ID: viruses Flashcards
How many types of herpes viruses can affect humans
-the group is called?
8
known as Herpes Human Viruses HHV
how many types of herpes simplex viruses are there
two HSV-1 (above the waist) and HSV-2 (genital lesions)
when is HSV most contagious
-when else can it spread
when virus-filled lesions are present
can also spread during asympto shedding in saliva and genital secretions
herpes labialis
- also called
- which virus
HSV-1
cold sore
genital herpes
HSV-2
HHV-3 also called
varicella zoster virus
Varicella zoster virus also called
HHV-3
HHV-4
Epstein-barr virus
Epstein barr virus also called
HHV-4
HHV-5
Cytomegalovirus
Cytomegalovirus also called
HHV-5
Kaposi-sarcoma associated herpesvirus also called?
HHV-8
HHV-8
Kaposi-sarcoma associated herpesvirus
roseola infantum
HHV-6
Cytomegalovirus Mononucleosis
CMV or HHV-5
infectious mononucleosis
EBV or HHV-4
chicken pox
varicella zoster virus ir HHV-3
where does the herpes virus reside in for life?
sensory neurons—trigeminal and sacral ganglia
what general s/s occur before a HSV lesion develops
burning and stinging
herpetic whitlow
HSV infection of finger
Herpes gladiatorum
-common among?
HSV infection of trunnk and extremities (Common among wrestlers)
Keratoconjunctivitis
HSV infection of the eye
HSV in CNS causes?
meningitis or encephalitis
which strains of HHV can cause certain kinds of CA
HHV-8 or Kaposi sarcoma associated herpesvirus
and
EBV or HHV-4
Varicella Zoster (HHV-3):
- what dz does it cause
- transmission–how long is someone contagious–start to end
- prodrome?
- classic evolution of the rash?
- PE… hallmark?
- diagnosis— best one?
- tx: immunocompetent vs immunocomp
- prevention
Primary: varicella —>chicken pox
Reactivation: herpes zoster–>shingles
CHICKEN POX:
- transmission=aerosol droplets or direct contact
- contagious 48 hours prior to the onset of the rash up until ALL the lesions have crusted over**
Prodrome:
- fever
- malaise
- anorexia and/or pharyngitis followed by——>generalized vesicular rash usually w/in 24 hours
RASH: evolution
- *start as erythematous macules–>papules–>vesicular (crops)–>crust over
- *starts on face–>trunk–>spreads to extremities
- ***pruritic ** DEW DROPS ON A ROSE PETAL
PE:
**HALLMARK= maculopapules, vesicles, and scabs in various stages of evolution
Diagnosis:
- ***clinical
- *but can do a
1. Tznack smear= take scraping from the vesicle and will see MULTI NUCLEATED GIANT CELLS
2. VZV DNA via PCR
3. Immunofluorescent detection of viral antigen in lesions or culture
4. serologic tests - **BEST TEST IS PCR ***
TX:
1. health children <12 YO= supportive and sympto tx–tylenol and calamine lotion–NO NO NO NSAIDS it can cause superinfection
- Adults/adolescents >12, and immunocomp: Acylovir to help prevent complications— win 72 hrs of onset
* avoid contact with pregnant women
PREVENTION:
- Varicella (VAR) vaccine: live attenuated
* 1st dose=12-15MO
* 2nd dose=4-6 YO
what do we not want to give kids as anti-pyretic tx?
ASA because it can lead to Reye Syndrome
what do we not want to give as anti-pyretic for chicken pox
NSAIDS— can risk superinfection
complications from chicken pox
- MC comp in kids?
- MC in adults?
