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Pathology (Guide) > Microbiology - Virology > Flashcards

Microbiology - Virology Flashcards

1
Q

What is the virology of HSV?

A
  • Enveloped dsDNA genoma
  • Lies latent in sensory neurones
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2
Q

What is the clinical picture of Herpes labialis (cold sores - HSV1)?

A
  • Incubation: 2-12/7
  • Severe painful ulceration
  • Tendency to coalesce
  • Erythematous base
  • Fever
  • Submandibular lymphadenopathy
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3
Q

What is the clinical picture of HSV2 (genital ulceration)?

A
  • Incubation: 4-7/7
  • Fever
  • Dysuria
  • Malaise
  • Inguinal lymphadenopathy
  • Painful
  • Vesicular rash
  • Herpes meningitis 1-2/52 later in <8% of primary genital herpes
  • SACRAL RADICULOMYELITIS (urinary retention) = self-limiting
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4
Q

How does HSV present in an immunocompromised patient?

A
  • Cutaneous dissemination
  • Oesophagitis
  • Hepatitis
  • Viraemia
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5
Q

How does HSV present in a congenital infection?

A

Neurological:
- Microcephaly
- Encephalomalacia
- Hydranencephaly

Skin:
- Scarring
- Active lesions
- Hypo- + hyperpigmentation

Eyes:
- Microphthalmia
- Retinal dysplasia
- Optic atrophy +/- chorioretinitis

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6
Q

What is the treatment of HSV?

A
  • Aciclovir = guanosine analogue
    OR
  • Valaciclovir
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7
Q

What is the MoA for aciclovir?

A
  • Guanosine analogue
  • Competitively inhibits viral DNA polymerase by acting as analogue to deoxyguanosine triphosphate (dGTP)
  • Incorporation of aciclovir triphosphate into DNA results in chain termination
  • Absence of 3’ hydroxyl group prevents attachment of additional nucleosides
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8
Q

What is the virology of VZV?

A
  • Enveloped dsDNA genoma
  • Lies latent in sensory neurones, hence dermatomal distribution when reactivated
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9
Q

How does chicken pox present?

A
  • Fever
  • Malaise
  • Headache
  • Crops of rash follow prodromal Sx (Dew on rose petal)
  • Lesions scab after 1/52 (no longer contagious)
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10
Q

What are some complications of chicken pox?

A

General:
- Scarring
- Pneumonitis
- Haemoorrhage
- Eye involvement
- Reye’s syndrome

Neurological:
- Acute cerebellar ataxia
- Guillain Barre
- Ramsey Hunt syndrome (facial palsy + vesicles in ear)
- Geniculate ganglion of CNVII (hearing loss + vertigo)
- Encephalitis (vasculopathy)
- Post-herpetic neuralgia (pain in dermatome)

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11
Q

How does shingles present?

A
  • Reactivation caused stress or decreased immunity (e.g. immunocompromised or >50yrs)
  • Painful rash in specific dermatome
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12
Q

How does VZV present in an immunocompromised patient?

A
  • Rare complications more likely
  • Acute retinal necrosis
  • Progressive outer retinal necrosis (PORN)
  • Mutlidermatomal shingles
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13
Q

How does VZV present as a congenital infection?

A

Eyes:
- Chorioretinitis
- Cataracts

Neurological:
- Microcephaly
- Cortical atrophy

MSK/Skin:
- Limb hypoplasia
- Cutaneous scarring

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14
Q

How does VZV present in a neonate?

A
  • Purpura fulimans
  • Visceral infection
  • Pneumonitis
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15
Q

Why are vesicles on the nose concerning for a patient with shingles?

A

Risk of ophthalmic herpes zoster which is a medical emergency

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16
Q

What are vesicles on the ears indicative of for a patient with shingles?

A

Risk of Ramsey Hunt Syndrome

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17
Q

What is the management for a patient with chicken pox?

A

Aciclovir 800mg PO 7/7 OR Valaciclovir 1g TDS IF:
- Adults with chickenpox (risk of complications)
- Neonates
- immunocompromised
- Eye involvement
- Pts presenting with pain

Post-exposure prophylaxis = VZIG IF:
- Pregnant woman
- Immunocompromised

Live vaccine against varicella = attenuated
- Oka strian (CI = pregnancy)

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18
Q

What is the treatment for shingles and when is it indicated?

A

Indications: (IF <24hrs of rash)
- Symptomatic children
- Healthy adult smokers
- Chronic lung disease
- >20/40 gravid

Tx:
- Aciclovir 800mg PO 5x daily
- Famaciclovir 250mg PO TDS
- Valaciclovir 1g PO TDS
- Topical eye drops + oral for ophthalmic
- PEP 7-9/9 for immunocompromised (IVIG)

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19
Q

How is VZV diagnosed?

