Micro - opportunistic viral infections

Question 1

Egs of AIDs defining illnesses

Answer 1

CMV retiinitis
HSV oesophagi's/bronchitis/pneumonitis
Kaposi's
Burkitt's lymphoma
Progressive multifocal leukoencephalopathy

Question 2

JC virus in an immunocompromised patient –>

Answer 2

Progressive multifocal leukoencephalopathy

Question 3

In BMT patients, why are they so immunocompromised?

Answer 3

Continuous immunosuppression to prevent GvHD

Question 4

Immunosuppressive treatments:
Depleting antibody treatment?
Non-depleting antibody treatment?

Answer 4

Depleting: Rituximab (antiCD20)

Non-depleting: Basiliximab (antiCD25)

Question 5

In a patient who is post-BMT, which lab investigation result would make you suspicious of an opportunistic infection?

Answer 5

Raised transaminases (AST/ALT)

Question 6

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

Answer 6

Serology (pt can’t yet amount an immune response)

• viral PCR or rapid Ag test

Question 7

3 routes of viral infection in transplant patients

Answer 7

1) From the GRAFT
2) immunosuppression –> REACTIVATION
3) immunosuppression –> INFECTION from outside

Question 8

Name 2 herpes viruses which reside in WBCs?

Answer 8

EBV

CMV

Question 9

When does HSV tend to affect transplant patients?

Answer 9

<1 month Post-transplant

Question 10

How can HSV reactivation be prevented in transplant patients?

Answer 10

Acyclovir prophylaxis

Question 11

What is PORN (lol) in the context of an immunocompromised patient?

Answer 11

Progressive Outer Retinal Necrosis

• VZV reactivation

Question 12

In solid organ transplantation, what kinda serology is at highest risk of CMV infection

Answer 12

Donor +

Recipient -

Question 13

In bone marrow transplantation, what kinda serology is at highest risk of CMV infection

Answer 13

Donor -

Recipient + (as chemo/radio wipes out the recipient’s antibodies)

Question 14

CMV prophylaxis in solid organ transplant patients?

Answer 14

Valganciclovir for 10 days

Question 15

How is potential CMV infection monitored in bone marrow transplantation patients?

Answer 15

CMV viral load monitoring and treated when it rises

Question 16

1st line tx of CMV infection

Answer 16

Ganciclovir

Question 17

2nd line tx of CMV infection

Answer 17

Foscarnet

Question 18

which Ix confirms post transplant lymphoproliferative disease

Answer 18

Lymph node biopsy (+ viral load)

Question 19

Post-transplant lymphoproliferative disease - responsible virus?

Answer 19

EBV

Question 20

Progressive multifocal leukoencephalopathy

• Cause?
• Pathology?

Answer 20

JC virus

Demyelination of white matter

Question 21

Cystitis in a post-transplant patient : potential causative organism?

Answer 21

BK virus

Question 22

Tx of adenovirus infection?

Answer 22

Cidofovir

Question 23

When is adenovirus a problem? how is it prevented (kids vs adults)?

Answer 23

problematic in post-BMT patients
Kids: weekly monitoring
Adults: symptomatic screening

Question 24

Dx of parvovirus B19 ? Tx?

Answer 24

Dx: PCR
Tx: human normal Ig

Question 25

Transmission of Hepatitis E

Answer 25

Undercooked meat (+blood transfusion??)