Second Set of VIR Cards (Dz-specific)

Question 1

Common Cold (most common cause)

Family = ?; Genus = ?

Epidem = ?

Pathogen w/ s/sx = ?

Dx = ?

Vaccines? = ?

Tx = ?

Answer 1

Family = Picornaviridae; Genus = Enterovirus; Species = Human rhinovirus

Epidem = worldwide; worse in fall/winter; most common cause of infection in humans

Pathogen w/ s/sx = spread via aerosol AND indirectly via contaminated surfaces; prefer lower temps of nasopharynx; causes common cold (sneezing, nasal discharge, sore throat, cough, headache, maybe chills but few systemic sx), lasts 1 week; does NOT grow in low pH (i.e. highly labile at low pH)

Dx = clinically, but could technically dx from cell culture

Vaccines? = no, too many serotypes (>100)

Tx = not really, supportive/sx mgmt

Question 2

Poliomyelitis

Family = ?; Genus = ?
Epidem = ?

Pathogen w/ s/sx = ?
Dx = ?

Vaccines? = ?
Tx = ?

Answer 2

Family = Picornaviridae; Genus = Eneterovirus; Species =

Epidem = eradicated from W hemisphere; still 1000-2000 cases/yr in: Afghanistan, India, Nigeria and Pakistan; epidemics used to occur in summer/fall; was assoc’d w/ development: both incr conc of poop + maybe hygiene hypothesis?

Pathogen w/ s/sx = fecal-oral route; 10-14 day incubation; only 1% develop sx

Four grades: 1) asymptomatic infection; 2) abortive (short course w/ h/a sore thr, n/v), 3) non-paralytic p-m (aseptic meningitis), 4) paralytic p-m

oropharynyx/small bowel—>bloodstream—>CNS (also retrograde axonal trans) perferring motor neurons in ant. horn of spinal cord + brain stem—>neuronal death —>paralysis (resp paralysis if also brain stem = “bulbar poliomyelitis”)

Dx = isolation (throat, stool, CSF)—>CPE—>specific anitsera; OR elev. Ab titer

Vaccines? = Salk (“IPV,” killed, given IM); Sabin (“OPV,” live-atten. given PO)

Tx = sx mgmt; resp. support; PT after

Question 3

Coxsackie Viruses

Family = ?; Genus = ?

Epidem = ?

Pathogen w/ s/sx = ?
Dx = ?

Vaccines? = ?
Tx = ?

Answer 3

Family = Picornaviridae; Genus = Enterovirus
Epidem = daycare (b/c F-to-O and stable in environment)

Pathogen w/ s/sx = F-to-O

TYPE A: Skim/Muc-Memb tropic

Herpangina (fev, sore thr, pharyngeal lesions); Hand, foot and mouth dz; Asep meningitis; Paralytic disease (rare)

TYPE B: Viscerotropic

pleurodynia (unilateral intercostal pain; possible orchitis); myocarditis; aseptic menin; paralytic dz (rare); possibly: Type I DM, chronic fatigue?

Dx = isol/culture, elev [Ab] or PCR of CSF

Vaccines? = None

Tx = None

Question 4

ECHO VIRUSES

Family = ?; Genus = ?

Epidem = ?

Pathogen w/ s/sx = ?
Dx = ?

Vaccines? = ?
Tx = ?

Answer 4

Family = picornaviridae; Genus = enteroviruses; Species = Enteric Cytopathic Human Orphan viruses

Epidem = worldwide; daycare, again b/c non-env and therefore stable in the environment

Pathogen w/ s/sx = F-to-O trans; leading cause of aseptic meningitis; broad spec of dzs e.g. multiple rashes

Dx = isolation/cuture; sero tests not useful b/c >32 serotypes to date (of 67 total in enterovirus genus!)

No vaccine; no tx

Question 5

Other Enteroviruses

Family = ?; Genus = ?

Epidem = ?

Pathogen w/ s/sx = ?
Dx = ?

Vaccines? = ?
Tx = ?

Answer 5

Family = Picornavirus; Genus = Enteroviruses

Epidem = ?