A

Exam:
- vesicles

Cytology:
- Scrapings for multinucleated giant cells (Tzanck cells)

Immunofluorescence Cytology:
- Cells from vesicles

PCR:
- Especially if rash is old, CNS + ocular disease

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20
Q

What is the virology of HCMV (human cytomegalovirus)?

A
  • Enveloped dsDNA genome
  • Lies latent in monocytes + dendritic cells
  • CMV cells = OWLS EYE INCLUSIONS
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21
Q

How does HCMV (human cytomegalovirus) present in an immunocompromised patient?

A

ERPC (M):
1. E: Encephalitis
2. R: Retinitis
3. P: Pneumonitis
4. C: Colitis
(5. Marrow Suppression)

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22
Q

How does HCMV (human cytomegalovirus) present as a congenital infection?

A
  • Ears: Sensorineural deafness
  • Eyes: Choreoretinitis
  • Heart: Myocarditis
  • Neurology: Microcephaly, Encephalitis
  • Lung: Pneumonitis
  • Liver: Hepatitis, Jaundice, Hepatosplenomegaly
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23
Q

What is the treatment for HCMV (human cytomegalovirus)?

A
  1. Ganciclovir IV / Valganciclovir PO
  2. Foscarnet IV
  3. Cidofovir IV

IVIG = adjunct in pneumonitis

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24
Q

What is the mechanism of action of ganciclovir?

A

guanosine analogue chain terminator

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25
Q

What is the mechanism of action of foscarnet?

A
  • Non-competitive inhibitor of viral DNA polymerase
  • Pyrophosphate analogue, inhibits nucleic acid synthesis without requiring activation
  • NEPHROTOXIC
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26
Q

What is the mechanism of action of cidofovir?

A
  • Cytidine analogue chain terminator
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27
Q

What is the virology of EBV (Epstein-Barr Virus)?

A
  • Enveloped dsDNA genome
  • Lies latent in B cells
  • Not dangerous in pregnancy
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28
Q

How does EBV generally present?

A
  1. Glandular fever: TRIAD (FEVER, PHARYNGITIS, LYMPHADENOPATHY) + splenomegaly + maculopapular rash
  2. Predisposes to Burkitt’s lymphoma
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29
Q

How is glandular fever diagnosed?

A
  • Blood Film
  • Monospot agglutination
  • EBV Abs
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30
Q

How does EBV present in an immunocompromised patient?

A
  • Post-transplant lymphoproliferative disease (predisposed to lymphoma)
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31
Q

What is the treatment for EBV in post-transplant lymphoproliferative disease in immunocompromised patients?

A
  • Reduce immunosuppression
  • Rituximab (anti-CD20 monclonal Ab)
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32
Q

What is the treatment for glandular fever?

A
  • Supportive care
  • Avoid high-contact sports
  • Avoid penicillins = maculopapular rash
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33
Q

What is the virology of HHV 6/Roseola Virus (Human Herpesvirus 6)?

A

Latent in monocytes/lymphocytes

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34
Q

What is the clinical presentation of HHV 6 / Roseola Virus?

A

Roseola Infantum (Exanthum Subitum, Sixth disease)
- 3/7 fever THEN sudden maculopapular rash
- Rash starts on trunk then spreads to face + extremities

  • Rarely causes encephalitis
  • Most common cause: febrile convulsions
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35
Q

What is the route of transmission for HHV6 (Roseola Virus)?

A

Droplet infection

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36
Q

What is the management for roseola infantum?

A
  • Sx treatment = fluids
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37
Q

How is roseola infantum diagnosed?

A
  • Clinical Dx
  • Blood PCR
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38
Q

What is the virology of HHV / Kaposi’s Sarcoma (Human Herpesvirus 8)?

A
  • Enveloped dsDNA genome
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39
Q

What is the transmission of HHV8/Kaposi’s sarcoma?

A

Genitally

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40
Q

How does HHV8 present in an immunocompromised patient?

A
  • Kaposi’s sarcoma (pathognomonic for HIV)
  • Primary effusion lymphoma (a/w EBV coinfection)
  • Castleman’’s disease (non-cancerous growth in LNs)
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41
Q

How is HHV8/Kaposi’s sarcoma treated?

A
  • Chemoradiotehrapy
  • Surgical excision
  • Initiation of HAART (highly active anti-retroviral treatment) for causative HIV infection
42
Q

What are the polyomaviridae viruses?

A
  • JC virus
  • BK virus
43
Q

What is the virology of JC virus?

A
  • Unenveloped dsDNA genome
44
Q

How does JC virus present in an immunocompromised patient (especially AIDs)

A
  1. Progressive multifocal leukoencephalopathy
  2. Rapidly demyelinating disease + neurological deficits
45
Q

What is the treatment for JC Virus?

