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Infectious Disease > Viral infections- Exam 2 > Flashcards

Viral infections- Exam 2 Flashcards

1
Q

_____ are the smallest of the microbes

A

viruses

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2
Q

T/F: Viruses need a host cell to survive and reproduce

A

FALSE, can survive on inanimate objects but need a host cell to reproduce

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3
Q

What are the 3 classification of viruses? Where do they each invade?

A

DNA- host cell nucleus

single stranded RNA viruses- host cytoplasm

retroviruses- host RNA

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4
Q

_____ use reverse transcription to create a DNA copy of their RNA genome and insert it into the host cell - becomes a part of the host RNA

A

retroviruses

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5
Q

Name some instances in which a viral infection can occur

A

Virus attaches to host cell

Viral DNA or RNA then enters the host cell and replicates inside host cell

The host cell typically dies - releasing new viruses that move on to infect other host cells.

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6
Q

Where can you interrupt the viral infection process?

A

during each step of viral replication because it involves different enzymes

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7
Q

What are some modes of transmission for viral infections?

A

Respiratory secretions (airborne droplets)
Enteric secretions (fecal-oral route)
Sexual contact (direct mucosal contact, semen/body fluids)
Blood (contaminated needles and blood products)

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8
Q

What is classic herpes virus lesion presentation?

A

red base with vesicular lesions on top

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9
Q

What family of viruses does herpes belong to? How many types can infect humans?

A

Herpesviridae

8 different types

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10
Q

T/F: After a herpes infection the virus remains within specific host cells and can reactivate. They usually do not survive long outside the host

A

True

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11
Q

Roseola infantum is caused by what herpes strand?

A

HHV 6-7

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12
Q

Kaposi sarcoma is commonly found in what patient population? What strand?

A

AIDS patients

HHV8

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13
Q

In general, HSV 1 affects the ____ region

HSV 2 affects the ____ region

A

1: oral

2: genital

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14
Q

What are the risk factors for contracting HSV?

A

Female
History of STDs
Multiple sexual partners
Contact with sex workers
WSW

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15
Q

_____ or ______can trigger an outbreak of lesions

A

immunocompromise

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16
Q

How is HSV transmitted?

A

skin to skin contact, fluid from vesicle releases HSV

Can transmit infection without presence of vesicles

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17
Q

What is the clinical presentation of HSV 1?

A

Vesicles forming crusts and moist ulcers
Singular or grouped
Lips (upper), nares, mouth

Pain, burning, tingling of skin
Pain with eating (if inside mouth)
Swollen lymph nodes
Low grade fever

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18
Q

What is Herpetic Whitlow?

A

herpes on the finger

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19
Q

What is the clinical presentation for HSV 2?

A

Multiple vesicles forming crusts and ulcers
Multiple, grouped, painful vesicles
May have pain or itching before appearance of lesions
External genitalia, vaginal canal, perianal

Pain, burning, tingling of skin
Dysuria
Cervicitis
Urinary retention
Swollen lymph nodes
Fever, body ache

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20
Q

Severity of symptoms worse and duration typically longer with (first/second) outbreak!

A

initial outbreak

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21
Q

What are some conditions that could trigger a HSV flare?

A

Febrile illness
Hormonal changes (pregnancy, menstrual cycle)
Physical or emotional stress
Overexposure to sunlight

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22
Q

What is it called when HSV is in the eye?

A

HSV Keratoconjunctivitis

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23
Q

Why is HSV Keratoconjunctivitis considered serious?

A

can lead to blindness

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24
Q

What are some s/s of HSV Keratoconjunctivitis? How is it transmitted?

A

unilateral
Initially present with blepharitis
Impaired visual acuity
Pain, sensation of something in eye, photophobia

direct inoculation
very common in neonates

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25
Q

HSV Keratoconjunctivitis usually follow a _____ nerve spead

A

trigeminal

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26
Q

Name some less common presentations that are usually only seen in immunocompromised patients?

