Viral infection in the immunocompromised Flashcards
1
Q
What can immunocompromised hosts develop
A
- they can develop more severe acute infection
- may develop severe, life-threatening disease
- can present prolong shedding: spread to others
- can fail to clear the virus leading to chronic infection
- may reactive latent infections
- can present with reoccurrence of disease
- may develop unusual presentations of the infections
2
Q
What is a chronic persistent infection
A
infection maintained by continuous replication of a virus (e.g. hepatitis C, HIV)
3
Q
What is a chronic latent infection
A
persistent or lifelong infection maintained by a pool of latently infected cells (non-replicating)
4
Q
What is reactivation
A
re-emergency of the same virus after apparent clearance
5
Q
What is the difference between HSV 1 and HSV2
A
- Cold sores are nearly always HSV-1
- Genital herpes are classically HSV-2
6
Q
Describe how Herpes simplex virus spreads
A
- direct contact with the lesion
7
Q
what is the primary infection of herpes simplex associated with
A
- frequently asymptomatic although the suffer may experience pharyngitis, fever, ulceration and lymphadenopathy
8
Q
How does herpes simplex reoccurrence occur and how long does it last for
A
- reoccurrence is very common
- classical periodontal tingling followed by an localised painful blister than resolves over 5-7 days
9
Q
How do you diagnose herpes simplex virus
A
- Swab the area/lesion with PCR
10
Q
How do you treat herpes simplex virus
A
- Aciclovir
11
Q
describe what you prevent with when you have varicella zoster virus
A
Primary infection: Chicken pox
- fever
- generalised vesicular rash
12
Q
How does Varicella zoster virus spread
A
- spreads via respiratory droplets and shedding from lesions
13
Q
when is Varicella zoster virus most infectious
A
1-2 days before rash onset
14
Q
How do you diagnose Varicella zoster virus
A
- clinical diagnosis but you can swab and then PCR the infected area
15
Q
What is the reactivation of VZV called
A
shingles
16
Q
Who does shingles present in
A
immunosuppressed patients
17
Q
How does shingles present
A
- can be multidermfomal
- encephalitis
- both infectious until all lesions crusted over
- chickenpox generally uncomplicated in healthy children
- immunocompromised can experience severe disease when pneumonitis and disseminated infection
18
Q
How do you treat VZV in immunocormpised patients
A
- Aciclovir
- IV treatment if VZV pneumonitis, encephalitis, and eye disease
- resistance is uncommon but can develop on treatment of immunocompromised
19
Q
what viruses are major hazard for allogenic HSCT and certain SOT transplants
A
ACE viruses
- adenovirus
- cytomegaloviruses
- Epstein-Barr viruses
20
Q
When is CMV common
A
- infection is common in childhood, usually minimal symptomatic and self-limiting
21
Q
What type of illness can CMV cause
A
- can cause a mononucleosis-like illness and hepatitis
22
Q
When can CMV reactivate
A
- remains latent in monocytic cells and can reactive in immune suppression
23
Q
CMV is a..
