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MICRO ADYA > Microbiology 13 - Opportunistic viral infection > Flashcards

Microbiology 13 - Opportunistic viral infection Flashcards

1
Q

What system is used to classify viruses?

A

Baltimore classification system

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2
Q

What class of viruses form latent infections?

A

DNA viruses

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3
Q

How is most viral serology performed?

A

Indirectc ELISA

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4
Q

Recall 3 reasons for immunosuppression

A
  1. Solid organ transplant
  2. Human stem cell transplant (short term, or long term if they have significant GVHD)
  3. HIV/AIDS
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5
Q

Recall 4 types of immunosuppressing drugs

A
  1. Steroids
  2. Calcineurin inhibitors
  3. Anti-proliferative agent (eg. Azothioprine/ mycophenolate)
  4. Antibodies
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6
Q

What is the most important opportunistic virus in transplant patients?

A

CMV

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7
Q

What virus causes multifocal leukoencephalopathy?

A

JC virus

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8
Q

What is a common re-activator of latent HSV?

A

Stressful situations

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9
Q

What is HHV4?

A

EBV

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10
Q

What is HHV8?

A

Kaposi’s sarcoma associated herpesvirus

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11
Q

What drug would you give to someone who has CMV AND is immunosuppressed?

A

Valganciclovir

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12
Q

For which hepatitis viruses are there vaccines?

A

Hep A and B

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13
Q

Why is adenovirus particularly problematic in post-bone marrow transplant children?

A

You get disseminated disease

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14
Q

What is the treatment for disseminated adenovirus?

A

Cidofavir

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15
Q

In which patients does JC virus cause PML?

A

AIDS patients

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16
Q

What two conditions can BK virus cause in the immunosuppressed?

A
  • *Stem cell transplant:** Haemorrhagic cystitis
  • *Renal transplant:** Nephropathy

If have a patient with haematuria and lots of clots, think about this

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17
Q

What disease does parvovirus cause in a chronically immunosuppressed patient?

A

Anaemia

18
Q

In renal transplants, is risk of CMV transmission when the donor or recipient is positive?

A

Donor is pos as recipient has never seen CMV before

19
Q

In Human Stem Cell Transplants, is risk of CMV transmission when the donor or recipient is positive?

A

Donor is neg (recipient is pos) as patient with CMV has immune system replaced with one that is CMV-naive

20
Q

Describe the pattern of symptoms caused by varicella infection in the immunocompromised

A

Pneumonitis, encephalitis and hepatitis
In neonate: purpura fulminans

21
Q

What is the most common malignancy caused by EBV?

A

Post-transplant lymphoproliferative disorder

22
Q

What is the most common clinical syndrome caused by CMV infection in immunocompromised? HOw is this idff to immunocomptenet?

A

immunosuppressed: Retinitis
immjnocompetent: tends to be asymptomatic or can cause infectious mononucleosis

23
Q

What CMV prophylaxis is offered, and to whom?

A

Ganciclovir
Given to all transplant patients

24
Q
A
25
Q

Recall which infections affect HIV patients?

A
26
Q

What is HHV3?

A

VZV

27
Q

Solid organ transplant vs stem cell transplant: viral infections

A

Solid organ transplant:

  • viral reactivation occurs >1month after

Stem cell transplant:

  • viral reactivation occurs within 1 month as there’s extensive immunosuppression
28
Q

What are the 3 sources of infection following transplant?

A
29
Q

Are herpes viruses DNA or RNA viruses?

A

DNA viruses

30
Q

What is a defining feature of herpes viruses?

A

they have a tendency to reactivate in immunocompromised patients

and persists for life in the host

31
Q

Where do VZV, EBV and CMV cause latent infection?

A

VZV: dorsal root ganglion

EBV: B cells

CMV: dendirtic cells and monocytes

32
Q

Which HHV’s tend to reactivate in BM transplant patients?

A

HSV, HHV6 and HHV7

33
Q
A
34
Q

HSV1 vs HSV 2

A

HSV1- oral/ mucocutaneous

HSV2- genital

35
Q

Indications for HSV prophylaxis

A
  • CD4 <200 in HIV/AIDS
  • Bone marrow:
    • 1 month (until engraftment)
  • Solid organ:
    • 3-6 months prior to transplant
    • And if treated for rejection
36
Q

When does VZV present?

A
  • Usually a late complication in post-transplant
  • Can be an early manifestation in HIV:
  • → indication for HIV testing particularly in young person
37
Q

How does VZV present in immunocmpmroised?

A

Really severe

Multi-dermatomal

Can disseminate

→ associated with high mortality

38
Q

What is PTLD?

A

post-transplant lympho-proliferative disorder

Immunosuppression used in organ transplants

→ breakdown of immunosurveillance keeping B cells and EBV in check

→ polyclonal expansion of B cells

→ predisposes to lymphoma

39
Q
A
40
Q

What is the pathological hallmark of CMV?:

A

Owl’s eye appearance on lung pneumocytes

due to inclusion bodies

41
Q

How much immunosuppression is needed post-transplant in SOT vs HSCT?

A
  • Solid Organ Transplant
    • requires lifelong immunosuppression
  • Haematological Transplant
    • intense immunosuppression
    • for a relatively short period of time
42
Q

Kaposi sarcoma histology

A

spindle cell proliferation

neo-angiogenesis

inflammation

and oedema

MICRO ADYA (22 decks)

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