Feb 26 2014 - Viral Pathogens, Influenza

Question 1

What are you looking for with an EIA (Enzyme ImmunoAssay)?

Answer 1

Color change, which indicates the presence of an antigen

Question 2

What is the most sensitive and specific test for identifying a viral infection?

Answer 2

PCR

Question 3

What drug do you commonly use to treat a herpes virus?

Answer 3

Acylcovir

Question 4

What does a HSV-1 or HSV-2 vesicle look like?

Answer 4

Clear fluid bubble with red base - painful!

Question 5

Is initial contact or reactivation the disease-causing part of herpes?

Answer 5

Reactivation - Sx = lesions, fever, anorexia

Question 6

What is gingivostomatitis?

Answer 6

Herpes lesions/manifestations in the FRONT of the mouth and tongue

Question 7

What is herpetic whitlow?

Answer 7

Herpes-inoculated finger via contact (healthcare workers)

Question 8

What is herpes gladiotorum?

Answer 8

Other herpes skin lesions via contact - think ears, neck, etc.

Question 9

What is the difference between genital herpes lesions, syphilis ulcers, and a chancroid?

Answer 9

genital herpes: very painful, red, ulcerated

syphilis: hard and painless ulcers
chancroid: soft, painful ulcer, with lymph node involvement

Question 10

What is herpes keratitis?

Answer 10

Dendritic lesions in the cornea (herpes virus reaches cornea from opthalmic br. of CN5)

Question 11

Why is neonatal herpes an emergency?

Answer 11

Bc lesions in the skin, eyes, and mucous membranes will often lead to CNS issues and Disseminated (lethal) herpes

Question 12

Can you pass on herpes in an asymptomatic phase?

Answer 12

Yes. Viral shedding happens often even with out Sx’s

Question 13

How is herpes virus transmitted?

Answer 13

Through contact, sexual or otherwise, and mom to child

Question 14

How is VZV (Varicella Zoster Virus) transmitted?

Answer 14

Via aerosol droplets or contact

Question 15

What are some symptoms of initial VZV (Varicella Zoster Virus) infection?

Answer 15

Fever, cough, cropping/itchy rash (chicken pox)

Question 16

What kind of vaccine is the chicken pox vaccine?

Answer 16

Live, attenuated (VAR), do not give to immunocompromised Pts

Question 17

Can you pass on VZV (Varicella Zoster Virus) in an asymptomatic phase?

Answer 17

Nope :) There is no asymptomatic shedding

Question 18

What are some symptoms of reactivated VZV (Varicella Zoster Virus) infection?

Answer 18

Shingles - so intensely painful, dermatomal rashes. Can cause neuralgia

Question 19

What do you give 60+ y/o Pt’s to boost immune system against VZV?

Answer 19

Zostavax - a vaccine booster to prevent shingles

Question 20

Is VZV immune response Ab or Tcell mediated?

Answer 20

Tcell mediated

Question 21

Sx of EBV infection?

Answer 21

Fever, cough, mild HSM, lymphadenopathy

Question 22

Where is EBV hanging out during a latent period? Is EBV infection curable?

Answer 22

EBV hangs out in B-cell lymphocytes, and once infected, always infected

Question 23

Proportion of the population that will be infected with EBV by age 40?

Answer 23

90% (believe it. Also, yikes)

Question 24

What do you look for on histologic slide with EBV?

Answer 24

Large, abundant, basophillic WBC cytoplasm

Question 25

What does it mean if Pt has EBNA?

Answer 25

Pt had an active EBV a little while ago

Question 26

How is CMV (Cytomegalovirus) transmitted?

Answer 26

Via contact, blood transfusion, transplant, being pregnant (?)

Question 27

Which cells are infected with CMV?

Answer 27

epithelial cells, esp. in salivary glands and genital/urinary tract (shed in the urine)

Question 28

Proportion of the population that will be infected with CMV by age 40?

Answer 28

50-80% will be carriers

Question 29

Where does latent CMV virus hang out?

Answer 29

In MO, LY

Question 30

Sx of CMV reactivation?

