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GEM > 2.12 Enteric Viruses > Flashcards

2.12 Enteric Viruses Flashcards

1
Q

What is the underlying pathology in inflammatory versus non-inflammatory gastroenteritis?

A

Inflammatory: Damage to intestinal mucosa from pathogen invasion or cytotoxins.

Non-inflammatory: Malabsorption or enterotoxin-mediated fluid secretion without significant mucosal damage

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2
Q

What are the clinical signs of dehydration?

A

• Reduced urination or dark urine.
• Dry mouth and throat.
• Sunken eyes, absence of tears.
• Skin tenting.
• Rapid, weak pulse.
• Orthostatic hypotension
• Lethargy, irritability in children

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3
Q

Why is identifying dehydration important in viral gastroenteritis?

A

major complication due to fluid loss from diarrhea and vomiting; timely rehydration prevents severe outcomes

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4
Q

What are the main causative agents of viral gastroenteritis?

A

Rotavirus, norovirus, adenovirus (types 40, 41), and astrovirus

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5
Q

Astrovirus modes of transmission and pathogenesis

A

Fecal-oral; damages intestinal epithelial cells

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6
Q

Rotavirus modes of transmission and pathogenesis

A

Fecal-oral; infects small intestine, causing villi destruction and malabsorptive diarrhea

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7
Q

Norovirus modes of transmission and pathogenesis

A

Fecal-oral, airborne droplets; binds histo-blood group antigens, disrupting intestinal cells

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8
Q

Adenovirus modes of transmission and pathogenesis

A

Fecal-oral; replicates in gut, causing watery diarrhea.

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9
Q

What is the peak age of incidence and seasonal variation for rotavirus?

A

Infants and young children; peaks in winter and spring (Dec–Jun)

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10
Q

peak age of incidence and seasonal variation for norovirus?

A

All ages; outbreaks occur Nov–Apr

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11
Q

What is the peak age of incidence and seasonal variation for adenovirus?

A

Primarily young children; no seasonal variation

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12
Q

What are the route of administration, age recommendations, and production of the rotavirus vaccine?

A

Oral
RotaTeq (3 doses: 2, 4, 6 months), Rotarix (2 doses: 2, 4 months). Must start before 15 weeks of age.
Live attenuated, human and bovine strains

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13
Q

common diagnostic methods for viral gastroenteritis?

A

Rotavirus: Enzyme immunoassay (EIA), RT-PCR.
Norovirus: Real-time qPCR, conventional RT-PCR outbreaks.
Adenovirus: PCR, EIA, antigen detection.
Astrovirus: EIA, immune electron microscopy

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14
Q

Hepatitis type that is Fecal-oral; severe in pregnancy?

A

HEV

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15
Q

What two kinds of hepatitis are blood borne with one with chronic infection risk and another with chronic liver damage?

A

HBV (infection)
HCV (liver damage)

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16
Q

Which type of hepatitis is fecal oral and self limiting?

A

HAV

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17
Q

Which kind of hepatitis requires co-infection with HBV?

A

HDV

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18
Q

What are the hallmark symptoms of acute hepatitis?

A

Jaundice (skin/eye yellowing).
Dark urine, pale stools.
RUQ pain.
Fatigue, nausea, vomiting.
Fever during prodromal phase

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19
Q

What are the key differences between HAV and HEV infections?

A

HAV: Common in developed and developing nations, resolves spontaneously, vaccine available.

HEV: Widespread in developing countries, severe in pregnancy, limited vaccine availability (China only) .

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20
Q

How are HAV transmitted and prevented?

A

Fecal-oral. HAV via close contact
Prevent with Vaccination, hygiene.

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21
Q

How are HEV transmitted and prevented?

A

Fecal-oral. via contaminated water/food.
Hygiene, avoid unsafe water/meat .

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22
Q

significance of elevated bilirubin (>3mg/dL)?

A

Indicates jaundice; reflects impaired hepatic excretion

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23
Q

significance of elevated liver enzymes (AST/ALT>1000U/L)?

