Opportunistic Viral Infections

Question 1

primary cause of immunocompromised?

Answer 1

Primary
§ UNC93B deficiency and TLR3 deficiency
□ Associated with predisposition to herpes simplex encephalitis

§ Epidermodysplasia verruciformis

§ SCID

perforin deficiency in Familial Hemophagocytic Lymphohistiocytosis

§ HHV8 is associated with a STIM1 mutation

Question 2

acquired cause of immunocompromised?

Answer 2

§ Solid organ transplantation 
			§ Bone marrow transplantation HSCT
			§ Immunosuppressive drugs 
			§ Advanced HIV infection 
				□ NOTE: measles also causes a prolonged immunodeficient state after the infection

Question 3

what is the Baltimore class-action?

Answer 3

is a virus classification system that groups viruses into families, depending on their type of genome (DNA, RNA, single-stranded (ss), double-stranded (ds), etc..)

and their method of replication.

Question 4

are these DNA/RNA viruses:

Herpesvirus (HSV, VZV, EBV, CMV)
Adenovirus
Polyomavirus (BK, JC)
Papillomavirus

Answer 4

ds DNA viruses

Question 5

are these DNA/RNA viruses:

Parvovirus

Answer 5

ss DNA virus

Question 6

are these DNA/RNA viruses:

Norovirus
Coronavirus
Picornavirus (entero, echo, polio, coxsackie)
Flavivirus (Dengue, JapEnceph, West Nile)
Toga (Rubella, Chik)

Answer 6

ss+ RNA

Question 7

Ebola, Marburg, Lassa, Hantavirus, CCHF
Influenza, Parainfluenza
Mumps, Measles

Answer 7

ss- RNA

Question 8

what type of viruses are :

Hep B (DNA)
HIV (RNA)

Answer 8

retroviruses

Question 9

what is a retrovirus?

Answer 9

A retrovirus is a type of RNA virus that inserts a copy of its genome into the DNA of a host cell that it invades, thus changing the genome of that cell.

Question 10

both HEP B and HIV are retroviruses but what is the difference?

Answer 10

Hep B - ds dna virus

HIV - RNA

Question 11

if you’re looking for infection which viral diagnostics to do?

Answer 11

PCR

NAAT - for neiserria

Question 12

if you’re looking for evidence of previous infection which viral diagnostics to do?

Answer 12

serology

usually via ELISA

Question 13

which virus can cause cancer in immunocompromised?

Answer 13

hhv8

karposi sarcomi

associated with STIM1 mutation

Question 14

3 procedures needing immunosuppression?

Answer 14

SOT (solid organ transplant)

HSCT (human stem cell transplant)

HIV/AIDS

Question 15

name a lentivirus and its condition?

Answer 15

HIV - causes AIDs

Question 16

which virus causes Progressive multifocal leukoencephalopathy PML?

Answer 16

JC virus

John Cunningham virus, is a germ so common that the majority of adults have been exposed to it.

Question 17

which virus causes Cervical cancer?

Answer 17

HPV

Question 18

which virus causes chronic ulcer(s), pneumonitis, esophagitis…

Answer 18

HHV1

Question 19

which virus causes Lymphoma, Burkitt’s

Answer 19

HHV4 (EBV)

Question 20

which virus causes retinitis, other disease

Answer 20

HHV5 - CMV

Question 21

which virus causes Encephalopathy

Answer 21

HIV

Question 22

2 Types of HSCT?

Answer 22

Allo-graft

Auto-graft

Question 23

Classes of immunosuppressive Drugs

Answer 23

• Steroids
• Calcineurin inhibitors (T-Cell) i.e. tacrolimus
• Anti-proliferative agents eg azathioprine & Mycophenolate mofetil
• Anti-bodies
• T-cell Depleting / non-depleting

Question 24

What must you remember in Bone marrow transplants?

Answer 24

if patient had immunity and is replaced with donor who did not have immunity, reactivation risk is BIG

espesh for opportunistic infections i.e. CMV

Question 25

when do viruses reactivate after SOtransplants ?

Answer 25

over a month after their transplant

Question 26

when do viruses reactivate after Bone marrow transplant?

Answer 26

within a month! espesh herpes viruses so faster!

Question 27

sources of infection in post transplant infections?

