Term
hepatitis A: fecal-oral mainly, rarely sexually or parenterally (IVDU)
hepatitis B and C: blood and bodily fluids; parenteral, both IVDU and health care workers, blood transfusions and clotting factor concentrates; perinatal from mother to child = high risk; sexual contact and mucous membranes, less common |
|
Definition
| transmission of hepatitis A, B, and C |
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Term
acute only
no chance of cirrhosis or hepatocellular carcinoma |
|
Definition
| clinical course of hepatitis A |
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|
Term
chronic disease and hepatocellular carcinoma possible, but uncommon in adults
most likely to become chronic when acquired as a NEWBORN |
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Definition
| clinical course of hepatitis B |
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|
Term
very likely to become chronic in adults, but it takes many years (20) for cirrhosis to develop
hepatocellular carcinoma possible |
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Definition
| clinical course of hepatitis C |
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Term
sources of infection:
person to person contact, fecal contamination followed by oral ingestion
contaminated water and food - raw, unwashed fruits, vegetables, or inadequately cooked shellfish
associated with unsanitary conditions and hygiene practices
persons at risk in US:
INTERNATIONAL TRAVELERS
associated with food-borne outbreaks
homosexual men
IVDU (rare) |
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Definition
| hepatitis A: sources of infection and persons at risk in US |
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Term
infection usually MILD, SELF-LIMITING DISEASE lasting only a few weeks, but can take up to 6 months to resolve
children: mild FLU-LIKE SYMPTOMS without clinical jaundice
adults:
ABRUPT ONSET OF ANOREXIA, N/V/D, malaise, fever, headache, and right upper quadrant pain
JAUNDICE from increased total bilirubin leads to scleral icterus
ELEVATED LFTS = hepatic transaminases
fulminant hepatitis or death can occur rarely
no cases of chronic hepatitis or carrier state |
|
Definition
| clinical features of hepatitis A |
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|
Term
avoid alcohol and hepatotoxic drugs
eat a healthy diet and rest |
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Definition
|
|
Term
hepatitis A vaccine
good hand-washing and hygiene will also help |
|
Definition
| prevention of hepatitis A |
|
|
Term
| hepatitis A vaccine or IV immunoglobulin depending on age |
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Definition
| post-exposure prophylaxis of hepatitis A |
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Term
PARENTERAL TRANSMISSION
BLOOD AND BODILY FLUID = saliva, vaginal fluids, or semen
high risk groups: IV DRUG ABUSERS; multi-transfused patients, clotting factors; health care workers through needle sticks; male homosexuals; heterosexual partners with HBV infected persons, and partners of HIV infected patients |
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Definition
| risk factors/high risk groups of hepatitis B |
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|
Term
asymptomatic incubation period first, then:
symptomatic prodromal phase: mailase, fatigue, weakness, anorexia, myalgias, and arthralgias.
jaundice occurs in 1/3 of patients and may persist for several weeks
SYMPTOMS ARE AGE DEPENDENT:
newborns are more likely to develop chronic hepatitis
newborns are generally asymptomatic but UP TO 90% OF NEONATES DEVELOP CHRONIC OR PERSISTENT INFECTION. THEREFORE VACCINATION IS CRITICAL AT BIRTH.
65% of adults have subclinical infection and most recover completely
the other adults have symptoms
range from no signs to developing liver failure
chronic infection can lead to cirrhosis or hepatocellular carcinoma |
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Definition
| clinical features of hepatitis B |
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|
Term
first line ORAL NRTIS: Entecavir, Tenofovir (effective against HIV also!)
other oral NRTIs: Telbivudine, Lamivudine (effective against HIV also!), Adefovir
alternative at any time: Interferon alfa-2 SQ injection (effective, but poorly tolerated. Benefit is you can take it for a year and stop, unlike the oral therapies which are usually life long) |
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Definition
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|
Term
disease:
loss of antigen and viral DNA
decrease symptoms
normalize LFTs
reduce rate of cirrhosis, liver failure, and death
treatment side effects:
NRTIs - lactic acidosis, peripheral neuropathy/paresthias
tenofovir and adefovir - renal function/SrCr
telbivudine - myopathies
interferon - bone marrow suppression |
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Definition
| monitoring of hepatitis B |
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|
Term
| hepatitis B VACCINE recommended for all children and at risk adults |
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Definition
| prevention of hepatitis B |
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Term
| Hepatitis B IV Immunoglobulin |
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Definition
| post exposure prophylaxis of hepatitis B |
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Term
TRANSMISSION IS THROUGH BLOOD AND BODILY FLUIDS
IVDU
sexual contact of infected persons
persons with multiple sex partners: sexual transmission may be facilitated by concomitant HIV infection
recipient of transfusion before July 1992
recipient of clotting factors made before 1987
infants born to infected women
intrnasal cocaine use
tattooing/body piercing
shared razors
hemodialysis patients
health care workers |
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Definition
| risk groups for hepatitis C |
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|
Term
little evidence that disease is progressing in a patient
serum enzymes can be normal or mildly elevated
if patient is symptomatic: fatigue, malaise, anorexia, and weight loss common
some patients have jaundice (25%)
mild but persistent elevations of LFT's are common
can have extrahepatic syndromes
PHYSICAL SYMPTOMS DO NOT CORRELATE WELL WITH SEVERITY OF LIVER INJURY
ongoing viral replication is the most important factor in evaluating disease progression
can progress to cirrhosis, then liver failure and/or hepatocellular carcinoma |
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Definition
| clinical features of hepatitis C |
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Term
ALWAYS USE A COMBINATION IF POSSIBLE
INTERFERON-ALFA SQ INJECTION: PEGYLATED FORMULATION ALLOWS ONCE WEEKLY
PLUS
RIBAVIRIN PO BID with food for GI upset
genotype 1 and 4: 1 YEAR OF TREATMENT = cure rates poor (50%)
genotype 2 or 3: 6 months of treatment = cure rates good (80-90%)
VACCINATE AGAINST HEPATITIS A AND B |
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Definition
|
|
Term
Drug Side Effects:
INJECTION SITE REACTIONS - plus rash and dry skin
FLU-LIKE SYMPTOMS AND FATIGUE
PSYCHIATRIC EVENTS - depression and suicidal ideation
CBC - HEMOGLOBIN, NEUTROPHILS, PLATELETS, and TSH
BIRTH DEFECTS WITH RIBAVIRIN - test for pregnancy monthly
Disease:
VIRAL LOAD - by half way point, it must decrease by 2 log or else therapy is very unlikely to work |
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Definition
| ADRs and monitoring of hepatitis C treatment |
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|
Term
it can only be acquired in the presence of HBV
therefore, vaccinate against hepatitis B to prevent it |
|
Definition
| prevention of hepatitis D |
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|
Term
genotype 1
it is important b/c it is the most difficult to treat |
|
Definition
| what is the most common hepatitis C genotype in the US and why is this important |
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|
Term
|
Definition
| what does the pegylated formalation of interferon-alfa allow? |
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