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Clin Med - ID > Viral > Flashcards

Viral Flashcards

1
Q

Cytalomegavirus (CMV) overview:

Family

A

Herpesviridae family (includes CMV, HSV-1, 2, VZV etc)

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2
Q

CMV usually causes a(n) _________ infection

A

asymptomatic

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3
Q

What symptoms might a person who has symptoms of CMV present with?

A

symptomatic mononucleosis in immunocompetent individuals.

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4
Q

What is more common on physical exam with EBV than CMV?

A

cervical adenopathy

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5
Q

t/f CMV remains latent throughout life?

A

T it remains latent and may reactivate.

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6
Q

What organs does CMV affect in immunocompromised individuals?

A

Almost every organ of the body.

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7
Q

How does CMV in immunocompromised pt’s present?

A 
Fever of unknown origin
Pneumonia
Hepatitis
ecephalitis
myelitis
colitis
uveitis
retinitis 
neuropathy
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8
Q

Who is at risk for contracting CMV?

A

Those who attend/work at daycare centers
Pt’s w/ blood/bone marrow/organ trans.
People who have at risk behavior (multiple partners)

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9
Q

How is CMV transmitted?

A

via close contact. Person to person

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10
Q

What does transmission from mother to baby during pregnancy cause?

A

neurological abnormalities and deafness

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11
Q

congenital CMV infection presentation?

A 
Petechiae
Jaundice
microcephaly
SGA
 Deafness
 retinitis
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12
Q

Common lab abnormalities for congenital CMV infection?

A

hyperbillirubinemia
increased hepatocellular enzymes
thrombocytopenia
increased CSF protein levels

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13
Q

Who is symptomatic CMV congenital disease less likely to occur in?

A

Women with pre-existing immune responses to CMV are less likely than CMV-naiive individuals

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14
Q

Who is at high risk for developing life-threatening CMV pneumonia?

A

Lung transplant recipients have a 50% risk of developing CMV illness

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15
Q

What disease is Cytalogmegavirus retinitis related with?

A

Opportunistic infection with AIDS (esp w/ CD4+ counts

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16
Q

What does CMV retinitis look like on ophthalmic exam?

A

“Cottage cheese and ketchup”

retinitis w/ obvius hemorrhages and perivascular yellowish-white exudates

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17
Q

What relationship does CMV have with Graft Vs. Host dz?

A

CMV has been associated with acute graft vs. host disease in bone marrow transplant pt’s.

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18
Q

CMV is an _______ disease; may aggravate underlying immune disorders?

A

Immunomodulatory

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19
Q

Wu for CMV?

A

Elevated IgM
4-fold incrase in IgG titers
Anti-CMV immediate early antigen monoclonal antibody test (can detect 3 hous into infection)
Cytopathology
Amplification CMV pp65 antigen in leukocytes

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20
Q

What may produce a False-positive CMV IgM result?

A

EBV or HHV-6 infections

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21
Q

What will cytopathology for CMV show?

A

“owls eye.” Enlarged cell with viral inclusion bodies

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22
Q

CMV tx?

A

1st line: Gangciclovir and Valganciclovir

2nd line: Fosacarnet or Cidofavir are used off label.

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23
Q

What is used for prophylactic or preemptive tx of CMV in transplant recipients?

A

Ganciclovir

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24
Q

EBV clinical syndrome:

A

Fever
Pharyngitis
Adenopathy

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25
How is EBV transmitted?
Intimate contact with body secretions, primarily oropharyngeal
26
What does EBV infect in the opropharynx specifically?
B cells in oropharyngeal epithelium
27
Where do circulating Bcells spread the infection of EBV?
throughout entire reticular endothelial system (RES) Liver Spleen Peripheral lymph nodes
28
What does EBV infection of B lymphocyte result in?
a humoral AND cellular response to the virus.
29
What is the cascade of Pathologic response in EBV?
B cells infected in oropharyngeal epithelium B cells spread infection to RES Infection of EBV B lymphocytes results in humoral and cellular response to virus T-Cell Response
30
What is critical to determining clinical expression of EBV?
T-cell response Rapid and efficient T-Cell response=primary EBV infection w/ lifelong suppression of EBV Inneffective EBV T-Cell response=excessive/uncontrolled B-cell proliferation w/ B-lymphocyte malignancies
31
Symptoms of EBV?
Fatigue profound initially following a 1-2 month incubation Gradually resolves in 3 mos Some have initial recovery then prolonged fatigue w/out the features of infectious mono.
32
What symptoms of EBV are consistent with an increased morbidity?
Airway obstruction and CNS mononucleosis. (although morbidity and mortality is rare)
33
Classic Presentation of EBV?
Common: Triad of: Fever, Pharyngitis, and lymphadenopathy Leukocytosis with atypical lymphocytes-common Splenomegaly-late finding
34
Presentation of elderly pt's with EBV?
-Elderly: may present w/ anticteric viral hepatitis (jaundice), otherwise older pts have fewer oropharynx/adenopathic signs.
35
Hoaglund sign
Associated with EBV Bilateral upper lid edema, lasts only a few days
36
EBV workup
Heterophile antibody test: often negive early; increasing during 1st 6 weeks Monospot If negative test serologically
37
EBV tx?
``` Evaluate tonsil/adenoid for obstruction -Short course corticosteroids (7-10 days) only if symptoms are very bad Hemolytic anemia Thrombocytopenia CNS invovlement Obstructive adenoid/tonsillar enlargement -Fatigue will be present for some time ```
38
Which exanthem is erythema infectiosum?
5th
39
What are the sings that need to be present to diagnose 5th dz?
Classic slapped-cheek AND!!! subsequent lacy exanthem
40
What various causes 5th disease?
Human parvovirus (HPV) B 19
41
How is Erythema Infectiosum transmitted?
Respiratory secretions/fomites Vertical transmission from mom-fetus Transfusion of blood/blood products
42
What is incubation period for erythema infectiosum?
7-10 days
43
What factors are responsible for the dermatologic and rheumatic symptoms of Erythema Infectiosum?
Antigen-antibody (Ag-Ab) complexes
44
What Dermatologic and Rheumatic symptoms are present with erythema infectiosum?
Arthropathy (MC in women) | Anemia: (Transient)
45
Phases of 5th dz?
Phase 1: Slapped-cheek rash Phase 2: 1-4days after-lace-like reticular rash Phase 3: Recurrences of lacy rash for weeks/months
46
At what phase can you diagnose 5th dz?
Phase 2 (once the lacey rash shows up)
47
Erythema infectiosum in pregnancy can cause what?
Fetal hydrops (although occurrence is
48
When are those who have 5th dz no longer infectious?
When the rash appears
49
w/u for erythema infectiosum?
Consider CBC if hemolytic Serology: IgM Ab is usually detectable w/in 3 days of symptom onset IgG AB w/ previous infection is helpful in exposed pregnant women to determine hydrops risk
50
Prevention/isolation of 5th dz
children w/ 5th are not infectious May attend childcare/school Exposed pregnant women hold consult OB/GYN regarding immune status.
51
What is HSV-1 traditionally associated w/?
Orofacial disease
52
What is HSV-2 traditionally associated w/?
genital disease
53
Unique HSV biological properties?
Neurovirulence Latency Reactivation
54
How is HSV transmitted?
close personal contact of susceptible mucosal surfaces
55
How long do symptoms of HSV gingivostomatitis last?
5-7 days (subside in 2 weeks)
56
Presentation of HSV gingigvostomatitis?
``` Abrupt onset High temp Anorexia/listlessness gigivitis Vesicular lesions Tender regional lymphadenopathy ```
57
What does HSV oropharyngeal cause in adults?
Pharyngitis and tonisillitis
58
Presentation of acute herpetic pharyngotonsillitis
``` Fever Malaise H/A Sore throat Vesicles Oral and labial lesions ```
59
What is the most common manifestation of recurrent HSV-1 infection?
Acute Herpetic labialis
60
Presentation of acute herpetic labialis?
Pain/burning/tingling at site | erythematous papules that develop into tiny thin-walled intraepidermal vesicles that become patellar and ulcerate.
61
What causes genital herpes?
either or both HSV-1, and HSV-2
62
Which type of HSV more commonly has recurrences?
HSV-2
63
Primary genital herpes is characterized by _________?
Severe and prolonged systemic and local symptoms
64
What infections prevent against genital HSV-1?
Orolabial HSV-1, (but not HSV-2)
65
Subclinical and symptomatic reactivation is more common in HSV-___ than in HSV-___?
