Viral Inf of Circ, Lymph, and Res Flashcards

Question

Cytomegalovirus Disease presentation in patients

Answer 1

- depends on patient demographics - normal immune status indiv: asymptomatic carrier or mono-like symptoms (distinct from EBV bc heterophile AB negative& no EBV antigens) - baby of seronegative mother: prior to birth --> cytomegalic inclusion disease - immunodef/AIDS population: Multisite symptomatic disease

Answer 2

- Herpesviridae family - Enveloped - dsDNA - Viral Replication: 1. Mucosal epithelium 2. Viremia (highest risk of spread to others) - Latency in monocyte - Reactivation is rarely symptomatic in immunocompetent individuals.

Answer 3

- Saliva - Breast milk - Urine - Fomites - Sexual contact

Answer 4

- Detection of viral DNA or virus culture from diseased tissue.: Note: Virus may be shed from urine or saliva for months to years after acute infection. Not necessarily diagnostic of acute. - Seroconversion: ***Timing and multiple samples needed to differentiate recent from current infection.

Answer 5

---1st--- -Gancyclovir: converted to viral polymerase inhibitor by CMV enzymes (i.v. or oral). -Valganciclovir: converted to gancyclovir within the body. Increased bioavailability. (oral) -Toxicity: Bone marrow toxicity, drug-related neutropenia. ---2nd--- -Cidofovir: converted to viral polymerase inhibitor by cellular enzymes. More toxic than gancyclovir.(i.v.) -Foscarnet: direct inhibitor of the CMV polymerase. renal toxicity. (i.v.) (ACYCLOVIR AND VALACYCLOVIR = NO GOOD)