Pathogen w/ s/sx =

EV 70 —> acute hemorrhagic (of bulbar) conjuctivitis

EV 71 —> H,F&M dz; leading cause of viral CNS dzs

EV 72 —> HAV

Dx = ?

No vaccines/tx

Question 6

Rotaviruses

Family = ?; Genus = ?

Epidem = ?

Pathogen w/ s/sx = ?
Dx = ?

Vaccines? = ?
Tx = ?

Answer 6

Family = Reoviridae; Genus = Rotavirus

Epidem = Endemic worldwide; peaks in winter; most deaths in poorer countries; children <2 y/o

Pathogen w/ s/sx = F-to-O trans; 2-day inc then gastroenteritis (n/v + diarrhea); dehydration —> death

Dx = usually clinical; radioimmunoassay or ELISA from stool sample

Vaccines? = yes, two orals now: Rotarix is live monovalent for more common U.S. serotype; Rotateq reassortment of surface Ags from 5 human serotypes on a live bovine strain

Tx = No antiviral; WASH YO HANDS

Question 7

Norwalk virus

Family = ?; Genus = ?

Epidem = ?

Pathogen w/ s/sx = ?
Dx = ?

Vaccines? = ?
Tx = ?

Answer 7

Family = Calciviridae; Genus = Norovirus

Epidem = cruise ships/nursing homes/camps, highly contagious; easily spread via food esp shell fish/salads

Pathogen w/ s/sx = F-to-O trans; gastroenteritis; incr susceptibility if O blood type

Dx = usu. clinical; PCR of stool available for Public health measures

Vaccines? = in development
Tx = none; hygiene, rehydration-

Question 8

adenovirus

Family = ?; Genus = ?

Epidem/trans = ?

Pathogen w/ s/sx = ?
Dx = ?

Vaccines? = ?
Tx = ?

Answer 8

Family = adenviridae

Epidem/trans = f-to-o—most common for kiddos et leur familles; aerosol; direct inoculation of eye (e.g. with tonometer/fingers); common in military

Pathogen w/ s/sx = 3-10 incubation; persists in ADENOIDS, tonsils—> resp; pink eye (i.e. epidemic keratoconjunctivitis); gastroent.

Dx = cell culture, elev titer, serologic (hemagglutination inhibition and complement fixation)

Vaccines? = no
Tx = no

Question 9

Influenza

Family = ?; Genus = ?

Epidem/trans —>what strains, how are they different? how do they mutate?

Pathogen w/ s/sx = ?
Dx = ?

Vaccines? = ?
Tx = ?

Answer 9

Family = orthomyxoviridae; Genus = e.g. Influezavirus A

EPIDEMIOLOGY AND STRAINS

3 strains:

A = worst

B = less severe, epidemics q3-6 yrs

C = NBD

MINOR EPIDEMICS (i.e. yearly) due to antigenic DRIFT (i.e. mutation w/in existing RNA segments, specifically H gene); we’ll have partial immunity to this from previous immunization/illnesses

MAJOR PANDEMICS due to antigenic SHIFT involving reassortment of animal and human influenza strains; must be an H-shift, even worse if there is concomitant N-shift; this will be a Novel H (and N) which means we will have NO immunity

TRANSMISISON: droplets and surface contamination

Pathogen w/ s/sx = even though locatlized infection in resp tract (i.e. usually no virema)—>systemic sx incl. f/c and myalgia from pro-inflammatory mediators; destroys cilia of resp tract

—can develop 2° viral pneumonia—>leads to bacterial pneumonia

Dx = rapid uses fluorescent Ab on throat swab specimen; compare acute and convalescent Ig levels

Vaccines = usually killed virus trivalent w/ 2 A strains and 1 B strain given IM

FluMist = polyvalent, live, attenuated —>induces IgA

new quadrivalent just out w/ 2 A and 2 B strains

Tx = neuraminidase inhibitors (e.g. osteltavir, zanamivir) for both A and B; amantadine and rimantidine—>only A and then only sub-set of As

Question 10

RSV

Family = ?; Genus = ?

Epidem/trans —>Pathogen w/ s/sx = ?

Dx = ?