- bacterial superinfection MC in kids due to itching
- ->staph aureus
- ->staph pyogenes - Varicella pneumonia leading cause of mortality and morbidity in adults (3-7 days after rash)
HHV-3 Shingles
- when does it occur
- RF (3)
- CM
- diagnosis
- tx
- prevention
after primary infection with Varicella zoster– virus remains latent in the DRG or cranial nerve ganglia—- where it can reactivate
RF:
- normal aging.. >50 YO
- poor nutrition
- immunocompromised status
* **can occur in younger PT too
CM
- prodrome of fever, malaise, sensory changes (PAIN, burning, paresthesias)
- followeed by painful eruption of vesicles on erythematous base
- unilateral rash within a single dermatome—does not cross the midline–MC thorax
* Zoster ophthalmicus: opthalmic branch of trigeminal nerve (CNV) is involved—- can cause blindness in absence of tx **HUTCHINSON’s SIGN**
* *Ramsay Hunt Syndrome: facial nerve (CN-VII) pain and vesicles appear in external auditory canal–lose sense of taste in anterior two thirds of tongue + ipsilateral facial palsy
Diagnosis:
- clinical
- if need to confirm: best test is PCR
- Tzanck smear does NOT differentiate b/w chicken pox and shingles… not best choice
TX
- Acyclovir, Valacyclovir, famicilovir
* **Valacyclovir used MC bc of the dosing - Analgesics for pain–narcotics for serious cases
- can be transmited until all the lesions crust over
PRevention: the following are both good for 5 years
- recombinant vaccine (RVZ): adults >50 YO, 2 doses
* **second dose is given 2-6 MO after first - Zostavax: live attenuated vaccine–no longer in US
what CN is invovled with ramsay hunt syndrome
CN VII– facial nerve
what CN is invovled with Zoster opthalmicus
trigeminal nerve…CN V– the opthalmic branch
complications from shingles
MC?
- post-herpetic neuralgia= persistent pain/sensory symps >90 days—–MC
- cranial neuropathies/CNS involvement
Epstein-Barr Virus aka?
- MC when
- also associated with?
- infects what
- CM
- diagnosis– TOC?
- tx
Infectious Mononucleosis—HHV-4
MC early childhood—second peak late adolescence
by adulthood— more than 90% have been infected and have antibodies
also assoc with Hodginks disease, t cell lymphoma and other tumors
infects B cells–causes them to proliferate—-CA
transmission: “kissing disease”
* close contact of infected secretions–saliva
CM: 4-6 week incubation pd
1. young children may be asympto or can have mild pharyngitis +/- tonsillitis
3. adolescents: 75% present as infectious mono–TRIAD
**Lymphadenopathy–MC is posterior cervical
**Splenomegaly (wk 2-3)
**exudative pharyngitis
PRODROME before triad: extreme fatigue, fever, HA,
**if PTs get ampicillin + mono= RASH
diagnosis:
* Lab work: lymphocytosis with >10% atypical lymphocytes–Downey cells
- elevated LFTs
- elevated billi
*heterophile antibody test (monospot) –done week 3 is the TOC
TX:
- supportive measures–rest, analgesia
- increased risk of splenic rupture–>avoid contact sports***
ampicillin + Mono infection =?
rash
CMV, HHV-5
- MC?
- assoc w?
- cm– primary and reactivation
- diagnosis
- tx
- prophylaxis
MC congenital viral infection
assoc with developmental defects and hearing loss
transmission: close contact or sexual transimssion, body fluids, blood, organ transplantation, placenta, breastmilk
CM:
- primary infection: most are asympto
* if symptom: similar to EBV w/o sore throat or lymphadenopathy - reactivation: immunocompromised patients
* colitis: diarrhea, fever, abd pain, bloody stools–MC
* Retinitis: decreased vsual acuity and floaters (imp cause of blindness in AIDS)
* esophagitis: odynophagia with large superficial ulcers on upper endoscopy
diagnosis:
* atypical lymphocytosis, heterophile antibody NEGATIVE
* negative monospot test
* pathology: intracellular inclusions surrounded by a clear halo— “owl eye cells”
TX:
- primary dz for immunocompetnet= supportive
- tx for reactivation
* Ganciclovir is first line and TOC
* others: Foscarnet, Cidofovir, Valacyclovir - HIV PT w/ CD4< 50 cell/uL–>Valganciclovir is given prophylactically
HIV prophylaxis for CMV
Valganciclovir if CD4<50
Roseola Infantum
- which virus
- transmission
- MC in?
- CM
- tx
HHV-6
- common childhood disease
- trans via resp droplets
MC in 9-12MO
CM:
**HIGH fever, over 104 sometimes–lasting 3-5 days
**other than fever— child appears fine
**fever will resolve abruptly before onset of rash
RASH: rose pink, maculopapular, blanchable rash, begins on the trunk and neck–>moves to face–lasts up to 2 days
Diagnosis: clinical
TX:
- supp
- self limitng
Erythema Infectiosum
- virus?
