Viral Flashcards
1
Q
3TC- chemical, class
A
lamivudine
NRTI
2
Q
ABC- class, name, SE
A
NRTI
abacavir
hypersensitivity with HLA-B5701
3
Q
ABC- class, name, SE
A
abacavir
NRTI
hypersensitivity, esp HLA-B5701
4
Q
Aedes aegypti- appearance, transmits 3
A
dark body with white stripes
DEN, CHIK, YF
5
Q
Anopheles transmits which viruses/parasites (2)
A
ONY, malaria
6
Q
ARBOvirus transmission: no vector (4), blood exposure (2), ribavarin use (
A
Ebola, Marburg, Lassa, Hanta
RVF, CCHF
Ribavirin use: Lassa, CCHF, Hanta, RVF
7
Q
Arenaviridae- 2
A
Lassa, lymphocytic choriomeningitis
8
Q
ART has NOT led to reduction in which CA
A
cervical
9
Q
at what prevalence need HIV and Hep B screening
A
> 0.1% HIV
> 2% Hep B
10
Q
AZT- chemical, class, SE
A
zidovidine
NRTI
macrocytic anemia
11
Q
B virus- agent, host, Sx
A
DNA Herpesviridae
macaque bite
localized neuro to CNS (fatal)
12
Q
Bacillary angiomatosis- agents, Dx, Tx
A
B. henslae and B. quintana
silver stain
macrolide or doxy
13
Q
Bunyaviridae (3)
A
CCHF, RVF, Hantavirus
14
Q
CCHF family, geo, vector, classic Sx, mortlaity, Tx
A
bunya
Eastern Europe, Africa, Asia, Middle East
tick
extensive prupura
25%
ribavarin
15
Q
CCHF- family, vector, reservior, geo, characteristic Sx
A
Bunyaviridae (nairovirus)
transmitted by the hard (Ixodid) Hyalomma ticks
herd animals
Eastern Europe, Africa, Indian subcontinent, and Middle East
extensive purpura
16
Q
Chik vs dengue clinically
A
arthralgia vs myalgia
17
Q
Chik- family, vector, Sx (3), sequalae (3)
A
toga/alpha
Aedes (aegypti and albopictus)
fever, rash, arthralgia
tenosynovitis for years, Raynauds, cryoglobulinemai
18
Q
Chikungunya- family, vector, geo, classic
A
RNA togo/alpha
Aedes
Asia, Africa, Europe
fever, joint pain esp hands and feet
half may have pain mos to yrs
19
Q
Contraindications to AZT
A
bone marrow suppression, myopathy, lactic acidosis (rare), and hepatic
Also antogonistic with d4T (stavudine)
20
Q
cryptococcus maintenance in HIV
A
fluconazole 200 QD for life (NOT proph)
21
Q
cryptococcus prophylaxis with HIV- when, what
A
CD4< 200
fluconazole
22
Q
Culex transmits which viruses (2)
A
JE, WNV, equines
23
Q
CXR typical HIV with TB
A
hilar and mediastinal adenopathy
lower non-cavitating infiltrate
24
Q
d4T- chemical, class, SE
A
staduvidine
NRTI
neuropathy, pancreatitis,hepatitis
Antaginistic with AZT
25
ddC- class
NRTI
26
ddI- class, name, SE
NRTI
didanosine
pancreatitis, peripheral neuropathy
27
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
28
Dengue- class, cases, deaths, vector
flavivirus
75 million (but \> 50% ASx), 25K deaths
Aedes
29
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
30
Ebola/Marburg Sx
severe headache, arthralgias or myalgias, anorexia, asthenia, GI Sx
31
EFV- chemical, class, SE
efavirenz
NNRTI
teratogenic, interact rifampin
32
Esophageal candidiasis is which WHO HIV stage
4
33
Faget's sign
relative brady despite fever
seen YF and DEN
34
Filovirus- agents, reservior, Sx
Ebola, Marburg
fruit bat reservior, unknown host
capillary leak, DIC, asthenia, diarrhea, abd pain, conjunctival, rash
high fatality- 25% Marburg
35
Flaviviridae
Hep C
Mosq: DEN, WNV, JE, YF, Zika
Tick: Powassan, Kysanar Forest dz, Omsk hem fever, tick-borne enceph (POW, TBE, OMS, KFD)
36
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
37
Hep A shedding duration
2 wks before
kids up to 6 mo
38
Hep A vaccine contraindications
allergy- neomycin, yeast, latex
age \< 12 mo
39
Hep A vaccine effectiveness after 1 and 2
94% after 1 mo
99% after 2 shots
40
Hep B acute Sx- infants and older than 5 YO
infant 1%, older 40%
BUT more kids get chronic
41
Hep B chronic % in infants, \> 5 YO
90% infants
10% \> 5 YO
42
Hep B highly endemic in
Southeast Asia, Sub-Saharan Africa, Amazon basin in South America, Greenland, Northern Canada
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43
Hep B overall mortality
0.75%
44
Hep B prevalence
2 billion, 1/3 of world
45
Hep C % chronic, % cirrhoisis
80% chronic
20% cirrhosis
46
Hep C acute %
20%
47
Hep C and cancer
NHL lymphoma \> liver CA
48
Hep C- family, transmission, incubation, Tx
RNA
fluids, perinatal 5% risk
6 wk
interferon and ribavarin
49
Hep E and pregancy
10% mortality
50
Hep E- family, tansmission, incubation, geo, severity
RNA hepevirdae
FO\>\>P2P, swine workers
6 wks
India, Africa, ME...