Answer 27

○ Viruses acquired from the graft (e.g. HBV) ○ Viral reactivation from the host (e.g. HSV) - assess 1+2 via serology ○ Novel infection from infected individual (e.g. VZV)

Question 28

what to do for HSV prophylaxis?

Answer 28

HSV igG test if its low (poor immunity) ... Prophylaxis: acyclovir 1 month until HSCT 3-6 for SOT

Question 29

hsv and vzv which causes encephalitis?

Answer 29

vzv hsv - can if TLR3 UNC93B deficiency (primary immunodeficiency)

Question 30

what to do for VSV prophylaxis?

Answer 30

Antiviral - acyclovir. Or Give them VZV IgG

Question 31

how to treat varicella? in immunosuppressed ofc chicken pox

Answer 31

Anti-viral for 7-10 days IV until no new lesions; PO until all crusted

Question 32

how to treat zoster? in immunosuppressed off shingles

Answer 32

Anti-viral (IV if disseminated) + analgesia | If Ramsay-Hunt: add steroids

Question 33

EBV can cause which 2 things?

Answer 33

B-cell lymphoma PTLD - post-transplant lympho-proliferative disorder

Question 34

how to treat EBV?

Answer 34

Rx: ?Rituximab - antiCD20 - Removes the B cells

Question 35

you see Inclusion bodies on histology for which opportunistic infection in HIV?

Answer 35

CMV

Question 36

Ocular (retinitis) is a presentation of which infection?

Answer 36

CMV remeber inclusion bodies - owls yes

Question 37

what viral infection happens when CD4<50

Answer 37

CMV around 6 months

Question 38

what viral infection happens when CD4 approx 500

Answer 38

HSViruses

Question 39

treatment of CMV?

Answer 39

Bone marrow transplant: - measure viral load treat if reactivation (pre-emptive) IV Ganciclovir SOT: Prophylaxis - valganciclovir (PO) 100 days

Question 40

in SOT what is the risk with CMV?

Answer 40

directly threatens the graft - allograft disease and damages endothelial cells

Question 41

what Presents with brownish/purplish vascular lesions that can be cutaneous or visceral ?

Answer 41

kaposi sarcoma

Question 42

diagnosis of KP sarcoma?

Answer 42

biopsy

Question 43

treatment of KP sarcoma?

Answer 43

§ Chemotherapy | § Antiretroviral therapy

Question 44

Main pathological feature is demyelination of white matter in which condition

Answer 44

JC virus - PML

Question 45

diagnosis of JC virus - PML?

Answer 45

MRI and PCR of CSF

Question 46

what is the investigation of choice in respiratory Viruses in the Immunocompromised?

Answer 46

• Multiplex PCR

Question 47

which Hepatitis viruses should get a vaccine before procedure?

Answer 47

Hep A

Question 48

core antibody cAb and surface antibody sAb which is a marker of immunity?

Answer 48

sAb

Question 49

which antibody is marker of immunity?

Answer 49

IgG

Question 50

how to prevent hep b reactivation?

Answer 50

Nucleoside/nucleotide analogue Prophylaxis i.e. TENOFOVIR

Question 51

which virus: • In developed countries, it is a zoonosis caused by genotype 3 virus In developing countries, it is mainly caused by genotype 1 virus

Answer 51

hep E

Question 52

who gets chronic hep b infections?

Answer 52

neonates

Question 53

NAME 2 POLYOMA VIRUSES?

Answer 53

JC virus | BK virus

Question 54

which virus Causes chronic anaemia in the immunocompromised ?

Answer 54

parvovirus B19

Question 55

Which virus can cause hydrops faetalis?

Answer 55

parvovirus B19

Question 56

what is the difficulty with CMV infection as opposed to EBV in immunosuppresed?

Answer 56

CMV - big issue with end organ damage EBV - no end organ damage, but is Oncogenic!

Question 57

In hep B serology, what are the markers of infection?

Answer 57

sAg+ Circulating virus cAb+ (IgM) Acute immune response eAg+ Circulating virus

Question 58

In hep B serology, what are the markers of immunity?

Answer 58

sAb+ Generated from: sAg (virus) sAg (vaccine) cAb+ (IgG/total) Generated from cAg (virus) eAb+ Generated from eAg (virus)

Question 59

the presence of the following indicates? Anti-hbs – surface antibody Antihbc – core antibody

Answer 59

Anti-hbs – surface antibody (immunity) | Antihbc – core antibody (immunity)