Herpes, Varicella, Influenza

Question 1

retroviruses

Answer 1

viruses that require reverse transcription of RNA to DNA

Question 2

6 steps in viral replication

Answer 2

(1) Attachment of the virus to the host cell surface, (2) Entry of the virus into the host with uncoating of capsid (3) Processing and replication of viral nucleic acids, by RNA polymerase, reverse transcriptase, etc. (4) Translation of viral genetic material into a large polyprotein, by host cell ribosomes (5) Cleavage of polyprotein into individual functional proteins, by protease (6) Assembly of viral particles and release from the host cell.

Question 3

Herpes virus

Answer 3

(HSV1), (HSV2), (VZV), (CMV), (EBV),

Question 4

HSV-1

Answer 4

Orofacial infection

gingivostomatitis (very sore mouth) and pharyngitis (inflammation of the back of the throat) during primary infection manifestation- core sore

Question 5

HSV-2

Answer 5

genital HSV infections high frequency of reactivation subclinical HSV-2 shedding in genital mucosa it is possible for someone to be contagious even without visible or other symptoms, which is an important counseling point

Question 6

HSV diagnosis

Answer 6

DNA PCR

Question 7

HSV Treatment

Answer 7

Acyclovir 200mg PO 5x/day x 10 days (7 days for orolabial)

Valacyclovir 1g PO BID x 7-10 days

Famciclovir

Docosanol (Abreva®) works by preventing viral attachment and entry into the cell and is a topical antiviral for orolabial infections

Question 8

VZV disease

Answer 8

varicella (chickenpox) zoster (shingles) Chickenpox is the primary infection Shingles represents the recurrence of infection

Question 9

Varicella - presantation

Answer 9

self- limited rash, low fever, malaise, pruritus, anorexia, CI: aspirin - Reye’s syndrome

Question 10

Shingles - presantation

Answer 10

severe burning pain precedes the lesions by 48-72 hr.

Painful Rash

Question 11

VZV diagnosis

Answer 11

PCR - ELISA

Question 12

VZV treatment

Answer 12

Acyclovir (Zovirax) Valacyclovir (Valtrex) Famciclovir (Famvir)

Question 13

CMV - symptoms

Answer 13

mononuleosis: fever, lymphadenopathy, and relative lymphocytosis.

In immunocompromised patients, CMV disease typically manifests as colitis (diarrhea), pneumonitis (bibasilar pneumonia), and retinitis (changes in vision) but can occur in any organ system.

Question 14

CMV treatment

Answer 14

DOC: Ganciclovir causes myelosupression, nephrotoxicity Valganciclovir (Valcyte) (taken with food). Foscarnet and cidofovir reserved for patients with resistant virus Nephrotoxicity and electrolyte disorders are BBW with foscarnet and saline pre-loading may help reduce incidence. Cidofovir has dose-dependent nephrotoxicity associated with it.

Question 15

Influenza presentation

Answer 15

significant morbidity and mortality most commonly in young children and the elderly. Children, adults under 20 years of age, and the elderly are at highest risk of severe disease. Signs and symptoms of influenza include fever, myalgia, headache, malaise, nonproductive cough, sore throat, and rhinitis Typically signs and symptoms resolve around 3 – 7 days with the exception of the cough and malaise which may last for > 2 weeks.

Question 16

Influenza diagnosis

Answer 16

rapid antigen detection PCR

Question 17

Influenza virus

Answer 17

Hemaglutinin allows the virus to enter the host Neuraminidase allows the release of the viral particles from host cells

Question 18

Influenza treatment

Answer 18

most effective within 48 hrs of onset

only high risk individuals or those with severe symptoms are considered candidates f

Neuraminidase inhibitors:

Oseltamivir (Tamiflu), 75mg PO BID x 5 days 150mg PO BID x 5-10 days in severe disease renal dose adjustments for CrCl < 30 ml/min N/V, delirium, seizures, hallucinations

zanamivir (Relenza diskhaler, 10mg inhaled BID x 5 days), not recommended for those with underlying asthma or COPD

IV agent peramivir (Rapivab, 600mg IV once). CrCl <50