Mi - Opportunistic Viral Infections Flashcards
Egs of AIDs defining illnesses
CMV retiinitis
HSV oesophagi’s/bronchitis/pneumonitis
Kaposi’s
Burkitt’s lymphoma
Progressive multifocal leukoencephalopathy
JC virus in an immunocompromised patient –>
Progressive multifocal leukoencephalopathy
In BMT patients, why are they so immunocompromised?
Continuous immunosuppression to prevent GvHD
Immunosuppressive treatments:
Depleting antibody treatment?
Non-depleting antibody treatment?
Depleting: Rituximab (antiCD20)
Non-depleting: Basiliximab (antiCD25)
In a patient who is post-BMT, which lab investigation result would make you suspicious of an opportunistic infection?
Raised transaminases (AST/ALT)
Which lab investigation is pointless in identifying presence of opportunistic infection in a post-BMT patient? therefore which investigation should you request?
Serology (pt can’t yet amount an immune response)
- viral PCR or rapid Ag test
3 routes of viral infection in transplant patients
1) From the GRAFT
2) immunosuppression –> REACTIVATION
3) immunosuppression –> INFECTION from outside
Name 2 herpes viruses which reside in WBCs?
EBV
CMV
When does HSV tend to affect transplant patients?
<1 month Post-transplant
How can HSV reactivation be prevented in transplant patients?
Acyclovir prophylaxis
In solid organ transplantation, what kind of CMV serology is at highest risk of CMV infection in recipient
Donor +
Recipient -
In bone marrow transplantation, what kinda serology is at highest risk of CMV infection
Donor -
Recipient + (as chemo/radio wipes out the recipient’s antibodies)
CMV prophylaxis in solid organ transplant patients?
Valganciclovir for 10 days
How is potential CMV infection monitored in bone marrow transplantation patients?
CMV viral load monitoring and treated when it rises
1st line tx of CMV infection
Vancyclovir
2nd line tx of CMV infection
Foscarnet
which Ix confirms post transplant lymphoproliferative disease
Lymph node biopsy (+ viral load)
Post-transplant lymphoproliferative disease - responsible virus?
EBV
Progressive multifocal leukoencephalopathy
- Cause?
- Pathology?
JC virus
Demyelination of white matter
Haemorrhagic cystitis in a post-transplant patient : potential causative organism?
BK virus
Transmission of Hepatitis E
Undercooked meat (+blood transfusion??)
Viral classification system? What is it based on?
Baltimore - how viruses replicate, whether DNA or RNA
Definition of opportunistic virus
Doesn’t affect an immunocompetent person, but will to an immunocompromised person
What does IgM presence mean?
Active infection
What does IgG presence mean?
Previous infection in last 6 weeks
How do you directly detect a virus?
PCR
Which HIV patients are most at risk of bad CMV?
If CD4 <200
Tx of HSV in immunocompromised pt?
Prophylaxis - HSV Ig test
Tx of VZV in immunocompromised patients?
7-10 days antivirals if chicken pox
Antiviral IV if disseminated +/- steroids
Complications of EBV
Oncogenic - PTLD or B cell lymphoma
Dx of EBV?
biopsy lymph nodes
What drug may work for EBV?
Rituximab
CMV Sx
Retinitis, polyradiculopathy, pneumonitis, encephalitis, GI disease
Which HIV pts get CMV?
If CD4 <50 (very low)
Which hepatitis virus is this: severe, vaccinate against?
A
Which hepatitis virus is this: reactivation, only occurs in presence of hep D, vaccinate or prophylaxis against?
B
Which hepatitis virus is this: causes fibrosis. Can give antivirals for a potential cure?
C
Which hepatitis virus is this: chronic infection, need to reduce immunosuppression as no cure?
E
What is this persons hepatitis status: sAg+ eAg+ IgM+?
Current infection
What is this persons hepatitis status: sAb+ eAB+?
Prior infection & immune
What is this persons hepatitis status: sAb+ eAb-?
Vaccinated
Mx of monkey pox?
Isolation
Small pox vaccine (low stock)
Tecovirimat if very severe (££££)
Screen for STDs inc HIV
Inform UKHSA
Sx of monkeypox
Systemic illness eg fever
Atypical rash on genitals
