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Year 3 - Clinical Science and Professionalism > Viral infection in the immunocompromised > Flashcards

Viral infection in the immunocompromised Flashcards

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Biology 101 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
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2
Q

What is a chronic persistent infection

A

infection maintained by continuous replication of a virus (e.g. hepatitis C, HIV)

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3
Q

What is a chronic latent infection

A

persistent or lifelong infection maintained by a pool of latently infected cells (non-replicating)

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4
Q

What is reactivation

A

re-emergency of the same virus after apparent clearance

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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

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6
Q

Describe how Herpes simplex virus spreads

A
  • direct contact with the lesion
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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
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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

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9
Q

How do you diagnose herpes simplex virus

A
  • Swab the area/lesion with PCR
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10
Q

How do you treat herpes simplex virus

A
  • Aciclovir
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11
Q

describe what you prevent with when you have varicella zoster virus

A

Primary infection: Chicken pox

  • fever
  • generalised vesicular rash
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12
Q

How does Varicella zoster virus spread

A
  • spreads via respiratory droplets and shedding from lesions
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13
Q

when is Varicella zoster virus most infectious

A

1-2 days before rash onset

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14
Q

How do you diagnose Varicella zoster virus

A
  • clinical diagnosis but you can swab and then PCR the infected area
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15
Q

What is the reactivation of VZV called

A

shingles

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16
Q

Who does shingles present in

A

immunosuppressed patients

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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
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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
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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
Q

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
A
  • 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
Q

How do you diagnose CMV

A
  • pre transplant serology

- post transplant monitoring for evidence of CMV viraemia/infection

27
Q

What do you need to have in order to diagnose CMV disease

A
  • 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
Q

name the ways that CMV can present

A
  • oesophagitis - common in immunocomrpomised
  • fever
  • colitis/hepatits
  • retinitis - common in immunocomrpomised
  • pneumonitis - common in immunocomrpomised
  • myelosuppression
  • CNS
  • adrenal involvement
29
Q

What are the common ways CMV presents in immunocompromised patients

A
  • oesophagitis
  • retinitis
  • pneumonitis
30
Q

What is the management of CMV

A

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
Q

name the antiviral drugs that are used to treat CMV

A
  • ganciclovir
  • ciclofovir
  • foscarnet - used when the CMV is resistant to ganciclovir
32
Q

What are the two concerns of developing EBV in immunosuppressed patients

A
  • development of Post transplant lymphoproliferative disorder
  • lymphoma
33
Q

What are the risk factors for Post transplant lymphoproliferative disorder

A
  • 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
Q

What are the symptoms of Post transplant lymphoproliferative disorder

A
  • unexplained fever
  • GI upset
  • lymphadenopathy
  • tonsillar hypertrophy
  • IM
  • hepatic/splenic enlargement
  • anaemia/pancytopenia
  • graft dysfunction
35
Q

How do you treat Post transplant lymphoproliferative disorder

A
  • reduction of immunosuppression

- rituximab

36
Q

What are the three main syndromes that adenovirus can cause in healthy patients

A
  • respiratory disease
  • keratoconjuctivits
  • gastroenteritis
37
Q

What can adenovirus cause in immunosuppressed patients

A
  • pneumonia
  • hepatitis
  • haemorrhage cystitis
  • enterocolitis
  • encephalitis
  • disseminated infection
38
Q

What are the risk factors for Adenovirus in immunosuppressed patients

A
  • children
  • severe graft versus host disorder
  • core blood transplant
  • alemtuzumab conditioning
  • liver, heart, and multi visceral solid organ transplant
39
Q

What is the problem with adenovirus

A
  • asymptomatic viral shedding in immunosuppressed

- disseminated infection in more than 2 sites/ detection of adenovrial DNA can help you diagnose adenovirus

40
Q

How do you diagnose adenovirus in the immunosuppressed

A
  • screening via blood, urine PCR - if positive then test other sites such as respiratory and stool
41
Q

How do you treat adenovirus in the immunosuppressed

A
  • antivirals such as Brincidofovir

- reduction on immune suppression

42
Q

What are the two types polyomaviruses

A
  • JC viruse

- BK virus

43
Q

Describe how polyomaviruses initially infects a person and how it reactivates

A
  • 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
Q

What symptoms do you get with polymaviruses

A
  • 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
Q

how do you detect COVID

A

detection of Viral RNA by PCR

- nasopharyngeal swabs

Year 3 - Clinical Science and Professionalism (32 decks)

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