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I&I WC2 > Immunodeficiencies II > Flashcards

Immunodeficiencies II Flashcards

1
Q

What is the main stay of detection in viral serology?

A

Detection of antibodies (IgG, IgM)

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2
Q

How is the virus detected in viral diagnostics? (3)

A
  1. Culture
  2. RNA/DNA with PCR
  3. Antigen serology
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3
Q

How is the immune response against a virus detected in viral diagnostics? (2)

A
  1. T-cell responses
  2. Antibodies
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4
Q

What are the characteristics of the immunocompromised patient? (3)

A
  1. Special host
  2. Common viruses
  3. Unique syndromes
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5
Q

Why is antigen serology not always possible in immunocompromised patients?

A

Some patients have antibody deficiency

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6
Q

True or false: diagnostics can be false negative in the immunocompromised

A

True

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7
Q

What are the symptoms of B19 virus in children? (4)

A
  1. Fever
  2. Chills
  3. Headache
  4. Myalgia
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8
Q

What are the symptoms of B19 virus in adults? (2)

A
  1. Rash
  2. Arthralgia
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9
Q

Which cells are involved in the pathogenesis of B19 virus? Leads to?

A

Precursor cells of erythrocytes causing anemia

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10
Q

What are the characteristics of a reaction of sikkel-cell anemic patients to B19 virus? (2)

A
  1. Hemolytic/stressed erythrocytes
  2. Virus excess
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11
Q

What kind of anemia occurs when sikkel-cell anemia patients get infected with B19 virus?

A

Transient aplastic anemia

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12
Q

Why do patients with a poor immune system need a lot of blood transfusions upon infection with B19 virus?

A

Mounting of an incorrect immune response -> very heavy disease and very anemic

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13
Q

True or false: antivirals work against B19

A

False

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14
Q

What is the standard treatment for B19 virus?

A

Immunoglobulins

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15
Q

Which viruses are part of the Polyomaviruses?

A
  1. BK virus
  2. JC virus
  3. Trichodysplasia spinulosa polyoma virus
  4. TSPyV
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16
Q

Polyomaviruses: the virus remains active/latent

A

Active

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17
Q

What is the percentage seroprevalence of polyomaviruses?

A

~80%

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18
Q

How does TSPyV present in heart transplant patients? (2)

A
  1. No eyebrows
  2. Spikes/hairs growing out of the skin
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19
Q

When do the symptoms ‘no eyebrows’ and ‘spikes/hairs growing out of the skin’? occur in heart transplant patients?

A

Primary infection -> almost always most severe infection

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20
Q

Why is the chance of TSPyV primary infection quite low?

A

Because of the high seroprevalence

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21
Q

Which disease is caused by JC virus?

A

Progressive Multifocal Leukoencephalopathy (PML)

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22
Q

Which drug is used to treat PML? What is its mechanism of action?

A

Natalizumab -> prevents lymphocytes to go to the brain

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23
Q

You can be either JC virus antibody positive or negative. In which instance do you have an increased change of developing PML?

A

JC viral antibody positive

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24
Q

What is the seroprevalence of CMV in adolescents?

A

~40%

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25
Q

What is the seroprevalence of CMV in adults?

A

~70%

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26
Q

What is the main route of CMV transmission?

A

Direct- and indirect contact with bodily fluids

27
Q

What are examples of direct- and indirect contact with bodily fluids leading to CMV transmission? (5)

A
  1. Saliva
  2. Urine
  3. Blood
  4. Breastmilk
  5. Sperm
28
Q

How can solid organ transplantation cause CMV transmission?

A

When a CMV negative patient receives an organ with CMV

29
Q

CMV: What is the definition of a ‘primo-infection’?

A

CMV infection in a CMV negative person

30
Q

CMV: What is the definition of ‘CMV reactivation’?

A

Replication of latent CMV

31
Q

CMV: What is the definition of ‘CMV reinfection’?

A

CMV positive person infected with a new CMV strain

32
Q

CMV: What is the definition of a ‘recurrent infection’?

A

CMV reactivation + CMV reinfection

33
Q

CMV: What is the definition of a ‘infection’?

A

Recurrent infection + primo-infection

34
Q

How does a primo-infection with CMV in immunocompetent patients often show in the clinic?

A
  1. Asymptomatic
  2. Mild viral syndrome
35
Q

How does a primo-infection with CMV in immunocompetent patients very rarely show in the clinic?

