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Clinical Pathology > Theme 1: Lecture 2 - Viral and prion pathogens > Flashcards

Theme 1: Lecture 2 - Viral and prion pathogens Flashcards

1
Q

What 4 structures might a virus consist of?

A
  1. genome (RNA or DNA)
  2. capsid (protein coat)
  3. Envelope (lipid bilayer)
  4. some viruses also carry their own enzymes
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2
Q

What are the 6 steps in the lifecycle of a virus?

A
  1. adsorption
  2. penetration
  3. uncoating
  4. synthesis
  5. assembly
  6. release
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3
Q

How are viruses classified?

A
  1. By the genetic material inside them
    - DNA or RNA
    - single or double stranded
    - if single, +ve or -ve strand
  2. presence or absence of an envelope
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4
Q

What is the structure of herpes virus, how many types are known to infect humans and what is their characteristic feature?

A
  • double stranded enveloped DNA viruses
  • 9 types known to infect humans
  • characterised by their ability to establish latency and reactivate
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5
Q

What are 2 other names for herpes simplex 1?

A
  • HSV-1

- ‘cold sores’

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6
Q

What is the mode of transmission of herpes simplex 1?

A
  • direct contact with vesicle fluid from lesions

- latency in sensory nerve ganglion - periodic reactivations

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7
Q

What symptoms/syndromes does herpes simplex 1 cause?

A
  • fluid filled vesicles/ ulcers to skin or mucous membrane - typically mouth (can also be found on genitals due to oral sex)
  • encephalitis - brain inflammation
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8
Q

What is the commonest cause of viral encephalitis?

A

HSV-1

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9
Q

What are 2 other names for herpes simplex 2?

A
  • hsv-2

- genital herpes

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10
Q

What is the mode of transmission of herpes simplex 2?

A
  • direct contact with vesicle fluid from lesions
  • latency in sensory nerve ganglion - periodic reactivations
  • vertical (from mother’s genital tract after vaginal birth)
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11
Q

What symptoms/syndromes does herpes simplex 2 cause?

A
  • vesicles/ ulcers to skin or mucous membrane (typically genitals/buttocks)
  • meningitis
  • neonatal herpes - severe disseminated viraemia (life-threatening)
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12
Q

What are the other disease names of varicella zoster virus?

A

primary infection = chicken pox

reactivation = ‘herpes zooster’, ‘shingles’

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13
Q

What is the mode of transmission of chicken pox?

A
  • respiratory droplet from person infected

- direct contact with vesicle fluid

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14
Q

Where is latency established in varicella zoster virus?

A

dorsal root ganglia

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15
Q

What is the clinical presentation of chicken pox?

A

febrile (fever) illness with widespread vesicular rash

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16
Q

What are other disease names for Epstein Barr virus?

A
  • glandular fever
  • infectious mononucleosis
  • ‘kissing disease’
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17
Q

What is the mode of transmission of Epstein Barr virus?

A

virus is shed in saliva and genital secretions

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18
Q

What is the primary infection of Epstein Barr virus and what can it cause?

A

infectious mononucleosis

-can cause tonsillitis, fever, lymphadenopathy, hepatospleomegaly

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19
Q

Why might Epstein Barr virus reactivate?

A

if unwell or immunosuppressed

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20
Q

How is epstein Barr virus an oncogenic virus?

A

associated with malignant B cell lymphoproliferative disorders

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21
Q

What is the mode of transmission of cytomegalovirus?

A
  • saliva or genital secretions
  • donated blood, stem cells or solid organs
  • latency in myeloid progenitors/monocytes/ dendritic cells
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22
Q

What is the primary infection of cytomegalovirus?

A

infectious mononucleosis

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23
Q

What is congenital CMV infection?

A
  • in infants morn to mothers who have the infection during pregnancy
  • can cause retinitis, deafness, microcephaly, hepatospenomegaly
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24
Q

Reactivation of latent CMV in immunosuppressed patients can cause which conditions?

A

retinitis, colitis, pneumonitis

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25
Q

What are the 5 herpes viruses?

A
  • herpes simplex-1
  • herpes simplex-2
  • varicella zoster virus
  • epstein barr virus
  • cytomegalovirus
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26
Q

What are the 7 known causes of the ‘common cold’?

A
  • rhinovirus
  • coronavirus
  • influenza virus
  • respiratory syncytial virus
  • parainfluenza virus
  • adenovirus
  • enterovirus
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27
Q

What is rhinovirus and what is its mode of transmission?