A

Anti-retroviral therapy for HIV

46
Q

What is the virology of BK virus?

A
  • Unenveloped dsDNA genoma
47
Q

How does BK virus present in an immunocompromised patient (especially post-transplant)?

A
  1. BK haemorrhagic cystitis
  2. BK nephropathy
48
Q

What is the treatment for BK virus?

A

Cidofovir (cytidine analogue chain terminator)

49
Q

What are the respiratory viruses?

A
  • Influenza
  • Adenovirus
  • Coronavirus
50
Q

What is the virology of the influenza virus?

A
  • Enveloped, negative sense segmented genome
  • 8 segments
51
Q

How does the influenza virus present?

A
  • URTI
  • Systemic features inc. muscle aches
52
Q

What is the treatment for the influenza virus?

A
  1. Oseltamivir (Tamiflu) = inhibits NA, blocks virion release
53
Q

What is the virology of adenovirus?

A

Unenveloped dsDNA genoma

54
Q

How does adenovirus present in an immunocompromised patient (especially transplant)?

A
  1. Encephalitis (meningoencephalitis)
  2. Pneuomonitis
  3. Colitis
  4. Haemorrhagic cystitis
55
Q

What is the treatment for adenovirus?

A
  • Usually self-limiting
  • Supportive care in ITU/HDU

In multi-organ involvment:
- Cidofovir
- IVIG

56
Q

What is the virology of coronaviruses?

A
  • Positive sense ssRNA genomes
  • Causative organisms for SARS + MERS pandemics
57
Q

How does coronavirus present?

A
  • URTI
  • Sometimes has systemic infections

Severe infection can cause:
- ARDS
- Respiratory failure
- Shock
- Multi-organ dysfunction

58
Q

What is the treatment for coronavirus?

A
  • Self limiting

IF severe/hospital admission:
- Dexamethasone
- Remdesivir

59
Q

What is the virology of Hep A?

A
  • Unenveloped picornavirus
  • Positive sense ssRNA genome
60
Q

How does Hep A present and how is it diagnosed?

A

Acute Hepatitis:
- 2-6wk incubation
- Severe in elderly
- Jaundice
- Hepatitis
- Cholestasis
- Malaise

  • Dx:
  • Acute: Anti-HAV IgM (persists <14wks)
61
Q

What is the transmission of Hep A?

A

Faeco-oral

62
Q

What is the treatment for Hep A?

A
  • Supportive care (resolves in 2 months)
  • Vaccine (live attenuated + inactivated)
63
Q

What is the virology of Hep B?

A
  • Enveloped hepadnavirus (reversivirus)
  • Hybrid genome
  • Mostly DNA with an associated RNA species
64
Q

What are the features of Hep B?

A
  1. Acute + chronic diseaase
  2. Transmission by bodily fluids: Sexual, vertical, blood products
  3. Virus cleared in majority of individuals (90% clearance> 5 y.o; 10% clearance in neonates)
  4. Lasts ~6 months
65
Q

How is Hep B treated?

A
  1. Interferon α
  2. TENOFOVIR (nuceloTide analogue)
  3. Lamivudine (nuceloside analogue)
  4. Entecavir (nucleoside analogue)
  5. Telbivudine (nucleoside analogue)
66
Q

What are the treatment goals for Hep B?

A
  • Prevent progression to cirrhosis + HCC
  • Maintain serum HBV DNA level as low as possible
67
Q

What is the Hep B vaccine comprised of?

A
  • Recombinant vaccine
  • Purified HbSAg
68
Q

What is the virlogy of Hep C?

A
  • Enveloped flavivirus
  • Positive sense ssRNA genome
69
Q

What are the general features of Hep C?

A
  1. Acute + chronic disease
  2. Mainly blood product spread (60-80% chronicity)
  3. Transmission = bodily fluids + vertically
  4. Mostly symptomatic
70
Q

What are some complications of Hep C?

A
  • Cirrhosis
  • Cryoglobulin Ax disease
  • Glomerulonephritis
71
Q

What are the most common Genotypes for Hep C?

A

Genotypes 1 (treatment less successful than 2 + 3)

72
Q

How is Hep C diagnosed?

A
  • Measure of HCV RNA (confirms infection)
73
Q

What is the treatment for Hep C?

A

Direct Acting Antivirals = curative:
- NS3/4 protease inhibitors (-previrs) = block translation
- NS5A inhibitors (-asvirs) = block release
- Direct polymerase inhibitors -buvirs) = block replication

OR:
- Interferon α therapy

74
Q

What is the virology of Hep D?

A
  • Deltavirus
  • Enveloped virus
  • Negative Sense
  • Single-stranded circular RNA
75
Q

What are the clinical features of Hep D?

