Viral Flashcards
3TC- chemical, class
lamivudine
NRTI
ABC- class, name, SE
NRTI
abacavir
hypersensitivity with HLA-B5701
ABC- class, name, SE
abacavir
NRTI
hypersensitivity, esp HLA-B5701
Aedes aegypti- appearance, transmits 3
dark body with white stripes
DEN, CHIK, YF
Anopheles transmits which viruses/parasites (2)
ONY, malaria
ARBOvirus transmission: no vector (4), blood exposure (2), ribavarin use (
Ebola, Marburg, Lassa, Hanta
RVF, CCHF
Ribavirin use: Lassa, CCHF, Hanta, RVF
Arenaviridae- 2
Lassa, lymphocytic choriomeningitis
ART has NOT led to reduction in which CA
cervical
at what prevalence need HIV and Hep B screening
> 0.1% HIV
> 2% Hep B
AZT- chemical, class, SE
zidovidine
NRTI
macrocytic anemia
B virus- agent, host, Sx
DNA Herpesviridae
macaque bite
localized neuro to CNS (fatal)
Bacillary angiomatosis- agents, Dx, Tx
B. henslae and B. quintana
silver stain
macrolide or doxy
Bunyaviridae (3)
CCHF, RVF, Hantavirus
CCHF family, geo, vector, classic Sx, mortlaity, Tx
bunya
Eastern Europe, Africa, Asia, Middle East
tick
extensive prupura
25%
ribavarin
CCHF- family, vector, reservior, geo, characteristic Sx
Bunyaviridae (nairovirus)
transmitted by the hard (Ixodid) Hyalomma ticks
herd animals
Eastern Europe, Africa, Indian subcontinent, and Middle East
extensive purpura
Chik vs dengue clinically
arthralgia vs myalgia
Chik- family, vector, Sx (3), sequalae (3)
toga/alpha
Aedes (aegypti and albopictus)
fever, rash, arthralgia
tenosynovitis for years, Raynauds, cryoglobulinemai
Chikungunya- family, vector, geo, classic
RNA togo/alpha
Aedes
Asia, Africa, Europe
fever, joint pain esp hands and feet
half may have pain mos to yrs
Contraindications to AZT
bone marrow suppression, myopathy, lactic acidosis (rare), and hepatic
Also antogonistic with d4T (stavudine)
cryptococcus maintenance in HIV
fluconazole 200 QD for life (NOT proph)
cryptococcus prophylaxis with HIV- when, what
CD4< 200
fluconazole
Culex transmits which viruses (2)
JE, WNV, equines
CXR typical HIV with TB
hilar and mediastinal adenopathy
lower non-cavitating infiltrate
d4T- chemical, class, SE
staduvidine
NRTI
neuropathy, pancreatitis,hepatitis
Antaginistic with AZT
ddC- class
NRTI
ddI- class, name, SE
NRTI
didanosine
pancreatitis, peripheral neuropathy
Dengue Sx, course, mortality
DF- breakbone fever with retro-orbital HA, rash, tourniquet test, white islands on red sea rash in recovery
resolves by day 7 unless DHF develops; avoid fluid overload
mortality: 12% DHF, 50% DSS
Dengue- class, cases, deaths, vector
flavivirus
75 million (but > 50% ASx), 25K deaths
Aedes
Dengue- family, vector, geo, Sx
RNA flavivirus
Aedes
Latin and S. America, Asia, Africa
75% ASx
retro-oribital pain, rose spots, bradycardia, petechiae, V, abd pain, low PLT, shock if goes hemorrhagic
Ebola/Marburg Sx
severe headache, arthralgias or myalgias, anorexia, asthenia, GI Sx
EFV- chemical, class, SE
efavirenz
NNRTI
teratogenic, interact rifampin
Esophageal candidiasis is which WHO HIV stage
4
Faget’s sign
relative brady despite fever
seen YF and DEN
Filovirus- agents, reservior, Sx
Ebola, Marburg
fruit bat reservior, unknown host