A

HSV Encephalitis
Disseminated (Pneumonia)
Esophagitis
Proctitis

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27
Q

What is the correct procedure to dx HSV?

A

-clinical appearance
- culture (either the vesicular fluid or scrapings of crust)
-PCR (or CSF if concerned about HSV encephalitis)
-Tzanck smear

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28
Q

What will the Tzanck smear of a HSV patient look like?

A

multinucleated giant cells

Can also be positive with Varicella; does not tell you if HSV 1 or 2

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29
Q

What is the process for dx HSV Keratoconjunctivitis?

A

dendritic lesions on fluorescein stain and slit-lamp examination

IMMEDIATE referral to ophthalmology

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30
Q

How long is the initial outbreak of HSV usually last? Recurrences?

A

10-20 days initial

5-10 days with recurrence

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31
Q

What is the treatment for genital HSV?

A

Antivirals to help shorten the duration and lessen severity

NO CURE!!

Oral acyclovir (Zovirax) 400 mg TID
valacyclovir (Valtrex) 500 - 1000 mg BID
famciclovir (Famvir) 250 mg TID

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32
Q

What are some topical anesthetics to recommend for minor symptomatic relief for HSV outbreaks?

A

dyclonine (Sucrets)
benzocaine (Anbesol)
Rx viscous lidocaine rinse (Magic Mouthwash)

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33
Q

What are the HSV antiviral treatments?

A

acyclovir (Zovirax)
famciclovir (Famvir)
valacyclovir (Valtrex)

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34
Q

of the antivirals, _____ comes in oral, liquid, IV and topical forms

A

acyclovir

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35
Q

What is an OTC topical antiviral treatment for HSV?

A

docosanol (Abreva) - OTC

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36
Q

What medication do you give for ophthalmic HSV keratitis?

A

trifluridine (Viroptic)

oral acyclovir

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37
Q

______ MOA Inhibit herpes viral DNA synthesis and replication

A

antivirals

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38
Q

antivirals: _____ and _____ are prodrugs - converted to active form in GI tract

A

valacyclovir (Valtrex)

famciclovir (Famvir)

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39
Q

Which antiviral is metabolized in the liver?

A

acyclovir

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40
Q

antivirals (do/do not) interact with CYP450 system and are primarily _____ excreted

A

DO NOT

renally excreted

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41
Q

What are the MC SE of antivirals?

A

GI symptoms
HA, dizziness, malaise
Arthralgia

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42
Q

What are the more serious SE of antivirals?

A

Leukopenia, thrombocytopenia
Neurologic manifestations - hallucinations, psychosis, seizures

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43
Q

Are antivirals considered safe in pregnancy?

A

generally yes, category B

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44
Q

_____ would be prescribed to a pt if the HSV strain is severely resistant to acyclovir. When is it commonly prescribed?

A

foscarnet (Foscavir)

M/C use for CMV infections in AIDS patients

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45
Q

**What are the BBW for antivirals?

A

MULTIPLE BLACK BOX WARNINGS:
Seizures
renal impairment causing toxicity
hematologic abnormalities
possible carcinogenic

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46
Q

What is the treatment for genital HSV on the initial episode? recurrent episode? When should treatment be initiated? (give both initial and recurrent)

A

Oral acyclovir (Zovirax) 400 mg TID
valacyclovir (Valtrex) 500 - 1000 mg BID
famciclovir (Famvir) 250 mg TID

for 7-10 days: initial
3-5 days: recurrent

48 hours after onset (no more than 72hrs)
first onset of symptoms (within 24 hours)

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47
Q

What is the treatment for oral HSV?

A

same as genital

plus

Topical 1% hydrocortisone 5% acyclovir cream (Zovirax ointment), penciclovir (Denavir)

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48
Q

What is the treatment for recurrent HSV prophylaxis?

A

acyclovir 400 mg BID daily
valacyclovir 500 mg QD daily
famciclovir 250 mg BID daily

same medication just at a once daily dosing

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49
Q

What do you give a patient with Disseminated/Neonatal HSV?