A
  1. Simultaneous co-infection with Hep B
  2. Superinfection (on top of) Hep B = more severe (cirrhosis in 2-3yrs)
  3. Transmission = sexual, parental, perinatal
76
Q

What is the treatment for Hep D?

A

Peginterferon-α

77
Q

What is the virology of Hep E?

A

Unenveloped positive sense SSRNA genome

78
Q

What are the clinical features of Hep E?

A
  1. Acute hepatitis = India
  2. Faeco-oral transmission
  3. High risk in pregnant women

Sx:
- Jaundice
- Hepatitis
- Cholestasis
- Malaise

79
Q

What are some rare complications of Hep E?

A
  • CNS disease: Bell’s palsy, Guillain Barre, other
  • Chronic infection
80
Q

What is the treatment for Hep E?

A
  • Supportive care
  • Resolves in 2 months

Vaccine = recombinant HEVg1

81
Q

What are some paediatric infections?

A
  • Rubella virus
  • Human parvovirus B19
  • Morbillivirus
  • Zika virus
82
Q

What is the virology of rubella virus?

A
  • Enveloped virus
  • Positive sense ssRNA genome
83
Q

How does rubella present in a child?

A

German Measles:
- Maculopapular rash
- Lymphadenopathy
- Fever
- Lesions on soft palate (FORCHHEIMER SIGN)

84
Q

What is the treatment for rubella?

A
  • No antiviral therapy available
  • MMR VACCINE
85
Q

How does congenital rubella syndrome present?

A

Triad: Sensorineural deafness, cataracts, heart deformity (PDA)

Ears: SENSORINEURAL DEAFNESS
Eyes: CATARACTS, glaucoma, retinopathy, microphthalmia
Heart: PDA, VSD
Neurology: microcephaly, psychomotor retardation
Pancreas: Insulin dependent DM (late)

86
Q

What are the risks to rubella infection throughout pregnancy?

A
  • <8 wks = 20% chance of spontaneous abortion
  • 13-18wks = hearing defects + ?retinopathy
  • > 20 wks = No documented risk
87
Q

What is the virology of human parvovirus B19?

A
  • Unenveloped
  • dsDNA genome
88
Q

How does human parvovirus B19 present as slapped cheek (Fifth Disease)?

A
  • Erythema infectiosum
  • Transient aplastic crisis
  • Arthralgia
  • Fever + malaise
89
Q

What other conditions can human parvovirus B19 present as?

A

Viral myocarditis

90
Q

How can human parvovirus B19 present congenitally?

A
  • Foetal anaemia
  • Leads to cardiac failure
  • Leads to hydrops foetalis
91
Q

What is the the treatment for a congenital human parvovirus B19 infection?

A

Intrauterine blood tranfusion

92
Q

What is the virology of Morbilivirus?

A
  • Enveloped
  • Negative sense ssRNA genome
93
Q

What condition is associated with Morbilivirus and how does it present?

A

Measles
- Fever + malaise
- Cough, coryzal Sx + conjunctivitis
- Koplik’s spots (buccal mucosa)
- Maculopapular rash

94
Q

How does Morbilivirus present as a congenital infection?

A
  • No foetal abnormalities
  • Foetal loss, preterm delivery
95
Q

What is the virology of zika virus?

A
  • Enveloped falvivirus
  • Positive sense ssRNA genome
96
Q

How does Zika virus present congenitally?

A
  • Severe microcephaly + skull deformity
  • Decreased brain tissue, subcrotical calcification
  • Retinopathy, deafness
  • Talipes (feet turned in like club foot), contractures
  • Hypertonia
97
Q

What is the serology of Hep A?

A

Acute Infection:
- IgM = +ve
- IgG = -ve

Previous Infection:
- IgM = -ve
- IgG = +ve

Vaccinated:
- IgM = -ve
- IgG = +ve

98
Q

What is the serology of Hep B?

A

Acute Infection:
- IgM = +ve
- HBsAg = +ve
- Anti-HBc = +ve
- Anti-HBs = -ve

Chronic Infection:
- IgM = -ve
- HBsAg = +ve
- Anti-HBc = +ve
- Anti-HBs = -ve

Previous Infection:
- IgM = -ve
- HBsAg = -ve
- Anti-HBc = +ve
- Anti-HBs = +ve

Vaccinated:
- IgM = -ve
- HBsAg = -ve
- Anti-HBc = -ve
- Anti-HBs = +ve

99
Q

What is the serology of Hep C?

A

Acute Infection:
- IgG = -ve
- HCV RNA = +ve

Chronic Infection:
- IgG = +ve
- HCV RNA = +ve

Previous Infection:
- IgG = +ve
- HCV RNA = -ve

100
Q

What is the serology of Hep E?

A

Acute Infection:
- IgM = +ve
- IgG = -ve

Previous Infection:
- IgM = -ve
- IgG = +ve

Pathology (Guide) (84 decks)

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