A
  1. GBS
  2. Hepatitis
  3. HLH
36
Q

How does CMV show in transplantation settings of immunocompromised patients?

A

Dysfunction of an organ because of replication of CMV in that organ

37
Q

CMV: What is the definition of ‘CMV end-organ disease’?

A

Organ dysfunction due to CMV replication in that organ

38
Q

What are examples of CMV end-organ disease? (8)

A
  1. Pneumonitis
  2. Retinitis
  3. Encefalitis
  4. Hepatitis
  5. Nefritis
  6. Cystitis
  7. Colitis
  8. Oesofagitis
39
Q

CMV: What is the definition of ‘CMV syndrome’?

A

Fever + bone marrow suppression (neutropenia/trombopenia) due to CMV infection

40
Q

CMV: What is the definition of ‘CMV disease’?

A

CMV end-organ disease + CMV syndrome

41
Q

What are the pathological characteristics of CMV end-organ disease?

A
  1. Owl eyes (CPE)
  2. IHC
42
Q

What is a supportive diagnostic in the diagnosis of CMV end-organ disease?

A

Quantitative CMV PCR in plasma

43
Q

True or false: the probability of CMV disease is inversely related to the CMV viral load

A

False -> the higher the CMV load, the higher the probability of disease

44
Q

What are the chances of getting CMV disease for the different donor/recipient combinations?

A
  1. Donor pos / recipient neg = high risk
  2. Donor pos / recipient post = intermediate
  3. Donor neg / recipient post = intermediate
  4. Donor neg / recipient neg = very low
45
Q

Allo-HSCT: What are the chances of getting CMV disease in the different recipient situations?

A
  1. Recipient pos -> high (reactivation)
  2. Recipient neg -> low
46
Q

What is the mechanism of action of nucleoside analogues?

A

Blocking viral replication by causing termination of the DNA chain

47
Q

Which antiviral therapies can be used as therapy for herpes virus infection? (4)

A
  1. Aciclovir
  2. Ganciclovir
  3. Foscarnet
  4. Cidofovir
48
Q

Which antiviral therapies can be used as therapy for VZV infection? (4)

A
  1. Aciclovir
  2. Ganciclovir
  3. Foscarnet
  4. Cidofovir
49
Q

Which antiviral therapies can be used as therapy for CMV infection? (5)

A
  1. Ganciclovir
  2. Foscarnet
  3. Cidofovir
  4. Letermovir
  5. Maribavir
50
Q

QUESTION ABOUT SELECTIVE PHOSPHOLYRATION

51
Q

What are the toxicity issues with

52
Q

What are the toxicity issues with Ganciclovir?

A

Leukopenia and thrombopenia in 30%

53
Q

What are the toxicity issues with Foscarnet?

A

Nephrotoxicity in 30%

54
Q

What are the toxicity issues with

A

Nephrotoxicity in 50%

55
Q

What are the toxicity issues with Letermovir?

A

Gastro-intestinal in 10%

56
Q

What are the toxicity issues with Maribavir?

A

Dysgeusia in 10%

57
Q

To what ends can you use anti-CMV antivirals? (3)

A
  1. Prophylaxis
  2. Pre-emptive therapy
  3. Treatment CMV disease
58
Q

What is required to be able to use anti-CMV antivirals as a prophylaxis?

A

No CMV DNA detected in blood and no CMV disease

59
Q

What is required to be able to use anti-CMV antivirals as a pre-emptive therapy?

A

Treat only when CMV DNA is detected in blood

60
Q

What is required to be able to use anti-CMV antivirals as a treatment for CMV disease?

A

Treat only when there is CMV disease -> syndrome or end-organ disease

61
Q

Which assay can you use when using cell-mediated immunity to predict risk for CMV disease after stopping prophylaxis?

A

CMV-IFNy assay

62
Q

What is the principle of the CMV IGRA assay?

A

When CMV antigens are presented, CMV-specific CD8+ T cells will recognize this antigen and start to produce IFNy

63
Q

Describe the prognosis of positive-, negative- and intermediate IFNy readouts of the CMV IGRA assay

A
  1. Positive IFNy -> good prognosis
  2. Negative IFny -> bad prognosis
  3. Intermediate -> worst prognosis
64
Q

What are the characteristics of an intermediate IFNy readout? (2)

A
  1. Reflects a high net state of immunosuppression
  2. CD8+ are not functional -> very high chance of CMV disease

I&I WC2 (16 decks)

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