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Infectious Diseases
Infectious Diseases
HEPATITIS
HAV
-acute infection: <6 months
-transmission: fecal + oral route
-structures: no envelope + single stranded RNA
HBV
-acute + chronic
-transmission: sex + blood + perinatal detected in:
saliva + tears + sweat + semen + breastmilk
-structure: envelope + double stranded DNA
-incubation period 2-6 months
HCV
-acute + chronic
-transmission: sex + blood + perinatal
-structure: envelope + single stranded DNA
-no vaccine for that until now
HDV
-chronic
-transmission: sex + blood + perinatal
-need HBV requires HBsAg to enter the hepatocytes:
Co-infection: HBV and HDV
Super-infection: HBV infect the cell than comes later HDV
-structure: envelope + single stranded RNA
-vaccine for HBV protects against HDV
-someone who has HDV that means he has also HBV !!!
HEV
-acute
-transmission: fecal + oral
-structure: no envelope + single stranded RNA
- no vaccine for it until now
- Pregnant women with hepatitis E are at increased risk of acute liver failure, fetal loss and
mortality Fulminant hepatitis !!
-in case of lever damage in biliary system biliary salts to blood high bile
acids in blood
-UCB + CB + bile acids they accumulate in sclera yellow icterus
-also UCB + CB deposits in skin hands: palms + soles
-also in kidney: more CB will filtrate CB in urine dark urine appearance
-low lever activity reduce bile production decrease bilirubin in gut: less
urobilinogen less stercobilin clay colored stool (pale)
-liver damage inflammation lot of immune cells + more blood flow
hepatomegaly right upper quadrant pain
-virus immune system reaction plasma cells produce AB against virus AB + Virus
bind together and form: immune complex deposits in:
synovial joints arthritis
in vessels vasculitis polyarthritis nodosa (HBV)
in pericardium & myocardium myocarditis + pericarditis
in glomerulo BM GN
platelets + erythrocytes + neutrophiles thrombocytopenia + hemolytic
anemia + neutropenia
in viral infection high lymphocytes
-in chronic infection in HBV + HCV + HDV infect the cell cell death:
1. increase fibrosis formation increase cirrhosis
2. increase mitosis high risk for mistake in replication increase dysplasia
increase hepatic cancer
Serology:
-The “window period” refers to that period in infection when neither hepatitis B surface
antigen (HBsAg) nor its antibody (HBsAb) can be detected in the serum of the patient. It is an
immunologically mediated phenomenon caused by the precipitation of antigen-antibody
complexes in their zone of equivalent concentrations and, thereby, their removal from the
circulation BUT positive for HBcAb and HBeAb.
-window period:
Negative: HBsAg + HBsAb
Positive: HBcAb + HBeAb
HCV
1. Check blood for HCV-AB (IgG) if positive PCR (HCV-RNA) if positive infection
acute: positive <6 months & chronic: positive >6 months
-if negative PCR (HCV-RNA) cleared virus
Differential Diagnosis:
1. With other forms of hepatitis: alcoholic + drug-induced + acute biliary obstruction +
autoimmune + idiopathic + fatty liver
2. Cytomegalovirus
3. Epstein-Barr virus
4. Herpes simplex virus
Management:
3. HCV:
Acute: monitoring HCV RNA for few weeks if viral load is falling not
treatment required
Chronic: sofosbuvir/velpatasvir or sofosbuvir/ledipasvir
4. HEV: ribavirin
MENINGITIS
Signs:
Nuchal rigidity
Kernigs sign
Brudzinski sign
Causes:
1. Strep pneumoniae: most common cause beyond
neonatal period
-osler triad: meningitis + pneumonia + endocarditis Austrian syndrome