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Questions Answered: 215

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148
67

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Microbiology

Pathogens

Question 122 of 215

Regarding hepatitis C, which of the following statements is CORRECT:

Answer:

Hepatitis C is a notifiable disease. About 80% of patients with hepatitis C develop chronic infection but about 70 - 90% of patients will clear the virus with antiviral treatment. Transmission occurs primarily through infected blood, sexual transmission can occur but is much less common. Acute infection may cause a mild hepatitis but many cases are asymptomatic; fulminant disease is rare.

Hepatitis C

Microbiology / Pathogens / Hepatitis

Last Updated: 21st April 2019

Transmission

Transmission is mainly through infected blood.

Risk factors include:

  • healthcare workers
  • blood transfusion recipients
  • intravenous drug users

Sexual transmission and vertical transmission do occur but are uncommon.

Clinical Features

Infection may cause a mild hepatitis but many cases are asymptomatic; fulminant disease is rare. In about 20% of cases infection is cleared by the immune system but patients are not immune to future HCV infection.

HCV infection persists in up to 80% of patients, who are at high risk of developing cirrhosis, liver failure and hepatocellular carcinoma between 10 - 30 years later.

Diagnosis

Diagnosis is by detection of anti-HCV IgG antibodies which indicate if a person has ever been infected with HCV (resolved or current infection). If the antibody test is positive, HCV RNA should be tested for, which if positive indicates that a person has current infection with active hepatitis C.

Treatment

Hepatitis C is a notifiable disease.

Treatment is with combination therapy initiated by a specialist, usually with ribavirin and pegylated interferon, and often combined with a newer medication such as simeprevir or sofosbuvir; response is best in patients with particular genotypes and those with low initial viral loads but about 70- 90% will clear the virus.

Liver transplantation is the treatment of choice for people with end-stage liver disease.

There is no HCV vaccine available currently.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l
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