Chapter 166- Poxvirus infections

Question 1

Largest animal viruses that can cause disease of varying severity in humans

Answer 1

Poxviuses

Question 2

___ sole reservoir is humans which allowed its eradication

Answer 2

Smallpox

Question 3

Four genera of poxvirus that infect humans (4)

Answer 3

Orthopoxvirus
Parapoxvirus
Molluscipoxvirus
Yatapoxvirus

Question 4

Major reservoir of cowpox is cow.

True or False

Answer 4

False, cats and small rodents

Question 5

Mortality from variola major is ___; variola minor is ___

Answer 5

30%

Less than 1%

Question 6

MOT of smallpox

Answer 6

Respiratory route

Question 7

Intentional introduction of smallpox virus from pustule of infected person to healthy nonimmune person to induce mild form of disease

Answer 7

Variolation

Question 8

Smallpox is less infectious than measles, varicella, and influenza.
True or False

Answer 8

True

Question 9

Risk of adverse effects from vaccine, particularly in (2), has prevented mass vaccination policies

Answer 9

Immunocompromised

Atopic dermatitis

Question 10

Key characteristic of smallpox

Answer 10

All lesions progress synchronously through macular, papular, vesicular stages

Question 11

Scarring is most common on ___ where there are larger and more numerous sebaceous glands

Answer 11

Face

Question 12

Most common type of smallpox

Answer 12

Classic or ordinary smallpox

Question 13

Mild, nonfatal form of variola major in previously vaccinated individuals and does not prigress to vesicles, pustules, crusting by day 10

Answer 13

Modified smallpox

Question 14

Lesions persist as soft, velvety vesicles that coalesce into confluent, edematous plaques with flat appearance common in children and nonimmunized individuals

Answer 14

Flat, malignant smallpox

Question 15

Hemorrhage into skin or mucous membranes and deadliest form of smallpox; almost always fatal

Answer 15

Hemorrhagic smallpox

Question 16

Brief febrile illness that occurs without a rash when vaccinated individual is exposed to variola major

Answer 16

Variola sine eruption

Question 17

Complications of smallpox (3)

Answer 17

Pneumonia
Arthritis
Osteomyelitis

Question 18

Major criteria for smallpox (3)

Answer 18

1-4 days fever before rash
Classic smallpox lesions
Lesions in same stage of development

Question 19

Minor criteria of smallpox (5)

Answer 19

Centrifugal
First as enanthem (oral mucosa, palate, face, forearms)
Toxic or moribund
Slow evolution of lesions
Lesions on palms and soles

Question 20

A patient is considered high risk for smallpox if

Answer 20

Patient has febrile prodrome + 1 major criteria with 4 or more minor criteria

Question 21

All testing for smallpox should be done in Biosafety __ lab

Answer 21

3

Question 22

Most useful for differentiating between poxvirus and varicella

Answer 22

Electron microscopy

Question 23

Lab abnormalities in early hemorrhagic form of smallpox (2)

Answer 23

Decrease in factor V

Increase in thrombin time

Question 24

Characteristic intracytoplasmic inclusion bodies for poxvirus

Answer 24

Guarnieri bodies

Question 25

Important factor in death from variola minor

Answer 25

Encephalitis

Question 26

Orthopox virus specific antiviral medication targeting F13Lvaccinia gene that reduces morbidity and mortality of variola infection in both prelesional and postlesional settings

Answer 26

Tecovirimat

Question 27

Lipid conjucate of cidofovir with broad spectrum in vitro activity against dsDNA

Answer 27

Brincidofovir

Question 28

The 3 currently stockpiled vaccines for smallpox

Answer 28

ACAM 2000 Adventis Pasteur Smallpox Vaccine Imvamune

Question 29

Contraindications for smallpox vaccination in pre-exposure settings: (6)

Answer 29

AD Immunosuppression (HIV CD4 count 50-199 cells/ul) Heart disease or sig. cardiac risk factors Allergy Younger than 12 mos Pregnancy, breastfeeding

Question 30

In an outbreak, the ff would not benefit from vaccination (4)

Answer 30

BM transplant within past 3 mos HIV with CD4 count less than 50 cells/ul SCID DiGeorge syndrome

Question 31

Vaccination provides full immunity for ___ and waning immunity for at least another ___

Answer 31

3-5 years | 10 years

Question 32

Adverse reactions are ___ times more common with primary vaccination than revaccination

Answer 32

10

Question 33

Most common adverse event in vaccinia vaccination

Answer 33

Accidental vaccinia

Question 34

Most common sites of transfer of accidental vaccinia (4)

Answer 34

Eyelids Nose Mouth Genitals

Question 35

Localized or generalized spread of vaccinia virus in individuals with atopic dermatitis

Answer 35

Eczema vaccinatum

Question 36

Vaccination of individuals with severe impairment of immune system leads to nonhealing primary lesion which enlarges to a painless ulcer with central necrosis

Answer 36

Vaccinia necrosum Vaccinia gangrenosa Progressive vaccinia

Question 37

Postvaccinial encephalopathy occurs in children younger than ___ 6-10 days after vaccination

Answer 37

2 years old

Question 38

Most common serious adverse effect ff immunization with ACAM 2000

Answer 38

Myocarditis/Perocarditis

Question 39

Introduction of vaccinia virus into outer layers of skin by multiple punctures is termed as

Answer 39

Scarification

Question 40

___ punctures are recommended for primary vaccination and ___ punctures for revaccination

Answer 40

2-3 | 15

Question 41

Treatment of accidental vaccinia, progressive vaccinia, generalized vaccinia

Answer 41

IV administration of vaccinia immune globulin (VIG) or cidofovir

Question 42

Preevent vaccination younger than 18 years of age is ___ and younger than 1 year of age is ___

Answer 42

Not recommended | Contraindicated

Question 43

Main orthopoxvirus affecting humans

Answer 43

Monkeypox

Question 44

Hallmark of monkeypox

Answer 44

Lymphadenopathy | Submandibular, cervical, inguinal

Question 45

MOT of monkeypox

Answer 45

Handling of infected body fluids or infected animals

Question 46

Postexposure prophylaxis is recommended within ___ days of exposure including pregnant, infants less than 12 mos, skin conditions

Answer 46

4-14 days

Question 47

Vaccination is contraindicated in postexposure setting for (5)

Answer 47

``` CD4 count < 200 cells/ul High dose immunosuppressants Lymphosarcoma Hematologic malignancies Primary T cell congenital immunodeficiencies ```