- dz?
- what happens if pregnant mom has it
Parovirus B19
Fifths dz
trans: respiratory droplets, percutanous exp to blood, crosses placenta
Pregnancy: cytotoxic effect on fetal RBCs–severe anemia and CHF, spontanous abortions, hydrops fetalis
CM:
- begins with flu like symp
- then a rash— “slapped cheeck”
- then: erythematous maculopapular rash on proximal extremities (usually arms and extensor surfaces) and trunk— fades into classic lacelike reticular pattern rash
* *rash can return from overheating in the sun, hot baths or stress
Diagnosis:
-clinical
TX:
- Symptomatic
- self limiting
Measles
- also called
- virus?
- CM
- diagnosis
- tx including superinfection preventions
- prevention
Rubeola
Paramyxovirus
***one of the most contagious directly transmitted pathogens
transmission: resp droplets
CM:
- prodrome (3 C’s)
* *Cough
* *coryza–nasal discharge
* *Conjunctivitis - Koplik spots–bluish grey grain of salt with red halo
- followed by a macular rash and fever–starting on the HEAD/HAIRLINE and spreading downwards–palms and soles
diagnosis:
* Clinical
* confirmatory: serology MC: either one is a + test
1. + measles virus-specific IgM in a single specimen of serum or oral fluid
2. fourfold or greater increase in measles virus-specific IGG antibody levels
3. PCR*****
tx:
1. supportive care
2. superinfection preventions
* Vit A high doses
* ribavirin–in cases of pneumonia
* Mealses immune globulin (if high risk PT)
Prevention MMR vaccine-- live attenuated 2 doses 1st: 12-15 MO 2nd: 4-6YO
complication of measles
encephalitis
—rare
pneumonia–mc of mortality
Rubella or German measles
- virus
- transm
- CM
Togavirus
respiratory transmission
CM:
- prodrome: low grade fever, cough, anorexia, lymphadenopathy (posterior cervical, posterior auricular)
- RASH: pink or light pink nonconfluent maculopapular rash starting on the FACE and spreads to the trunnk and extremities—-rash is usually first symptom
* **rash lasts 3 days - Forchheimer spots: petechia on soft palate
Diagnosis:
- diff to diagnose clinically bc the rash looks similar to other dz
1. Serologic testing–rubella specific IgM OR a 4-fold increase in rubella-specific IGG antibody titer
2. viral culture
TX:
- supportive
- Prognosis: not assoc with complications in children (compared to rubeola)
- BUT it is teratogenic in first trimester
Prevention: MMR
1st: 12-15MO
2nd: 4-6 YO
which spreads more rapdily– rubeola or rubella
rubella
which is MC to cause poorer prognosis–rubella or rubeola
Rubeola– measles
which is more of a mild illness–rubella or rubeola (measles)
rubella
maculopapular rash that starts on the hairline/forehead–>extremities and then disappears from head to toe direction
Rubeola or measles
which is a congential infection that is highly pathologic esp in the first trimester
Rubella or german measles
mumps
- virus
- was MC in____ but now MC in____
- CM
- complications
- prevention
Paramyxovirus
transmission= respiratory droplets, fomites, saliva
*was MC in 5-9… now MC in college students
CM *low grade fever *malaise *HA *myalgias *anorxia \+parotid gland swelling + pain--usuually bilateral in 48 hours
diagnosis: clinical
Labs: incr amylase
complications:
1. Orchitis–inflamm of testicle(s)– usually unilateral
2. encephalitis
3. meningitis
4. pancreatitis–MC infectious cause of pancreatitis in kids
Prevention:
MMR–two doses
1st=12-15MO
2nd=4-6YO
rabies virus
- what viral family
- infects what?
