Sydromes

Question 1

List viral infections causing retinitis

Answer 1

Rift Valley Fever
“usually bilateral, occurring 1–3 weeks after the primary febrile illness. Fifty per cent of cases suffer permanent loss of central vision; there may be permanent unilateral or bilateral blindness”

Herpes viruses (HSV, CMV)
VZV- PORN, ARN
Rubella- Congenital rubella causes pigmentary retintis, “salt and pepper” (also cataracts, micropthalmia)
Congenital

Question 2

Viral infections causing conjunctivitis

acronym MEAANZ

Answer 2

Measles
EV- (specifically, EV-D70 or coxsackievirus A24), haemorrhagic conjunctivitis
Adenovirus
Avian influenza
Newcastles disease
Zikaand Dengue

(not inclusive,feel free to add more!)

MEAAN (this exam is so mean I want to poke my eyes out)

Question 3

Viral infections causes arthralgia

Answer 3

Alphaviruses (Togaviridae)

Chikungunya virus (East Africa, India, Southeast Asia, and Philippines Caribbean and in 2014 nd United States)
O’nyong-nyong virus – East Africa
Ross River virus – Australia, New Zealand, and South Pacific islands
Mayaro virus – South America
Sindbis virus – Europe, Asia, Africa, Australia, and Philippines
Barmah Forest virus – Australia

Parvovirus
Rubella
Viral Hep- HAV, B and C
HTLV

Question 4

Causes of guillain Barre Syndrome
(not complete)

Answer 4

Viral:
Zika, (dengue and chik more rarely)
CMV, EBV
VZV
HEV
Post vaccine phenomeom

Bacti: campylobacter, mycoplasma, h.influenzae

Note GBS is is an acute, immune-mediated polyradiculoneuropathy typically occurring 2–8 weeks after viral or bacterial infection. Motor function is usually affected, beginning distally and progressing proximally over an up to 4-week period. Areflexia, sensory disturbances, and cranial nerve involvement may also occur (then called miller- fischer).

Question 5

Neurological presentations of VZV (to be completed)

Answer 5

post-infectious cerebellitis (young children)

Encephalitis

Vasculopathy (typically linked to shingles but can occur before shingles presents. Intrathecal antibodies can be used for diagnostics.

Question 6

A patient presents with a suspected Acute flaccid paralysis, and enterovirus D 68 infection. Which samples should you prioritise for testing

Answer 6

Respiratory swabs
D-68 is mainly a respiratory infection
Does not stay long in poop
(in reality to request CSF, blood and poop also, but the resp is the money shot)

Question 7

Cause of nephropathia epidemica.

Answer 7

Puumala

Question 8

Clinical syndromes associated with HTLV
List 8

Answer 8

ATLL- occurs in approx 5% (can be acute/chronic/smouldering or lymphomatous)
TSP
HAM
Uveitis
Dermatitis
Joint pain
Bronchiectasis
Sjögren’s syndrome, rheumatoid arthritis, fibromyalgia and ulcerative colitis

Question 9

How does Acute T-cell Leukaemia or Lymphoma present (ie HTLV associated)

Answer 9

Hypercalcaemia
Lymphadenopathy
Hepatolsplenomegally

The acute and lymphatous types are more agressive

Question 10

What are the clinical features of HAM/TSP

Answer 10

2% lifetime risk if infected with HTLV
Lower limb signs
Causes spasticity (extensor plantars, increased tone, hyperreflexia, clonus)
Muscle weakness
Back pain
Bladder and bowel dysfunction

Question 11

Clinical syndromes associated with EBV infections

Answer 11

Infectious mononucleosis
MS
X linked lymphoproliferative disease (https://www.niaid.nih.gov/diseases-conditions/x-linked-lymphoproliferative)
PTLD
Nasopharyngeal cancer
Gastro cancer
Chronic active EBV

PTLD develops due to excessive B cel growth caused by immunosupression
Occurs in 1-10 percent of SOT patients

Question 12

Presentation of WEE

Answer 12

Positive single stranded RNA virus
Fever
5% mortality culex
Argentina, uraguay

Question 13

List differentials for Measles

Answer 13

Viral: HHV6
HHV6
Parvovirus
Rubella
Primary HIV

Travel Related: Dengue, Chik, Zika

Scarlet fever
Syphilis

Question 14

Encephalitis in someone from europe

Answer 14

Travel related:
Toscana (group 2 phlebevirus)
West Nile (Group 3, flavi)
Usutu (Group 2, flavi)
?Rabies (Group 3)
LCMV (Group 3 or 2 depending on strain)
Borna virus (group 3)

