Questions from S 24 Flashcards
I161I
T184L
Entecavir mutations HBV
Does this confer resistance to tenfovir?
No
Cowpox
What type of virus is it?
dsDNA virus
Orthopox
Edward Jenner used Cowpox as vaccine against smallpox
Cowpox
What does rash look like?
Usually singular localised lesion
same as Mpox
maculopapular then
vesicular then
pustular then
crust
Cowpox
Which countries have it>
Europe
East Asia
Cowpox what are hosts?
rodents are actually the main reservoirs
Cow/ Humans/ cats are incidental host
Cowpox
What is treatment?
Usually resolves in 4-6 weeks spotnaneously
Can trial cidofovir IV or intra-lesional
Want to perform a test on a sample you dont usually perform testing on
What needs to be done before issuing reports?
Confirm validation by sending results to reference lab
New SOP
Staff training
change IT ordering system
communicate to end user - report comment - testing has not be validated
communicate to UKAS - increased scope of testing
Antenatal HSV infection, suspect infection in neonate
When does mucocutaneous/ disseminated/ CNS infection appear?
What is mortality rate?
Mucocutaneous 5-14 days after birth
1% mortality
Disseminated 5-10 days after birth
30-50% mortality
CNS 4-14 days after birth
15% mortality
How does HSV infection present in neonate?
fever
Poor feeding
lethargy
Hepatitis
thrombocytopenia
pneumonitis
rash
convulsions
Neonatal HSV infection
What is treatment?
Aciclovir 20mg/kg TDS
14 days for mucocutaneous infection
21 days for disseminated/ CNS
CNS needs follow on oral aciclovir for 12 months - 300mg/square metre
Antenatal CMV infection
What treatment is available for mother?
Oral valaciclovir
CMV hyper immunoglobulin
both have weak evidence and aren’t standard practice
Neonate confirm CMV infection
What is most common presentation?
10% will have sensorineuraal hearing loss
Antenatal CMV infection
Amniocentesis performed
What is sensitivity?
90% sensitivity if performed after week 21
and 6 weeks after suspected infection
Baby born unwell
Treated with aciclovir
CSF pos for HSV2
clinical team baby is fine and dont suspect HSV
What do you do?
Risk factors -
check does mother have lesions at birth or during pregnancy
Why was LP performed
any skin lesions
any hepatitis/ thrombocytopenia/ pneumonitis
Consider switched samples or contamination on PCR run
Baby born unwell
Treated with aciclovir
CSF pos for HSV2
clinical team baby is fine and dont suspect HSV
CSF result was next to a strongly positive genital HSV2 swab
Waht do you do?
Continue treatment until situation clarified
check PCR paperwork - did all pos/ neg controls work. Any signs of contamination - check CT values
Repeat in parallel - re-extract and PCR from original sample
Baby born unwell
Treated with aciclovir
CSF pos for HSV2
clinical team baby is fine and dont suspect HSV
CSF result was next to a strongly positive genital HSV2 swab
You repeat the CSF, and it is negative
What do you do?
Inform consultant of clinical team - apologise and explain issue
Datix - learning event
Re-issue amended report
Duty of Candour
Investigate
- training
SOP
Air flow
unidirectional workflow
disposable pipettes
controls/ reagents correctly stored temp/ humidity
negative controls
waste disposal
environmental cleaning
Make an improvement plan to prevent in future
What is duty of candour?
Every healthcare professional must be open and honest with patients when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress.
If test has amended report, may need to speak to patient or write letter
What is unidirectional work flow
nothing to be brought back from amp to pre-amp
Amplification section has high concentration of products which can easily contaminate
this includes pens, books, lab coats, pippettes etc
Woman with HIV presenting in labour
what is management
Urgent HIV test/ VL, HBV/ HCV/ Syphilis
IV zidovudine if presenting in labour
C-section if VL likely >1000
Baby - 4 weeks of lam/ zido/ nev
What is ibalizumab
Ibalizumab, a long-acting monoclonal antibody, is a CD4-directed post-attachment inhibitor approved for the treatment of infection with multidrug-resistant HIV-1 strains
Entry inhibitors
Enfuvirtide gp41
Maraviroc CCR5
Ibalizumab
Which drugs are active against HIV2?
NRTI
INSTI
PI
Entry inhibitor - ibalizumab - in vitro datra only
Capsid assembly inhibitor - lenacapavir - in vitro data only
