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Clinical virology Flashcards

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0
Q

Hepadnavirus

A

dsDNA, circular, enveloped (naked = PAPP)

  • HBV –> acute or chronic hepatitis
  • Vaccine available (HBV surface antigen)
  • Has reverse transcriptase (but not retrovirus)
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1
Q

DNA virus names

A

HHAPPPPy

  • Hepadnavirus
  • Herpesvirus
  • Adenovirus
  • Papillomavirus
  • Polyomavirus
  • Pox virus
  • Parvovirus
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2
Q

Herpesviruses

A

dsDNA, linear, enveloped (naked = PAPP)

  • HSV1
  • HSV2
  • VSV (HHV-3)
  • EBV (HHV-4)
  • CMV (HHV-5)
  • HHV-6
  • HHV-7
  • HHV-8

Tx = valcyclovir daily

  • 50% decr recurrence
  • 70% decr recurrence
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3
Q

HSV1

A

Oral lesions, gingivostomatitis, herpes labialis, temporal lobe encephalitis, keratoconjunctivitis

  • Transmission = resp secretions/saliva
  • Recurrent - cold sores
  • Latent in trigeminal ganglia
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4
Q

HSV2

A

Genital lesions (herpes genitalis), neonatal herpes

  • Transmission - sex, perinatally
  • Latent in sacral ganglia
  • Tzank smear shows multinucleated giant cells w/ intranuclear inclusions
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5
Q

HSV3

A

VZV - chickenpox, zoster (shingles) = vesicles in 1 dermatome, encephalitis, pneumonia

  • Post-herpetic neuralgia - after shingles
  • Transmission - oral secretions
  • Latent in dorsal root of trigeminal ganglia

*Vaccine available (live attenuated)

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6
Q

HSV4

A

EBV - mononucleosis, Burkitt lymphoma, Hodgkin lymphoma (latent infection)

  • Mono - fever, hepatosplenomegaly, pharyngitis, lymphadenopathy (posterior cervical nodes)
  • Transmission - resp secretions/saliva
  • Infects B cells - atypical lymphocytes on blood smear (= reactive cytotoxic T cells), not B cells!
  • Test - Monospot test +
  • Complic - hodgkin lymphoma, burkitt lymphoma, nasopharyngeal carcinoma
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7
Q

HSV5

A

CMV - infection in immunocompromised (AIDS retinitis), esp transplant pts

  • Mono (Monospot neg), pneumonia, retinitis, congenital infection
  • Stain = “owl eye” inclusions
  • Transmission - congenital, transfusion/sex/saliva/urine/transplant
  • Latent in mononuclear cells
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8
Q

HSV6

A

Roseola - high fevers for days (can cause sz), then diffuse macular rash
- Transmitted by saliva

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9
Q

HSV8

A

Kaposi sarcoma - neoplasma of endothelial cells

  • Get in HIV/AIDS, transplant pts
  • Dark/biolaceous flat + nodular skin lesion - endothelial growths
  • Can affect GI/lungs too
  • Tx = sexual
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10
Q

HSV identification

A
  • Skin/genitalia - viral culture
  • Herpes encephalitis - CSF PCR
  • Tzanck test (genital herpes) - smear of opened vesicle –> multinucleated giant cells and intranuclear inclusions

Tzanck god I dont have herpes

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11
Q

Adenovirus

A

dsDNA, linear, naked (PAPP)

  • Febrile pharyngitis w/ sore throat
  • Acute hemorrhagic cystitis
  • Pneumonia
  • Conjunctivitis - “pink eye”
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12
Q

Papillomavirus

A

dsDNA, circular, naked (PAPP)

  • HPV - warts (1,2,6,11); CIN/cervical cancer (16,18)
  • Recombinant vaccine for 6,11,16,18*
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13
Q

Polyomavirus

A

dsDNA, circular, naked (PAPP)

  • JC virus - PML in HIV
  • BK virus - transplant pts, targets kidney
  • JC = junky cerebrum; BK=bad kidney
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14
Q

Parvovirus

A

ssDNA, linear, naked (PAPP)
B19 virus:
- Aplastic crises in sickle cell
- “slapped cheeks” in kids = erythema infectiosum (fifth disease)
- RBC destruction in fetus = hydrops fetalis/death
- Pure RBC aplasia/RA-like sx in adults

