VIRAL

• Syphilis


  The most commonly acquired spirochete disease in the United States
• Causative agent of syphilis

  • T. pallidum subspecies pallidum
  • T. pallidum subspecies pertenue (agent of yaws)
  • T. pallidum subspecies endemicum (cause of nonvenereal endemic syphilis)
  • T. carateum (agent of pinta)
• Congenital infections


  Can occur during pregnancy
• Stages of syphilis


  1. 1st Stage

  2. 2nd Stage (symptoms include generalized lymphadenopathy, malaise, fever, pharyngitis, rash)

  3. Latent Stage (patients are noninfectious except pregnant women)

  4. Third Stage (appears 10-30 years after secondary stage, has 3 major manifestations)
• Traditional laboratory tests for syphilis

  • Direct Detection of Spirochetes
  • Nontreponemal Serological Test (detect antibody to cardiolipin, high sensitivity, used to screen)
  • Treponemal Serological Test
• VDRL


  Qualitative and quantitative slide flocculation test for serum and spinal fluid, uses VDRL antigen, must be performed at 23-29°C with specific rotation speed and timing
• Hamilton Syringe


  Used for qualitative serum VDRL (18 gauge), quantitative serum VDRL (19 gauge), CSF VDRL (21 or 22 gauge)
• Grading of VDRL flocculation


  Reactive (medium to large clumps), Weakly Reactive (small clumps), Nonreactive (no clumps or slight roughness)
• RPR


  Modification of VDRL with macroscopic agglutination, uses cardiolipin-containing antigen bound to charcoal particles, 20 gauge needle
• FTA-ABS


  Indirect fluorescent antibody test, uses sorbent of nonpathogenic treponemes and Nichols strain of T. pallidum, read on fluorescence microscope
• Agglutination test


  Passive Hemagglutination Test
• Possible causes of hepatitis

  • Non-infectious agents (drugs, alcohol)
  • Infectious agents (viral hepatitis)
• Viral hepatitis


  Systemic disease with primary inflammation of the liver by hepatotropic viruses
• Common causes of viral hepatitis


  • Hepatitis A virus
  • Hepatitis B virus
  • Hepatitis C virus
• Clinical findings of viral hepatitis

  • Fever
  • Anorexia
  • Nausea
  • Vomiting
  • Jaundice
  • Dark urine
  • Pale feces
  • Hyperbilirubinemia
  • Elevated liver enzymes
• Hepatitis A virus


  • Picornaviridae family, Enterovirus/Hepatovirus genus, naked icosahedral linear ssRNA, 28nm, fecal-oral transmission, 10-50 day incubation, supportive care, inactivated vaccine, treatment of water, prophylactic administration
• Hepatitis A virus diagnosis

  • HAV Ag, IgM anti-HAV, IgG anti-HAV, total anti-HAV, HAV RNA (RT-PCR)
• Total anti-HAV


  Positive indicates immunity through vaccination or natural infection
• Hepatitis B virus


  • Hepadnaviridae family, Orthohepadnavirus genus, enveloped icosahedral circular dsDNA, 42nm, parenteral/perinatal/sexual transmission, 40-180 day incubation, supportive care, interferon, lamivudine, liver transplant, HB immunoglobulin, inactivated vaccine
• Hepatitis B virus serologic markers

  • HBsAg
  • HBeAg
  • HBcAg
  • IgM Anti-HBc
  • IgG Anti-HBc
  • Anti-HBe
  • Anti-HBs
  • HBV DNA
• HBsAg


  First marker to appear in blood after infection
• HBeAg


  Appears concurrently with or soon after HBsAg, indicates viral replication and infectivity, persistence beyond 3 months indicates chronic hepatitis B
• HBcAg


  Not detectable in serum due to viral envelope
• Anti-HBc


  IgM appears shortly after HBsAg, IgG also appears and persists indefinitely
• Anti-HBe


  Indicates patient is recovering from HBV infection
• Anti-HBs


  Disappearance of HBsAg and appearance signals recovery and protective immunity, persists for years
• Hepatitis B virus disease states

  • Healthy
  • Early Acute
  • Late Acute
  • Chronic
  • Resolved
  • Vaccinated
• Hepatitis C virus


  • Flaviviridae family, Hepacivirus genus, enveloped icosahedral linear ssRNA, 45nm, parenteral/sexual transmission, 30-50 day incubation, supportive care, interferon, ribavirin, liver transplant, no vaccine available
• IgM anti-HBc


  May also or can persist for 3-6 months or longer
• IgG anti-HBc


  Appear during acute hepatitis B but persist indefinitely
• Anti-Hbe


  Indicates that the patient is recovering from HBV infection
• Anti-HBs(HBsAb)


  • Disappearance of HBsAg and the appearance of anti-HBs signals recovery from HBV infection, non-infectivity
  • Persist for years and provide protective immunity
• Serologic Markers


  • HBsAg
  • HBeAg
  • Anti-HBc
  • Anti-Hbs
  • Anti-HBe
  • DNA virus
• Disease State


  • Healthy
  • Early Acute
  • Early Acute
  • Chronic
  • Late Acute
  • Resolved
  • Vaccinated
• Hepatitis C Virus


  • Flaviviridae family
  • Hepacivirus genus
  • Enveloped, Icosahedral, linear, ss RNA
  • 45 nm morphology
  • Non-A Non B hepatitis
• Transmission


  Parenteral, Sexual Intercourse
• Incubation Period


  30-50 days
• Treatment


  Supportive care, interferon, Ribavirin, Liver Transplant
• No vaccine available
• Diagnosis


  • Anti-HCV
  • HCV-RNA (PCR)
  • HCV antigen