3.3

Question 1

HHV stands for?

Answer 1

Human Herpesviruses

Question 2

What mechanisms does HHV use?

Answer 2

Replication cycle and viral shedding

Question 3

What HHVs have latency in sensory ganglia?

Answer 3

HSV-1, HSV-2, and VZV

Question 4

What HHV have latency in T-cells?

Answer 4

CMV and HHV-6

Question 5

What HHV have latency in B-Cells

Answer 5

EBV and HHV-8

Question 6

HSV -1 signs

Answer 6

Cold Sores

Question 7

How long does someone have HSV -1 and when will signs show up?

Answer 7

You have HSV-1 for LIFE and the cold sores will reoccur throughout the persons life.

Question 8

How is HSV -1 transmitted

Answer 8

saliva and direct contact with the cold sores

Question 9

What are the symptoms of HSV-2

Answer 9

genital herpes

Question 10

Pathogenesis: HSV

Answer 10

• host cell’s RNA polymerase transcribes the HSV DNA into mRNA
• host cell translates portions of mRNA to produce:
• DNA polymerase: helps further replicate the HSV genome
• thymidine kinase: phosphorylates thymidine for viral DNA replication
• anti-herpes drugs such as acyclovir and penciclovir are phosphorylated by this enzyme and
  subsequently antagonize replication of HSV DNA

Question 11

What is gingivostomatitis?

Answer 11

infection of the mouth and gums

Question 12

What is herpes labialis?

Answer 12

fever blisters/cold sores

Question 13

What is neonatal HSV?

Answer 13

• acquired during passage through birth canal
• HSV-2 infections more common
• CNS (encephalitis) herpes

Question 14

What is keratitis?

Answer 14

Corneal ulcers

Question 15

What is herpetic whitlow?

Answer 15

painful infection of the hand

Question 16

What is HHV -3 and how do you get it.

Answer 16

• Varicella Zoster Virus (VZV/Shingles)
• You have Chicken Pox first and the later in life develop shingles.

Question 17

Transmission of VZV

Answer 17

primary infections spread by respiratory route with latency established in ganglia neurons

Question 18

Pathogenesis of VZV

Answer 18

• pustules then dry up and itchy scab/lesions
• he varicella virus can also migrate to sensory ganglia where may not be cleared by the immune system;
  inside the ganglion, the virus becomes dormant (latent) and can be reactivated as zoster virus later in life
• reactivation occurs when the virus travels from sensory ganglia to the peripheral

Question 19

Epidemiology of VZV

Answer 19

reactivation of herpes zoster virus most
often occur in elderly >60 and persons that have T-cell immunodefiencies

Question 20

Manifestations of VZV

Answer 20

• complication of zoster is risk of post-herpetic neuralgia (PHN) which can cause chronic pain
  (stabbing) at the infection site
• ophthalmic zoster can also result in corneal ulceration
• recurrent/chronic VZV is prevalent in persons with low CD4+ counts

Question 21

What is another name and explain HHV -4?

Answer 21

• Epstein-Barr Virus (EBV)
• primary infection is most often asymptomatic and occurs in childhood
• classical infectious mononucleosis (glandular fever)
• has also been associated with neoplastic diseases in immunocompromised people

Question 22

Transmission of EBV

Answer 22

mostly spread by asymptomatic salivary shedding; close oral contact (kissing disease)

Question 23

Pathogenesis of EBV

Answer 23

Results in the classical triad of signs of mononucleosis: splenomegaly (large spleen), exudative
pharyngitis, lymphadenopathy (swollen glands)

Question 24

What is another name and explain HHV -5?

Answer 24

• Cytomegalovirus (CMV)
• CMV establishes laten infection in T cells
• CMV is a STD with semen containing the highest titer levels

Question 25

Epidemiology of CMV

Answer 25

Cause of congenital defects

Question 26

Transmission of CMV

Answer 26

Transplacental

Question 27

Manifestations of CMV

Answer 27

- CMV retinitis is an inflammation of the retina that can lead to blindness - occurs predominantly in immunocompromised patients - in neonates, CMV can damage the CNS

Question 28

What is another name and explain HHV -8

Answer 28

- Kaposi’s Sarcoma-associated Herpesvirus - Infects B cells - mostly in immunocompromised patients - Infected cells form benign tumors

