Major viral pathogens

Question 1

what are the causes of necrotizing retinitis?

Answer 1

HSV and VZV

Question 2

what is the most common cause of acute, sporadic encephalitis? what are the signs?

Answer 2

HSV encephalitis

fever and focal signs (temporal lobe enhancement)

Question 3

what should be considered in recurrent meningitis associated with reactivation of HSV?

Answer 3

mollaret syndrome

Question 4

what constitutes the clinical diagnosis for HSV?

Answer 4

painful vesicular lesions with a surrounding erythematous base

Question 5

what constitutes the cytologic diagnosis for HSV?

Answer 5

Tzanck smear - intranuclear inclusions and multinucleated giant cells (suggestive)

Question 6

what is the gold standard test for HSV diagnosis?

Answer 6

culture / PCR on direct specimens

Question 7

route and dose/duration treatment for HSV is dependent upon what factors?

Answer 7

• primary infection or reactivation?
• deep / visceral or superficial, or CNS
• immunocompromised host?

Question 8

what is the main drug used to treat HSV?

Answer 8

acyclovir

Question 9

what visceral involvement is seen in VZV infection?

Answer 9

CNS
pneumonitis
hepatitis

Question 10

what are the clinical manifestations of VZV infection?

Answer 10

exanthema and enanthem
bacterial skin superinfection
visceral involvement
disseminated

Question 11

what is the most common visceral complication of VZV infection?

Answer 11

varicella pneumonia

Question 12

what are the risk factors associated with varicella pneumonia?

Answer 12

smoking
pregnancy
immunosuppression

Question 13

what is herpes zoster?

Answer 13

reactivation of latent VZV in sensory DRG

Question 14

which DRGs are commonly associated with herpes zoster?

Answer 14

T3-L3

Question 15

what antiviral is used to treat VZV?

Answer 15

acyclovir

Question 16

what are the diagnostic lab tests for VZV?

Answer 16

Tzanck
culture
PCR
serology (previous infection)

Question 17

zoster treatment depends on what?

Answer 17

complicated or uncomplicated infection

Question 18

what drugs are used for herpes zoster treatment?

Answer 18

acyclovir
valacyclovir
famcyclovir
foscarnet

Question 19

does EBV have a cytopathic effect?

Answer 19

no

Question 20

what are the clinical manifestations of EBV? when do symptoms resolve?

Answer 20

• fever, adenopathy, pharyngitis
• splenomegaly (50%)
• rash (50%)

most symptoms resolve in 3 weeks

Question 21

what are the lab diagnostic tests for EBV?

Answer 21

• heterophil antibodies
• atypical lymphocytosis
• EBV specific antibodies
• PCR for viral DNA, not in healthy hosts

Question 22

what is the treatment for EBV?

Answer 22

• supportive care
• avoid contact sports
• steroids only for limited situations
• acyclovir

Question 23

what is the transmission for CMV?

Answer 23

childhood
sexual
transfusion / transplant

Question 24

what is diagnostic for CMV?

Answer 24

histology - owl’s eye inclusions

Question 25

what are the clinical manifestations of CMV?

Answer 25

• exudative pharyngitis and cervical adenopathy rare as opposed to EBV
• ampicillin induced rash
• alk phos and transaminases usually elevated

Question 26

what constitutes diagnosis for CMV?

Answer 26

• viral isolation (PCR)
• serology (antibodies)
• PCR for CMV DNA

Question 27

does a positive PCR prove CMV disease?

Answer 27

no

Question 28

what is the treatment for CMV?

Answer 28

gancyclovir / valgancyclovir

foscarnet

Question 29

what is the MOA of gancyclovir / valgancyclovir?

Answer 29

selective inhibitor of CMV DNA pol mojor toxicity - neutropenia

Question 30

which drug is effective in gangcyclovir resistant strains?

Answer 30

foscarnet