A

IV acyclovir

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50
Q

What are some ways to prevent HSV?

A

Barrier methods during sexual activity

C-section for women with active genital lesions

Sunscreen can reduce the occurrence of herpes labialis

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51
Q

______ is caused by the Varicella zoster virus (VZV) after the initial infection of chickenpox

A

Herpes Zoster (Shingles)

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52
Q

_____ remains dormant, then reactivates causing ______

A

Varicella zoster virus (VZV)

Herpes Zoster (Shingles)

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53
Q

What are 2 risk factors for developing Herpes Zoster (Shingles)?

A

older than 60

immunocompromised

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54
Q

Evolution of macules-papules-vesicles-crusts,
Lesion sits atop an erythematous base “dew drop on rose petal”, severe pain commonly precedes rash.

What am I?

A

Herpes Zoster (Shingles)

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55
Q

Herpes Zoster (Shingles) follows a ____ distribution, normally _____, most common on the ___ and ____ regions. _____ nerve involvement

A

dermatomal

unilateral

thorax and lumbar regions

involves the trigeminal nerve

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56
Q

What is the most serious form of Herpes Zoster (Shingles)?

A

Herpes Zoster Ophthalmicus

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57
Q

What are Herpes Zoster (Shingles) lesions in the corner of eye and side of the nose referred to as _______. What can it cause?

A

Hutchinson’s sign

blindness with severe eye involvement

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58
Q

What are common Herpes Zoster (Shingles) complications?

A

Post-herpetic neuralgia (Occurs in 30-40% of patients > 60 years of age)

Bacterial secondary skin infections

Vision loss (Herpes Zoster Ophthalmicus)

Bell’s palsy

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59
Q

What are the treatment goals of Herpes Zoster (Shingles)?

A

Reduce duration
Lessen severity of symptoms
Reduce risk of post-herpetic neuralgia

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60
Q

What medications do you use to treat Herpes Zoster (Shingles)? When should treatment be initiated?

A

acyclovir (Zovirax), valacyclovir (Valtrex), famciclovir (Famvir)

Treatment should be started within 72 hours of onset of symptoms

61
Q

What is the treatment for Herpes Zoster Ophthalmicus?

A

Considered an EMERGENCY!!
Admit for IV acyclovir
Topical steroids

62
Q

What is the treatment for Post-Herpetic Neuralgia?

A

Opioids
TCA’s
gabapentin (Neurontin)

63
Q

What is the best way to prevent Shingles? Who qualifies for the prevention? What is the schedule?

A

zoster vaccine (RZV or Shingrix)

50 years and older

2 vaccines required 2-6 months apart whether or not they received Zostavax

64
Q

What is the Shingles
prevention recommendation for pt who are immunocompromised?

A

19 years of age and older should receive 2 doses of RZV

think pts starting chemo

65
Q

What is the best motivator to get the Shingles vaccine?

A

to avoid the extremely painful post-herpetic neuralgia

66
Q

What strand of HSV is Epstein-Barr virus caused by? It is the causative agent for _____

A

human herpesvirus 4

Infectious Mononucleosis

67
Q

How is Epstein-Barr Virus transmitted?

A

saliva or blood products

68
Q

Malaise/fatigue, fever, sore throat, tonsillar enlargement, myalgia, posterior cervical lymphadenopathy, pharyngeal irritation
Splenomegaly (50% of patients)
Palatal petechiae
Maculopapular rash (20% of patients)

A

Epstein-Barr Virus

69
Q

Maculopapular rash is common in 20% of patients who have Epstein-Barr Virus, the percentage jumps up to 90% in patient who have received _____

A

ampicillin

70
Q

Concerned about Epstein-Barr Virus, what PE should you absolutely perform?

A

abdominal exam to check for Splenomegaly

71
Q

super horrible sore throats are usually _____

A

viral

72
Q

What are some common lab findings in mono?