Vaccines? = ?
Tx = ?

Answer 10

Family = Paramyxoviridae

Epidem/trans = trans like flu (direct droplets and indirect surfaces); outbreaks in winter; occurs worldwide and virtually everyone has been exposed by 3 y/o

Pathogen w/ s/sx = LOWER resp tract—>bronchiolitis and pneumonia more severe in infants—>hospitalization; can have immunopathogenic mech w/ maternal IgG forming immune complexes and injuring baby’s lungs

Dx = rapid antigen testing of resp secretions; CPE w/ giant, mulitnuc cells; RT-PCR; 4x rise in Abs

Vaccines? = no vaccine

Tx = inhaled ribavirin (unsure how well it works); maybe combine with hyperimmune Igs

Question 11

Croup

Family = ?; Genus = ?

Epidem/trans = ?

Pathogen w/ s/sx = ?

Tx = ?

Answer 11

Family = Paramyxoviridae; (Genus = Respirovirus & Rubalavirus;) Species = Parainfluenza (most common cause; other viruses can cause similar syndrome)

Epi/trans—> first three years of life

Pathogenesis = “acute laryngo-tracheo-bronchitis” causing dyspnea and stridor

Tx = glucocorts w/ bad cases

Question 12

SARS

Family = ?

Epidem / Trans = ?

Pathogen w/ s/sx = ?
Dx = ?

Vaccines? = ?
Tx = ?

Answer 12

Family = Coronaviridae

Epidem/trans = human-to-human trans

Pathogen w/ s/sx = 1-3 days incubation; severe infection uncharacteristic of other coronaviruses; pneumonia w/ diffuse edema—>hypoxia; binds to ACE-2 which may play role in edema

Dx = PCR- and Ab-based tests used to dx SARS

No vaccine nor specific antiviral; ribavirin + steriods

Question 13

Hepatitis A

Family = ?
Epidem = ?

Trans = ?

Pathogen w/ s/sx = ?
Dx = ?
Vaccines? = ?
Tx = ?

Answer 13

Family = picornaviridae

Epidem = overt dz less common in developing countries b/c nearly everyone seroconverts by age 5 and virus is mild chez les petits enfants; MAIS, dans les pays plus developés, il y a plus des adults immuno-naïve

Examples: 1) outdoor events w/o sanit, 2) raw shellfish contam w/ sewage; 3) within fam w/ small kid, 4) infected foodhandler, 5) imported contam food

Trans = F-to-O trans; blood if pt is viremic

Pathogen w/ s/sx = incub is 30 days; viremia—>liver—>anorexia, nausea, fever, jaundice elev. LFTs (e.g. AST); liver damage to cell lysis by replicating virions

There is no chronic stage

Dx = Anti-HAV-IgG and IgM sero assays

Vaccines? = killed IM vaccine

Tx = pooled Ig

Question 14

Hepatitis B

Family = ?
Epidem = ?
Trans = ?

Pathogen w/ s/sx = ?
Dx = ?
Vaccines? = ?
Tx = ?

Answer 14

Family = Hepadnaviridae

Epidem =
Trans = sexual, blood, perinatal, needles

Pathogen w/ s/sx = 70 incubation;

Has chronic phase in 5% of cases. —>liver carcinoma and chornic hepatitis

Dx = HB-Ags from serum

Vaccines? = Yes, inactivated subunit vaccine given IM (only contain antigenic subunits)

Tx = pooled IgG for infants of known-infected mothers

Give alpha-INF w/ lamivudine, a chain-terminating RT inhibitor from HIV txs past

Question 15

Hepatitis C

Family = ?
Epidem = ?
Trans = ?

Pathogen w/ s/sx = ?
Dx = ?
Vaccines? = ?
Tx = ?

Answer 15

Family = Flaviviridae

Epidem

20,000,000 chronically infected worldwide; men > women; caucasianc > Afr. Amer.; Age > 40 y/o; increased risk factors: coinfection (HBV, HIV), EtOH, steatosis (fat droplets in liver)

Trans

Mostly injection drug users, also: sex, vertical, tatoos; needlestick and transfusion RARE

Pathogen w/ s/sx

60 day incub.; 70-80% become chronic hepatitis pts!