capillary leak, DIC, asthenia, diarrhea, abd pain, conjunctival, rash
high fatality- 25% Marburg
Flaviviridae
Hep C
Mosq: DEN, WNV, JE, YF, Zika
Tick: Powassan, Kysanar Forest dz, Omsk hem fever, tick-borne enceph (POW, TBE, OMS, KFD)
Hantavirus- family, source, geo, incubation, Sx
bunya
inhalation urine, droppings, or saliva of the deer mouse
central and western US and Canada, also Korea
incubation 3-4 wks
Hantavirus pulmonary syndrome (HPS)- 38% mortality Sin Nombre virus
ALSO, hemorrhagic fever renal syndrome in Korea
Hep A shedding duration
2 wks before
kids up to 6 mo
Hep A vaccine contraindications
allergy- neomycin, yeast, latex
age < 12 mo
Hep A vaccine effectiveness after 1 and 2
94% after 1 mo
99% after 2 shots
Hep B acute Sx- infants and older than 5 YO
infant 1%, older 40%
BUT more kids get chronic
Hep B chronic % in infants, > 5 YO
90% infants
10% > 5 YO
Hep B highly endemic in
Southeast Asia, Sub-Saharan Africa, Amazon basin in South America, Greenland, Northern Canada
Hep B overall mortality
0.75%
Hep B prevalence
2 billion, 1/3 of world
Hep C % chronic, % cirrhoisis
80% chronic
20% cirrhosis
Hep C acute %
20%
Hep C and cancer
NHL lymphoma > liver CA
Hep C- family, transmission, incubation, Tx
RNA
fluids, perinatal 5% risk
6 wk
interferon and ribavarin
Hep E and pregancy
10% mortality
Hep E- family, tansmission, incubation, geo, severity
RNA hepevirdae
FO>>P2P, swine workers
6 wks
India, Africa, ME…
15% pregnant mortality
worse in older
HepA- family, transmission, age, incubation
RNA flavivirus
FO, P2P
more severe > 50 YO
4 wk
Hepatitis B endemic in
Southeast Asia Sub-Saharan Africa Amazon basin in South America Greenland Northern Canada
Hepatocellular CA assoc
B > C
B- 40% no cirrhosis first
HepB- family, transmission, geo, incubation
DNA hepadnaviridae
body fluds (90% perinatal)
Asia, Africa
6 wks
high nosocomial spread
CCHF, filovirus, MERS
HIV and HBV co-infection Tx
NRTI: tenovir (TDF), lamivudine (3TC), emtricitabine (FTC)
less liver
HIV breast feeding transmission rate
15%
HIV drug teratogenic 1st trimester
EFV
HIV med causing cytopenia
AZT
HIV med commonly causing drug eruption
NVP, worse higher CD4
HIV med nephrotoxic
TDF (tenovir)
HIV meds causing dyslipidemia
PI
HIV meds causing hepatitis
all, esp NVP
HIV meds causing neuropathy and pancreatitis
d4T (staduvidine), ddI (didanosine)
HIV meds causing pancreatitis (2)
d4T, ddI
HIV second line Tx in Africa
Ritonavir protease inhibitier + 2 NRTI (at least 1 new)
HIV Tx firstline in Africa
2 NRTI + 1 NNRTI (usually EFV)
HIV with fever and HA- Asia, Africa
Penicillinosis in Asia
Cryptococcus in Africa
HIV-2- number, resistance
< 500K
NNRTI resistant
How effective is Hep B vaccine
90%
How many in world infected with Hep B
2 billion
HTLV-1- assoc dz (3), transmission (3), geo
adult T-cell (in 4%), tropical spastic paresis, worse strongy
STD, iatrogenic, BF
Japan, Carribean, New Guinea, S. Am
Incubation for hemorrhagic fevers
< 21 d
Infections resembling moluscum contagiousum (2)
Penicillinosis
cutaneous cryptococcus
Japanese encepahalitis- family, vector, mortality
flavi
Culex
if Sx, 25% fatal, 40% morbidity
