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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
Q

How is EBV transmitted?

A

Intimate contact with body secretions, primarily oropharyngeal

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26
Q

What does EBV infect in the opropharynx specifically?

A

B cells in oropharyngeal epithelium

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27
Q

Where do circulating Bcells spread the infection of EBV?

A

throughout entire reticular endothelial system (RES)
Liver
Spleen
Peripheral lymph nodes

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28
Q

What does EBV infection of B lymphocyte result in?

A

a humoral AND cellular response to the virus.

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29
Q

What is the cascade of Pathologic response in EBV?

A

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

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30
Q

What is critical to determining clinical expression of EBV?

A

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

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31
Q

Symptoms of EBV?

A

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.

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32
Q

What symptoms of EBV are consistent with an increased morbidity?

A

Airway obstruction and CNS mononucleosis. (although morbidity and mortality is rare)

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33
Q

Classic Presentation of EBV?

A

Common:
Triad of: Fever, Pharyngitis, and lymphadenopathy
Leukocytosis with atypical lymphocytes-common
Splenomegaly-late finding

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34
Q

Presentation of elderly pt’s with EBV?

A

-Elderly: may present w/ anticteric viral hepatitis (jaundice), otherwise older pts have fewer oropharynx/adenopathic signs.

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35
Q

Hoaglund sign

A

Associated with EBV

Bilateral upper lid edema, lasts only a few days

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36
Q

EBV workup

A

Heterophile antibody test: often negive early; increasing during 1st 6 weeks
Monospot

If negative test serologically

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37
Q

EBV tx?

A 
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
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38
Q

Which exanthem is erythema infectiosum?

A

5th

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39
Q

What are the sings that need to be present to diagnose 5th dz?

A

Classic slapped-cheek AND!!! subsequent lacy exanthem

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40
Q

What various causes 5th disease?

A

Human parvovirus (HPV) B 19

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41
Q

How is Erythema Infectiosum transmitted?

A

Respiratory secretions/fomites
Vertical transmission from mom-fetus
Transfusion of blood/blood products

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42
Q

What is incubation period for erythema infectiosum?

A

7-10 days

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43
Q

What factors are responsible for the dermatologic and rheumatic symptoms of Erythema Infectiosum?

A

Antigen-antibody (Ag-Ab) complexes

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44
Q

What Dermatologic and Rheumatic symptoms are present with erythema infectiosum?

A

Arthropathy (MC in women)

Anemia: (Transient)

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45
Q

Phases of 5th dz?

A

Phase 1: Slapped-cheek rash
Phase 2: 1-4days after-lace-like reticular rash
Phase 3: Recurrences of lacy rash for weeks/months

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46
Q

At what phase can you diagnose 5th dz?

A

Phase 2 (once the lacey rash shows up)

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47
Q

Erythema infectiosum in pregnancy can cause what?

A

Fetal hydrops (although occurrence is

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48
Q

When are those who have 5th dz no longer infectious?

A

When the rash appears

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49
Q

w/u for erythema infectiosum?

A

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

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50
Q

Prevention/isolation of 5th dz

A

children w/ 5th are not infectious
May attend childcare/school
Exposed pregnant women hold consult OB/GYN regarding immune status.

51
Q

What is HSV-1 traditionally associated w/?

A

Orofacial disease

52
Q

What is HSV-2 traditionally associated w/?

A

genital disease

53
Q

Unique HSV biological properties?

A

Neurovirulence
Latency
Reactivation

54
Q

How is HSV transmitted?

A

close personal contact of susceptible mucosal surfaces

55
Q

How long do symptoms of HSV gingivostomatitis last?

A

5-7 days (subside in 2 weeks)

56
Q

Presentation of HSV gingigvostomatitis?

A 
Abrupt onset 
High temp
Anorexia/listlessness
gigivitis
Vesicular lesions
Tender regional lymphadenopathy
57
Q

What does HSV oropharyngeal cause in adults?

A

Pharyngitis and tonisillitis

58
Q

Presentation of acute herpetic pharyngotonsillitis

A 
Fever
Malaise
H/A 
Sore throat
Vesicles
Oral and labial lesions
59
Q

What is the most common manifestation of recurrent HSV-1 infection?

A

Acute Herpetic labialis

60
Q

Presentation of acute herpetic labialis?

A

Pain/burning/tingling at site

erythematous papules that develop into tiny thin-walled intraepidermal vesicles that become patellar and ulcerate.

61
Q

What causes genital herpes?

A

either or both HSV-1, and HSV-2

62
Q

Which type of HSV more commonly has recurrences?

A

HSV-2

63
Q

Primary genital herpes is characterized by _________?

A

Severe and prolonged systemic and local symptoms

64
Q

What infections prevent against genital HSV-1?

A

Orolabial HSV-1, (but not HSV-2)

65
Q

Subclinical and symptomatic reactivation is more common in HSV-___ than in HSV-___?

A

More common in HSV-2 than in HSV-1

66
Q

What is the length of time for prodrome for genital herpes?

A

2hr to 2 day prodrome of tenderness, pain, burning around site

67
Q

w/u for HSV

A

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
Q

What is seen on cytology for HSV?

A

Multinucleate giant cells

punch bx most reliable

69
Q

Complications of HSV

A

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
Q

What is indicated in OB for mothers w/ active genital lesions during labor?

A

C-section

71
Q

What is a primary genital infection of HSV during the third trimester of pregnancy associated with?

A

neonatal HSV infections
intrauterine growth retardation
prematurity

72
Q

tx for HSV

A 
Same meds are given for HSV-1 and HSV-2
Antivirals
Penciclovir
Acyclovir
Valacyclovir
Famciclovir
73
Q

How is HIV transmitted?