A
  • common cold
  • aerosolised respiratory secretions (coughs and sneezes)
  • droplets from nose and eyes
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28
Q

What are the symptoms of rhinovirus?

A

sneezing, nasal obstruction & discharge, sore throat, cough, headache and fever

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29
Q

What is the 2nd commonest cause of the common cold?

A

coronaviruses

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30
Q

What is the mode of transmission in coronavirus?

A
  • aerosolised respiratory secretions (coughs and sneezes)

- droplets from nose and eyes

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31
Q

What are the subtypes of coronaviruses discovered?

A

Coronaviruses are divided into alpha and beta
Some beta coronaviruses include:
-COVID-19
-SARS
-MERS - Middle East respiratory syndrome - occurs from camels

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32
Q

Which respiratory viruses are zoonotic?

A
  • coronaviruses

- influenza

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33
Q

What are the 3 types of influenza?

A

A, B and C

-Influenza A mutates regularly so strains vary yearly

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34
Q

What are the two important surface proteins found in influenza?

A

H&N

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35
Q

What is the H1N1 strand of influenza also called?

A

swine flu

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36
Q

What is the mode of transmission of influenza?

A

aerosolised respiratory secretions (coughs and sneezes)

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37
Q

What are the symptoms of primary influenza illness?

A

fever, myalgia, headache, cough, sore throat, nasal discharge

38
Q

What secondary infection might occur post-influenza?

A
  • bacterial lung infection e.g S.pneumoniae, H.influenza, S. aureus
  • virus damages lung tissue so bacteria use this opportunity to colonise
39
Q

What does RSV stand for?

A

respiratory syncytial virus

40
Q

What is the mode of transmission of RSV?

A

Aerosolised respiratory secretions

41
Q

RSV can cause bronchiolitis. What is this?

A
  • inflammation of smallest airways - bronchioles
  • causes cough, wheeze, hypoxia and apnoeas
  • affects children under 2 yrs
42
Q

What is the mode of transmission of HIV?

A
  • virus is present in blood, genital secretions and breast milk
  • transmitted vertically, sexually, needle stick
43
Q

What is the clinical course of HIV?

A
  • HIV targets helper T cells (CD4)
  • 2-6 weeks after transmission, patients may develop acute seroconversion illness (flu-like)
  • asymptomatic chronic infection follows (5-15 years)
  • AIDS
  • with regular and effective antiviral therapy, HIV+ patients can have normal life expectancy
44
Q

What is AIDS?

A

Rise in viral load and fall in CD4, patients become vulnerable to opportunistic infections

45
Q

What is a hepatotrophic virus?

A

virus that specifically effects hepatocytes

46
Q

What are the 5 primarily hepatotrophic viruses identified?

A

HepA
Hep E
Hep B
Hep C

47
Q

How is hepatitis A and E spread?

A

faeco-orally

48
Q

How is hepatitis B and C spread?

A

blood borne

49
Q

What is hepatitis D?

A

Defective virus, can only survive with hepB

50
Q

What are the clinical symptoms of hepA and hepE?

A

Nausea, myalgia, fevers, jaundice, right upper quadrant pain

51
Q

In Western Europe and North America, what is hepE associated with?

A

pigs/undercooked pork

52
Q

In what populations is HepA more common in?

A
  • lower socioeconomic groups
  • returning tourists
  • men who have sex with men
53
Q

who might fulminant hepE affect badly?

A

infected pregnant woman - high mortality (25%)

54
Q

What % of adults with HepA are asymptomatic?

A

50%

90% of children are

55
Q

What % of adults with HepE are asymptomatic?

A

95%

56
Q

What are the modes of transmission of HepB?

A
  • vertical

- sexual

57
Q

What is the clinical course of HepB infection?

A
  • after transmission, acute clinical hepatitis may occur

- hepB is then cleared, or becomes chronic

58
Q

How is risk of chronicity of HepB related to age?

A

inversely related - 90% of perinatally acquired infection progresses to chronic, vs 5% in adults

59
Q

What might chronic hepatitis lead to?

A

cirrhosis–> hepatocellular carcinoma

60
Q

What is the mode of transmission of HepC?

A
  • Sharing needles, needle stick injuries, transfusion of contaminated products
  • vertical (mother to child) & sexual transmission
61
Q

In the UK, what % of PWIDs have hepC?

A

50%

62
Q

What is the clinical course of hepC?

