Viral Infections I Flashcards

1
Q

What is the smallest of the microbes?

A

virus

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2
Q

What do viruses depend on in order to reproduce?

A

host cell

(human, animal, bacterial, plant)

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3
Q

Can viruses survive on inanimate objects?

A

YES

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4
Q

What are some vectors for viruses?

A

Mosquitos, ticks, bats

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5
Q

What are the three types of viruses?

A

DNA virus
Single stranded RNA virus
Retrovirus

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6
Q

How are DNA viruses classified?

A

they invade and replicate in host cell nucleus

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7
Q

How are single stranded RNA viruses classified?

A

they invade and replicate in host cytoplasm

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8
Q

How are retroviruses classified?

A

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

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9
Q

Describe a viruses pathophysiology

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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10
Q

Once a host cell is infected, is the virus able to lay dormant?

A

YES isnt that crazy? They can lay dormant and can reactivate at a later time

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11
Q

How are viruses transmitted?

A

Respiratory secretion (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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12
Q

What kind of virus is Herpesvirus?

A

DNA virus

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13
Q

What family is the herpes virus in?

A

Herpesviridae

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14
Q

How many types of herpes are there that infect humans?

A

8

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15
Q

Can a herpes virus be latent in a host cell?

A

Yes, after an infection, herpesvirus can remain latent within specific host cells and reactivate at a later date

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16
Q

Can herpesvirus survive outside of a host?

A

nope!! not for long. transmission usually requires intimate contact

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17
Q

Can herpesvirus mutate host cells into a malignant cell?

A

YES, watch yaSELF

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18
Q

What are the 8 human Herpesvirus

A

Herpes simplex virus (HSV) type 1
Herpes simplex virus (HSV) type 2
Varicella zoster virus (VZV)
Epstein-Barr virus (EBV)
Cytomegalovirus (CMV)
Human Herpesvirus (HHV) 6-7
Human Herpesvirus (HHV) 8

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19
Q

which herpesvirus is only seen in AIDS patients?

A

Kaposi sarcoma
Human herpesvirus (HHV) 8

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20
Q

What herpesvirus often presents as a rash in little babies?

A

Roseola infantum

Human herpesvirus (HHV) 6-7

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21
Q

Where does HSV 1 typically present?

A

it affects the oral region

(ie herpes labialis, gingivotomatitis)

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22
Q

Where does HSV 2 typically present?

A

affects the genital region

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23
Q

What are some risk factors for contacting HSV?

A

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

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24
Q

How is HSV transmitted?

A

skin to skin contact
the fluid from the vesicles releases HSV but you are able to transmit the infection without actual presence of vesicles
Once you’re infected, it’s a lifelong thing
It may lay dormant for months or years