- tx
- post exposure first episode
Rhabdoviridae
infection of the CNS— encephalitis of the gray matter is 80%
* paralytic dz is 20%
trans from infected saliva of rapid animal bites–ZOONOTIC DZ
*dogs, cats, bats, raccoons, skunks, foxes, coyotes, groundhogs (only rodent)
CM
PRODROME: *Pain *parathesia *itching at bite site–hallmark
CNS phase: encephalitis, hydrophobia (painful laryngospasm after drinking—seeing or hearing water is bad), numbness, paralysis
“rapid rage” and hypersalivation
respiratory phase= paralysis of resp muscles–DEATH
diagnosis:
NEGRI BODIES in the brain— seen on autopsy
negri bodies=eosinophilic cytoplasmic inclusions composed of rabies virus proteins and viral RNA
*diagnostic TOC= direct fluorescent antibody testing from bisy of specimen of skin from the nape of the neck
TX:
*no effective management once symptoms start— pts rarely survive
EXPOSURE:
- first episode: Rabies vaccine AND rabies Immune Globulin (RIG)
* vaccine—if healthy: days 0, 3, 7, 14, (add 5th dose, day 28 if immunocomp*
* RIG—-half direclty into the wound and surrounding areas… other 1/2 IM distal frm wound - second exposure or more: vaccine alone on days 0 and 3–NO immunoglobulin
only rodent capable of rabies
groundhog
name the viruses part of the paramyxovirus family (4)
- measles/rubeola
- mumps
- Rubella/german measles
influenza A causes?
worldwide epidemics–pandemics
Influenza B causes
major outbreak of influenza
Influenza C causes
mild respiratory
highest rates of influenza age group
<5 and >64
MC population to be affected by influenza
children
MC population to have serious dz with influenza
pregnant
elderly
children
Influenza -which train is assoc with more severe illness transmission -cm -when do s/s go away -diagnose--gold standard? -tx-- when should it begin, DOC?
A»_space;>B for more severe outbreaks
transmission= resp secretions–sneezing, couhgin, talking, breathing, or fomite
CM:
- *ABRUPT ONSET of the following
1. fever/chills
2. muscle/body aches–MC legs and lumbosacral
3. HA
4. sore throat
5. cough - s/s usually spontaneously resolve 4-7 days
Diagnosis:
- rapid influenza nasal swab–high specificity and fast
- clinical
- gold standard=viral culture (takes 3-7 days) or RT-PCR
- if secondary infection is present– order CXR
TX: given w/in 48 hours of onset of s/s
**mostly supportive but can give antivirals
THREE DRUGS FDA APPROVED FOR A and B:
1. Oseltamivir (tamiflu) PO ** DOC for anyone even pregnant/elderly/hospitallized/complicated infections
2. Zanamivir–inhaled nose
3. Peramivir–IV
M2 inhibitors: given within 48 hours of onset of s/s
- Amantadine***
- Rimantadine
* **act only against influenza A
* *high resistance to these drugs—not recc for tx or prophylaxis
complications from influenza
- pneumonia
- resp failure
- meningitis
- myocarditis
- encephalitis
- rhabdo
- Kidney failure
- death
list the neuraminidsae inhibitors and what do they treat
antivirals and tx influenza A and B
Oseltamivir (tamiflu) PO ** DOC for anyone even pregnant/elderly/hospitallized/complicated infections
2. Zanamivir–inhaled nose
3. Peramivir–IV
list the M2 inhibitors and what they tx
tx influenza A only
- Amantadine **
- Rimantadine
* **act only against influenza A
* *high resistance to these drugs—not recc for tx or prophylaxis
influenza prevention
Prevention
1. chemoprophylaxis–>antivirals if contact with infected
2. Influenza vaccine–ANNUALLY for everyone >6MO who dont have contraindications
**contains both A and B strains
**two types avail in US:
A) inactivated vaccine–70% efficiacy
B) A live, attenuated vaccine–recc for kids with 90% efficacy, 85% in adults, given intranasally–NEVER GIVE TO PREGNANT OR IMMUNOCOMP
80-90% of genital lesions are caused by
HSV-2
the other 10-20% is HSV-1
Genital Herpes
- RF (5)
- CM–primary and recurence infectinos
- PE findings
- diagnosis (3)– TOC? gold standard?