Answer 6

``` -Mono-like: most mild outcome of CMV infection Fever Fatigue Pharyngitis (usually non exudative) Abnormal T cells No heterophile antibody production (ONLY PRIMARY INF WITH CMV) ```

Answer 7

-Cytomegalovirus (CMV) manifestation -Most common with primary infections -Hepatosplenomegaly Jaundice Petechiae/Rash

Answer 8

- Prevention (primarily for seronegative pregnant women) - Interrupt CMV transmission in body fluids (children are frequent shedders of CMV) - Handwashing - Avoid sharing drinks and toothbrushes with young children - Avoid contact with saliva when kissing a child - Treatment - Maternal treatment with CMV immunoglobulin during pregnancy (currently under investigation)

Answer 9

-Most important and common viral pathogen complicating organ transplant. Highest risk – 1- 4 mo. following transplant. -AIDS patients present with CMV diseases usually with highly advanced disease -CD4 counts between 50 and 100 cells/μL Spiking Fever (100- 104 ºF) -Sources: Transplanted Organ, reactivation of latent CMV

Answer 10

-CMV pneumonitis -Symptoms: Fever; Hypoxia; Interstitial Lung Infiltrates -GI tract -Symptoms: Diarrhea; Abdominal Pain Nausea; Vomiting --> Complication: perforation and hemorrhage of GI epithelium -Graft vs. Host Disease

Answer 11

- ----CMV Retinitis: Symptoms: Blurred Vision; “Floaters”; White lesions --> Lesions with irregular, white necrotic border - Diagnosis: Pupil dilation and ophthalmoscope examination - ---GI tract - ---CMV pneumonitis

Answer 12

- Organ transplant prevention - Donor matching - Prophylaxis or preemptive therapy with antivirals - CMV immunoglobin - AIDS Prevention: Maintenance therapy with antivirals when reaching a threshhold level of CD4+ T-cells. - Treatment Indications: immunocompromised patients with severe disease are treated with I.V. antivirals.

Answer 13

inflammation of the middle muscular layer of the heart wall leading to ventricular dysfunction.

Answer 14

- Most prevalent in adult men. - Typical presentation: Shortness of breath; Exercise intolerance; Fatigue - May mimic cardial infarction

Answer 15

historicaly: -adenoviruses (especially types 2 &5) -enteroviruses (especially coxsackievirus B) more recently: B19 parvovirus & HHV-6

Answer 16

- High index of suspicion in patients with congestive heart failure of unknown origin. - Chest Radiograph, electrocardiogram, endomyocardial biopsy. - Nucleic acid based test on the biopsied material may reveal viral cause.

Answer 17

- Manage symptoms of CHF and arrhythmias | - Mild disease --> bed rest and observation

Answer 18

- Swollen, tender parotid glands - Sometimes accompanied by submandibular gland swelling. - Prodrome of malaise and anorexia (1-2 days).

Answer 19

- Paramyxoviridae family. - ssRNA genome. - One serotype - Incubation period is 14-18 days. - Age of onset usually between 5-14 years. (in pre-vaccine era) - 20% of infections are asymptomatic.

Answer 20

- Meningitis (15% of mumps cases) - Orchitis (testicular inflammation) common in postpubertal males. Rarely affects fertility. - Deafness in 1/20,000 mumps cases. - Myocarditis (extremely rare, but often fatal)

Answer 21

- entry into respiratory tract - spreads into local lymph nodes - primary viremia established - sperad to salivary glands, teste,ovaries, pancreas, CNS - more viremia - generalized spread to other body sites including kidneys - more viremia

Answer 22

-swelling of parotid gland or other salivary gland without any other reason is enough

Answer 23

if uncomplicated will resolve on its own

Answer 24

- Direct contact - respiratory droplets - saliva - contaminated fomites

Answer 25

- live attenuated -- Intramuscular | - recommended for all children

Answer 26

-Mumps -Measles -Rubella -Varicella 2 doses 12-15mo and 4-6 years

Answer 27

- all adults one done | - 2 doses for high risk exposure

Answer 28

- --Cutaneous Lesions: - Pink, Purple, or Brown in Color - Usually non-painful - Can become confluent (combine into one giant lesion) - Increased proliferation of endothelial cells.* - --Cases with visceral lesions: Weight loss or fever - --Histology: Spindle morphology of cells

Answer 29

rare middle eastern or miditerranean few lesions -not life threatening

Answer 30

- equatorial africa - Presents like Classic KS - Aggressive form in pre-pubrescent children, often fatal within 3 years

Answer 31

- Occurs in individuals whose immune systems have been suppressed following organ transplant. - Often lesions resolve when immunosuppressive therapy is discontinued (or modified).

Answer 32

- Often more widespread lesions than other KS forms. - May include other symptoms - Lymph node swelling - Fever - Weight loss - Often fatal when lung involvement occurs

Answer 33

Herpes virus 8 (HHV-8)

Answer 34

(-causes Kaposi’s Sarcoma) - Enveloped - dsDNA genome - Latent state in KS lesions - Contains several homologues of cellular genes.

Answer 35

-blood borne - needle, sex

Answer 36

- Prevention of HHV-8 transmission: Safe sex practices; Limit needle sharing - Treatments for KS: Often controlling immune deficiency higher priority that treating KS.;Not herpes antivirals because virus is in the latent state in KS lesions.; Treatment can be with chemotherapy, radiation, and/or surgery.

Answer 37

- caused by human t-cell lymphoma virus-1 - T-cell origin - --Clinical presentation:--- - Lymphadenopathy - Hepatosplenomegaly - Hypercalcemia - Skin infiltration of tumor cells: Papules; Plaques; Tumors; Ulcers

Answer 38

"flower cells!"

Answer 39

- Disease most common in southern Japan, the Caribbean, and Central Africa. - Median age of onset = 55 years

Answer 40

Serology: antibodies to Human T-cell leukemia virus 1 (HTLV-I).

Answer 41

- caused by human t-cell lymphoma virus-1 - Demyelination of neurons within the spinal cord. - Likely autoimmune disease

Answer 42

- Highest incidence adult women - Symptoms: Stiff gait ; Lower extremity; weakness, back pain; Incontinence; 1/3 patients bedridden at 10 yr post diagnosis

Answer 43

-Infects CD4 and CD8 positive cells -Retrovirus -Enveloped +ssRNA genome -Reverse transcription

Answer 44

- gets in via glut1 receptor - reverse transcriptase to make dsDNA from its +ssrNA - integrate into genome - transcribed = mRNA and protein - maturation step with budding

Answer 45

- Nursing - Blood transfusion - Sexual transmission (Male to Female more efficient)

Answer 46

- Nursing discouraged in endemic areas. - Screening the blood supply - Reduce unprotected sex - Treatment with combined chemotherapy, however limited effectiveness.