A
  • 25% will develop acute clinical hepatitis
  • 15% will clear virus, 85% will become chronically infected
  • chronic hepatitis —> cirrhosis —> hepatocellular carcinoma
63
Q

What are the 3 viruses that are transmitted via the GI tract?

A
  1. norovirus
  2. rotavirus
  3. enteroviruses
64
Q

How is Norwalk (norovirus) transmitted?

A

ingestion/ inhalation of aerosolised vomit particles

65
Q

What is the main clinical feature of norovirus/norwalk ?

A

vomiting

66
Q

Which virus transmitted via the GI tract is a major cause of infant mortality in the developing world?

A

rotavirus

67
Q

How is rotavirus transmitted?

A

faeco-oral - contaminated food/water, and aerosolised faeces, vomit

68
Q

What are the symptoms of rotavirus?

A

fever, vomiting, watery diarrhoea

69
Q

What are some examples of enteroviruses?

A

poliovirus, echovirus, cocksackie A and B

70
Q

What is the mode of transmission and pathogenesis of enteroviruses?

A
  • enteric route: face-oral, contaminated food/water
  • replicate in gut, but do NOT cause GI symptoms
  • from gut –> lymph nodes –> blood (CNS)
71
Q

What are the important clinical syndromes caused by enteroviruses?

A
  • fever-rash in children
  • meningitis (>50% viral meningitis cases are enteroviruses)
  • severe disseminated disease in neonate
  • poliomyelitis
72
Q

How is mumps transmitted?

A
  • virus shed in saliva and respiratory secretions

- very infectious

73
Q

What is the characteristic sign of mumps?

A

acute parotitis (infection of parodic glands) - unilateral or bi lateral

74
Q

What is orchitis and what virus can it occur in?

A

inflammation of the testicles: affects 20-30% of males with mumps

75
Q

What is a more severe condition caused as a result of mumps?

A

meningitis - can lead to meningoencephalitis and sensoneurial deafness

76
Q

How is measles transmitted?

A

respiratory droplet transmission - very infectious

77
Q

What are the 3 potential clinical syndromes developed as a result of measles?

A
  1. primary measles
  2. acute post infectious measles encephalitis (brain inflammation)
  3. subacute sclerosis pan-encephalitis (progressive, degenerative, fatal disease of CNS)
78
Q

What are the symptoms of primary measles?

A

-fever
-3 C’s:
Coryza - inflammation in mucous membrane of nose
Cough
Conjunctivitis
-Koplik’s spots on inside of cheek
-maculopapular rash

79
Q

What is another name for rubella?

A

German measles

80
Q

Which is the most rare, out of measles mumps and rubella?

A

rubella

81
Q

How is rubella transmitted?

A

droplet transmission from respiratory route

82
Q

What are the symptoms of primary rubella?

A
  • mild illness, fever, maculopapular rash
  • arthralgia/arthritis (30%)
  • slightly more severe in adults
83
Q

What is congenital rubella?

A
  • risk of foetal malformation is highest in first 12 weeks of pregnancy
  • classic triad: bilateral cataracts, sensorineural deafness, cardiac defects
84
Q

What are the other names for parvovirus B19?

A
  • slapped cheek syndrome

- fifth disease

85
Q

Why does parvovirus B19 cause transient anaemia?

A

Infects and kills erythrocyte progenitor cells

86
Q

What are 3 important clinical syndromes caused by parvovirus B19?

A
  1. Erythema infectiosum - fever, coryza, fiery red rash to cheeks, ‘lacy’ rash to body
  2. transient aplastic crisis
  3. infection in pregnancy
87
Q

What is a prion?

A

small, infectious particle containing protein but no nucleic acid

88
Q

What might be the effect of a gene mutation on a prion?

A
  1. gene mutation leads to changes in folding pattern of protein
  2. prion becomes resistant to protease enzyme due to abnormal folding
  3. prion accumulates abnormal in cell
  4. promotes other proteins to abnormal fold
89
Q

What are the modes of transmission of prion proteins?

A

-inherited (genetic defects)
or
-transmitted via consumption or direct exposure

90
Q

What are 4 properties of human prion diseases?

A
  1. manifest in CNS
  2. Produce spongiform change in brain tissue
  3. have long incubation times
  4. are progressive and fatal
91
Q

What is nvCJD?

A
  • new variant Creutzfeldt-Jakon disease
  • very rare
  • progressive ataxia, depression, dementia then death
  • associated with consumption of contaminated beef
92
Q

What is BSE?

A

Bovine spongiform encephalopathy

Clinical Pathology (57 decks)

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