Microbiology 22: Opportunistic Viral Infections

Question 1

Which 2 organisms can cause Infective mononucleosis ?

Answer 1

CMV

EBV

Question 2

Which genetic mutation gives a predisposition to invasive Herpes simplex encephalitis ?

Answer 2

UNC93B

Question 3

What type of virus is HIV ?

Answer 3

Lentivirus

Question 4

Which cells does HIV target ?

Answer 4

CD4+ T cells

Question 5

Which Virus causes Kaposi Sarcoma ?

Answer 5

HHV8

Question 6

Which virus causes Burkitss lymphoma in HIV patients?

Answer 6

EBV

Question 7

Which infections are people receiving anti -TNF therapy particularly predisposed to ?

Answer 7

Intracellular infections- TB

Question 8

Can BMT patients receive VZV vaccination ?

Answer 8

No because it is a live virus and they are immunocompromised.

Question 9

What is the difference in Immunocompromise of solid organ and bone marrow transplant patients ?

Answer 9

BMT patients are the most immunocompromised just before receiving the transplant because their own bone marrow is wiped out. After receiving the transplant a new immune system has to be established from the donors bone marrow.

Solid organ patients are less immunocompromised but then have to suppress their immune system for the rest of their lives.

Question 10

List different herpes viruses ?

Answer 10

HSV 1 and 2
VZV
CMV
EBV
HHV8
HHV6

Question 11

Where does VZV lay dormant ?

Answer 11

Dorsal root ganglia

Question 12

In which cells does CMV lay dormant ?

Answer 12

Monocytes

Question 13

In which cells does EBV lay dormant ?

Answer 13

B lymphocytes

Question 14

What is the main treatment for HSV infection ?

Answer 14

Acyclovir

Question 15

What are 2 treatment/prophylaxis of VZV options for immunocompromised or pregnant women ?

Answer 15

Prophylactic aciclovir

Post-exposure prophylaxis with VZig

Question 16

Which virus is associated with Progressive leukoencephalopathy ?

Answer 16

JC virus

Question 17

Which virus causes mouth ulcers in post transplant patients ?

Answer 17

HSV

Question 18

Which viruses causes a patient to be very unwell and appear septic with high fevers post bone marrow transplant ?

Answer 18

Adenovirus

Question 19

What is the typical serology of a patient with chronic hepatitis B infection ?

Answer 19

HBs Ag +ve
IgG HBc antibodies +ve
IgM HBc antibodies -ve
HBs antibodies -ve

Question 20

List 2 things that are caused by EBV in HIV patients ?

Answer 20

oral hairy leukoplakia

lymphomas: Burkitt’s lymphoma, Hodgkin’s

Question 21

Which disease is caused by EBV in patients post transplant?

Answer 21

post-transplant lymphoproliferative disorder (PTLD)

Question 22

Which virus causes graft rejection ?

Answer 22

HHV6

Question 23

list some primary causes of immunocompromise

Answer 23

UNC93B deficiency and TLR3 deficiency 
SCID 
epidermodysplasia verruciformis 
STIM1 
haemophagocytic lymphohistiocytosis in perforin deficiency

Question 24

list some of the major classes of immunosuppressive drugs

Answer 24

glucocorticoids/steroids
calcineurin inhibitors
antiproliferative agents - azathioprine, mycophenolate mofetil

Question 25

when do infections commonly occur after BM transplants

Answer 25

early (within 1 month) from graft - HBV reactivation from host - HSV new infection - VZV

Question 26

symptoms and complications of HSV

Answer 26

symptoms: cold sores, stomatitis, mouth ulcers, recurrent genital disease complications: cutaneous dissemination, oesophagitis, hepatitis, viraemia

Question 27

HSV treatment

Answer 27

aciclovir/ varaciclovir | foscarnet

Question 28

VZV manifestations

Answer 28

``` skin lesions pneumonitis encephalitis hepatitis purpura fulminans in neonates acute retinal necrosis VZV-assciated vasculopathy shingles = late manifestation ```

Question 29

CMV manifestations

Answer 29

retinitis encephalitis pneumonia gasteoenteritis histology - owls eye

Question 30

EBV treatment in immunosuppression

Answer 30

reduce immunosuppression | anti-CD20 monoclonal antibodies (rituximab)

Question 31

histology of kaposi sarcoma

Answer 31

spindle cell proliferation neo-angiogenesis inglammation and oedema tx = chemo and antiviral therapy

Question 32

features of JC virus

Answer 32

associated with progressive multifocal leukoencephalopathy demyelination of white matter diagnosis: MRI and PCR of CSF

Question 33

features of BK virus

Answer 33

polyomavirus dsDNA can cause: BK cystitis, BK nephropathy treat by reducing immunosuppression

Question 34

manifestations of adenovirus

Answer 34

problem after BM transplant | fever, encephalitis, penumonitis, colitis

Question 35

which respiratory viruses are concerning in the immunocompromised

Answer 35

``` influenza A + B parainfluenza RSV adenovirus MERS ```

Question 36

features of human parovirus B19

Answer 36

causes chronic anaemia in the immunocompromised diagnosis - blood PCR treatment - IVIG