A

low WBC
atypical large lymphocytes
elevated LFTs

73
Q

Low WBC count, should be thinking _____

A

viral infection

74
Q

What tests should you order to help confirm a EBV diagnosis?

A

Monospot
Heterophile agglutination (HA) antibody test
Blood smear
CBC
EBV antibodies

75
Q

What will a blood smear look like on a pt with EBV?

A

atypical large lymphocytes

76
Q

What will a CBC look like on a EBV pt?

A

Leukopenia, lymphocytosis

77
Q

EBV antibodies: IgM will (rise/fall) with an acute infection

A

rise in acute infection

78
Q

T/F: EBV antibodies: IgG will only be present during an acute infection

A

FALSE, IgG antibodies to EBV persist for life

79
Q

What are some EBV complications you need to be mindful of? What education points should you tell your patients?

A

Splenomegaly/splenic rupture -> Avoid strenuous activity / contact sports

Hepatitis -> Watch for s/sx: jaundice, N/V, Monitor LFTs

80
Q

What is the treatment for EBV?

A

supportive treatment only!!!

antivirals are NOT indicated
antibiotics are NOT indicated

81
Q

EBV, which abx specially would you have to avoid?

A

Avoid all abx but amoxicillin especially!!

82
Q

What is the prognosis for EBV?

A

Fever, sore throat - resolves in 10 days
LAN, splenomegaly - resolves in 4 weeks
Fatigue - can linger for months
Can rarely have a chronic EBV syndrome
Bells Palsy: usually last 2 weeks

83
Q

What are the associated EBV disorders?

A

Burkitt Lymphoma
B-cell malignancies in immunocompromised persons
Nasopharyngeal carcinomas

84
Q

____ of the population has cytomegalovirus, most are asymptomatic. What pt population might have symptoms?

A

60-90%

immunocompromised persons

85
Q

How is CMV transmitted?

A

Transmitted via blood, body fluids, and transplacentally

86
Q

What are the three clinical CMV syndromes?

A

CMV inclusion disease - newborns

Acute viral syndrome - immunocompetent persons

CMV disease - immunocompromised persons (HIV)

87
Q

What are some s/s of CMV inclusion disease - newborns?

A

Hepatitis, mental retardation, hearing loss
Stillbirth

88
Q

What are s/s of CMV Acute viral syndrome - persons?

A

Fever, malaise, arthralgias
Mono-like illness without the pharyngitis

89
Q

What are s/s of CMV disease - immunocompromised persons (HIV)?

A

CMV Retinitis
GI (gastritis/colitis), Respiratory (pneumonitis), Neurologic (encephalitis) CMV

90
Q

How do you diagnose CMV and what is the treatment?

A

serologic testing

ganciclovir- only for serious illnesses (CMV retinitis, encephalitis)

91
Q

___ and ___ strains of HPV cause genital warts

A

HPV 6 and 11

92
Q

___ and ___ strains of HPV cause cervical cancers

A

16 and 18 cause 70% of cervical cancers

93
Q

How is HPV Condyloma acuminata transmitted? More common in men/women?

A

Sexually transmitted (vaginal, oral, anal)
More common in women

94
Q

What is the incubation period for Condyloma acuminata HPV? When do they resolve?

A

3 weeks to 8 months

most resolve within 2 years

95
Q

What is the clinical presentation of Condyloma acuminata HPV?

A

Pedunculated lesion
Scaly, raised, skin colored to pearly lesions

May have associated pruritus, burning, bleeding, or pain

96
Q

How do you dx Condyloma acuminata? Do you need to biospy?

A

visual inspection

NO! clinical presentation is okay

97
Q

What is the treatment for Condyloma acuminata HPV?

A

Chemical destruction

Podophyllin/Podofilox topical cream
Imiquimod (Aldara) topical cream

Cryotherapy (office)

Systemic treatment- Interferon

Laser surgery
OR
Surgical excision

98
Q

What are the steps for HPV turning into cancer? What types of cancers can HPV cause?

