215.2 📚 國考版

215.2.0.1 必背 — HDV

  • Defective ssRNA virus — requires HBV (HBsAg)
  • Co-infection vs Superinfection:
    • Co-infection: usually resolves; fulminant 5-20%
    • Superinfection: 70-90% chronic; accelerated cirrhosis + HCC
  • Endemic: Mediterranean, Eastern Europe, Mongolia, Amazon
  • Bulevirtide (Hepcludex) = NTCP inhibitor, 2020 EU approval, FDA 2024 breakthrough
  • Anti-HDV IgM/IgG + HDV RNA PCR
  • HBsAg always +

215.2.0.2 必背 — HEV Genotypes

  • Genotype 1, 2: human-only, fecal-oral, S Asia + Africa outbreaks
  • Genotype 3, 4: zoonotic (pork, wild game), Europe + Asia sporadic

215.2.0.3 必背 — HEV Pregnancy Severity

  • 20-30% mortality in 3rd trimester (Genotype 1)
  • Fulminant hepatic failure
  • Obstetric emergency
  • Vaccine could be lifesaving

215.2.0.4 必背 — HEV Chronic in Immunocompromise

  • Genotype 3 + transplant / HIV / chemo
  • Ribavirin 600-1000 mg/d × 3-12 mo
    • Reduce immunosuppression

215.2.0.5 必背 — Extrahepatic HEV

  • GBS (post-infectious; common cause in Europe)
  • Neuralgic amyotrophy
  • Transverse myelitis

215.2.0.6 必背 — Hepai 239 (Hecolin)

  • China only HEV vaccine (2011)
  • Not widely available globally

215.2.0.7 必背 — HEV Diagnosis

  • Anti-HEV IgM acute
  • HEV RNA PCR active (especially chronic)

215.2.0.8 必背 — Differential All 5 Hepatitis Viruses

Virus Family Transmission Acute Chronic Vaccine
HAV Picornavirus Fecal-oral Yes No Yes
HBV Hepadnavirus Blood/sexual/vertical Yes Yes (esp pediatric) Yes
HCV Flavivirus Blood/IDU Usually subclinical Yes (80%) No
HDV Defective RNA Blood (needs HBV) Yes Yes (90% superinfection) No (HBV vaccine prevents)
HEV Hepevirus Fecal-oral; zoonotic Yes (severe pregnancy) Rare in immunocompromise Hepai 239 (China only)