More common in HSV-2 than in HSV-1
66
What is the length of time for prodrome for genital herpes?
2hr to 2 day prodrome of tenderness, pain, burning around site
67
w/u for HSV
Tissue culture is best to confirm Immunofluorescent staining quickly identifies HSV and can distinguish between HSV-1/2 Tzank smear-doesn't differentiate HSV-1/2 PCR - rapid and noninvasive, can detect asymptomatic viral shedding and may detect HSV-2 as cause of meningitis DFA AB testing (NOT IgM testing!!!)
68
What is seen on cytology for HSV?
Multinucleate giant cells | punch bx most reliable
69
Complications of HSV
Bacterial and fungal superinfection (balanitis) Candidal vaginitis Ocular infections (dendiritic corneal ulcers!!!) Eczema herpeticum w/ underlying dermatitis Herpetic Whitlow-Finger near cuticle Aseptic Meningitis Ganglionitis and myelitis Encephalitis Necrotizing viral encephalitis
70
What is indicated in OB for mothers w/ active genital lesions during labor?
C-section
71
What is a primary genital infection of HSV during the third trimester of pregnancy associated with?
neonatal HSV infections intrauterine growth retardation prematurity
72
tx for HSV
``` Same meds are given for HSV-1 and HSV-2 Antivirals Penciclovir Acyclovir Valacyclovir Famciclovir ```
73
How is HIV transmitted?
Sexual intercourse Shared IV drug Mother to child
74
What is different about HIV-2?
Has slightly lower risk of transmission Progresses more slowly to AIDS Lower viral load HIV2 is rare in developed world (most research has been done on HIV1)
75
What is the cellular response in HIV?
cellular immune deficiency d/t decline in CD4+ helper T cells Results in inversion of normal CD4/CD8 T-cell ratio Immune response to certain antigens begins to decline Host can't respond to opportunistic infections (non-bacterial)
76
What are people with HIV prone to?
US-Pneumocystis and Candida spec. Homosexual men-Kaposi sarcoma (co-infection of HHV8) Developing countries-TB
77
what are MC co-infections of HIV?
Hep B Hep C Human herpes virus 8 (Kaposi sarcoma)
78
Infected (hetero/homosexual) (Men/Women) outnumber infected (hetero/homosexual) (Men/Women).
Infected heterosexual women outnumber heterosexual men 2:1
79
What physical findings are specific to HIV infection?
NONE!! - none are specific although a few exit as r/f: Acute seroconversion results in flulike illness Generalized lymphadenopathy Minor concurrent opportunistic infections
80
What test is used for screening of HIV?
ELISA
81
What should be done if pt's ELISA is positive?
confirmatory test in the form of 1/more Western blot assays
82
W/u HIV
CD4 t-cell count (indicate risk of opportunistic infection) Viral load in peripheral blood (estimates viral replication rate) Newly diagnosed HIV workup includes: CMV Syphilis Rapd amplification for gonococcal and chlamydial infection Hep A, B, C serology Anti-Toxoplasma antibody Ophtlamologic exam PPD for TB CXR for those w/ + PPD
83
Staging HIV:
Cat A-asymptomatic HIV Cat B- HIV infection w/ symptoms Cat C- HIV infection w/ AIDS defining opportunistic infection *once HIV is staged it remains in that stage forever.
84
TX of HIV
Antiretroviral: | in all pts with CD4
85
what basis is antiretroviral tx prescribed on?
``` Virologic efficacy toxicity pill burden dosing frequency Drug-drug interaction potential drug resistance testing results comorbid conditions ```
86
What do you tx for prophylactically in pt with HIV?
Pneumocystis jiroveci (TMP-SMX; Bactrim) Mycobacerium avium - (weekly azithromycin/clarithromycin) CMV-in advanced AIDS pt's(oral ganciclovir)
87
What exanthem is 1st dz?
Measles, hard/red measles
88
How contagious is measles?
VERY >90% secondary infection rate in households
89
How is measles transmitted?
respiratory droplets
90
Presentation for measles?
Incubation period 10-12 days Communicable 1-2 days before symptoms until 4 days post rash 1st sign usually stepwise fever ``` CLASSIC TRIAD Conjuctivitis Coryza Cough *also photophobia, periorbital edema, and myalgias ```
91
What groups are complications mc in for measles?
``` 20yo Immunocompromised Malnutrition (vit A def) Under-vaccinated Preg. ```
92
common complications of measles?
``` Pneumonia (MC) acute encephalitis (permanent brain damage) OM Interstitial pneumonitis Exacerbation of TB Encephalomyelitis diarrhea sinusitis stomatitis subclin hepatitis lymphadenitis keratitis (leading to blindness) ```
93
W/u for measles?
Observed the triad-Conjunctivits, Coryza, Cough ``` Confirmation serologic testing for IgG and IgM Isolation of the virus PCR-RT CSF-in suspect encephalitis ```
94
Tx of Measles?
CONTACT CDC! Supportive IV hydration Vit A Post exposure prophylaxis in unvaccinated contacts Abx for 2nd infections (OM, Pna) Rivavirin (in severely immunocompromised adults) MMR-preventative if admin within 3 days of exposure Human Ig within 6 days
95
Mumps definition
an acute self-limited, systemic viral illness characterized by swelling of one or more of the salivary glands
96
What virus causes mumps?
RNA virus known as Rubulavirus
97
transmission of mumps?
