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YR5 Microbiology > Crash Course Immunocompromised + Influenza > Flashcards

Crash Course Immunocompromised + Influenza Flashcards

(65 cards)

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1
Q

Which organisms are patients with splenectomy susceptible to?

A

encapsulated organisms- NHS
Neisseria
Haemophilus
Streptococcus

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2
Q

What are 2 microbiological consequences of immunocompromise?

A

Infection with unusual organisms

Infection in unusual sites

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3
Q

Name 2 unusual organisms and 2 unusual sites of infection seen in HIV patients

A

Organisms:
Microsporidium: GI infection exclusively seen in HIV
MAC

Sites:
CMV colitis
Oesophageal candidiasis

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4
Q

What unusual organism are patients with CF susceptible to? What is the significance of this?

A

Burkholderia cepacia

CI to lung transplant

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5
Q

What organism causes an unusual site of infection in sickle cell disease patients?

A

Salmonella septic arthritis

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6
Q

What unusual organism are patients on monoclonals such as anti-TNF alpha susceptible to?

A

JC virus

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7
Q

What prophylactic measures can be taken for immunocompromised?

A

Pre-splenectomy: Vaccination against meningitis + pneumonococcus

HIV: Co-trimoxazole if CD4 <200

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8
Q

What is caused by reactivation of JC virus?

A

Progressive multifocal leukoencephalopathy

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9
Q

What is JC virus AKA?

A

Human polyomavirus 2

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10
Q

How many serovars of influenza? Which is worst?

A

4 serovars (C+D not clinically relevant)
A worse than B- more likely to cause pandemic

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11
Q

What 3 characteristics are required for a virus to cause a pandemic?

A

Novel antigenicity

Replicates efficiently in human cells.

Transmit efficiently between people.

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12
Q

What results in novel antigenicity?

A

Antigenic drift
Antigenic shift

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13
Q

What is antigenic drift?

A

Accumulation of mutations over time.

Error prone replication process, slightly different primary sequence for some of the proteins, happens relatively frequently, small changes accumulate

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14
Q

Why are new vaccines to influenza required each year?

A

Antigenic drift
Leads to production of new epidemic strain every year
Pre-formed antibodies from last exposure are not so effective.

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15
Q

What is antigenic shift?

A

Recombination of genomic segments of 2 co-infecting flu strains→ leads to rapid antigenic change+ production of new viral strain (shift)

Allows exchange of RNA segments between human + animal strains

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16
Q

Why does antigenic shift not happen often?

A

Rare for an organism to be co-infected with 2 strains of influenza

Often recombination produces nonsense

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17
Q

What is the natural reservoir of influenza A viruses?

A. Pigs

B. Chickens

C. Ducks

D. Tigers

A

Ducks

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18
Q

How is the viral genome of influenza composed?

A

8 “chunks” of RNA

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19
Q

What is Haemagglutinin? What is its function?

A

Protein on surface of influenza
Allows ENTRY: binds to sialic acid, cleaved by tryptase on surface of cells in lungs

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20
Q

What is haemagglutinin especially prone to? What is the significance of this?

A

Prone to antigenic DRIFT
Target this protein in yearly vaccine

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21
Q

What is Neuraminidase? What the function of Neuraminidase?

A

Protein on surface of influenza virus
Allows EXIT: Cleaves sialic acid
Facilitates viral release

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22
Q

What is neuraminidase more prone to?

A

Antigenic SHIFT process

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23
Q

What technique can determine virus and strain of influenza?

A

RT-PCR
(Reverse transcription polymerase chain reaction)

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24
Q

What is the most commonly used influenza antiviral?

A

Oral Oseltamivir
Neuraminidase inhibitor
Prevents viral release + thus replication + infection of other cells

