3.1 Micro 1

Question 1

for viral CNS inx: WBC in CSF

Answer 1

increased (mostly lymphocytes). in bacterial, mostly PMN

Question 2

for viral CNS inx: culture gram stain in CSF

Answer 2

no organisms

Question 3

for viral CNS inx: glucose in CSF

Answer 3

normal (~65mg/dL). In bacteria, decreased

Question 4

for viral CNS inx: protein in CSF

Answer 4

mildly elevated vs bacteria which is sharply elevated

Question 5

best way to test for enterovirus

Answer 5

Quickest & most sensitive method is RT-PCR using CSF or throat swab (directly testing for viral RNA).

Question 6

1. best treatment for enteroviral diseases:

2. best prevention against enterovirus:

Answer 6

1. NO antiviral treatment available dummy.

2. no vaccine. only prevention is hand-washing (alcohol gel must be above 70%)

Question 7

Picornaviridae (family of enerovirus species): +/- sense? DNA or RNA? naked/non-enveloped? Shape? replication?

Answer 7

naked, SS, + sense RNA virus. icosahedral. replicates in cyoplasm

Question 8

there can be some deviation from this, but If i have herpes lesions on my junk, it’s HSV ____. if on my upper lip, it’s HSV____

Answer 8

1. above the waist= HSV 1 usually

2. below the waist = HSV 2 (sexually transmitted)

Question 9

How does the herpes virus evade host immunity? most obvious way

Answer 9

1. LATENCY with latency-associated transcripts (LATs) & microRNAs = noncoding, regulatory RNAs. a. Silencing lytic gene expression
   b. Blocking apoptosis & innate immune responses
   c. Evading acquired immune response

Question 10

3 major (red) methods to diagnose HSV

Answer 10

Cowdry type A inclusions, Tzanck smear, PCR using CSF

Question 11

How to treat HSV?

prevention?

Answer 11

1. acycolovir for treatment

2. no vaccine. safe sex, gloves, c-sections for + mother

Question 12

location of HSV 1, 2, 3 (VZV) latency?

Answer 12

sensory ganglia. Flare only affects dermatome corresponding to affected (infected) ganglia

Question 13

varicella particularly rough for immunocompromized patients. how so?

Answer 13

infx can lead to dissemination leading to pneumonia, hepatitis, encephalitis & disseminated intravascular coagulopathy

Question 14

how is VZV encephalitis diagnosed

Answer 14

PCR of CSF

Question 15

VZV treatment? prevention?

Answer 15

1. Acyclovir treatment for severe infx or those at risk for severe infx
2. a. Post-exposure prophylaxis using varicella IG for immunocompromised/newborn b. Varicella vaccine for children & non-immune adults (two doses)
   c. Zoster vaccine for adults over 60 years

Question 16

newborn with petechial rash, microcephaly & jaundice. CSF glucose normal. what’s probable diagnosis?

Answer 16

CMV.

Question 17

HIV patient has CMV. How do you diagnose it?

treat it? what’s the name of the vaccine to prevent it?

Answer 17

1. CMV DNA PCR is best 2. can treat with gancivlovir, cidofovir, foscarnet 3. no vaccine available

Question 18

What is the timeframe of the illness after infection by enterovirus, including symptomatic state and immune system?

Answer 18

Incubation, then illness, then as soon as immune system begins to work disease diminishes.

Question 19

Herpes virus: shape? Envelope status? size? genetic info? replication?

Answer 19

Icosahedral, enveloped, large, dsDNA linear, replicates in nucleus.

Question 20

What is the pathogenesis of enterovirus? (replicates where, how can it cause encephalitis/ meningitis, what time of year is it most prevalent?).

Answer 20

Replicates in oropharynx and intestines (found in fecal matter).
Replicates in lymphoid tissue => viremia => spread to brain/ meninges.
Common in summer/ early fall.

Question 21

5yr old pt presents with delirium, fever, and severe pain in head. Travel history = none, no recent cuts/injuries. Pts mother says they recently went to a new park, has not seen a mosquito since its below freezing every night even though its only september, she also states ashamed that her son usually picks his butthole and licks his fingers all the time. You take a mouth swab sample and after rt-pcr find it to be a single stranded +sense RNA virus. What is the likely shape of this organism, would it have an envelope? What is the treatment for this young punk kid? What suggestions would you give to the mother?

Answer 21

• Icosahedral
• Naked
• No treatment (supportive)
• Tell the mom to use 70%+ ethanol hand sanitizer for this young butt-licking punk.

Question 22

A 17yr male presents to your clinic, the boys mother is concerned because her son “just hasn’t been himself today”, he complains of a massive H/A and is even feeling numbness in his limbs. After collecting the history you find out that this boy just recently tried oral sex with his GF for the first time 2 days prior and still has a mouth sore from it. He states his GF has been sexually active in the past but he has not. You get a CSF sample and use PCR to find a dsDNA virus. What is the most likely shape of this culprit? Enveloped? Where does this virus replicate? What virulence factors does this culprit use in this kids GF to keep her outbreaks hidden? What other tests could be used for diagnosis (what would have been seen)? Who is the MOST LIKELY culprit? How do you treat this young horny little punk? How do you educate this little dude?

Answer 22

• Icosahedral
• Enveloped
• Nucleus
• LATs and microRNAs to keep immune response down.
• Cowdry (type A inclusions), Tzanck smear (giant multinucleate bodies)
• HSV-2, GF had it on her genitalia, dude licked it off onto his mouth.
• Acyclovir
• Tell him to wrap up his junk if he starts banging this girl and probably not try anymore oral sex with her.

Question 23

A 85yo HIV+ pt presents to your hospital with diagnosed encephalitis, time is brain so you are running diagnostic tests to determine what you are competing with. The pts son who brought him in states the pt was playing with his grandchild 2wks ago. You ask the son, “was your child ill?” the son says “no he is healthy…. well he did just get over the chickenpox but that was before he had them so there is no way it could have been that!” You look at the dude and say______? and it spreads by way of? To make sure you have the dx right you run what test(s)? You treat with what? This organism must have stayed dormant in this pts _______ for the past two weeks.

Answer 23

• It could be varicella due to the fact that the infectious stage occurs prior to breakout of rash.
• Droplets.
• CSF-PCR, Tzanck, immunoflourescence of antigen.
• Acyclovir.
• Dorsal root ganglion.

Question 24

You are volunteering in rural Giny, where anything goes. You deliver a kid and the child has a petechial rash, jaundice, and microcephaly. You are thinking one thing. How do you substantiate your claim, what tests? What do you see in one of your tests? Where does this virus go latent, how is it activated? The husband was recently diagnosed with mono, at the clinic today he is feeling worse than ever and can barely enjoy his child’s birth, how do you treat this dude if he isn’t already being treated?

Answer 24

• DNA-PCR
• Owl’s eye - in cell observation
• Monocytes, activated by differentiation into macrophages
• -clovir type drugs.