Non travel related: HSV1-1, VZV, enterovirus

In Europe A total of 104 human cases of USUV infections were reported (between 2012 and 2021- as per EDCD) , with neurological manifestations in 11 cases

Note USUTU and WNV are very similar- in birds and equids

Question 15

Encephalitis in traveller from Australia- what tests would you do

Answer 15

Common tests
-exclude non-infectious

Bloods: HIV, Syphylis

LP (standard, biocem)
-HSV 1/2, VZV, entero, parecho

Travel related: Murray Valley, West nile (Kunjin)Hendrah (none since 1994)

Immuncompromised: CMV, HHv6/7,

Question 16

Encephailitis in traveller from America

Answer 16

HSV, VZV, ENTERO, PARECHO

Travel:
WNV
EEEV
WEEV
La cross
St Louis
I’m sure there are more

Question 17

What percentage of encephalitis is non-infectious?

Answer 17

30%

Question 18

Symptoms of west nile

Answer 18

80% asymptomatic
Worse outcome in elderly

https://www.cdc.gov/westnile/resources/pdfs/West_Nile_Virus_Diagnostic_Algorithm_Print-Only.pdf

Question 19

PTLD managament

Answer 19

Discuss at MDT, transplant organ assessment
RIS- then re-assess after 3-4 weeks
4 weekly 375 mg/m2 (if no remission then give CHOP, if yes then 4 x3 weekly 375 mg/m2)

Question 20

TBE is a biphasic illness T/F

Answer 20

True

25% of those infected get neurological disease

NEEDS COMPLETING

Question 21

Complications of shingles

Answer 21

Post herpetic neuralgia, paresis (motor
weakness), facial palsy and ‘herpes zoster ophthalmicus’, -eye associated dermatome, which may result in keratitis, corneal ulceration, conjunctivitis, retinitis, optic neuritis and/or glaucoma.

Risks increase with age

Disseminated disease in immunocompromised (with a case fatality rate reported to be between 5 and 15%, and most deaths being attributable to pneumonia)

The risk of shingles is also increased in individuals with certain conditions, including systemic lupus erythematosus, rheumatoid arthritis, diabetes and Wegener’s granulomatosis

Question 22

Cancers associated with HBV

Answer 22

Liver
GI- orl, stomach, colorectal pancreatic
Lymphoma

Question 23

Describe clinical syndromes assoc with HHv8 (incomplete)

Answer 23

Endemic (more KS like) subsaharan africa and mediteranean
Epidemic (HIV assoc)

MCD, KS, PEL
Inflammatory cytokine sydrome
HLH

Question 24

Describe HLH grading systems (2 types) incomplete

Answer 24

Fever
Splenomegaly
Two cytopenias
High triglycerides
High ferritin (>500, typically over 2000)

Question 25

EEG findings for HSV encephalitis

Answer 25

PLEDS- Periodic lateralized epileptiform discharges (aka periodic discharges), diffuse or focal slowing

Question 26

Presentation of kyasaunar forest

Group 3

Answer 26

After an incubation period of 3-8 days, the symptoms of KFD begin suddenly with chills, fever, and headache. Severe muscle pain with
vomiting, gastrointestinal symptoms and bleeding problems may occur 3-4 days after initial symptom onset. Patients may experience
abnormally low blood pressure, and low platelet, red blood cell, and white blood cell counts.
After 1-2 weeks of symptoms, some patients recover without complication. However, the illness is biphasic for a subset of patients (10-
20%) who experience a second wave of symptoms at the beginning of the third week. These symptoms include fever and signs of
neurological manifestations, such as severe headache, mental disturbances, tremors, and vision deficits.
The estimated case-fatality rate is from 3 to 5% for KFD.

Question 27

Spinal cord neurology causes

Answer 27

VZV
Enterovirus
HTLV
Chik

Question 28

Parvovirus presentation in congenital infection

Answer 28

Hydrops- fetal heart failure, anemia, effusions (extravasion of fluid, polyhydramnios)
Myocarditis
Echogenic bowel
Dental loss