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15
Q

Poxvirus

A

dsDNA, linear, enveloped (PAPP, not pox)

  • Smallpox (eradicated)
  • Cowpox (milkmaid blisters)
  • Molloscum cotagiosum - flesh colored dome lesions w/ central umbilicated dimple
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16
Q

RNA viruses names

A

RPHCFTRCOPRFABD

  • Reovirus
  • Picornavirus
  • Hepevirus
  • Calicivirus
  • Flavaivirus
  • Togavirus
  • Retrovirus
  • Coronavirus
  • Orthomyxoviruses
  • Paramyxoviruses
  • Rhabdoviruses
  • Filoviruses
  • Arenaviruses
  • Bunyaviruses
  • Delta virus

“Reta picked Her California flavas, to-go return coronas; orthos re-PARA Rhabdo with help of Files, Arenas, Buny and Delta”.

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17
Q

Reovirus

A

dsRNA, 10-12 segments, icosahedral, naked (CPR + hepevirus)

  • Coltavirus - Colorado tick fever
  • Rotavirus - #1 peds fatal diarrhea
  • Live attenuated and recomb rota vaccines*
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18
Q

Hepevirus

A

ssRNA, icosahedral, non-enveloped (PCR + hepevirus)

- HEV

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19
Q

Calicivirus

A

ssRNA, icosahedral, naked (PCR + hepevirus)

- Norovirus - viral gastroenteritis

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20
Q

Picornavirus = enteroviruses

A

ssRNA, icosahedral, naked (PCR + hepevirus)
- RNA translated into 1 large polypeptide –> protease cleaves into fxnal viral proteins

  • PERCH on a “peak” (pico):
  • Poliovirus - polio, Salk/Sabin (killed/live)
  • Echinovirus - aseptic (viral) meningitis
  • Rhinovirus - “common cold”
  • Coxsackievirus - aseptic meningitis, herpangina, hand/foot/mouth disease, myo/pericarditis
  • HAV - acute viral hep
  • **All cause aseptic meningitis (except rhino/HAV)
  • All enteroviruses (fecal-oral) except rhinovirus bc it’s acid labile (destroyed by stomach acid)*
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21
Q

Togaviruses

A

ssRNA, icosahedral, enveloped

  • Rubella
  • Easter + western equine encephalitis (arthropods)
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22
Q

Flavavirus

A

ssRNA, icosahedral, enveloped

  • HCV
  • Yellow fever*
  • Dengue fever*
  • St. Louis encephalitis*
  • West Nile virus*
  • = transmitted by arthropods
23
Q

Retroviruses

A

ssRNA, icosahedral (HTLV); conical (HIV), enveloped

  • HTLV - T-cell leukemia
  • HIV-AIDS
  • *Have reverse transcriptase
24
Q

Coronaviruses

A

ssRNA, helical, enveloped

- “common cold” and SARS

25
Q

Orthomyxoviruses

A

ssRNA, helical, enveloped

- Influneza virus

26
Q

Paramyxoviruses

A

ssDNA, helical, enveloped
*Have surface F (fusion) protein –> resp endothelial cells fuse/multinucleate

  • PaRaMyxovirus*
  • Parainfluenza (Croup = seal-like bark cough)
  • RSV - bronchiolitis in infants, Rx = ribavarin
  • Measles, Mumps
  • Palivizumab = monoclonal Ab against F protein, prevent pneumonia from RSV in premies
  • MMR = live attenuated vaccine
27
Q

Filovirus

A

ssRNA, helical, enveloped

- Ebola/Marburg hemorrhagic fever –> often fatal

28
Q

Arenavirus

A

ssRNA, helical, enveloped

  • LCMV = lymphocytic choriomeningitis virus
  • Lassa fever encephalitis - spread by mice
29
Q

Delta virus

A

ssRNA, uncertain capsid, enveloped

- HDV = “defective” virus that requires HBV co-infection

30
Q

Bunyavirus

A

ssRNA, helical, enveloped

  • California encephalitis
  • Sandfly/Rift Valley fevers
  • Crimean-Congo hemorrhagic fever
  • Hantavirus - hemorrhagic fever, pneumonia
31
Q