A

HPV virus infection - sexually transmitted
Persistence of HPV infection
Progression of normal epithelial cells to precancerous cells
Development of carcinoma

Cervical
Anogenital
Oropharyngeal
Vulvar
Penile cancer

99
Q

How are cervical cancers dx?

A

Typically asymptomatic
Found on routine screening: Pap smear

Can take bx to examine for other diseases

100
Q

What is the treatment for cervical cancers?

A

Laser ablation
“Cone biopsy”/LEEP
Surgery

101
Q

What is the prevention for cervical and anogentital cancer?

A

Gardasil - protects against HPV strains 6, 11, 16, 18, 31, 33, 45, 52, and 58

102
Q

What is the HPV vaccine recommendation? What is the goal?

A

Females and males aged 11 - 12 (earliest is 9)

Catch up for females up to 26; males 21

No recommendations for >26; but approved up to age 45

Goal is to start BEFORE female or male is sexually active

103
Q

Seasonal flu is caused by ___ or ___

A

flu A or B

104
Q

Antigenic drift is (slow/sudden) change

A

slow, gradual change

105
Q

Antigenic shift is (slow/sudden) change

A

sudden change

Little to no immunity/responsible for pandemics

106
Q

How is the seasonal flu spread? What is the typical incubation period?

A

infected persons via respiratory droplets
Also by touching contaminated objects

1-4 days

107
Q

H1N1 and H3N2v are considered the ___ flu

A

swine flu

108
Q

H5N1 and H7N9 are considered the ___ flue

A

Bird flu

109
Q

What is the clinical presentation of influenza?

A

Sudden onset fever, chills, headache, myalgia, malaise
Non-productive cough, sore throat, nasal discharge

110
Q

How are strep and flu PE different from each other?

A

Strep: NO cough or nasal discharge

Flu: will have cough and nasal discharge

111
Q

What are some complications from flu?

A

Secondary bacterial infections - pneumonia, sinusitis
Rhabdomyolysis, myositis
CNS involvement - encephalitis, aseptic meningitis
Cardiac complications

112
Q

What is the testing for influenza? what is the common problem?

A

Rapid Influenza Diagnostic Test (RIDTs)
NP swab, nasal aspirate
Detects both A and B within several minutes

Problem - high false negative rate

113
Q

If you patient is in the hospital will flu, what should you order to help confirm your diagnosis?

A

Viral culture:more definitive testing

Should be conducted for all hospitalized patients or if different strain suspected

Results in 2-3 hours; but culture may take up to 5 days

114
Q

What is the treatment for influenza?

A

Antipyretics
Fluids
Analgesics
Antiviral Medications

115
Q

Which flu medications cover both A and B? What class of medication?

A

oseltamivir (Tamiflu)- oral

zanamivir (Relenza)- inhaled

peramivir (Rapivab)- IV

Neuraminidase Inhibitors

116
Q

What medications only cover flu A? What class of medication?

A

amantadine
rimantadine

NMDA receptor antagonists

117
Q

**What is the dosing for Oseltamivir capsules? What is the dosage based on?

A

75mg bid x 5 days

age and weight

118
Q

**What form is Zanamivir come in? Dosing?

A

inhaler

2 inhalations BID for 5 days

119
Q

What is the Neuraminidase Inhibitors MOA?

A

prevents replication so the s/s do not last as long and are not as severe

120
Q

When do you need to start Neuraminidase Inhibitors?

A

Need to start medications within 48 hrs of symptoms

121
Q

All flu medications can be used for treatment and prophylaxis of flu except ____

A

Except peramivir (Rapivab) - treatment only

122
Q

What is the population criteria in order to use zanamivir?

A

ages 7 and up (5 or up for prophylaxis)

Do not use zanamivir in persons with lung disorders

123
Q

What is the prescribing information for peramivir (Rapivab)?

A

peramivir (Rapivab) 600 mg IV
Infuse over 15 - 30 minutes; Single dose
Only for adults > 18

124
Q

What are the SE of Neuraminidase Inhibitors?