A

Sexual intercourse
Shared IV drug
Mother to child

74
Q

What is different about HIV-2?

A

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
Q

What is the cellular response in HIV?

A

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
Q

What are people with HIV prone to?

A

US-Pneumocystis and Candida spec.
Homosexual men-Kaposi sarcoma (co-infection of HHV8)
Developing countries-TB

77
Q

what are MC co-infections of HIV?

A

Hep B
Hep C
Human herpes virus 8 (Kaposi sarcoma)

78
Q

Infected (hetero/homosexual) (Men/Women) outnumber infected (hetero/homosexual) (Men/Women).

A

Infected heterosexual women outnumber heterosexual men 2:1

79
Q

What physical findings are specific to HIV infection?

A

NONE!! - none are specific although a few exit as r/f:

Acute seroconversion results in flulike illness
Generalized lymphadenopathy
Minor concurrent opportunistic infections

80
Q

What test is used for screening of HIV?

A

ELISA

81
Q

What should be done if pt’s ELISA is positive?

A

confirmatory test in the form of 1/more Western blot assays

82
Q

W/u HIV

A

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
Q

Staging HIV:

A

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
Q

TX of HIV

A

Antiretroviral:

in all pts with CD4

85
Q

what basis is antiretroviral tx prescribed on?

A 
Virologic efficacy
toxicity
pill burden
dosing frequency
Drug-drug interaction potential
drug resistance testing results 
comorbid conditions
86
Q

What do you tx for prophylactically in pt with HIV?

A

Pneumocystis jiroveci (TMP-SMX; Bactrim)
Mycobacerium avium - (weekly azithromycin/clarithromycin)
CMV-in advanced AIDS pt’s(oral ganciclovir)

87
Q

What exanthem is 1st dz?

A

Measles, hard/red measles

88
Q

How contagious is measles?

A

VERY >90% secondary infection rate in households

89
Q

How is measles transmitted?

A

respiratory droplets

90
Q

Presentation for measles?

A

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
Q

What groups are complications mc in for measles?

A 
20yo
Immunocompromised
Malnutrition (vit A def)
Under-vaccinated
Preg.
92
Q

common complications of measles?

A 
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
Q

W/u for measles?

A

Observed the triad-Conjunctivits, Coryza, Cough

Confirmation 
serologic testing for IgG and IgM
Isolation of the virus 
PCR-RT
CSF-in suspect encephalitis
94
Q

Tx of Measles?

A

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
Q

Mumps definition

A

an acute self-limited, systemic viral illness characterized by swelling of one or more of the salivary glands

96
Q

What virus causes mumps?

A

RNA virus known as Rubulavirus

97
Q

transmission of mumps?

A

Respiratory entry-replication occurs locally

Viremic dissemination occurs in target tissues-salivary glands and CNS

98
Q

prognosis of uncomplicated mumps?

A

excellent.

99
Q

complications of mumps

A

RARE:
encephalitis
sensorineural deafness

LESS rare:
Orchitis
Oophoritis
Pancreatitis

100
Q

Presentation of Mumps

A 
Fever (subsides in 7 days before swelling)
headach 
malaise
otalgia
sudden hearing loss
thyroiditis
pancreatitis
orchitis
aseptic meningitis
morbilliform rash
101
Q

w/u for mumps:

A

clinical diagnosis typically

Serum amylase elevated
nasopharyngeal swab
PCR of CSF
IgG
IgM titer
Mumps orchitis-elevated CRP
CSF
Audiology
102
Q

Tx of mumps:

A 
supportive care
reduce acidic food
analgesic/antipyretics
5 DAYS OF ISOLATION!!
Vaccine coverage needed to interrupt community transmission
post exposure vaccine-NOT BENEFICIAL
103
Q

What does the rabies virus affect?

A

CNS

104
Q

How is rabies transmitted?

A

saliva or in aerosolized secretions from infected animals -typically via bite.

105
Q

Pathophys of rabies

A

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
Q

Is rabies cytotoxic?

A

No

107
Q

On eastern coast what animals most commonly transmit rabies?

A

raccoons

108
Q

Presentation of rabies:

A

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
Q

Post exposure tx for Rabies:

A

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
Q

What is the pathogen for Roseola?

A

Human Herpesvirus 6 (HHV-6)

111
Q

What is the presentation of Roseola?

A

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
Q

Who is at risk for symptomatic roseola?

A

Immunocompromised patients

babies

113
Q

Which exanthem is German measles?

A

3rd disease, Rubella

114
Q

What is the clinical manifestation of rubella by age group?

A

Young children: Mild, rash, suboccipital adenopathy
Older children, adolescents, adults: arthralgia, arthritis, TCPP-rarely encephalitis
prego-teratogenic especially early in gestation

115
Q

How is Rubella transmitted?

A

aerosolized particles

116
Q

Pathophys of Rubella?

A

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
Q

Rubella presentation?

A 
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
Q

What is the classic triad of congenital rubella?

A

Sensorineural hearing loss (MC)
Ocular abnormalities-cataract, glaumcoma, pigmentary retinopathy
CHF

119
Q

W/u for Rubella

A

Viral culture

serology

120
Q

Varicella Zoster virus transmission

A

airborne respiratory droplets

121
Q

Presentation of varicella?

A

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
Q

Complications of Varicella

A

(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
Q

Varicella w/u

A

Tzanck smear-Multinucleated giant cells and epithelial cells with eosinophilic intranuclear inclusion bodies

Vesicular fluid culture

Serolgoy

CXR-for pna

Histologic exam

124
Q

tx for Varicella

A

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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