Negative-stranded viruses

A

Must transcribe neg strande to positive

  • Virion brings own RNA-dependent RNA polymerase
  • Arenavirus, Bunyaviruses, Paramyxoviruses, Orthomyxoviruses, Filoviruses, Rhabdoviruses

“Always Bring Polymerase Or Fail Replication”

32
Q

Segmented viruses

A

All are RNA viruses

BOAR:

  • Bunyaviruses
  • Orthomyxoviruses (influenza)
  • Arenaviruses
  • Reoviruses
33
Q

Yellow fever

A

Flavivirus

  • Transmit: Aedes mosquito (monkey/human reservoir)
  • Sxs: high fever, black vomitus, jaundice

Flavi = yellow, jaundice

34
Q

Rotavirus

A

Reovirus, dsDNA, segmented

  • Major caused of diarrhea in kids –> infantile gastroenteritis!
  • Villous destruction w/ atrophy = decr Na+ absorption, loss of K+
  • ROTAvirus = Right Out The Anus*
  • Vaccination (live attenuated)
35
Q

Influenza viruses

A

Orthomyxoviruses - ssRNA, enveloped, 8-seg genome

  • Hemagglutinin (vira entry) and neuraminidase (progeny virion release)
  • Rapid genetic changes
  • At risk for fatal bacterial superinfection
  • Vaccines: contain few strains
  • Killed - injected, most common
  • Live attenuated - intranasal (replicates in nose, not lung)
36
Q

Rubella virus

A

Togavirus –> Rubella = German measles

  • Fever, postauricular and other LAD, arthralgia, fine rash (start face, move centrally + extrem)
  • Mild disease in children
  • Serious congenital (ToRCHeS infection!) –> cataracts, deafness, blueberry muffin appearance (extramedullary hematopoeisis)
37
Q

Measles virus

A

Paramyxovirus, causes measles (rubeola)

  • CCC: coryza, cough, conjunctivitis
  • Koplik spots + descending maculopapular rash
  • SSPE - subacute sclerosing panencephalitis –> yrs later
  • Mutated/absent matrix protein, evades immune system + replicates in neurons
  • MMR vaccines - live attenuated
  • VitA to prevent exfoliative dermatitis in malnourished
38
Q

Mumps virus

A

Paramyxovirus
Mumps makes parotid/testes as big as POM-poms:
- Parotitis, Orchitis (inflamm testes), aseptic (viral) Meningitis
*Can cause sterility after puberty

39
Q

Rabies virus

A

Bullet-shaped, Negri bodies in Purkinje cells of cerebellum/hippocampus

  • Incubation = wks-months before sx
  • Travels to CNS retrograde (up axon cells)
  • Sx: fever, malaise –> agitation, photophobia, hydrophobia –> paralysis, coma –> death
  • More from bat, raccoon, skunk bites than dogs in US
  • PEP = wound wash, vaccine +/- rabies Ig
40
Q

Hepatitis viruses

A

Sx - fever, jaundice, high ALT/AST

“Picked Hell - Fibrosis Death Hepatomegaly”

  • HAV - RNA picornavirus
  • HBV - DNA hepadnavirus
  • HCV - RNA flavivirus
  • HDV - DNA delta virus
  • HEV - RNA hepevirus

*A and E = fecal-oral (vowels hit your bowels) –> naked viruses, dont rely on envelope, so not destroyed by gut

41
Q

HAV

A

RNA picornavirus

  • Fecal-oral transmission
  • No carries
  • Short incubation = weeks
  • No risk HCC

HAV = Asymptomatic, Acute, Alone (no carrier)

42
Q

HBV

A

DNA Hepadnavirus

  • Parenteral, sexual, maternal-fetal
  • Carriers
  • Long incubation = months
  • HCC risk - integrates into host genome (acts as oncogene)
43
Q

HCV

A

RNA Flavivirus

  • Blood transmission (IVDU, tattoos)
  • Carriers
  • Long incubation
  • HCC risk - chronic inflammation

