3.26.14* Ryan - Viral Hematology

Question 1

CMV, EBV, KSHV (HHV-8) are what kind of virus

Answer 1

a. subsets of herpes virus, enveloped dsDNA.

all attack lymphocytes

Question 2

what are oncogenic the viruses

Answer 2

EBV

KSHV

Question 3

MOA of antiviral drugs

Answer 3

inhibit replication. Can still lead to oncogenesis due to latency.

Question 4

What are the steps of CMV infection?

Answer 4

a. infect/replicate in epithelial cells
b. spread to lymphoid tissue
c. become latent in B and T cels and monocytes
d. childhood infections are asymptomatic, adult infects may lead to mono/fever. AIDs patients may get retinitis, colitis, and pneumonia

Question 5

CMV VS TRANSPLANT PATIENTS

Answer 5

Infection can occur by receipt of CMV+ organ or by reactivation of CMV+ recipient/ Most severe outcome is pneumonia about 1-4 months after transplant (preceded by fever).

Question 6

CMV: Diagnosis and Treatment

Answer 6

Detection of large lymphocytes
Diagnosed by ELISA, PCR or shell vial assay.
Treatment: Selective prophylaxis with CMV Ig and ganciclovir-

Question 7

EBV infection

Answer 7

a. 90% of population. Teens get mono.

Question 8

EBV in AIDs patients

Answer 8

hairy leukoplakia

Question 9

EBV in transplant patients

Answer 9

posttransplant lymphoproliferative disease

Question 10

EBV in normal patients

Answer 10

Burkitt lymphoma and nasopharyngeal carcinoma

Question 11

EBV

Answer 11

a. Spread through saliva. Incubation period is several weeks. Initial replication in oropharyngeal epithelium, spread to lymphocytes and then liver and spleen. EBV remains latent in throat epithelia and B cells, there can be oral shedding for weeks.

Question 12

HAIRY LEUKOPLAKIA

Answer 12

Productive infection of tongue epithelial cells. Rarely seen except in AIDS patients.

Question 13

How to diagnosis EBV infectious mononucleosis:

Answer 13

a. Diagnosed by symptoms and >50% atypical, large lymphocytes
b. Diagnostic markers
-EB nuclear antigens (EBNAs) assist in transcription and genome replication
-Viral capsid antigen (VCA) is produced during lytic replication
Because anti-VCA rises before anti-EBNA:
An anti-VCA+, anti-EBNA- patient is considered to have a primary infection
An anti-VCA+, anti-EBNA+ patient has had a past infection

Question 14

Posttransplant lymphoproliferative disease

Answer 14

Caused by EBV infection leaking to B cell lymphoma in transplant patients. Highest risk among seronegative recipients during the first year posttransplant
Treatment: stop immunosuppression

Question 15

Burkitt’s lymphoma

Answer 15

Neoplasm of B-cells that affects bones of the jaw. Nearly all have overproduction of MYC.
Endemic in central Africa, typically young children

Question 16

Compare CMV/EBV

Answer 16

Both can cause mono and are latent in B cells. Both can cause post-transplant complications, but presentation is different. CMV is sexually-transmitted and a source of congenital infections. CMV is always heterophile antibody negative. EBV is a known oncogenic virus.

Question 17

KSHV (HHV-8)

Answer 17

Necessary but not sufficient to cause Kaposi’s sarcoma (KS)
a. DNA can be amplified from B-cells of classical KS and AIDS KS patients
Sexually-transmitted.
Now, 95% of infections are asymptomatic, can be mild when symptomatic.
Tumor-specific treatment or target HIV, but not HHV-8.

Question 18

KSHV cancers

Answer 18

Kaposi’s sarcoma
primary effusion lymphoma
multicentric Castleman’s disease

Question 19

symptoms of infectious mononucleosis

Answer 19

Sore throat
Fever for 1-2 weeks
Malaise
Lymphadenopathy
Recovery is uneventful