A
important cause of congenital abnormalities
24
Q
in solid organ transplant describe how the CMV donor status impacts the risk of infection
- CMV Donor status = positive
- CMV recipient status = negative
- CMV Donor status = positive
- CMV recipient status = positive
- CMV Donor status = negative
- CMV recipient status = positive
- CMV Donor status = negative
- CMV recipient status = negative
A
- CMV Donor status = positive
- CMV recipient status = negative
- high risk of primary infection
- CMV Donor status = positive
- CMV recipient status = positive
- medium risk, reactivation or reinfection
- CMV Donor status = negative
- CMV recipient status = positive
- medium risk, reactivation
- CMV Donor status = negative
- CMV recipient status = negative
- Low risk
25
In HSCT describe how the CMV donor status impacts the risk of infection
- CMV Donor status = positive
- CMV recipient status = negative
- CMV Donor status = positive
- CMV recipient status = positive
- CMV Donor status = negative
- CMV recipient status = positive
- CMV Donor status = negative
- CMV recipient status = negative
- CMV Donor status = positive
- CMV recipient status = negative
- medium risk protected by the host T cells
- CMV Donor status = positive
- CMV recipient status = positive
- medium risk, reactivation or reinfection
- CMV Donor status = negative
- CMV recipient status = positive
- high risk, uncontrolled reactivation
- CMV Donor status = negative
- CMV recipient status = negative
- low risk
26
How do you diagnose CMV
- pre transplant serology
| - post transplant monitoring for evidence of CMV viraemia/infection
27
What do you need to have in order to diagnose CMV disease
- evidence of end organ involvement with syndrome appropriate for CMV
- may find evidence of CMV DNA in organ via per
- Histological evidence = gold standard for diagnosis
28
name the ways that CMV can present
- oesophagitis - common in immunocomrpomised
- fever
- colitis/hepatits
- retinitis - common in immunocomrpomised
- pneumonitis - common in immunocomrpomised
- myelosuppression
- CNS
- adrenal involvement
29
What are the common ways CMV presents in immunocompromised patients
- oesophagitis
- retinitis
- pneumonitis
30
What is the management of CMV
Prophylaxis
- antiviral use after transplantation
Pre-emptive therapy
- monitor CMV activity after transplant and start antiviral therapy at first indication of active CMV replication
31
name the antiviral drugs that are used to treat CMV
- ganciclovir
- ciclofovir
- foscarnet - used when the CMV is resistant to ganciclovir
32
What are the two concerns of developing EBV in immunosuppressed patients
- development of Post transplant lymphoproliferative disorder
- lymphoma
33
What are the risk factors for Post transplant lymphoproliferative disorder
- primary EBV infection post-transplant
- children under 5 years as they have no been exposed to EBV before
- anti rejection therapy
- CMV seromismatch
- type of transplant - small bowel, heart/lung/pancreatic-renal, liver, bone marrow
34
What are the symptoms of Post transplant lymphoproliferative disorder
- unexplained fever
- GI upset
- lymphadenopathy
- tonsillar hypertrophy
- IM
- hepatic/splenic enlargement
- anaemia/pancytopenia
- graft dysfunction
35
How do you treat Post transplant lymphoproliferative disorder
- reduction of immunosuppression
| - rituximab
36
What are the three main syndromes that adenovirus can cause in healthy patients
- respiratory disease
- keratoconjuctivits
- gastroenteritis
37
What can adenovirus cause in immunosuppressed patients
- pneumonia
- hepatitis
- haemorrhage cystitis
- enterocolitis
- encephalitis
- disseminated infection
38
What are the risk factors for Adenovirus in immunosuppressed patients
- children
- severe graft versus host disorder
- core blood transplant
- alemtuzumab conditioning
- liver, heart, and multi visceral solid organ transplant
39
What is the problem with adenovirus
- asymptomatic viral shedding in immunosuppressed
| - disseminated infection in more than 2 sites/ detection of adenovrial DNA can help you diagnose adenovirus
40
How do you diagnose adenovirus in the immunosuppressed
- screening via blood, urine PCR - if positive then test other sites such as respiratory and stool
41
How do you treat adenovirus in the immunosuppressed
- antivirals such as Brincidofovir
| - reduction on immune suppression
42
What are the two types polyomaviruses
- JC viruse
| - BK virus
43
Describe how polyomaviruses initially infects a person and how it reactivates
- intimal viraemia and seeding of the kidney and then latency
- can have reactivation which leads to viruria which leads to viraemia and then end organ disease
44
What symptoms do you get with polymaviruses
- usually aysymptomatic
3 main syndromes
- BK virus-associated haemorrhage cystitis - seen in allogenic transplant patients
- BK virus associated nephropathy - seen in renal tranpslant patients
- JV PML
45
how do you detect COVID
detection of Viral RNA by PCR
| - nasopharyngeal swabs
