Questions from S 5 Flashcards
Actual exam question
What is a clinical syndrome associated with each of these viruses?
KI virus
KI virus - polyomavirus
KI virus was discovered in 2007 in samples of human respiratory secretions being systematically searched as part of a program for identifying novel human viruses. It was identified by sequence homology to known human polyomaviruses BK virus and JC virus, and simian polyomavirus SV40. Named after Karolina Institute
Prevalence 1-5% in population in one study, but seroprevalence shows up to 70% of people infected
No clinical disease associated with KI virus
Respiratory disease potentially associated in immunocompromised patients
Actual exam question
What is a clinical syndrome associated with each of these viruses?
Wu virus
WU virus - Polyomavirus
It was discovered in 2007 in samples of human respiratory secretions, originally from a child patient in Australia who presented with clinical signs of pneumonia and in whom other common respiratory viruses were not detected. Follow-up studies identified the presence of WU virus in respiratory secretion samples from patients in Australia and the United States, suggesting that, like other human polyomaviruses, WU virus is widely distributed
Prevalence 1-3%, but seroprevalence shows up to 70% of people infected
No clinical disease associated with WU virus - but was originally found in patient with respiratory disease
Respiratory disease potentially associated in immunocompromised patients
Actual exam question
What is a clinical syndrome associated with each of these viruses?
Kunjin virus
Kunjin - flavivirus
First discovered in Australia. It is a sub-species of West Nile Virus
Transmitted by Culex mosquito - same as WNV
Causes milder disease than WNV
Actual exam question
What is a clinical syndrome associated with each of these viruses?
Torque Teno virus (TTV)
TTV - single stranded circular DNA genome
No clinical disease associated with it. Although often found in patients with hepatitis.
Patients with higher TTV viral loads can be used to estimate how immunocompromised a patient is
Actual exam question
What drugs are available to treat influenza?
Neuraminidase inhibitors
Oseltamavir
Zanamavir
Peramivir - IV therapy. Approved by FDA, but not by NICE
Polymerase acidic endonuclease inhibitor
Baloxavir marboxil
M2 ion channel inhibitors - A only
Amantadine
What is the mechanism of action of baloxavir marboxil?
Baloxavir marboxil - polymerase acidic endonuclease inhibitor
is a cap-dependent endonuclease inhibitor that inhibits influenza viral replication and is administered as a single oral dose
What is the resistance rate of baloxavir marboxil?
Baloxavir - 10% developed resistance in phase 3 trial
How effective is baloxavir for influenza treatment?
Better than placebo - reduces symptom duration by 1 day (similar to oseltamivir)
Probably better than oseltamivir as it seems to reduce viral load burden quicker than oseltamivir, and one study showed it reduced symptoms by 1 extra day than oseltamivir
Better if given early, as can reduce symptom duration by a day, and reduce household transmission from 13% with placebo to 1%
Adverse effects:
Oseltamivir 24.8%
Baloxavir 20.7%
When do influenza anti-virals need to start to be most effective?
Within 48 hours. Although efficacy up to 5 days after symptoms start
Oseltamavir
Zanamavir
Peramivir
Within 48 hours. No data on efficacy if started after this
Baloxavir marboxil
Actual exam question
Rabies PEP - need to know table in Green book
Which patients require no vaccine/ RIG?
Green composite risk assessment
based on low risk country/ animal and low risk of exposure
Actual exam question
Rabies PEP - need to know table in Green book
Composite rabies risk is amber, based on country/ animal and actual exposure
What to do for each patient group:
Non-immunised
Fully immunised
Immunosuppressed
Non-immunised
4x vaccine days 0, 3, 7, 21
Fully immunised
2x vaccine on days 0, and 3-7
Immunosuppressed
HRIG
5x doses of vaccine on days 0, 3, 7, 14, 30
Rabies antibody levels on day 30 to confirm adequate response to immunisation
Level >0.5 iu/ml are considered protective
Actual exam question
Rabies PEP - need to know table in Green book
Composite rabies risk is red, based on country/ animal and actual exposure
What to do for each patient group:
Non-immunised
Fully immunised
Immunosuppressed
Non-immunised
HRIG
4x vaccine days 0, 3, 7, 21
Fully immunised
2x vaccine on days 0, and 3-7
Immunosuppressed
HRIG
5x doses of vaccine on days 0, 3, 7, 14, 30
Rabies antibody levels on day 30 to confirm adequate response to immunisation
Level >0.5 iu/ml are considered protective
Rabies PEP
HRIG is required, but delayed.
How long a delay can it be given, after receiving first vaccine?
If vaccine is given but HRIG treatment is delayed, HRIG can still be given up to seven days after starting the course of vaccine.
HRIG is no longer required once an active antibody response to the rabies vaccine has started to develop.
Therefore, HRIG is not indicated more than seven days after the first dose of vaccine, or more than one day after the second dose of vaccine
Rabies exposure
Terrestrial mammals
What constitutes category 1 exposure
Category 1
No physical contact with saliva
For example:
touching, stroking or feeding animals
Rabies exposure
Terrestrial mammals
What constitutes category 2 exposure
Category 2
Minimal contact with saliva and/or unable to infiltrate wound with HRIG if needed
For example:
* bruising or abrasions
* licks to broken skin (i.e. over insect bites or scratches)
* scratches
* bites which do not break the skin
