges from mild to fulminant
TO DETERMINE ETIOLOGY AND TREATMENT, BLOOD TESTS MUST BE DONE BEFORE ANY TREATMENT IS INITIATED
-when diagnosed with viral hep, dont treat! first figure out cause |
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Term
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Definition
liver is primary target
things like CMV, EBV or VZV target liver secondarily |
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Term
Viral Hepatitis
-general remarks |
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Definition
types:
A- infectious; fecal oral; water borne
B - serum (saliva, semen)
C - transfusion associated
D - delta
E- epidemic; fecal oral; water borne |
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Term
Viral Hepatitis
-consequences |
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Definition
subclinical and anicteric (no jaundice) hepatitis A-E
-only detected through blood
typical, acute, icteric hep - jaundice; yellow skin; A-E
chronic hep - cirrhosis; liver cancer ONLY B, C, AND D
fulminant hep: massive necrosis resulting in coma and death A-E |
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Term
Viral Hepatitis
-course and symptoms |
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Definition
1. incubation period is variable and prolonged; wks-months
2. prodrome - fever, fatigue, GI symptoms n/v
3. icteric phase:
prodrome continues, dark urine, clay stool, jaundice
hepatomegaly, increased AST and ALT and iron
increased prothrombin time
serum albumin is low
4. convalescent phase: disappearance of jaundice and major symptoms; but fatigue and malaise may persist |
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Term
Viral Hepatitis
-treatment |
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Definition
A: HISG (serum globulin
B + D: HBIG
chronic HBV: PEG interferon and anti HIV drug - lamivudine, adefovir, entcavir
C: peg-interfereon alpha and ribavirin |
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Term
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Definition
for A and B
intramuscular for adults
into thigh for infants
person immune to B is also immune to D.
vaccinate b means you are safe from D too |
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Term
Hepatitis B Virus
-Serum Hepatitis
-etiology |
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Definition
surface antigen is HBsAg:
can be detected in clinic; HBsAg indicates infection
-neutralizing immunity: production of anti HBsAg Ab results in complete recover from HBV with clearance of HBsAg from blood and immunity from future infection
-all you need is surface Ag to be immune to HBV
-being immune means you have Ab to surface Ag; called antiHBsAg Ab
core antigen: HBcAg
cannot be detected in clinic
non-neutralizing immunity - Ab are produced but result in non-neutralizing immunity
soluble Ag of the core: HBeAg
-can be detected in clinic; free HBeAg in blood means active virus replication
some HIV drugs are useful because viral polymerase possesses reverse transcriptase activity
eight genotypes
A and C predominate in US |
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Term
Hepatitis B Virus
-Serum Hepatitis
-transmission and reservoir |
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Definition
transmission by serum, saliva, semen
-sexual contact
-parenteral
-perinatal
humans are sole host and reservoir |
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Term
Hepatitis B Virus
-Serum Hepatitis
-chronic disease |
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Definition
infants and kids will develop chronic
some will die from cirrhosis or primary hepatocellular carcinoma
2 forms of chronic:
HBeAG positive and negative |
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Term
Hepatitis B Virus
-Serum Hepatitis
-pathogenesis |
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Definition
infects liver cells
not a lytic virus! does not kill liver cells
CD4 and CD8 kill infected cells to control infection
anti-HBsAG Ab (aka anti-HBs) neutralizes extracellular virus; serves as serological markerfor immunity |
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Term
Hepatitis B Virus
-Serum Hepatitis
-diagnosis acute HBV |
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Definition
serological markers vary
markers show if acute or chronic
ACUTE HBV infection
-HBsAG detected 1-2 wk before onset of symptoms, as last as 12 wk after exposure
-igM anti-HBcAg detected
-HBeAg detected in acute infection
-anti HBsAg Ab detected after vaccination INDICATES IMMUNITY
-igG anti-HBc persists indefinitely as marker of past infection |
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Term
Hepatitis B Virus
-Serum Hepatitis
-diagnosis chronic HBV |
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Definition
| -persistence of HBsAg for more than 6 months |
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Term
Hepatitis B Virus
-Serum Hepatitis
-treatment |
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Definition
chronic HBV:
peg interferon alpha2a
or
antiviral drugs: lamivudine, adefovir dipivoxil, entecavir |
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Term
Hepatitis B Virus
-Serum Hepatitis
-prevention |
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Definition
HBIG passive immunity
high level sof HBs Ab; given soon after exposure reduces acquisition of symptomatic disease
-when baby born to HBV mom, wash it, give Ab and vaccine in two thighs and it will prevent baby from gettin sick
active immunization is recommended for all children
-only HBsAg; recombinant surface Ag made in yeast
-deltoid muscle for adults
-injection into gluts is for decreased immunogenicity |
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Term
Hepatitis D Virus HDV
-etiology |
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Definition
RNA virus
smallest genome of all viruses
encodes for two proteins
needs HBV to replicate - IF YOU DONT HAVE HBV INFECTION YOU CANNOT GET D
can cause either a disease associated with co-infection or superinfection with HBV and causes great morbidity by increasing severity and accelerating pace of chronic HBV infection |
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Term
Hepatitis D Virus HDV
-epidemiology |
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Definition
similar to HBV
transmission and reservoir:
similar to HBV; mostly passed through blood
-percutaneous exposures are most efficient mode of transmission
-sexual transmission less efficient than for HBV
-perinatal HDV transmission is rare |
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Term
Hepatitis D Virus HDV
-manifestations |
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Definition
co-infection with HBV
clinically same as HBV. D accelerates B; having both means severe disease
B+D is really bad.