Kyasanur Forest Disease- family, geo
flavi
India
Lassa treatment
ribavarin
Lassa- genus, geo, reservior, Sx (big 3), sequelae, perinatal, Tx
arenovirus
Africa
mastomys rats inhaled or ingested
fever, retrosternal pain, pharyngitis…GI, proteinuria, and mucosal bleeding, possible neuro
Deafness sequelae in 30%
Mortality 30% pregnant, 85% infants (“swollen baby syndrome”- anasarca and bleeding
Tx- early ribavirin can reduce mortality
Lymphocytic Choriomeningitis Virus (LCMV)- family, vector
arena
mouse
MAC prophylaxis at
CD4 50
macrolide- Zithromax/biaxin,
maternal HIV transmission rate
30%
(8% with AZT)
1% with infant triple drug and exclusive BF
measles clinical triad
cough, coryza, conjunctivitis
Measles complication 1:10,000
subacute sclerosing panencephalitis
5-10 yrs later
Measles- % exposed who become ill
90%
Measles- timing, Sx, contagious, complications (3)
incubation 7-14 d, 90% exposed get infected
prodrome-cough, conjunctivitis, and coryza
Koplik spots
rash (9-19 d from exposure), 2-5 days after prodrome
Head -> body fades in 3-5 days.
Contagious 4 days before to 4 d after rash
Pneumonia (giant cell and secondary bacterial)
Encephalitis (1/1000)
Sub-acute sclerosing panencephalitis (1/100,000) yrs later
Meds associated with lactic acidosis
Didanosine (ddI), stavidine (d4T) and zidovudine (AZT)
MERS- family, geo, host, mortality
betacoronovirus
Saudi Arabia
camels
40%
monkeypox geo
Africa
mosquito borne viruses
Aedes- DEN, CHIK, YF, RVF
Anopheles- ONY
Culex- JE, WNV, VEE, WEE, EEE
multiple: RR, SEM, lymphatic filariasis
most common 1st line HAART Tx in developing
Tenofovir (TDF) + lamivudine (3TC) + efavirenz (EFV)
mumps- family, transmission, complication
paramyxovirus
droplet, saliva, fomite
5-10% meningitis, orchitis
needlestick risk- B, C, HIV
30% B
3% C
0.3% HIV
NRTI assoc with lactic acidosis (3)
didanosine (ddI), stavidine (d4T) and zidovudine (AZT)
number infected with HIV
33 million, 2/3 in Africa
NVP- chemical, class, SE
nevirapine
NNRTI
dermatitis, hepatitis
more toxic M CD4>400, F CD4>250
OMSK- family, vector (2)
flavi
rodent, sheep/goat milk
Perinatal Hep B transmission
90%
PJP prophylaxis- when, what
CD4 <200
Bactrim SS sufficient
Polio Sx
most Asx, many mild GI, severe with meningismus
Polio- family, host, endemic (2), % post polio
RNA enterovirus, 3 serotypes
human
Pakistan, AFG
post polio in 25%
Polio- Sx %
0.5% of infected get paralytic polio
5-10% of paralytic will die so 0.05% of infected will die
0.05% will have irreversible paralysis
Prion- agent, Sx, Dx
protein
dementia, neuro
tonsil Bx
Progressive Multifocal Leukoencephalopathy- agent, assoc
Polyomavirus JC
IRIS in HIV
Proph for HIV- 50, 100, 200
50- MAC; macrolide
100- toxo; Bactrim DS, Fandisar
200- PJP and crypto- Bactrim SS and fluconazole
Rabies post exposure both unimmun and immunized in USA
Unimmun: RIG 100% into wound, vaccine 0, 3, 7, 14
Immun: No HRIG, vaccine 0, 3
Extra at 28 for immunocompromised
Rabies PrEP- schedule
0, 7, 21/28
do NOT start if cannot finish
Rabies US PEP- exposure, how fast start
for any exposure- touch, bat in same room while asleep
RIG at site within 24 hours