A

Hepatocyte injury. ALT often higher in viral hepatitis

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24
Q

What is a common characteristic of viruses that cause gastroenteritis?

A

Nonenveloped
They survive longer in the environment and as contagious fomites

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25
Q

Who are most susceptible to viral gastroenteritis?

A

Infants and young children

26
Q

What is the most defining clinical feature of viral gastroenteritis?

A

Vomiting

27
Q

+ds RNA Virus and Segmented

A

Rotavirus

28
Q

What is notable about a segmented virus?

A

Can change their genotype easily

29
Q

+ss RNA ?

A

Norovirus, Astrovirus
HAV and HEV

30
Q

DsDNA non enveloped?

A

Adenoviruses

31
Q

Most viruses that cause gastroenteritis have what transmission pattern?

A

Water borne and food borne

32
Q

Leading cause of severe diarrhea in children in developing world versus USA?

A

Rotavirus (develop) vs. Norovirus (USA)

33
Q

Key rotavirus structural proteins for vaccine development as neutralizing antibody targets?

A

VP4 (P pro) and VP7 (G pro)

34
Q

What contributed to rapid spread of rotavirus?

A

Very high infectivity (low infectious dose) and high number shed in stool

35
Q

What do rotaviruses target and how do they cause damage?

A

Villus epithelial cells with NSP4 enetrotoxin (& ca+ release)

36
Q

Most common test for rotavirus infection?

A

EIA stool sample

37
Q

What is unique about Noroviruses that allows them to survive in harsh environments?

A

Heat and acid stable

38
Q

What is essential for the norovirus to bind and infect?

A

ABH and Lewis blood group antigens (@saliva and mucosa)

39
Q

“Winter vomiting disease”?

A

Norovirus

40
Q

Common settings for norovirus outbreaks?

A

Long term care facilities, restaurants and catering… cruise ships 6%

41
Q

Preferred diagnostic test for norovirus?

A

Realtime qPCR Assay

42
Q

Adenovirus serotypes common in viral gastroenteroritis especially in young children?

A

40 and 41

43
Q

What is special about adenovirus attachment and toxicity?

A

Fiber proteins

44
Q

Best diagnostic test for adenovirus?

A

Stool but PCR done too

45
Q

What virus appears like a “star” under electron microscopy?

A

Astroviruses

46
Q

What virus looked like a “wheel” with electron microscopy?

A

Rotavirus

47
Q

What are key features of norovirus clinically?

A

Affects all ages and projectile vomiting

48
Q

What gastroenteritis viruses are year round?

A

Adenovirus, Astrovirus, and Sapovirus

49
Q

What is bilirubin normally conjugated to by hepatocytes in order to be excreted?

A

Glucuronic acid

50
Q

What is a sign of liver damage in if found in urinalysis ?

A

Unconjugated bilirubin

51
Q

What family does HAV belong to?

A

Picovirinidae

52
Q

Where does HAV replicate?

A

Hepatocytes and Kupffer cells

53
Q

What causes the liver damage in HAV?

A

Immune response (NK and CD8 T cells)

54
Q

How long are you protected for after recovering from HAV?

A

For life (Anti-HAV IgG antibodies)

55
Q

Is there a vaccine for HAV?

A

Yup, universal infant recommendation and high risk adults

56
Q

When does the HAV post exposure prophylaxis need to be administered?

A

Within 2 weeks

57
Q

What are the main HEV genotypes?

A

1&2 = human infection (develop)
3&4 = zoonotic (industrial)

58
Q

Most cases of HEV in the US are?

A

Travel related

59
Q

What are main clinal feature of HEV?

A

Jaundice and pruritus**

60
Q

What is the diagnostic tools for HAV and HEV?

A

HAV/HEV-IgM
RT-PCR

61
Q

Unvaccinated child under <5 years with watery diarrhea and viral origin should hint at?

A

Rotavirus

GEM (28 decks)

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