Respiratory entry-replication occurs locally | Viremic dissemination occurs in target tissues-salivary glands and CNS
98
prognosis of uncomplicated mumps?
excellent.
99
complications of mumps
RARE: encephalitis sensorineural deafness LESS rare: Orchitis Oophoritis Pancreatitis
100
Presentation of Mumps
``` Fever (subsides in 7 days before swelling) headach malaise otalgia sudden hearing loss thyroiditis pancreatitis orchitis aseptic meningitis morbilliform rash ```
101
w/u for mumps:
clinical diagnosis typically ``` Serum amylase elevated nasopharyngeal swab PCR of CSF IgG IgM titer Mumps orchitis-elevated CRP CSF Audiology ```
102
Tx of mumps:
``` supportive care reduce acidic food analgesic/antipyretics 5 DAYS OF ISOLATION!! Vaccine coverage needed to interrupt community transmission post exposure vaccine-NOT BENEFICIAL ```
103
What does the rabies virus affect?
CNS
104
How is rabies transmitted?
saliva or in aerosolized secretions from infected animals -typically via bite.
105
Pathophys of rabies
neurotropic zoonotic virus evades immune surveillance by sequestering in the nervous system after inoculation enters peripheral nerves length of incubation dependent on size of inoculum Nucleosapsid spill into mineral junction and enter motor and sensory axons. (prophylaxis futile by this stage) Multiplies in ganglion-pain, parastehsis, itching spreads quickly into CNS then to periphery and salivary glands
106
Is rabies cytotoxic?
No
107
On eastern coast what animals most commonly transmit rabies?
raccoons
108
Presentation of rabies:
Incubation period: Asymptomatic for 20-90 days-rabies virus is segregated to immune system; no Ab response Prodromal period: Virus enters CNS Parasthesia, pain, INTENSE ITCHING AT INOCULATION SITE IS PATHOGNOMONIC for rabies. Acute Neurologic period: 2-7 days muscle fasciculations, priapism, Furious rabies, Paralytic rabies Coma - arrest, death
109
Post exposure tx for Rabies:
Washing wound and debridement at time of the bite >10min Lets wounds heal by second intention ABx prophylaxis Rabies vaccine IM (deltoid) Rabies Immunoglobulin-as much as feasible around and under the bite wound Prophylaxis can be d/c'd if animal doesn't have rabies w/in 10 days. Pregnancy is not a contraindication to post exposure prophylaxis 1/3 rabies involves children that were unknown to be exposed-ie: if a bat is found in a childs room the bat should be caught, killed and brought to health department
110
What is the pathogen for Roseola?
Human Herpesvirus 6 (HHV-6)
111
What is the presentation of Roseola?
9-12 mo infant Acute onset, high fever, commonly febrile seizure Lack of URI or GI symptoms Nagayama spots (enanthem)-papules on soft palate 72 hrs later rapid defervesc. w/ onset morbilliform rash HHV-6 remains latent in immunocompetent
112
Who is at risk for symptomatic roseola?
Immunocompromised patients | babies
113
Which exanthem is German measles?
3rd disease, Rubella
114
What is the clinical manifestation of rubella by age group?
Young children: Mild, rash, suboccipital adenopathy Older children, adolescents, adults: arthralgia, arthritis, TCPP-rarely encephalitis prego-teratogenic especially early in gestation
115
How is Rubella transmitted?
aerosolized particles
116
Pathophys of Rubella?
invasion of resp. system spreads through blood to lymph system and replicates in RES 2nd viremia-virus can be found in different body sites (urine) Viremia peaks just before onset of rash and disappears shortly after.
117
Rubella presentation?
``` Incubation 14-21 days Prodrome common in adolescents and adults only s+s appear 1-5 days post onset of rash -Eye pain on lateral and upward eye -Conjunctivitis -sore throat -HA -General Body aches -Low fever -Chills -FORCHEIMER SIGN (pinpoint or larger petechiae that usually occur on soft palate) ```
118
What is the classic triad of congenital rubella?
Sensorineural hearing loss (MC) Ocular abnormalities-cataract, glaumcoma, pigmentary retinopathy CHF
119
W/u for Rubella
Viral culture | serology
120
Varicella Zoster virus transmission
airborne respiratory droplets
121
Presentation of varicella?
No prodrome in children (adults and adolescents-prodrome nausea, myalgia, anorexia, HA) Infectious 1-2 days prior to rash papules to clear vesicle to pustules which umbilicate and crust intense pruritus DEW DROP ON A ROSE PETAL
122
Complications of Varicella
(MC) Secondary bacterial infection-erysipelas, cellulitis, impetigo Staph and strep MC bacteria of secondary infection. Disseminated primary varicella infection-immunocompromised. CNS-Reye syndrome, Buillain-Barre, Acute Cerebella ataxia, encephalitis Hemorrhage
123
Varicella w/u
Tzanck smear-Multinucleated giant cells and epithelial cells with eosinophilic intranuclear inclusion bodies Vesicular fluid culture Serolgoy CXR-for pna Histologic exam
124
tx for Varicella
clip fingernais Antihistaminestopical and parenteral abx if 2nd infection Acyclovir if risk for severe dz Varicella zoster immune globulin is immunosuppressed.

Clin Med - ID (6 decks)

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