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Hepatitis Viridae & Retroviridae
NA
6
Medical
Graduate
05/25/2011

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Term
HAV
morphology
transmission
clinical
serology
misc
Definition
Picorna virus
+ SS RNA
Naked
Icosahedral capsid

Fecal-oral
Shellfish, contaminated H2O

Acute viral hepatitis: fever, jaundice, painful enlarged liver
Never becomes chronic

Anti-HAV IgM = active disease
Anti-HAV IgG = Old, no active disease, protective for life

HAV you washed your hands?
unlike B & C, it's self-limiting, you don't get chronic disease
Term
HBV
morphology
transmission
clinical
serology
misc
Definition
Hepadna virus
DS circular DNA
Envelope
Icosahedral
Dane particle (intact virus)
-envelope
-capsid associated proteins
-capsid
-core (DNA + protein enzymes)
HBsAg: envelope, capsid assoc proteins
HBcAg: DS DNA, DNA polymerase, capsid
HBeAg: soluble component of the core, marker for active disease
Dissociation of the Dane particles leaves HBsAg and HBcAg

Blood transfusion
needle sticks
sexual
across placenta (90% if mom is HBeAg+)

Acute viral hepatitis
Fulminant hepatitis: severe acute with rapid destruction of liver
Chronic hepatitis (10%):
-asymptomatic carrier
-chronic persistent hepatitis
-chronic active hepatitis
Coinfection or superinfection with HDV
Complications: *primary hepatocellular carcinoma, Cirrhosis*

HBsAg = disease (acute or chronic)
Anti-HBsAg = immunity
IgM anti-HBcAg = new infxn
IgG anti-HBcAg = old infxn
HBeAg = high infectivity
Anti-HBeAg = low infectivity
During window period, the only detectable marker is anti-HBcIgM

Only HBV carries a DNA polymerase enzyme within the virion (catalyzes the formation of the cell's DNA)
Liver injury occurs from a CMI attack on HBV
Carrier: persistence of HBsAg > 6 mo, w/o sx
Term
HCV
morphology
transmission
clinical
serology
misc
Definition
Probably Flavivirus
SS RNA
Enveloped icosahedral

Blood transfusion
Needle sticks (drug users, medical personnel)
Sexual (low risk)
Placental (<10%)

Acute viral hepatitis
-up to 85% develop chronic hepatitis
-20% will develop cirrhosis
-i/c risk of developing primary hepatocellular carcinoma

Screening: anti-HCV Ab
doesn't distinguish b/t acute and resolved

HCV is leading cause for liver transplantion
PCR used to detect viral RNA, can be used to detect active infxn
Term
HDV
morphology
transmission
clinical
serology
Definition
incomplete RNA virus - only infective with help of HBV
Helical nucleocapsid that requires HBV envelop (HBsAg) to be infective

blood transfusion, needles, sex, placenta

Coinfection: HBV and HDV are acquired simultaneously, cause acute hepatitis.
Superinfection: HDV infects pt with chronic HBV who can't make Anti-HBsAg Ab
-complications: fulminant hepatitis, cirrhosis

Serology isn't very helpful; detectable titers of IgM and IgG anti-HDV are present fleetingly
Term
HEV
morphology
transmission
clinical
misc
Definition
Hepeviridae family
SS RNA
Naked

Fecal-oral

Hepatitis like HAV

Hepatitis epidemics in Asia, very rare in U.S.
Term
HIV
Serology
TORCH
AIDS
-opportunistic infxns
-malignancies
Definition
ELISA detects Ab, very sensitive but not terribly specific
give second ELISA, then confirm with Western Blot test (+ if it has bands to 2 HIV gene products - p21, gp41, gp120)
CD4 T-lymp count < 200

One of the TORCH pathogens: rate is ~30%, occurs transplacentally, during delivery, and perinatally

Staph aureus or Staph epidermidis
encapsulated: H. influenzae, Strep pneumo
Mycobacterium tb
Mycobacterium avium-intracellulare
UTI in young males
Candida albicans
Cryptococcus neoformans (often won't exhibit meningeal inflammation)
Histoplasma capsulatum, Coccidioides immitis
Herpes zoster
EBV (oral hairy leukoplakia)
HSV
CMV
Pneumocystic carinii pneumonia
Toxoplasma gondii (TORCH) - mass lesions in brains
Crytosporidium, Microsporidia, Isospora belli

B-cell lymphoma (often present with brain mass), half contain EBV DNA
Kaposi's sarcoma (cofactor is HHV-8)
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