A

N/V/D, headache
Can cause behavioral disturbances (rare)

125
Q

The SE _____ is seen with Zanamivir (Relenza)

A

bronchospasm

126
Q

______ is primarily renally excreted and dosing needs to be adjusted for renal failure

A

Oseltamivir (Tamiflu)

127
Q

Who is the flu vaccine recommended for? What pt population is it VERY important for?

A

Routine annual vaccinations of all persons aged 6 months and older

Young children
Persons >50
Persons with chronic cardiopulmonary disease
Persons with immunodeficiency
Pregnant women
Healthcare personnel (HCP)
Persons who live with or care for persons at high risk

128
Q

What month should you get your flu vaccine in?

A

October

129
Q

the normal flu shot is _____ vs the intranasal flu vaccine is ____

A

Inactivated Influenza Vaccine (IIV)

Live Attenuated Influenza Vaccine (LAIV)

130
Q

What are the causative agents for viral pneumonia?

A

Influenza

Respiratory syncytial virus (RSV)

Parainfluenza virus

Adenovirus

Coronaviruses

131
Q

______ also causes pneumonia and bronchiolitis in children

A

Respiratory syncytial virus (RSV)

132
Q

_____ also causes laryngotracheobronchitis (Croup) in children

A

Parainfluenza virus

133
Q

______ also a cause of the “common cold”

A

Adenovirus

134
Q

What is the clinical presentation for viral pneumonia?

A

Fever, chills, myalgias
Nonproductive cough
May have rhonchi on PE

135
Q

What would your treatment be for a patient with viral pneumonia?

A

antivirals and supportive care

136
Q

Adenovirus can cause lots of other mild, self limiting presentations. Name some.

A

Respiratory illness (cold)
Viral pneumonia
Diarrhea
Conjunctivitis
Pharyngitis

137
Q

What are the three arboviruses?

A

West Nile Virus
La Crosse encephalitis
Zika Virus

138
Q

Name a rhabdovirus.

A

Rabies

139
Q

West Nile Virus is ____ transmitted. In its mild form how does it present?

A

mosquito

Fever, HA
Body aches
N/V/D
Rash
can lead to more severe neurologic illness

140
Q

What does serious west nile virus present as?

A

High fever
Severe HA/stiff neck
Confusion
Stupor/coma
Seizures
Muscle weakness
Paralysis

141
Q

How do you dx West Nile? What is the treatment? Prevention?

A

Lumbar puncture with CSF testing

supportive care

mosquito control

142
Q

_____ is transmitted by a mosquito, can be asymptomatic or present with fever, HA, N/V/D, fatigue. Is also neuroinvasive and can lead to seizures, coma, paralysis and death. Most severe disease presents in patients who are ____

A

La Crosse Virus

Most severe disease occurs in patients <16

143
Q

What is the treatment for La Crosse Virus? Prevention?

A

Supportive care

mosquito control

144
Q

What is the way a human can get infected with rabies? Name some common animals

A

through a bite of an infected animal

usually a bats, raccoons, skunks, foxes, woodchucks, and coyotes

145
Q

What is the pathophys behind rabies?

A

Travels from site of bite through nervous system

Affects the brain = Encephalitis

Lead to death if untreated

146
Q

What is the initial presentation of rabies? When do the neurologic symptoms start to appear?

A

flu like illness than lasts for 2-3 days

2-10 days: anxiety, confusion, agitation
Progresses: delirium, abnormal behavior, hallucinations, insomnia

147
Q

Once a person starts to exhibit neurologic s/s, what is the prognosis?

A

survival is rare (only 10 documented cases per CDC) once neurologic

148
Q

What should you do if your patient was bitten by a potentially rabid animal?

A

Wash wound immediately
Report to doctor / ED
Post exposure prophylaxis (PEP)
-1 dose immune globulin
-4 doses of rabies vaccine over a 14 day period
Given on day 1, 3, 7, and 14
Current vaccines are given in arm (not
as painful)

149
Q
A

Infectious Disease (16 decks)

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