Dx

PCR test of HCV RNA

Vaccines?

no, mutates incredibly fast

Tx

chronic: alpha-INF (expensive and not very effacious); consider ribavirin; new: HCV protease inhibs (telaprevir and boceprevir) can be given with other two

Question 16

Hepatitis D

Family = ?
Epidem = ?

Trans = ?

Pathogen w/ s/sx = ?

Answer 16

Family = n/a b/c not true virus (Deltavirus genus)

Epidem = only those with Hep B; break-outs among pops w/ high HBV prev

Trans = venereal, parenteral, perinatal

Pathogen w/ s/sx = acute onset; can be life-threatening

Question 17

Hepatitis E

Family = ?
Epidem = ?

Trans = ?

Pathogen w/ s/sx = ?

Answer 17

non-env (+)ssRNA from Hepeviridae

trans = f-to-o

contam water/food

only in developing countries

20% mortality w/ preg women

Question 18

Mumps

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 18

Family = paramyxoviridae

Epidem = worldwide, peaks in winter; some reccent epidemics have occured in North America

Trans = saliva—>resp droplets

Incubation = ~3 wks

Pathogenesis, s, sx = virus grows in resp epithel—>local lymph nodes—>viremia—>parotids etc.

most people are symptomic (70%)

prodrome: 1st malaise, anorexia, fever; 2nd uni- or bi-lateral parotiditis—>spreads via saliva; 3rd other encapsulated organs via viremia (e.g. testes = orchitis in 30% of post-pubertal males; meninges causing aseptic meningitis pretty common; ovaries and pancrease less common)

Dx = usu clinical; viral culture from saliva, CSF or urine; PCR also; 4x incr in IgG

Prevention = live attenuated vaccine given twice in childhood

Tx = none

Question 19

Measles

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 19

Family = paramyxovirus

Epidem = highly infectious! humans = sole carriers; most contagious dz known but always antigenically the same! caused dz q3 years (# non-immune incr w/ births breakdown in herd immunity)

Trans = resp drops and also tears and urine

Incubation = 2 weeks from exposure to rash

Pathogen w/ s/sx = resp to resp; growth in epithel, lymph nodes and conjunctiva; 100% attack rate (everyone exposed gets it); 1st) prodrome w/ coryza; 2) koplik’s spots (see photo); 3) pathognomonic maulopapular erythema that starts on head and spreads inferiorly

—causes syncytia; rare giant-cell pneumonia w/o rash chez les personnes sans cell-mediated immunity; show cell-med imm imprt for rash

—suppressed cell-mediated immunity—>2° infections that cane be deadly esp. in resource-limited situations = ANERGY

—Photophobia also common

—1:20 pneumonia; 2° bact. otitis media; acute encephalitis —> neuro def if survived

—1-3:1000 death rate

Dx = usu. clinically; culture, 4x incr [Ab] or PCR also available

Prevention = live, attenuated vaccine

Tx = no antiviral therapy available

Question 20

Progressive Multifocal Leukoencephalopathy (PML)

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 20

WILL BE ON BOARDS

Family = polyomaviridae—>JC virus

Epidem = most common chez les immunodéprimées

Trans = unbiquitous

Incubation = long long time

Pathogen w/ s/sx = immunocompromizaiton causes affects oligodendrocytes causing demyelenation: visual field defects, mental status ∆s, weakness—>blindness, dementia, coma and death =(

Dx = PCR of brain biopsy or CSF

Prevention = don’t get cancer or HIV?

Tx = cidofovir may help, but really no effective tx

Question 21

Subacute Sclerosing Panencephalitis (SSPE)

Family = ?
Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?
Dx = ?

Prevention = ?

Tx = ?

Answer 21

Family = Paramyxoviridae—>MEASLES VIRUS
Epidem = kids several years after initial infection

Trans = ?