Answer 30

Asymptomatic unless immunocompromised (gotcha!)

Question 31

Sx of Congenital CMV Syndrome?

Answer 31

Hearing loss, HSM, jaundice, "blueberry spots"

Question 32

Which tests Dx CMV?

Answer 32

Serology for IgM and IgG, or PCR, or viral culturing, or direct fluorescence

Question 33

What do you look for on histologic slide with CMV?

Answer 33

"Owl's eye" intranuclear inclusion bodies

Question 34

Tx for CMV?

Answer 34

Gancyclovir

Question 35

What type of virus is RSV (Respiratory Syncytial Virus)?

Answer 35

enveloped, ssRNA

Question 36

What do G and F proteins do for RSV (Respiratory Syncytial Virus)?

Answer 36

G protein = virus attachment | F protein = fusion of cells

Question 37

How is RSV (Respiratory Syncytial Virus) transmitted?

Answer 37

Contact or aerosol

Question 38

Sx of RSV (Respiratory Syncytial Virus)?

Answer 38

fever, runny nose, involvement of lower resp tract

Question 39

Sx of Bronchiolitis?

Answer 39

congestion, cough, fever, decreased RR with retractions and pneumonia-like wheezing

Question 40

Possible Tx for RSV (Respiratory Syncytial Virus)?

Answer 40

Supportive mostly. Also Ribivirin (expensive), Albuterol, or mAb to RSV's F-protein

Question 41

What type of virus is Rotavirus?

Answer 41

dsRNA with segmented genome

Question 42

Sx of Rotavirus infection?

Answer 42

Vomiting, watery diarrhea, fever, abdominal pain for 3-8 days

Question 43

What does Rotavirus do to the GI tract?

Answer 43

Kills and causes sloughing of microvilli on enterocytes (osmotic diarrhea)

Question 44

What test to Dx Rotavirus?

Answer 44

ELISA assay on stool samples

Question 45

Does Rotavirus cross-protect against Norovirus?

Answer 45

Nope. Damn, bc Norovirus is also crazy contagious

Question 46

When is Influenza season normally?

Answer 46

December - March, with peak in February

Question 47

What type of virus is influenza?

Answer 47

Segmented RNA virus

Question 48

Type A influenza

Answer 48

Pandemic proportions - Severe in animals and humans

Question 49

Type B influenza

Answer 49

Epidemic proportions - Less severe, humans only

Question 50

Antigenic Drift

Answer 50

Small changes/muts that accumulate over time

Question 51

Antigenic Shift

Answer 51

One large change, usually due to 2 viral genomes infecting the same host that co-mingle. (Type A Flu)

Question 52

Influenza drugs that inhibit Neuramidase

Answer 52

Oseltamivir, Zanamivir

Question 53

Influenza drugs that inhibit Influenza matrix

Answer 53

Amantidine, Rimantadine

Question 54

Influenza Sx in neonates

Answer 54

high fever, mottling, apnea, GI issues, anorexia

Question 55

Influenza Sx in adults

Answer 55

High fever, muscle aches, chills

Question 56

FLAARDS?

Answer 56

Flu Acute Associated Respiratory Distress Syndrome

Question 57

2009 Swine Flu was which strain?

Answer 57

H1N1

Question 58

3 criteria for Pandemics?

Answer 58

1) Emergence of new subtype 2) Must infect humans & cause serious illness 3) Sustained transmission w/out interruption in humans

Question 59

Influenza nasal vaccine is (live, dead) (trivalent, quadravalent)

Answer 59

Live attenuated, Quadravalent

Question 60

Pt is febrile, with signs of focal process (redness, abscess). Bacterial or viral?

Answer 60

Bacterial (probably)

Question 61

Pt has a high lymphocyte count. Bacterial or viral?

Answer 61

Viral (probably)

Question 62

Pt has left-shift with elevated neutrophils. Bacterial or viral?

Answer 62

Bacterial

Question 63

Pt. has blood-tinged sputum. Bacterial or viral?

Answer 63

Probably bacterial (pneumonia)