Class: Herpes Virus: CMV, EBV, HHV6-8

Question 1

How is EBV associated infectious mononucleosis transmitted?

Answer 1

saliva

Question 2

What is incubation time for EBV associated infectious mononucleosis

Answer 2

30-50 days

Question 3

What are the 3 major sxs of EBV associated infectious mononucleosis

Answer 3

Triad for IM-lymphadenopathy, fever, pharyngitis

Question 4

major complications of EBV associated infectious mononucleosis (4)

Answer 4

i. Hemolytic anemia- dt auto-antibodies
ii. Thrombocytopenia- unclear etiology
iii. Neutropenia- mild, self-limiting
4. Neurologic complications <1% (85% recover completely)

Question 5

What happens to 80-90% of IM patients who take ampicillin for EBV IM?

Answer 5

rash from a hypersensitivity reaction

Question 6

X-linked lymphoproliferative disease is marked by increased what?

Answer 6

abnormally high numbers B cells, T cells and macrophages

Question 7

What can be result of X-linked lymphoproliferative disease (2)

Answer 7

fulminant hepatitis, or develop hemophagocytic lymphohistiocytosis.

Question 8

What causes X-linked lymphoproliferative disease?

Answer 8

inability of the body to effectively control EBV replication

Question 9

How is EBV IM diagnosed?

Answer 9

monospot test

Question 10

What does the monospot test detect?

Answer 10

heterophile antibodies

Question 11

If monospot test is negative what is the cuase of IM

Answer 11

CMV

Question 12

WHat oral infx is caused by EBV

Answer 12

oral hairy leukoplakia

Question 13

What distinguishes Oral Hairy Leukoplakia from candidiasis

Answer 13

OHL can’t be scraped off tongue

Question 14

how is CMV is transmitted

Answer 14

Saliva, urine, semen, cervical secretions
breast milk
trasnplants
Stem cells
sexual

Question 15

What disease doe CMV cause in normal immune people

Answer 15

heterophile (-) infectious mononucleosis

Question 16

how is congenital CMV is transmitted.

Answer 16

32% risk of congenital transmission if there is a primary infection of CMV during pregnancy
if already seropositive - 1% risk of congenital infection

Question 17

How it cCMV diagnosed and in what time frame? (2 ways)

Answer 17

Saliva (1 hour after nursing) and/or urine PCR test within 3 weeks of life.

Question 18

What percent of cCMV infants show symptoms at birth?

Answer 18

10%

Question 19

common sx of cCMV? (5)

Answer 19

petechiae
jaundice
hepatosplenomegaly
microcephaly
hearing loss

Question 20

if symptomatic at birth, what are sequelae (3)

Answer 20

higher risk of long term sequelae

1) Sensorineural hearing loss = #1 sequelae
2) Cognitive defect/intellectual defect
3) Vision loss

Question 21

if symptomatic at birth, what are sequelae (3)

Answer 21

1) Sensorineural hearing loss = #1 sequelae
2) Cognitive defect/intellectual defect
3) Vision loss

Question 22

What is the most serious complication of CMV infx in SOT and HSCT pts?

Answer 22

Pneumonitis - has a very high mortality (84%) rate

Question 23

How to manage CMV infx in highly susceptible groups

Answer 23

Prophylaxis -ganciclovir or valganciclovir

Question 24

What are two things serology detects in CMV test and problem with one of them

Answer 24

IgA - can last several months so can’t show acute infx

IgM

Question 25

PCR is used to dx CMV in what populations (3)

Answer 25

acute infx only
newborns
CNS pts

Question 26

Antigenemia assay detects only what type of CMV infection? how?

Answer 26

only detects active infx by detecting neutrophils which are only infected in active infx

Question 27

What are th emajor complications of CMV infx in AIDS (3)

Answer 27

end-organ disease
retinitis
IRIS (Immune Reconstitution Inflammatory Syndrome)

Question 28

When does CMV retinitis occur?

Answer 28

usually in patients presenting with AIDS or treatment failure

Question 29

When does CMV diseases occur in AIDS pts

Answer 29

When CD4 count <50

Question 30

What is rule in treating CMV retinitis

Answer 30

don’t just treat unilateral eye–> disease in other eye or other organs

Question 31

what ages are infected with HHV6 and 7

Answer 31

6- younger < 2yo

7 older > 2yo

Question 32

What diseases can HHV6 cause?

Answer 32

Encephalitis
Roseola infantum (exanthem subitum, sixth disease)
Febrile seizures
Febrile seizures epilepticus

Question 33

What diseases can HHV7 cause?

Answer 33

Febrile seizures and

Febrile seizures epilepticus but HHV6&raquo_space;»7

Question 34

What is complication of Febrile seizures epilepticus

Answer 34

epilepsy

Question 35

What is a general complication of HHV-6 infx

Answer 35

Integrated chromosomal HHV-6 (icHHV-6)- every cell in body has HHV-6 integrated into their teleomeres

Question 36

What causes Kaposi’s sarcoma?

Answer 36

HHV-8

Question 37

what population gets classical KS

Answer 37

elderly men of Mediterranean or Eastern European descent.

Question 38

what population gets endemic KS

Answer 38

male, African adults

Question 39

What pop gets Iatrogenic KS

Answer 39

transplant recipients

Question 40

What is strongest risk factor for KS?

Answer 40

Strongest risk factor is low CD4 cell count (if HHV8 positive)