Incubation = “long incubation time”

Pathogen w/ s/sx = VERY HIGH Ig titers; Measles Ag in CSF; slow cognitive decline, psych disturbances—remissions—>terminal paralysis and blindness

Dx = titer of blood and CSF

Prevention = vaccination? still 1:1,000,000 risk of SSPE w/ vaccination as compared to 1:100,000 w/ actual dz

Tx = none =(

Question 22

Scrapie

Family = ?
Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Prevention = ?

Answer 22

Sheep prion dz

genetic predisposition (inbred sheep at increased risk)

sheep goes crazy scrapes off all its skin

cannot be prevented with UV sterilzation, alyklating agents or formaldehyde

Question 23

Kuru

Family = ?
Epidem = ?

Trans = ?

Pathogen w/ s/sx = ?

Answer 23

Family = prion dz

epidem = limited to Foré

Trans = ingestion, direct injection into brain of chimps, possibly via open skin?

Pathogen = Kuru is a progressive degenerative disorder of the CNS, especially the cerebellum; similar to Scrapie

Question 24

CJD

Family = ?
Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?
Dx = ?

Prevention = ?

Tx = ?

Answer 24

Creutzfeld Jacob Disease

Family = prion dzs
Epidem = most cases in 50-70 y/o’s

Trans = 1) sporadic = most cases (sCJD); 2) genetic predisposition (fCJD familial); 3) iatrgoenic (iCJD) **Not linked to diet—vegetarians and meat-eaters have similar incidence

Incubation = clinically with: brain biopsy showing SE; imaging and EEG; definitely with: antiprion Abs

Pathogen w/ s/sx = dementia w/ behav ∆s/mem loss/confusion and myoclonic jerking
Dx = ?

Prevention = no vaccine

Tx = no tx

Question 25

Variant CJD

Answer 25

2. A spongiform encephalopathy of cows (“mad cow disease”) reached epidemic status in Great Britain as a result of using brains and bone marrow from cows and sheep in the manufacture of bovine food.
3. An outbreak of “atypical human Creuzfeld-Jacob disease” (vCJD) in Great Britain has been linked epidemiologically to eating beef from infected cows. Cows were infected by being fed dead cow brains in their feed. =/

Question 26

EEE

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 26

Family = togaviridae (classified also as an arbovirus)

Epidem = only in summer/when mosquitoes are alive; mostly children affected; swampy areas and wetlands are worst hit; also kills local horses; mostly kids <10 y/o

Trans = mosquito—>bird*—>mosquit—>horse/human (DEAD END HOSTS)

*the bird is usually unaffected

Incubation = 1 week intrinsic incubation in host (2 week extrinsic incubation in vector)

Pathogen w/ s/sx = direct viremia (delivered from mosquito’s saliva to bloodstream); sudden onset severe headach, n/v, fever—>mental status ∆s—>seizures and nuchal rigidity—>TWO OPTIONS:

1) if you survive: high %—>severe neuro sequelae
2) if a severe case: paralysis—>coma—>death

—EEE usually causes the worst dz w/ ~50% fatality rate

Dx = isolate virus or incr titer

Prevention = kill mosquitoes; wear repellent; monitor mosquito traps via PCRing ground up dead ones; killed vaccine for horses is available

Tx = none

Question 27

Compare WEE to EEE

Answer 27

Western Equine Encephalitis

Family = togavirus

similar to EEE w/ higher incidence rate and lower death and permanent neuro sequelae rates; usually infants and adults >50 y/o

Question 28

SLE

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 28

St. Louis Encephalitis

Family = flaviridae

Epidem = indigenous to North America more common in urban areas; adults >50y/o are most affected

Trans = maintained by bird—>mosq—>bird cycles w/ humans as DEAD END hosts

Incubation = again two: 1 week in humans two weeks in vector

Pathogen w/ s/sx = most infections inapparent but does cause moderately severe encephalitis w/ 10% fatality; sequalae uncommon

Dx = serologically

Prevention = no vaccine

Tx = no antiviral

Question 29

WNV

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 29

Family = flaviviridae

Epidem = urban and rural; causes the most cases of viral encephalitis per year in US now; usually in folks over 60

Trans = bird<—>mosquito—> human DEAD END host (also 10% via blood transfusion)

Incubation = same 2wks in vector 1wk in host

Pathogen w/ s/sx = <1% infected get symptomatic dz;

Dx = isolate virus from: brain tissue, blood, CSF or detect Abs in CSF or blood; PCR also available

Prevention = no vaccine; screen at bloodbanks

Tx = no antiviral

Question 30

Dengue

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 30

Family = flavivirus

Epidem = subtropics and tropics S.E. Asia and Caribbean

Trans = Aedes aegypti—>humans—>A. aegypti (i.e. humans are NOT dead ends!)