- TX
RF:
- female > male
- AA > caucasians
- new sexual partner
- infrequent condom use
- MSM
CM:
- PRIMARY INFECTION
1. prodrome of systemic features–Fever, HA, malaise, localized pain and itching, dysuria, or tender lymphadenopathy
2. then painful genital ulcers: starts as erythematous lesions then develops into groups of vesicles and pustules - RECURRENT INFECTION
- MC with HSV-2 and immunodeficient PT
- presentation LESS SEVERE, with fewer lesions and shorter duration (7-10days)
- but can occur very frequently up to 10X/yr
- recurrence usually decrs over time
PE:
- multiple, shallow, tender ulcers
- grouped vesicles on an erythematous base
- inguinal lymphadenopathy
Diagnosis:
- *TOC is PCR– msot sensitive and specific
- direct microscopy–Tzank smear–>multinucleated giant cells and +/- eosinophilic intracellular inclusions
- direct fluorescent antibody or type-specific serologic tests (Gold stand)—but not as sensitive/specific as PCR
TX:
- antivirals: Acyclovir, valacyclovir or famciclovir
- first episode: PO acyclovir (5x/day) or valacyclovir (BID)
- recurrent: PO acyclovir (TID) and valacyclovir (BID)
* *can also give the antivirals daily for suppression
which herpes strain can cause tonsillopharyngitis in adults and gingivostomatitis in children
HSV-1
which serotpes of HPV are linked to cervical CA
**16
**18
31
33
papilloma is?
benign tumors of squamous cells— warts
HPV
- transmission
- CM for the diff serotypes: 1-4, 6, 11, 16, 18,
- diagnosis
- tx and prevention
trans=skin to skin contact, including genital contact
infects squamous epithelial cells
CM:
- *serotypes 1-4**
1. skin warts–hands, fingers, soles of feet
serotypes 6, 11, 16, 18
1. condylomata acuminata–soft, fleshy, cauliflower like lesions, most are asympto but can be:
+itching +burning +pain and +tenderness
*6 and 11: koilocytes aka gential warts
]16 and 18: preneoplastic and can progress to squamous cell carcinoma
diagnosis:
* clinical
* Can do PCR or biospy of lesion
TX:
1. wart removal–cryoablation with liquid nitrogen, topical Imiquimod and Podofilox are PT applied at home vs Podophyllin, Bichloroacetic acid and Trichloroacetic acid are clinical applied
- prevention:
*Gardasil 9–> first dose age 10–12 and 2nd dose 6-12 MO later
*if starting after age 15: then 3 doses is reccomended
DO NOT GIVE TO PREGNANT OR BF MOMS
which serotypes of HPV cause condylomata acuminata
6, 11, 16, 18
what serotypes does Gardsil 9 cover
6 11 16 18 31 33 45 52 58
dosing schedule for Gardsil-9
- <15
- > 15
- immunocomp
- two doses six mo apart
- three doses: 0, 1-2 MO, and 6 mo
- three doses: 0, 1-2MO and 6 MO
HIV-1 vs HIV-2
HIV-1 is found wordwilde
HIV-2 is found mainly in western africa
both cause AIDS
HIV / AIDS
- transmission
- CM: each stage– how do you define late stage?
- two MC opportunistic infections ?
trans= MC person-person via sex, mother to child during delivery, contact with blood IVDU, needle sticks
takes a very high dose of HIV to cause infection—why very few HC workers have become sick thru needle sticks
CM: acute, middle/latent, late/immunodeficiency
- Acute phase: acute seroconvertion
* 2-4 weeks after infection
* flu-like or mononcleosis-like illness:
* fever
* lethargy
* sore throat
* gen lymphadenopathy
* Maculopapular rash on trunk, arms, and legs
* readily transmissible bc high viral load - middle/latent phase (chronic phase)
* usually measured in years
* if untx–>latent period lasts for 7-11 yrs
* pateints usually asympto—-but large amt of HIV is being produced
* AIDS-related complx (ARC)–>fever, fatige, wt loss and lymphadenopathy - Late/immunodeficient
AIDS
*CD4 count below 200 u/uL or a CD4+ T cell percent of total lymphocytes of <14%
AND/OR at least 1 AIDS-defining condition–>opportunistic infections
two MC infections are: - Kaposi’s sarcoma
- Pneumocystis pneumonia
who has higher risk of getting HIV– circumcised or uncircumcised males
uncircumcised
when do antibodies to HIV typically appear
10-14 days after infections (during the acute phase)
most patients will have a + test for HIV by when
3-4 weeks after infection
this means they have seroconverted
list fungal and parasitic infections that affect AIDS PT
Candidiasis *** Crptyococcal meningitis Cryptosporidium Coccidiodomycosis PCP Cerebral toxoplasmosis Histoplasmosis
Bacterial infections affecting AIDS pt
Mycobacterium avium-intracellulare
TB
Salmonella septicemia
Nocardia
Viral infections affecting AIDS pt
Herpes zoster
CMV
HSV encephalitis
Maliginancies assoc with AIDS
Lymphoma–Burkitt’s immunoblastic
Kaposi sarcoma
how to diagnose HIV
- pre test counseling?
