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BPT Infectious Diseases > Viral Infections > Flashcards

Viral Infections Flashcards

1
Q

How does CMV usually present in an immunocompetent host?

A

Mostly asymptomic

Can have fever, lymphadenopathy and lymphocytosis

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2
Q

`What are the complications of congenital/neonatal CMV infection?

A

IUGR, pneumonitis, thrombocytopaenia, microcephaly, chorioretinitis, SNHL

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3
Q

What are the risk factors for CMV infection in immunocompromised hosts?

A 
D+/R- (in solid organ transplant)
D-/R+ (in stem cell transplants)
Antilymphocyte induction drugs
Age
Comorbidities
Immune status
Genetics
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4
Q

What are the indirect effects of CMV infection in a transplant patient?

A

Allograft injury, allograft rejection, opportunistic infections

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5
Q

What is the mechanism of action of ganciclovir and valganciclovir?

A

Inhbits CMV DNA polymerase

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6
Q

What anti viral is used when there is resistance to ganciclovir/valganciclovir?

A

Foscarnet

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7
Q

What malignancies are associated with EBV?

A 
Post transplant lymphoproliferative disease
Nasopharyngeal carcinoma
Hodgkins lymphoma
Gastric carcinoma
Oral hairy leucoplakia
Burkitt’s lymphoma
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8
Q

What are the treatment options for post transplant lymphoproliferative disease?

A 
Reduction in immunosuppression
Antiviral agents
IVIG
Rituximab
Chemotherapy 
Immunotherapy
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9
Q

When is varicella infectious?

A

48 hours prior to development of rash and 4-5 days after crusting of the lesions

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10
Q

What are the clinical features of uncomplicated varicella?

A

Prodrome of fever, malaise, pharyngitis

Generalised vesicular itchy rash

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11
Q

What are the complications of varicella?

A

Bacterial skin infection
Encephalitis
Pneumonia

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12
Q

What is the management of varicella in adults?

A

Uncomplicated – oral acyclovir or valacyclovir

Complicated or immunocompromised – IV acyclovir

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13
Q

What post exposure prophylaxis should pregnant women receive for varicella?

A

Varicella immunoglovulin if < 4 days and non immune

Consider oral acyclovir if exposure > 4 days

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14
Q

What is the treatment for herpes zoster?

A

Valacyclovir or acyclovir

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15
Q

Who should be vaccinated against herpes zoster?

A

Elderly patients regardless of chicken pox or zoster history

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16
Q

When is measles infectious?

A

From 5 days prior to rash until 4 days after

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17
Q

What are the clinical feature of measles?

A

Prodrome – fever, conjunctivitis, cough, coryza abd koplick spots
Exanthema phase – erythematouys blanching macular rash that begins on face and descends

18
Q

What are the complications of measles?

A

Pulmonary – croup, bronchopneumonia, sinusitis, bronchiectasis
Neurologic – encephalitis, sub-acute sclerosing pan-encephalitis

19
Q

What is the treatment for measles?

A

No effective proven specific treatment but give vitamin A and ?ribavirin

20
Q

What are the clinical features of encephalitis?

A

Change in mental state for >24 hours, fever, unexplained seizures, focal neurology

21
Q

What are the early complications of encephalitis?

A 
Seizures
Cerebral oedema
Raised ICP
Hydrocephalus
Hypothalamic disturbance (SIADH, temperature)
22
Q

What are the late complications of encephalitis?

A

Persistent neurocognitive sequelae (e.g. cognitive impairment)
Post infectious autoimmune encephalitis (usually associated with HSV)

23
Q

What is the best predictor of mortality in encephalitis?

A

Level of consciousness

24
Q

What are the most common viral causes of encephalitis?

A

HSV, VZV, enteroviruses

25
Q

What are the common types of autoimmune encephalitits?

A 
Anti-NMDA
ADEM
AHLE
Anti-LGI
Anti-Caspr2
26
Q

Which antibody is associated with small cell lung cancer paraneoplastic encephalitis?

A

Anti-Hu

27
Q

Which antibody is associated with testicular cancer paraneoplastic encephalitis?

A

Anti-Ma2

28
Q

What specific history questions should be asked for patients with encephalitis?

A

Travel, animal exposure, immunocompromised, vaccination history, recent rash, features of malignancy

29
Q

What is the sensitivity of HSV PCR on CSF?

A

96%

30
Q

What are the classic CSF findings for viral encephalitits?

A

Lymphocyte predominant, normal glucose, mildly elevated protein

31
Q

Which area of the brain is typically affected in HSV encephalitits?

A

Temporal

32
Q

Which area of the brain is typically affected in autoimmune/paraneoplastic encephalitis?

A

Limbic

33
Q

What is the management for new unexplained encephalitis?

A

Acyclovir pending aetiological confirmation

Supportive treatment – anti epileptics, antibiotics if suspect meningoencephalitis, management of raised ICP

34
Q

What is the management for ADEM?

A

IV methylprednisolone

35
Q

What is anti NMDA receptor encephalitits associated with?

A

Ovarian teratoma

36
Q

What is ADEM (acute disseminated encephalomyelitis) associated with?

A

Measles

37
Q

What are the EEG findings for ADEM?

A

Diffuse slowing

38
Q

What are the MRI findings for ADEM?

A

White matter lesions

39
Q

What antibody is found in ADEM?

A

Anti-MOG

40
Q

What is AHLE?

A

Acute haemorrhagic leuco-encpehalopathy

A severe rapidly progressive form of ADEM, a necrotising vasculitis

BPT Infectious Diseases (9 decks)

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