Incubation = 1 week in host

Pathogen w/ s/sx = fever, severe retro-orbital headache, myalgia and arthralgia (“break-bone” fever”) and rash

—Dengue Hemmorrhagic fever in those native to endemic areas (likely b/c there are 4 cross-reacting antigenic types); severe/fatal: 2nd infection immune complexes form and then either a) activates complement cascade—>incr vasc perm + thrombocytopenia OR b) virus penetrates monocytes and macrophages—>release hella cytokines

—point: hemorrhage—>hematemesis—>shock—death

Dx = isolate—>cell culture or IgM or 4X IgG at convalesecent vs. acute phase

Prevention = no vaccine; insecticides, drain stagnant water, personal protection

Tx = no antiviral

Question 31

La fièvre jaune

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 31

Family = flavivirus (w/in arbovirus grouping, too)

Epidem = endemic to rural tropical Africa and South America; can cause import epidemics in U.S., etc.

Trans = Aedes aegypti—>humans—>A. aegypti (i.e. humans are NOT dead end host)

Incubation = 1 week in host, 2 weeks in vector

Pathogen w/ s/sx = instant viremia due to direct injection by mosquito—>multiplies in vasc endothelium—>worsen viremia—>liver, kidney, spleen—>fever, jaundice, n/v w/ hematemesis

—high mortality, occasional subclinical cases

Dx = PCR of plasma specimen

Prevention = 17-D vaccine is live-attenuated and gives great protection

Tx = ?

Question 32

Parvovirus B-19

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 32

Family = parvoviridae

Epidem = super common; 50% adults are seropoz

Trans = can go transplacentally

Incubation =

Pathogen w/ s/sx = RBC precursor tropism—>inhibits RBC synth for ~1 week

—usually just leads to ERYTHEMA INFECTIOSUM w/ sometimes a TRANSIENT ARTHRITIS

—can lead to TRANSIENT APLASTIC CRISIS in pts with pre-existing erythrocytopenia (e.g. sickle); fatal w/o transfusion tx

—HYDROPS FETALIS occurs when transplacental route occurs in 1st or 2nd trimester; still can cause fetal demise (just w/o the hydrops fetalis) in 3rd trimester; massive increase in CO b/c anemia leads to edema, etc.

Dx = IgM (would not be present in immunocompromised pts so PCR from blood); fetal infection use PCR of amniotic fluid

Prevention = none

Tx = pool Ig for chronic/immunocomp. pts

Question 33

Rubella

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 33

Rubella (a.k.a. “German Measles”)

Family = togavirus (though NOT arbovirus)

Epidem = less contagious than measles; near-universal vaccination in U.S.—>last case 2005

Trans = resp drops (spread one week before and after rash!)

Incubation = 18 days

Pathogen w/ s/sx = resp epithel—>viremia; 3 days of rash w/ fever and lymphadenopathy; even subclinical cases—>lifelong immunity

—TRANSPLACENTAL: cataracts, PDA, deafness, MR; less and less a risk as you move along in pregnancy

Dx = ?

Prevention = live-attenuated vaccine (in MMR); major purpose is to prevent congenital rubella

Tx = ?

