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Micro > Microbiology 15: Antiviral Therapy > Flashcards

Microbiology 15: Antiviral Therapy Flashcards

1
Q

What disease does EBV cause ?

A

Infective mononucleosis

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2
Q

Where does Varicella Zoster Virus lay dormant in the body?

A

Dorsal root ganglia

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3
Q

What is a complication of Chickenpox in adults?

A

Varicella pneumonitis

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4
Q

What is a complication of shingles in immunocompetent adults ?

What complication in immunocompromised

A

Post-herpetic neuralgia - dermatomal distribution occurs

experience multi-dermatomal or disseminated infection

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5
Q

Which medication is 1st line for treatment of HSV and VZV ?

A

Aciclovir

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6
Q

What type of anti viral is acyclovir ?

A

Nucleoside (guanosine) analogue

They get incorporated into growing chain of DNA causing it to terminate

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7
Q

Give 2 reasons why aciclovir has reduced toxicity to normal cells compared to cells infected with a virus?

A

Aciclovir requires activation by viral thymidine kinase (found in cells infected by viruses)

Aciclovir has a higher affinity for Herpes virus DNA polymerase compared to human DNA polymerase

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8
Q

Which medical emergency is caused by HSV ?

Tx

A

HSV encephalitis - get fever, confusion, altered consciousness +/- seizures

start empiric treatment IMMEDIATELY with IV Aciclovir 10mg/kg TDS WITHOUT waiting for test results

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9
Q

What is the characteristic histological appearance of CMV infection ?

A

Owl’s eye inclusions

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10
Q

Which virus are immunocompromised patients particularly at risk of compared to immunocompetent people ?

A

CMV (since opportunisitc infection) - lies latent in monocytes and dendritic cells

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11
Q

In which cells does CMV tend to lie dormant ? (2)

A

Monocytes
Dendritic cells

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12
Q

What anti viral treatments are used to treat CMV infection ?

A
  • 1st: Ganciclovir/valganciclovir
  • 2nd: Foscarnet
  • 3rd: Cidofovir
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13
Q

Which disease can EBV cause in immunocompromised patients ?

How do you treat?

A
  • PTLD - post transplant lymphoproliferative disease
  • This predisposes to lymphoma
  • The EBV keeps dividing unless kept in check by the immune system
  • This causes polyclonal activation of B cells

Tx: immunosuppression + rituximab

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14
Q

What does PTLD predispose to ?

A

B cell lymphoma

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15
Q

What is the treatment for PTLD ?

A

Rituximab - monoclonal antibody against CD20 B cell surface marker

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16
Q

What are the 2 main surface proteins on influenza virus ?

A
  • HA- haemaglutinin
  • NA- Neuraminidase

These allows viruses to bind and enter the target cells

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17
Q

Which disease is commonly caused by RSV ?

A

Bronchiolitis

18
Q

Who should palivizumab be given to prophylactically ?

A
  • High risk infants (preterm, heart or lung disease, SCID) in the winter months
  • Prevents severe LRTI from RSV
19
Q

Which 2 diseases does BK virus cause in immunocompromised patients?

A

Haemorrhagic cystitis in bone marrow transplant patients

BK nephritis in renal transplant patients

20
Q

Which immunomodulatory therapy is used to treat hepatitis B ?

A

Interferon Alpha

21
Q

Which antiviral drug is used to treat and prevent Influenza In the elderly?

What is MoA?

A

Oseltamivir (Tamiflu)

Directly inhibits the influenza neuraminidase (NA)

22
Q

Which antiviral can be used in aerosol form to prevent RSV infection in children with heart and lung disease ?

A

Ribavirin (guanosine analogue)

23
Q

Which antiviral is the drug of choice for CMV infection ?

A

Ganciclovir

24
Q

What is the prodrug of aciclovir that can be used in VZV infection ?

A

Valaciclovir (but aciclovir more common)

25
Q

Which antiviral drug is used to treat severe resistant herpes infection ?

A

Foscarnet

26
Q

Which HIV drug works by inhibiting reverse transcriptase by acting as a guanine analogue?

A

Zidovudine

27
Q

treatment for HSV meningitis

A

usually self limiting
IV aciclovir 2-3 days, then switch to oral for 10 days
valaciclovir alternative in immunocompetent to avoid cannulation

28
Q

describe how viruses gain entry into cells

A
  • HA mediated virus binding and entry into target cell
  • NA allows the release of progeny virus particles from the host cell
  • NA is the target for current anti-influenza drugs
29
Q

adenovirus treatment

A

cidofovir IV
IVIR
brindcidofovir PO

30
Q

A 42-year-old lady is admitted with a 2 day history of fever and confusion and presents with new onset seizures. What antiviral medication should she receive as soon as possible?

A

IV aciclovir

HSV encephalitis is a medical emergency and treatment is with a 2-3 week course of high dose IV aciclovir

31
Q

Transplant patients with CMV pneumonitis - what drug do you give + which adjunt?

A

Ganciclovir + IVIg

32
Q

New drug for CMV (2)

A

Maribavir

Letermovir

33
Q

BK Virus is part of which family of viruses

A

polyomavirus

34
Q

Where does BK virus stay latent (2)

A

lifelong carriage in kidneys and urinary tract

35
Q

Tx of BK Haemorrhagic Cystitis

Tx of BK nephropathy

A
  • IV Cidofovir (+ probenecid) if significant morbidity - NB this is nephrotoxic
  • Intravesical cidofovir (5mg/kg/week)- this is an option of there is nephrotoxicity
  • normal human IVIg
36
Q

Which group does adenovirus present in?

Tx (2)

A

paediatric transplant recipients

Tx: Cidofovir + IVIg

37
Q

2 main Tx of hep B

A
  • Main: IFN-alpha
  • Other: nucleotide analgoue (tenefovir)
38
Q

2 types of antiviral resistance assays (investigative procedure)

A
  • Genotypic: sequencing the viral nucleic acids and identifying mutations known to confer resistance
  • Phenotypic: consists of a cell culture
39
Q

HSV drug resistance mechanism

How to do Ix

Tx (2)

A

Mutations are usually in viral thymidine kinase - Almost exclusively seen in immunocompromised patients

Plaque Reduction assay

Foscarnet and Cidofovir

40
Q
A
41
Q

Mechanism of CMV resistance

Tx (2)

A

In protein kinase gene (UL97)

Foscarnet or Cidofovir

42
Q

Tx for EBV driven PTLD

A

Rituximab (anti-CD20)

Micro (20 decks)

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