- indications for testing ?
- what are the three main tests and what do they test
- other tests (6)
pre-test counseling:
- discuss inds for HIV testing
- risk assessment
- implications of positive test results
- discuss confidentiality and F/U
Indications for testing
- screening: test all adolescents and adults at incr risk for HIV and ALL PREGNANT WOMEN
- any PT with features of chronic HIV infection
TESTS:
- –>4th generation enzyme immunoassay (EIA) for HIV 1 an 2
- *detects antibodies (3-12 weeks psot infection) and p24 antigen of HIV
- *negative result=no further testing
- *pos result= —>test HIV-1 and HIV-2 antibody differentiation immunoassay
—> indeterminate results: test with FDA approed HIV-1 nucleic acid test
OTHER TESTS
- Western blot: 2 bands present= positive
- Reverse transcriptase-polymerase chain reaction (RT-PCR)–>tells you the viral load
- HBV and HCV serologies–can affect choice of therapy
- . other sexual transmitted dz
- CBC, BMP, LFTs, fasting lipid profile, A1c, UA
- Pregnancy test
* antivirlas can afffect liver funct and dyslipidemia and glucoe tolerance,
- **basically:
- combination of antigen/antibody immunoassay (screening) + HIV viral load testing (RT-PCR)
HIV Results: negative screening immunoassay + positive virologic tests– what does this mean
early HIV
*getting a second postiive virologic test will suggest HIV infection
Positive HIV screening immunoassay + positive virologic test=?
early or established infection
**confirm this with a second test: repeat HIV RNA or serologic test weeks later
4th generation enzyme immnoassay (EIA) tests for what
- HIV-1 and HIV-2 antibodies that appear 3-12 weeks after infection
- p24 antigen of HIV
CD4+ T cell count assess?
immune function of HIV PT
p24 antigen
viral core protein that appears in the blood as the viral RNA level rises following HIV infection
viral RNA load asseess?
viremia
*pronostic marker in long-term management
what tests do we do for monitoring of HIV
- Viral RNA load–indicator of antiretrovirl therapy response: decr viral load indicates effective tx
- CD4+ T cell count: increases with antiretroviral tx
TX HIV
- list the MC classes
- regimen for newly diganosed?
- post-exposure prophylaxis
- pre-exposure prohyplaxis
Antiretroviral therapy for ALL patients
- *highly active retroviral therapy (HAART) is mainstay in US
- *over 26 drugs
- *6 major classes
MC ones are:
- Nucleoside Reverse Transcriptase Inhibitor (NRTI)
- Non-nucleoside reverse transcriptase inhibitor (NNRTI)
- Integrase strand transfer inhibitor (INSTI)
- Protease inhibitor
Regimens for newly diagnose PT:
*2 different NRTIs + INSTI
POST-EXP Prophylaxis:
1. within 72 hours of exposure–3 drug regimen x28 days
PRE-EXP Prophylaxis:
- reduce the risk in uninfected high-risk individuals
* 2 drug regimen
CD4 count is <200, what is HIV PT at risk for and what is tx
PCP
Bactrim DS
CD4 count is <150, what is HIV PT at risk for and what is tx
Histoplasmosis if endemic area
Itraconazole
CD4 count is <100, what is HIV PT at risk for and what is tx
Toxoplasmosis
Bactrim DS
and
Cryptococcus
Fluconazole
CD4 count is <50, what is HIV PT at risk for and what is tx
MAC
Azithro or Clarithro
and
CMV Retinitis
Valganciclovir
AIDS is defined as?
CD4 count <200 cells/uL
recurrent and life threatening opportunistic infectinos or malginancies occur
criteria for the diagnosis of AIDS?
CD4 count <200
OR
AIDS-defining illness like Pneumocystis pneumonia