Question 34

HSV-1&2

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 34

Family = Alphaherpesviruses (HHV-1 & HHV-2)

Epidem = ubiquitous

Trans = saliva, vaginal secretions and lesion fluids—>eyes/breaks in the skin—>axonal transport to achieve latency

Incubation = ~7 days (CDC)

Pathogen w/ s/sx = Cold sores, ocular infections, (HSV-1) genital sores (HSV-2) and encephalitis (deadly, caused by both 1&2)

Dx = isolate and culture (causes CPE), ELISA, PCR of CSF, IgM/serology

Prevention = no vaccine

Tx = great drugs (nucleoside analogs) including: acyclovir, valacyclovir, famcilovir, pencilovir, adenosine arabinoside, iododeoxyuridine, trifluridine

Question 35

Chicken Pox

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 35

Family = herpesviruses —> alpha-herpesviruses —> varicella zoster (HHV-3)

Epidem = common in 4-10 y/o’s in non-vacc countries

Trans = aerosol or direct contact

Incubation = 2-3 weeks

Pathogen w/ s/sx = viremia —> prodrome w/ fever & malaise —> rash

IN ADULTS: worse; tx w/ ACV; re-activation causes shingles—> deratomal presentation VERY PAINFUL

Dx = clinically

Prevention = vaccines: pedi (oka strain = Varivax), adult (Zostavax = same strain, just 1/14 strength))

Tx = can try ACV in severe cases; usually just palliative

Question 36

CMV

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 36

Family = Herpesvirus—>betaherpesvirus (HHV-5)

Epidem = ubiquitous

Trans = blood, tissue, body secretions (URINE DIAPERS)

Incubation = ?slow? (see Dx)

Pathogen w/ s/sx = latency in leukocytes (powerful T-cell evasion strategy); usually subclinical, but also: Most common cause of congenital abnormalities in U.S.; Pneumonia, retinitis, esp in immunocompromized (esp pre-HAART)

Dx = have to PCR b/c grows very slowly

Prevention = wash hands, warn pregnant women

Tx = gancilovir, Vitravene (direct to retina)

Question 37

EBV

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 37

Family = herpesviruses—>gammaherpesviruses (HHV8)

Epidem = ubiq. (>90% U.S. adults positive)

Trans = kissing/saliva

Incubation = ~(2-?)4(-6? slides conflict) wks

Pathogen w/ s/sx = infects oral epithel—>blood—>B-cells—>immorts B-cells—>T-cells clear things up which cause “mono” sx in teens/adults (mild/asymp in kids)

—Mono sx: lymphadenopathy, hepatosplenomegaly

—in immunocomp: Burkitt’s lymphoma and nasophar. carcinoma I.E. TUMOR VIRUS

Dx =

Prevention = no vaccine

Tx = no anti-virals

Question 38

HHV‐6

Answer 38

roseola infantum/ exanthem subitum.
• Benign rash with high fever. Rarely encephalitis.
• >90% worldwide.
• Approx 1% have HHV‐6 integration into germline

Assoc’d with MS/CFS*/epilepsy

*chronic fatigue synd

Question 39

HHV-7

Answer 39

closely related to HHV‐6.
• “No treatment for HHV‐7 infec4on exists, but no clinical situation where such treatment would be useful has yet been discovered.”
“A virus that is looking for a dz.”

Question 40

HHV-8

Answer 40

Kaposi’s Sarcoma Herpes Virus (KSHV)

• tumor virus that causes opportunistic infection in HIV pts not on HAART
• common in sexually-trans HIV
• No vaccine
• Tx w/ excision

Question 41

B-virus

Answer 41

zoonosis that sometimes infects zookeepers, etc.

From Rhesus macaques

Rare but serious encephalitis

tx w/ acyclovir or immune serum

Question 42

HPV

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 42

Family = Papillomaviridae

Epidem = 1/3 of college-aged U.S. females have cervical infection of HPV

Trans = sexual

Incubation = ?

Pathogen w/ s/sx = condyloma (6b and 11) or cervical carcinoma (16 & 18)

Dx = Pap smear

Prevention = vaccine

Tx = ?

Question 43

Burkitt’s Lymphoma

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 43

Family = Herpesviridae—>Gammaherpesviridae—>EBV (HHV-4)

Epidem = common in “African children”; higher prev. in males

Trans =

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention =

Tx =

Question 44

HTLV

Family = ?

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?

Answer 44

Family = retroviruses

Epidem = ?

Trans = ?

Incubation = ?

Pathogen w/ s/sx = ?

Dx = ?

Prevention = ?

Tx = ?