Question 29

FDA approved uses for Acyclovir

Answer 29

- HSV -1 - HSV -2 - Herpes Zoster - Varicella

Question 30

Others uses of Acyclovir

Answer 30

Good CSF penetration for viral meningitis

Question 31

FDA approved uses Penciclovir

Answer 31

- HSV -2 - Herpes Zoster

Question 32

Brand for Ganciclovir

Answer 32

Cytovene

Question 33

Ganciclovir is an analog for _______

Answer 33

Guanosine

Question 34

Prodrug of Ganciclovir

Answer 34

Valganciclovir

Question 35

Brand for Valganciclovir

Answer 35

Valcyte

Question 36

FDA approved uses for Ganciclovir

Answer 36

CMV

Question 37

MOA of Ganciclovir

Answer 37

viral thymidine kinase phosphorylates inhibits herpes DNA polymerase

Question 38

Black Box Warning for Ganciclovir

Answer 38

cytopenia

Question 39

Cidofovir is an analog for _____

Answer 39

cytidine

Question 40

FDA approved uses for cidofovir

Answer 40

- CMV - acyclovir-resistant HSV

Question 41

MOA of cidofovir

Answer 41

inhibits herpes DNA polymerase

Question 42

Adverse reactions of cidofovir

Answer 42

dose-dependent nephrotoxicity

Question 43

Black box warning for Cidofovir

Answer 43

renal impairment

Question 44

FDA approved for Foscarnet

Answer 44

- CMV - acyclovir-resistant HSV infections

Question 45

MOA of Foscarnet

Answer 45

inhibits herpes DNA polymerase

Question 46

Adverse Reactions of Foscarnet

Answer 46

- nephrotoxicity - electrolyte imbalance (Ca+, Mg+, K+) - bone marrow suppression

Question 47

CNS Infections most commonly arise from ......

Answer 47

hematogenous spread from primary infection site

Question 48

What is encephalitis?

Answer 48

Inflammation of the brain

Question 49

What is a Brain Abscess?

Answer 49

Collection of pus in the brain

Question 50

What is Meningitis?

Answer 50

inflammation of the meninges

Question 51

The cortex and spinal cord are surrounded by the ______

Answer 51

Meninges

Question 52

When bacteria gain entry to the _____, the ______ are the first tissue to become inflamed

Answer 52

CSF and Meninges

Question 53

2 most common bacteria responsible for bacterial Meningitidis

Answer 53

- Streptococcus pneumoniae - Neisseria meningitidis

Question 54

Most Common Bacteria for Neonates Meningitidis

Answer 54

Streptococcus agalactiae (Group B)

Question 55

Most Common Bacteria for Infant Meningitidis

Answer 55

S. pneumoniae

Question 56

Most Common Bacteria for Children-teens Meningitidis

Answer 56

N. meningitidis

Question 57

Most Common Bacteria for adults Meningitidis

Answer 57

S. pneumoniae

Question 58

T/F antimicrobials can more readily enter CSF when meninges are inflamed?

Answer 58

True

Question 59

Classical manifestations of Meningitidis

Answer 59

Fever, neck stiffness (nuchal rigidity), headache, and altered mental status.

Question 60

S/S specific to N. meningitidis Menigitis

Answer 60

Severe rash and purpura/petechiae

Question 61

What is the Number 1 cause of Bacterial meningitidis?

Answer 61

Streptococcus pneumoniae

Question 62

T/F S. pneumoniae possess β-lactamase

Answer 62

False

Question 63

Meningococcal meningitis naturally inhabits what?

Answer 63

The nasopharynx

Question 64

What type of Meningococcal meningitis is associated with outbreaks in U.S. Colleges

Answer 64

Type C (Long didn't go into detail about any of the types)

Question 65

Pathophysiology of Meningococcal meningitis

Answer 65

- LPS induce inflammation that facilitates entry into the CNS - petechial eruption → purpura (hallmark sign) - Waterhouse-Frederichsen syndrome w/ hemorrhage

Question 66

Explain Haemophilus influenzae meningitis

Answer 66

encapsulated form (type Hib) of H. influenzae

Question 67

Pathophysiology of Haemophilus influenzae meningitis

Answer 67

Capsule helps penetrate nasopharynx epithelia and invade the blood

Question 68

Explain Encephalitis

Answer 68

- inflammation of the brain parenchyma due to infection usually through hematogenous spread - viruses are the primary cause of encephalitis

Question 69

Etiologies: Encephalitis

Answer 69

- HSV is the most common - HSV-2 is most common in neonates → acquired during delivery - viruses: VZV

Question 70

Treatments for Encephalitis caused by HSV

Answer 70

Acyclovir