MI: Opportunistic Viral Infections Pt.2

Question 1

What is the main concern regarding EBV and transplants?

Answer 1

Post-transplant lymphoproliferative disease

Question 2

Outline the main features of post-transplant lymphoproliferative disease.

Answer 2

Raised EBV viral load associated with widespread lymphadenopathy

Question 3

How is post-transplant lymphoproliferative disease managed?

Answer 3

Reduce immunosuppression

Anti-CD20 antibodies (e.g. rituximab)

Question 4

Which virus is Kaposi sarcoma associated with?

Answer 4

HHV8

Question 5

Which other diseases is HHV8 associated with?

Answer 5

Primary effusion lymphoma

Multicentric Castleman’s disease

Question 6

List the characteristic histological findings of Kaposi sarcoma

Answer 6

Spindle cell proliferation

Neo-angiogenesis

Inflammation and oedema

Question 7

How is Kaposi sarcoma treated?

Answer 7

Chemotherapy

Antiretoviral therapy

Question 8

What deadly condition is is JC virus associated with?

Answer 8

Progressive multifocal leukoencephalopathy (PML)

This is a dementing process characterised by loss of higher functions (personality change, motor deficits, focal neurological signs)

Characterised by demyelination of white matter

Question 9

How is PML diagnosed?

Answer 9

MRI

PCR of CSF

Question 10

Which specific medication is associated with an icreased risk of PML?

Answer 10

Natalizumab - monoclonal antibody used in the treatment of multiple sclerosis

Question 11

What can a BK virus cause?

Answer 11

BK cystitis (post-stem cell transplant)

BK nephropathy (post-renal transplant)

NOTE: can be treated by reducing immunosuppression

Question 12

In which group of patients is adenovirus a major problem?

Answer 12

Bone marrow transplant patients

Question 13

List some manifestations of adenovirus infection in bone marrow transplant patients.

Answer 13

• Fever
• Encephalitis
• Pneumonitis
• Colitis

Question 14

List some viral causes of pneumonia with high mortality in immunocompromised patients.

Answer 14

• Influenza A and B
• Parainfluenza
• RSV
• Adenovirus
• MERS

Question 15

How are viral infections causing pneumonia in immunocompromised patients diagnosed?

Answer 15

• Nasopharyngeal aspirates
• Bronchoalveolar lavage
• Nose and throat swabs
• Multiplex PCR is the best investigation

Question 16

What does parvovirus B19 cause in the immunocompromised?

Answer 16

Causes chronic anaemia

Question 17

How is parvovirus B19 infection diagnosed in the immunocompromised?

Answer 17

PCR of the blood

NOTE: serology is not useful in immunocompromised patients

Question 18

How is parvovirus B19 infection in the immunocompromised treated?

Answer 18

IVIG

Blood transfusion may be required to correct the anaemia

Question 19

What is a feature of chronic hepatitis B infection on serology?

Answer 19

Persistant HBsAg

Question 20

What are the two consequences of hepatitis B virus in the immunocompromised?

Answer 20

Carriers may have a flare of the disease

Those with past infection may reactivate

Question 21

Which treatments particularly increase the risk of hepatitis B infection?

Answer 21

B-cell depleting therapies (e.g. rituximab)

Question 22

How can risk of hepatitis B infection with certain treatments be prevented?

Answer 22

Nucleoside/nucleotide analogue prophylaxis (e.g. tenofovir)

Question 23

How is hepatitis E different in developed countries compared to developing countries?

Answer 23

• Devloped countries - zoonosis caused by genotype 3
• Developing countries - mainly caused by genotype 1

NOTE: high mortality in pregnant women