15% pregnant mortality
worse in older
51
HepA- family, transmission, age, incubation
RNA flavivirus
FO, P2P
more severe \> 50 YO
4 wk
52
Hepatitis B endemic in
Southeast Asia Sub-Saharan Africa Amazon basin in South America Greenland Northern Canada
53
Hepatocellular CA assoc
B \> C
B- 40% no cirrhosis first
54
HepB- family, transmission, geo, incubation
DNA hepadnaviridae
body fluds (90% perinatal)
Asia, Africa
6 wks
55
high nosocomial spread
CCHF, filovirus, MERS
56
HIV and HBV co-infection Tx
NRTI: tenovir (TDF), lamivudine (3TC), emtricitabine (FTC)
less liver
57
HIV breast feeding transmission rate
15%
58
HIV drug teratogenic 1st trimester
EFV
59
HIV med causing cytopenia
AZT
60
HIV med commonly causing drug eruption
NVP, worse higher CD4
61
HIV med nephrotoxic
TDF (tenovir)
62
HIV meds causing dyslipidemia
PI
63
HIV meds causing hepatitis
all, esp NVP
64
HIV meds causing neuropathy and pancreatitis
d4T (staduvidine), ddI (didanosine)
65
HIV meds causing pancreatitis (2)
d4T, ddI
66
HIV second line Tx in Africa
Ritonavir protease inhibitier + 2 NRTI (at least 1 new)
67
HIV Tx firstline in Africa
2 NRTI + 1 NNRTI (usually EFV)
68
HIV with fever and HA- Asia, Africa
Penicillinosis in Asia
Cryptococcus in Africa
69
HIV-2- number, resistance
\< 500K
NNRTI resistant
70
How effective is Hep B vaccine
90%
71
How many in world infected with Hep B
2 billion
72
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
73
Incubation for hemorrhagic fevers
\< 21 d
74
Infections resembling moluscum contagiousum (2)
Penicillinosis
cutaneous cryptococcus
75
Japanese encepahalitis- family, vector, mortality
flavi
Culex
if Sx, 25% fatal, 40% morbidity
76
Kyasanur Forest Disease- family, geo
flavi
India
77
Lassa treatment
ribavarin
78
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
79
Lymphocytic Choriomeningitis Virus (LCMV)- family, vector
arena
mouse
80
MAC prophylaxis at
CD4 50
macrolide- Zithromax/biaxin,
81
maternal HIV transmission rate
30%
(8% with AZT)
1% with infant triple drug and exclusive BF
82
measles clinical triad
cough, coryza, conjunctivitis
83
Measles complication 1:10,000
subacute sclerosing panencephalitis
5-10 yrs later
84
Measles- % exposed who become ill
90%
85
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
86
Meds associated with lactic acidosis
Didanosine (ddI), stavidine (d4T) and zidovudine (AZT)
87
MERS- family, geo, host, mortality
betacoronovirus
Saudi Arabia
camels
40%
88
monkeypox geo
Africa
89
mosquito borne viruses
Aedes- DEN, CHIK, YF, RVF
Anopheles- ONY
Culex- JE, WNV, VEE, WEE, EEE
multiple: RR, SEM, lymphatic filariasis
90
most common 1st line HAART Tx in developing
Tenofovir (TDF) + lamivudine (3TC) + efavirenz (EFV)
91
mumps- family, transmission, complication
paramyxovirus
droplet, saliva, fomite
5-10% meningitis, orchitis
92
needlestick risk- B, C, HIV
30% B
3% C
0.3% HIV
93
NRTI assoc with lactic acidosis (3)
didanosine (ddI), stavidine (d4T) and zidovudine (AZT)
94
number infected with HIV
33 million, 2/3 in Africa
95
NVP- chemical, class, SE
nevirapine
NNRTI
dermatitis, hepatitis
more toxic M CD4\>400, F CD4\>250
96
OMSK- family, vector (2)
flavi
