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Viruses & Parasites > L74 > Flashcards

L74 Flashcards

1
Q

What receptor confines the tropism of EBV?

A

CR2 receptor

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2
Q

Which tissues and cells does EBV infect?

A

B lymphocytes
Mouth & nose epithelium
Also an STI b/c in vaginal secretions from the cervical epi, but weird b/c no CR2Rs here

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3
Q

Can EBV have a lytic stage of infection?

A

Yes

In B cells & epithelium

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4
Q

Can EBV have a latent stage of infection?

A

Yes

More common in B cells

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5
Q

What genetic element allows EBV to become latent?

A

Episome

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6
Q

What is the worst case scenario of an EBV infection?

A

CANCER

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7
Q

What cancers are EBV associated?

A

B cell lymphoma - Burkitt
Nasopharyngeal carcinoma
Post transplant lympho-proliferative disorder (PTLPD)
Maybe other T & B lymphomas (Hodgkin’s)

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8
Q

Most common EBV disease in normal people.

A

Mono - aggultinin + !!

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9
Q

EBV transmission

A

Saliva
Blood product
Transplant
STI

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10
Q

How do you know staph vs EBV pharyngitis?

A

Present in clinic
Probably going to give penicillin (ampicillin)
EBV gets a RASH –> doesn’t get better

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11
Q

Which arm of the immune system is most important in controlling EBV latent infection?

A

T cells

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12
Q

What is a cue that a pt is EBV infected during the acute phase?

A

See atypical lymphocytes on peripheral blood smear

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13
Q

Describe the Ab response to EBV in terms of symptom progression.

A
  1. Before symptoms: IgM/IgG vs E antigens
  2. Symptomatic: IgM Abs that agglutinate!!!
  3. Resolving: Abs vs EBNA
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14
Q

What is EBNA?

A

Epstein Barr nuclear antigen

See Abs vs these - know infection is resolving

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15
Q

What is a neurologic disorder you might see with EBV in normal pts?

A

Guillain Barre - ascending paralysis

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16
Q

If an AIDs negative IC pt presents with falling CD4 ct + EBV infection, which clinical disease are you thinking of?

A 
B cell (Burkitt) lymphoma 
May present w/ malaria
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17
Q

Which EBV infection is most common in HIV pts?

A

Hairy oral leukoplakia

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18
Q

Which EBV infection is most common in transplant pts?

A

Post transplant lympho proliferative disorder

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19
Q

Describe the progression of PTLD.

A 
Early = benign growth that respond to anti-virals
Late = malignant growths
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20
Q

How does PTLD present on histo?

A

HISTO: multi-nucleated giant cells

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21
Q

Diagnose EBV

A
  1. PCR for EBV DNA

2. Immunocytochem for EBV proteins

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22
Q

EBV prophylaxis

A

Acyclovir

Gancyclovir (valgan)

23
Q

Treat EBV mono

A

Supportive

Severe: steroids - prevent spleen damage

24
Q

Can you treat EBV cancers with anti-virals?

A

No you dummy

That’s why you don’t what to progress this far - need chemo

25
Q

Treat PTLD

A

Non-specific immunoglobulin
IFNa
Chemo
Rituximab (anti-CD20)

26
Q

Name the 2 big diseases caused by VZV.

A

Chicken pox

Shingles

27
Q

What does the chicken pox rash look like?

A

Infects EPI cells - duh, why its a rash!
Blistering rash
May also be pustular
At all different levels of progression

28
Q

Why does it matter that VZV is neurotropic?

A

Reactivate (Shingles) = painful lesions

29
Q

When in the disease does the chicken pox rash occur?

A

2nd!
Infection
1. Prodrome viremia = 9-13 days post-infection
2. Rash on face/scalp first, then trunk = 10-20 days post-infect

30
Q

Where does VZV lie dormant?

A

DRG

CN ganglia

31
Q

Who is most likely to get chicken pox complications?

A

IC pts: newborns, pregnant, transplant, AIDs

32
Q

Complications of chicken pox

A

CNS
Lungs: pneumonitis
Liver
Reye’s syndrome - aka don’t give aspirin to kids!!!

33
Q

Hallmarks of Shingles rash

A

Vesiculopustular
Painful
Stops at midline

34
Q

Shingles complications

A

Post-herpetic neuralgia

If CN 5 involvement –> encephalitis

35
Q

What is the Shingles complication if there is geniculate ganglion involvement?

A

Ramsey Hunt Syndrome

  • 1 sided facial palsy
  • Lesions in ear
  • Loss taste ant 2/3 tongue
36
Q

Immune response to VZV

A

IgM + IgG - limit spread

CD4 - resolve rash

37
Q

You’re probably diagnosing CP/Shingles clinically, but if you really wanted to what test would you order?

A

Pap smear of a lesion
Direct fluorescent Ab
PCR of CSF if neuro involvment

38
Q

What is the chicken pox vaccine?

A

Live, attenuated
2 shots
Prevents chicken pox in kids & decreases shingles in elderly

39
Q

Which vaccine do you give to IC pts?

A

VZIG = immunoglobulin
Ex: pregnant women who have been exposed to chicken pox
Babies whose mothers have chicken pox

40
Q

When and how do you treat chicken pox?

A

24 hrs of 1st lesion: PO acyclovir

Otherwise supportive

41
Q

How do you treat IC pts with chicken pox?

A

Acyclovir IV

42
Q

When and how do you treat Shingles in normal pts?

A

72hrs of 1st lesion: 7 day course of PO

  • Acyclovir
  • Famciclovir
  • Valacyclovir
43
Q

Which shingles complication/presentation should you always treat?

A

Opthalmic zoster

44
Q

How do you treat shingles in IC pts?

A

IV acyclovir

Goal: decrease severity + speed healing

45
Q

When does HHV 6 infection occur in life in comparison to CMV and EBV?

A

Earlier in life!

46
Q

Which skin disease is most common in kids due to HHV6?

A

Roseola = exanthem subitum
1. Fever
Followed by
2. Red, raised rash w/o fever

47
Q

Which conditions would clue you into an HHV 6 infection in kids AND adults?

A

Mono
Seizures in kids
Delayed bone marrow grafts in bone marrow transplant pts
DRESS syndrome = drug rxn eosinophila w/ systemic symptoms

48
Q

Diagnose HHV6 infection.

A

Clinical
Serology: IgM & IgG
PCR

49
Q

What 3 characteristics are unique about HHV8?

A
  1. Tumor promoting genes
  2. Lympho AND angiotrophic
  3. Has proteins homologous to cell proteins
50
Q

Which tissues does HHV8 infect?

A

Uro & GI epithelium

51
Q

How does HHV8 lie latent?

A

Episome - contributes to oncogenic reactivation

52
Q

Where in the world are HHV8 infections most prevalent?

A

Mediterranean + Africa

53
Q

HHV8 transmission

A

Sex***
Mom-baby
Oral
Blood

Viruses & Parasites (21 decks)

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