Micro 4 - Opportunistic viral infections

Question 1

at what CD4 count do HIV opportunistic infections start to occur?

Answer 1

CD4<200

Question 2

2 examples of calcineurin inhibitors of T cell function

Answer 2

Tacrolimus, cyclosporin

Question 3

2 examples of anti-proliferative agents used in transplant patients

Answer 3

Mycophenolate mofetil (T>B)
Azathioprine (T>B)

Question 4

Renal transplant highest risk for CMV based on what donor and recipient virus status?

Answer 4

Donor + recipient -

Question 5

BM transplant highest risk for CMV based on what donor and recipient virus status?

Answer 5

Donor - recipient +

Question 6

which virus typically presents >12 months after transplant?

Answer 6

VZV (NOVEL VIRUS)

Question 7

what is the most important virus to screen for pre renal transplant?

Answer 7

CMV

Question 8

what are HHV-1 and HHV-2?

Answer 8

HSV-1 and HSV-2

Question 9

Name some herpes viruses

Answer 9

EBV, VZV, CMV, Roseola virus

Question 10

pain on swallowing after a liver transplant - which virus?

Answer 10

HSV

Question 11

pathognomic histology feature of CMV pneumonitis

Answer 11

Owl’s eye lung pneumocytes (inclusion Bodies)

Question 12

what is the prophylaxis regimen in those undergoing SOT

Answer 12

Valganciclovir (PO) for 100 days

Question 13

treatment of CMV post transplant

Answer 13

Ganciclovir (IV)

Question 14

management of CMV post HSCT

Answer 14

IV Foscarnet, NEVER GIVE GANCICLOVIR (HAS BM SUPPRESSIVE EFFECTS)

Question 15

WHAT IS THE biggest concern with EBV in transplant patients?

Answer 15

PTLD = Post transplant lymphoproliferative disease

Question 16

mx of PTLD

Answer 16

Rituximab to deplete the B cells + reduce the immunosuppression

Question 17

virus causing progressive multifocal leukoencephalopathy

Answer 17

JC Virus

Question 18

Risk factors for PML

Answer 18

Natalizumab (monoclonal antibody for MS)
Mycophenolate mofetil
Rituximab

Question 19

name 2 types of polyoma virus

Answer 19

JK virus and BK virus

Question 20

what two conditions can BK virus cause and in which population of people?

Answer 20

Post SOT –> BK Nephropathy

Post HSCT –> BK cystitis

Question 21

Tx of adenovirus infection?

Answer 21

cidofovir

Question 22

When is adenovirus problematic?

Answer 22

Post BMT pts

Question 23

diagnosis of parvovirus 19

Answer 23

PCR of blood (serology is NOT useful)

Question 24

treatment of parvovirus B19

Answer 24

IVIG

Question 25

symptoms of parvovirus B19 In immunocompromised?

Answer 25

chronic anaemia, aplastic anaemia

Question 26

Which lab investigation is pointless in identifying presence of opportunistic infection in a post-BMT patient? therefore which investigation should you request?

Answer 26

Serology (pt cannot yet mount an immune response) therefore you request VIRAL PCR

Question 27

When does HSV tend to affect transplant patients?

Answer 27

<1 month