4 doses vaccine within 24 hours (0, 3, 7, 14)
IF IMMUNIZED- 2 doses within 48 h (0, 3)
Rabies- 2 forms, mortality
furious (most)- 80%
paralytic (dumb)- 20%
100% fatal, 55K/yr (1/3 India)
Reoviridae (1)
Colorado Tick Fever
Rift Valley Fever- family, reservior, vector, geo
Bunya
sheep, cattle- abortions
Aedes mosquito
Africa, Mid East
Ross River virus- family, vector, geo, Sx
Togavirus
“endemic polyarthritis”
mosquitoes
Australia and Asia
Rubella- family, incubation, contagious time, complication
togavirus
2-3 wks
2 wks before rash; congenital for 1 yr
congenital with PA stenosis, deaf, cataract, microcephaly
Salk vs Sabin
oral vaccine (Sabin) 1 dose -> 50% immunity; 3 doses -> 95% immunity, also IgA, shedding may immunize others, better for wild type polio
Salk (injected/inactivated) vaccine 2 doses -> 90% immunity in 90%
sheep/goat milk possible source of which viruses (2), bacteria (4)
TBE, OMSK
M. bovis, Coxiella, EHEC, Yersinia
Smallpox vaccine post-exposure prophylaxis within…
4 days
Smallpox- incubation, Sx
incubation 10-12 days
fever, headache, and severe backache
centrifugal rash in 2-4 days
vesicles, pustules, scabs that desquamate end of the third or fourth week- SAME STAGE
more lesions on the arms and legs than on the trunk
TDF- chemical, class, SE
tenovir
NRTI
nephrotoxic
Tick borne encephalitis- family, host, vector, geo, prevention
Flavivirus
Rodents
Tick- 30% not recall AND sheep/goat milk
Europe, Russia, Siberia
vaccine in other countries
Tick borne viruses (6) P. TOCCK
CCHF, TBE, KFD, OMSK, POW, CTF
Togoviridae (4 types)
CHIK, EEE, VEE, WEE, RF (Ross), ONY, SEM
(CHIK, equine, Ross, rubella and odd)
toxoplama prophylaxis in HIV- when, what
CD4< 100
Bactrim DS or Fandisar
Toxoplasma maintenance of______ until CD4______
Pyrimethamine and sulfdiazine (fandisar) OR Bactrim DS
CD4 >100
Tx for infants of HIV pos mom
NVP for 1 year
Bactrim PJP proph
INH if TB exposed
Tx HIV with TB
rifampin and clarithromycin
drug interaction with EFV (use NVP or 3 NRTI)
start ART < 8 wks after start TB Tx
Varicella endemic
temperate
people in tropics may not be immune
Infections leading to hearing loss
Borrelia, Lassa, rickettsia
Where is HTLV-1 endemic
Japan, Carribean
WHO HIV stage 1
ASx to LAD
WHO HIV stage 2
minor rashes, zoster, URI
WHO HIV stage 3
weight loss
unexplained fever, diarrhea, or anemia
oral lesions/thrush
active TB
WHO HIV stage 4
HIV wasting
extrapulmonary TB
esophageal candidiasis
AIDS defining infections
WHO rabies PEP
lick, touch -> 0
minor scratch/no bleed -> vaccine
bite -> RIG and vaccine
Yellow fever- family, annually, geo, mortality, Sx
flavi
200K cases, 30K deaths
90% Africa (mortality 25%), 10% Americas (mort 55%)
15% acute go toxic
Jaundice, Abd pain, Diarrhea, ARF, Bleeding
YF Sx
3-4 d HA, photophobia, conjunctival injection, bradycardia
remission 1-2 d
15% get biphasic with mild jaundice, bleeding, hemetemsis, proteinura, EKG changes, nuero, secondary pneumonia
Zika- family, vector, Sx (4)
flavi
Aedes
rash, fever, joints, conjunctivitis
Hep B serotypes
A- more resistant to lamuvidine
B- respond better to inteferon
C- higher risk HCC
Rotovirus vaccine
killed, oral