Others: Inhaled Zanamivir + IV Peramivir

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25
How do normal antivirals and 'val-antivirals' differ?
Usually same drug Val- increases bioavailability + resistance to first pass metabolism Can be taken less often to get up to therapeutic dose Can be taken orally
26
What is the stepped treatment of HSV or VZV? (if previous step ineffective)
1. Acyclovir 2. Foscarnet 3. Cidofovir
27
What is the stepped treatment of CMV or EBV?
1. Ganciclovir 2. Foscarnet 3. Cidofovir
28
For non-herpes viral infections e.g. Adenovirus, what anti-viral should be used? What are the disadvantages of this?
Cidofovir "Dirty drug": Nephrotoxic, Ocular toxicity + BM suppression
29
What are the manifestations of HSV1?
Oral herpes: Herpes labialis Initially may be HSV gingival-stomatitis in mouth HSV encephalitis
30
What does reactivation of HSV1 usually cause?
Isolated vesicles + cold sores
31
What are the manifestations of HSV2?
Genital herpes HSV meningitis
32
Which types of HSV virus infections are AIDS defining illnesses?
HSV oesophagitis, colitis or rarely pneumonitis
33
What is eczema herpeticum?
Disseminated herpes infection in those with atopic dermatitis Usually kids with eczema
34
What is herpetic whitlow?
Herpes on the finger Common in HCPs
35
In which patients is disseminated cutaneous herpes seen?
Immunocompromised
36
How does VZV commonly present?
In children with fever, malaise + rash Rash starts on face, descends Macules -> Papules -> Vesicles
37
List 4 serious complications that can arise from VZV in adults/ immunocompromised
Pneumonitis Encephalitis Myocarditis DIC
38
What is caused by reactivation of VZV?
Herpes zoster: Shingles- dermatomal rash
39
What is Ophthalmic herpes zoster?
Shingles of V1 (1st branch of trigeminal nerve) Can damage retina Specific sign: Hutchinson sign- vesicles on tip of nose Emergency- send to ophthalmologist
40
What is Ramsay Hunt syndrome?
Shingles affecting facial nerve Ear pain Facial paralysis Vesicles usually in ear Requires prompt Tx
41
Which medication should NOT be given in VZV infection?
Ibuprofen Esp. in children Increases risk of secondary skin infections + necrotising fasciitis
42
Name one complication of shingles
Herpetic neuralgia Pain in distribution of that dermatome
43
How does Epstein-Barr virus present?
Presents with infectious mononucleosis: Fever Pharyngitis Lymphadenopathy (usually symmetrical, posterior cervical chain) Hepatitis +/- Splenomegaly
44
Give 3 investigations for EBV
EBV serology Atypical lymphocytes Heterophile antibody (monospot test)
45
Name 2 infections other than EBV that can cause infectious mononucleosis
CMV Toxoplasmosis
46
What is the management of EBV?
Not much evidence for using antivirals Avoid contact sports Avoid alcohol (have hepatitis)
47
If very fulminant EBV, what drug may be considered?
Ganciclovir
48
Why must high contact sports be avoided in EBV?
Splenomegaly- increases risk of splenic rupture
49
What malignancy is EBV associated with?
Nasopharyngeal carcinoma Burkitt's lymphoma
50
Where does EBV remain dormant?
B cells
51
What occurs in EBV post-transplant lymphoproliferative disease?
1. Immunosuppression for transplant 2. Once immunosuppressed lose surveillance of EBV 3. Leads to pre-lymphoma state 4. Needs intervention or will progress to lymphoma
52
How does Cytomegalovirus present?
Typically Asymptomatic or Infectious mononucleosis picture
53
Where does Cytomegalovirus live dormantly? How is it visualised?
Monocytes + Dendritic cells Owl's Eye inclusion bodies
54
Give 4 manifestations of CMV reactivation in immunosuppressed individuals
Pneumonitis Retinitis Colitis Encephalitis
55
What is firstline treatment for CMV?
Ganciclovir / Valganciclovir
56
How does CMV pneumonitis appear on imaging?
ground glass appearances multifocal widespread
57
Give 1 feature of CMV retinitis on fundoscopy
Cotton wool spots difusely
58
What are the manifestations of HHV6 and HHV7?
Principally causes ROSEOLA very very rarely encephalitis
59
How does HHV8 manifest?
Only seen in immunosuppressed, esp. HIV Lymphoproliferative diseases: Kaposi's Sarcoma Castleman disease Primary effusion lymphoma
60
Where do Kaposi Sarcoma lesions occur?
Skin Internally esp. resp + GI tract: can haemorrhage severely
61
What is the treatment of kaposi sarcoma?
Treat immunosuppression + immune system should clear the cancer
62
Give 4 manifestations of Adenovirus in immunosuppressed individuals
Pneumonitis/ pneumonia Haemorrhagic cystitis Meningioencephalitis Colitis
63
What occurs in JC virus in immunocompromised?
Can reactivate in brain causing Progressive Multifocal Leukoencephalopathy (resistant to antivirals)
64
In which patients is BK virus worrying?
Transplant patients
65
What does BK virus cause in renal transplant and bone marrow transplant patients?
Renal: BK virus infects transplanted kidney: Nephropathy BM: Haemorrhagic cystitis

YR5 Microbiology (23 decks)

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