HCV = Chronic, Cirrhosis, Carcinoma, Carrier

44
Q

HDV

A

RNA Deltavirus

  • Parental, sexual, maternal-fetal
  • Carriers
  • Superinfection (HDV after HBV) = short incubation
  • Co-infection (HDV with HBV) = long (like HBV)
  • HCC risk

HDV = Defective virus Dependent on HBV; superinfection is worse prognosis

45
Q

Hepatitis serologic markers

A
  • Anti-HAV (IgM) - IgM ab to HAV (detects active HAV)
  • Anti-HAV (IgG) - IgG ab to HAV (detects prior infec/immuniz)
  • HBsAg - antigen on surface of HBV = HBV infection
  • Anti-HBs - Ab to HBsAg –> HBV immunity
  • HBcAg - antigen assoc w/ HBV core
  • Anti-HBc - Ab to HBcAg; IgM = acute/recent infection, IgG = prior exposure/chronic infection
    • during window period*
  • HBeAg - active viral replication = high transmissibility
  • Anti-HBe - ab to HBeAg = low transmissibility

*SECES: SE = antigens, CES = abs

46
Q

HEV

A

RNA Hepevirus

  • Fecal-oral (esp waterborne epidemic)
  • No carriers
  • Short incubation
  • No HCC risk
  • High mortality in pregnant women!
  • Biphasic: 1 = self-limited, 2 = high serum transaminases, rise in IgM anti-HEV (correlates w/ disease)

HEV - Enteric, Expectant mothers, Epidemic

47
Q

Timing of hep serologic markers

A
  • Anti-HBs appear late (after HBsAg disappear = window period)
  • Anti-HBc appear early, continue (IgM vs. IgG)
48
Q

Markers of viral vs. alcoholic hepatitis

A

Viral: ALT>AST
Alcoholic: AST>ALT

49
Q

HIV binding mechanism

A
  • Binds CCR5 (early) or CXCR4 (late) co-receptor + CD4 on Tcells
  • Binds CCR5 and CDR on macrophages
  • Homo CCR5 mutation = immunity
  • Hetero CCR5 mutation = slower disease progression
50
Q

HIV

A

Retrovirus, carries own reverse transcriptase

3 structural genes:

1) env (gp120, gp41 –> cleavage of gp160)
- gp120 = docking protein (attach to CD4Tcell)
- gp41 = fusion/entry
2) gag (p24) = capsid protein (conical)
3) pol - reverse transcriptase, aspartate protease, integrase
* Reverse transcriptase synthesizes dsDNA from RNA –> incorporates into host genome

2 regulatory genes:
- tat + rev (for viral replication)

51
Q

HIV testing

A

1) ELISA - high false positive (rules-out)
2) If +, do Western blot - high false negative (rules-in)
3) PCR/viral load - higher viral load = worse prognosis; can monitor drug response this way

  • ELISA/western blot test antibody to viral proteins
  • False neg in mo 1-2
  • Babies born to infected mom (anti-gpl120 crosses placenta)*
52
Q

Stages/timing of untreated HIV

A

4 stages:

  • Flu-like feeling (acute) - dissemination of virus, seed lymphoid organs
  • Feeling fine (latent) - viral replic in LNs
  • Falling CD4 count
  • Final crises - constitutional sx/opportunistic disease
53
Q

AIDS

A
  • CD4 count < 200
  • HIV + AIDS defining illness (OIs)
  • CD4 count <14%
54
Q

Diseases of HIV+ pts

A

As CD4+ drops, risk of reactivation of past infections (TB/HSV/shingles), dissemination of bacterial/fungal infections (coccidioidomycosis), non-Hodgkin lymphoma

55
Q

Prions

A

Convert normal a-helical protein termed prion protein (PrPc) to B-pleated form (PrPsc) = more transmissible

  • PrPsc resists protease degradation, converts more PrPc to PrPsc
  • Get spongiform encephalopathy - from accumulation of PrPsc
  • Sx - encephalopathy, dementia, ataxia, death
  • Cruetzfeldt-Jakob disease - rapidly progressive dementia, sporadic
  • Also acquired (GSS syndrome) or acquired (kuru)

Microbiology (7 decks)

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