superinfection in chronic HBV infection - first HBV then HDV; patients suffer relapse of jaundice; higher chance of developing chronic cirrhosis |
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Term
Hepatitis D Virus HDV
-diagnosis |
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Definition
presence of igG ab to delta antigen in serum
igG anti-HDV persists for years |
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Term
Hepatitis D Virus HDV
-treatment/prevention |
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Definition
treatment: no products prevent HDV superinfection of pt with HBV infection
prevention: prevent HBV-HDV coinfection by either HBV pre-or postexposure prophylaxis |
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Term
Hepatitis C - HCV; transfusion Associated Hep
-etiology |
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Definition
HCV is enveloped RNA virus
-6 genotypes and 100 subtypes
-viral RNA polymerase has no proofreading ability; leads to rapid accumulation of mutations; virus escapes immune surveillance; leads to chronic infection |
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Term
Hepatitis C - HCV; transfusion Associated Hep
-epidemiology |
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Definition
worldwide
causes 10k deaths; single most common reason for liver transplants
-accounts for most cases of chronic hep; many cases of end-stage liver disease in US
cause of most parenterally transmitted non-A non-B hep
all ages affected; mostly 20-39 yrs
risk factors: exposure to blood - transfusion; shared needles
-sexual and vertical transmission is low
-happens in tattoos or piercings
chronic: occurs in many asymptomatic infection and nearly all acute symptomatic HCV
chronically infected pt is at risk for developing cirrhosis or carcinoma
-HBV only was chronic in kids |
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Term
Hepatitis C - HCV; transfusion Associated Hep
-clinical features |
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Definition
either
asymptomatic 70%
or
acute symptomatic HCV - mild illness; malaise; abdominal pain
-about 1/3 will resolve infection without seroconvertin |
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Term
Hepatitis C - HCV; transfusion Associated Hep
-diagnosis |
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Definition
detect anti HCV ab 5-12 we after onset of hep
cannot distinguish acute from chronic infection |
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Term
Hepatitis C - HCV; transfusion Associated Hep
-therapy |
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Definition
combination therapy:
peg interferon-a and ribavirin
but:
only 1/3 chronic pt are cured
very expensive
difficult-flu like symptoms for 48 wks
cure is "persistent loss of HCV RNA" during follow ups
criteria for treatment:
persistent elevation of aminotransferases
quantitative HCV RNA
severe histologic changes on liver biopsy
response to therapy is related to person's hep C genotype
-2 and 3 respond more than 1 |
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Term
Hepatitis C - HCV; transfusion Associated Hep
-prevention |
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Definition
screen blood, organ, tissue donors
modify high risk behavior
implement and adhere to strict universal precautions |
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Term
Hepatitis A virus
-infectious Hepatitis
-epidemiology |
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Definition
sporadic outbreaks; under reported
pop at risk:
day care center; closed population where no sanitation and hygiene; foods like oysters, some fruits
transmission:
fecal oral; food and water are major vehicles
person to person can occur |
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Term
Hepatitis A virus
-infectious hepatitis
-clinical features |
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Definition
igM anti HAV is present 5-10 days before onset of symptoms and lasts up to 6 months
igG anti-HAV appears early, stays for life --lifelong immunity
disease is mild and prolonged but self limited; does not become chronic
recover within 3 weeks; some may relapse up to 6 months
most infants do not manifest with jaundice
elderly are likely to have fulminant hep
all A-E fulminant pt will die in few weeks b/c rapid deterioration of liver |
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Term
Hepatitis A virus
-infectious hepatitis
-diagnosis |
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Definition
detect igM and total anti HAV in serum
anti HAV igM - recover from acute disease
anti HAV-IgG - past disease or vaccination; in person with current hepatitis, HAV is not the etiologic agent of current symptoms |
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Term
Hepatitis A virus
-infectious hepatitis
-treatment and vaccination |
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Definition
passive:
normal human immune globulin not HAIG
given within 2 wk post exposure prevents disease but does NOT prevent infection or transmissibility; protection lasts 3 months
active: KILLED vaccine
havriX = vaqta = hep A only
twin rix = A and B |
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Term
Hepatitis E Virus
-epidemiology |
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Definition
enterically transmitted NonA-nonB hep
-large outbreaks
-fecal oral transmission; water most common vehicle
-zoonosis with swine as reservoir
-farmers, butchers, water contaminated from farms
-HIGH MORTALITY in pregnant!!!! 25% |
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Term
Hepatitis E Virus
-clinical feature |
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Definition
acute HEV same as HAV
does not become chronic |
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Term
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Definition
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