rodent, sheep/goat milk
97
Perinatal Hep B transmission
90%
98
PJP prophylaxis- when, what
CD4 \<200
Bactrim SS sufficient
99
Polio Sx
most Asx, many mild GI, severe with meningismus
100
Polio- family, host, endemic (2), % post polio
RNA enterovirus, 3 serotypes
human
Pakistan, AFG
post polio in 25%
101
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
102
Prion- agent, Sx, Dx
protein
dementia, neuro
tonsil Bx
103
Progressive Multifocal Leukoencephalopathy- agent, assoc
Polyomavirus JC
IRIS in HIV
104
Proph for HIV- 50, 100, 200
50- MAC; macrolide
100- toxo; Bactrim DS, Fandisar
200- PJP and crypto- Bactrim SS and fluconazole
105
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
106
Rabies PrEP- schedule
0, 7, 21/28
do NOT start if cannot finish
107
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)
108
Rabies- 2 forms, mortality
furious (most)- 80%
paralytic (dumb)- 20%
100% fatal, 55K/yr (1/3 India)
109
Reoviridae (1)
Colorado Tick Fever
110
Rift Valley Fever- family, reservior, vector, geo
Bunya
sheep, cattle- abortions
Aedes mosquito
Africa, Mid East
111
Ross River virus- family, vector, geo, Sx
Togavirus
“endemic polyarthritis”
mosquitoes
Australia and Asia
112
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
113
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%
114
sheep/goat milk possible source of which viruses (2), bacteria (4)
TBE, OMSK
M. bovis, Coxiella, EHEC, Yersinia
115
Smallpox vaccine post-exposure prophylaxis within...
4 days
116
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
117
TDF- chemical, class, SE
tenovir
NRTI
nephrotoxic
118
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
119
Tick borne viruses (6) P. TOCCK
CCHF, TBE, KFD, OMSK, POW, CTF
120
Togoviridae (4 types)
CHIK, EEE, VEE, WEE, RF (Ross), ONY, SEM
(CHIK, equine, Ross, rubella and odd)
121
toxoplama prophylaxis in HIV- when, what
CD4\< 100
Bactrim DS or Fandisar
122
Toxoplasma maintenance of\_\_\_\_\_\_ until CD4\_\_\_\_\_\_
Pyrimethamine and sulfdiazine (fandisar) OR Bactrim DS
CD4 \>100
123
Tx for infants of HIV pos mom
NVP for 1 year
Bactrim PJP proph
INH if TB exposed
124
Tx HIV with TB
rifampin and clarithromycin
drug interaction with EFV (use NVP or 3 NRTI)
start ART \< 8 wks after start TB Tx
125
Varicella endemic
temperate
people in tropics may not be immune
126
Infections leading to hearing loss
Borrelia, Lassa, rickettsia
127
Where is HTLV-1 endemic
Japan, Carribean
128
WHO HIV stage 1
ASx to LAD
129
WHO HIV stage 2
minor rashes, zoster, URI
130
WHO HIV stage 3
weight loss
unexplained fever, diarrhea, or anemia
oral lesions/thrush
active TB
131
WHO HIV stage 4
HIV wasting
extrapulmonary TB
esophageal candidiasis
AIDS defining infections
132
WHO rabies PEP
lick, touch -\> 0
minor scratch/no bleed -\> vaccine
bite -\> RIG and vaccine
133
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
134
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
135
Zika- family, vector, Sx (4)
flavi
Aedes
rash, fever, joints, conjunctivitis
136
Hep B serotypes
A- more resistant to lamuvidine
B- respond better to inteferon
C- higher risk HCC
137
Rotovirus vaccine
killed, oral