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25
How does does HSV typically present?
Mucocutaneous lesions
26
Where does HSV 1 typically present?
vesicles form crusts and moist ulcers can be singular or grouped found in lips, nares, or mouth Also found on fingers -Herpetic whitlow
27
Where does HSV 2 typically present?
genital region (external genitalia, vaginal canal, perianal) multiple, grouped, painful vesicles may have pain or lesions before appearance of lesions
28
What are the associated symptoms with HSV oral infection?
pain, burning, tingling of skin pain with eating (if inside mouth) swollen lymph nodes low grade fever
29
What are the associated symptoms with genital infection?
Pain, burning, tingling of skin! Dysuria* Cervicitis* Urinary retention* Swollen lymph nodes Fever, body ache
30
How does HSV present clinically?
after initial infection, HSV remains dormant in nerve ganglia until flares occur
31
What are HSV periodic symptomatic reactivations called?
flares
32
How do HSV flares typically present?
febrile illness hormonal changes (pregnancy, menstrual cycle) Physical or emotional stress Overexposure to sunlight
33
How does HSV Keratoconjunctivitis present?
often unilateral initially present with blepharitis impaired visual acuity-can lead to blindness Pain, sensation of something in eye, photophobia
34
How is HSV Keratoconjunctivitis transmitted?
direct inoculation -neonates trigeminal nerve spread
35
What are some less common HSV presentations?
HSV encephalitis Disseminated Esophagitis Proctitis (inflammation of rectum)
36
How do you diagnose HSV?
Characteristic clinical appearance cultures-vesicular fluid or scraping of crust/ulcer PCR- CSF for HSV encephalitis Tzanck smear
37
What would you see on a Tzanck smear that clues you in to a herpetic infection?
presence of multinucelated giant cells- positive for herpetic infection Can also be positive with Varicella; does not tell you if HSV 1 or 2
38
How do you diagnose Keratoconjunctivitis?
Appearance of dendritic lesions on fluorescein stain and slit-lamp examination Requires immediate referral to Ophthalmologist!
39
What is the treatment for HSV?
-Outbreaks are self-limiting healing typically takes 10-20 days with initial outbreak and 5-10 days with recurrences -There is no definitive cure for it though -Antivirals shorten duration, lessen severity must start at first sign of outbreak patients with frequent recurrences can take as prophylaxis -symptomatic relief -secondary bacterial infections
40
what are some topicals that can be used for HSV?
topical anesthetics (gingivostomatitis) -dyclonine -benzocaine Rx viscous lidocaine rinse AND topical antibiotics (mupirocin, bacitracin)
41
How do you make lidocaine rinse (Magic mouthwash)
1/3 lidocaine/xylocaine 1/3 maalox 1/3 benadryl 3oz, 2R TID baby safe (18 months +)
42
What antivirals are given as a tx for HSV?
acyclovir (PO, IV, liquid, and topical) famciclovir (PO) valacyclovir (PO) topicals: penciclovir docosanol-OTC
43
What is the treatment for ophthalmic HSV keratitis?
trifluridine (viroptic)
44
What is the MOA for HSV antivirals?
inhibit herpes viral DNA synthesis and replication
45
What HSV antivirals are prodrugs? Where do they get converted into their active form?
valacyclovir and famciclovir are pro drugs converted to active form in GI tract
46
Where is acyclovir (HSV antiviral) metabolized?
in the liver
47
how are HSV antivirals primarily excreted?
Renally!! Use with caution in renal failure
48
What are some adverse reactions caused by HSV antivirals?
MC: GI symptoms HA, dizziness, malaise anthralgia Can cause elevation in BUN/Cr-check at baseline and monitor if prolonged use MS: Leukopenia, thrombocytopenia Neurologic manifestations-hallucinations, psychosis, seizures
49
What pregnancy category are HSV antivirals in?
Cat B
50
When would you use foscarnet as a HSV antiviral?
only use in HSV if severe strain is resistant to acyclovir M/C use for CMV infections in AIDS patients
51
When would you use ganciclovir and valganciclovir as an HSV antiviral?
only used for CMV (cytomegalovirus) infections in immunocompromised patients
52
What are some black box warnings for foscarnet, ganciclovir, and valganciclovir?
seizures renal impairment causing toxicity-hematologic abnormalities possible carcinogenic
53
What is the treatment for PRIMARY AND RECURRENT HSV genital infection?
oral acyclovir (400 mg TID) valacyclovir (500-1000mg BID) famciclovir (250 mg TID) treat initial episode for 7-10 days recurrences can often be reduced to 3-5 days Tx for initial episode should begin 48 hours of onset! recurrences should initiate tx at first sx of onset (w/in 24 hours)
54
How would you treat Primary and recurrent HSV oral infection?
oral antivirals (same as for genital herpes) Topical 1% hydrocortisone 5% acyclovir cream, penciclovir OTC docosanol (Abreva)
55
What are some tx options for recurrent HSV prophylaxis?
acyclovir (400 mg BID) valacyclovir (500mg QD) famciclovir (250 mg TID)
56
What treatment would you use for keatitis?
topical trifluridine ophthalmic drops oral acyclovir
57
what would you use to treat disseminated/neonatal disease?
IV acyclovir
58
How could you counsel a pt to prevent contracting HSV?
barrier methods during sex c-section for women with active genital lesions sunscreen can reduce the occurrence of herpes labialis
59
What is the etiology for Herpes Zoster (shingles)
It is the varicella zoster virus (VZV) initial infection results in chicken pox VZV remains dormant, then reactivates causing Herpes Zoster (shingles) Risk increases with age (>60) and immunocompromised persons
60
What are some CDC facts about shingles (probz not testable)
1 out of 3 people will develop shingles in their lifetime 1 million people treated annually
61
How does Shingles present?
skin lesions resembling chickenpox evolution of macules-papules-vesicles-crusts***have to present with all 4!! Lesion sits atop an erythematous base "dew drop on rose petal" Severe pain commonly precedes rash Follow dermatomal distribution
62
What part of the body are shingles typically most common?
typically a unilateral dermatomal distribution along thorax and lumbar regions trigeminal nerve involvement: -herpes zoster ophthalmicus- most serious -Lesions in corner of eye and side of nose (Hutchinson's sign) -Can cause blindness with severe eye involvement
63
What complications are seen with herpes zoster?
Post-herpetic neuralgia *PAIN* -occurs in 30-40% of patients >60 years of age -prolonged debilitating pain Bacterial secondary skin infections Vision loss (Herpes Zoster Ophthalmicus) Bell's palsy
64
What are some treatment options for Herpes Zoster?
Typically Self limiting Treatment Goals Medications -acyclovir, valacyclovir, famciclovir Treatment should be started within 72 hours of of onset of symptoms
65
What are the treatment goals for shingles?
reduce duration lessen severity of symptoms reduce risk of post-herpetic neuralgia
66
What medications are used for the treatment of herpes zoster?
acyclovir, valacyclovir, famciclovir Treatment should be started within 72 hours of onset of symptoms
67
How would you treat Herpes Zoster Ophthalmicus
Emergency Admit for IV acyclovir Topical steroids
68
How would you treat Post-herpertic neuralgia?
Pain management (opioids, TCA's, gabapentin)
69
What are some ways you can counsel someone about shingles virus prevention?
Recombinant vaccine "zoster vaccine" offer to persons >/50 years of age (2 vaccines required 2-6 months apart) whether or not they received Zostavax REDUCES SHINGLES and PHN 90% according to CDC
70
What is the primary reason to vaccinate someone against the shingles vaccine?
POST-HERPETIC NEURALGIA
71
What is human herpesvirus 4 also known as?
EPV
72
What is the causative agent for Monocucleosis?
EPV
73
Do all mono carriers show symptoms?
Nope!! You can be an asymptomatic carrier!! >90% of adult population worldwide have virus It persists for a lifetime!
74
How is mono/EBV transmitted?
Saliva, blood products
75
What are some symptoms for EBV?
malaise/fatigue sore throat tonsillar enlargement myalgia
76
What are some signs for EBV?
lymphadenopathy Phayngeal irritation Splenomegaly (50% of patients) Palatal petechiae Maculopapular rash (20% of patients) -if given ampicillin (incorrectly)-rash seen in >90%
77
How do you diagnose mono/EBV?
Serology -Mononucleosis spot test (Monospot) -Heterophile agglutination (HA) antibody test Blood smear -atypical large lymphocytes CBC -leukopenia -lymphocytosis EBV antibodies -IgM antibodies to EBV rise in acute infection IgG antibodies to EBV persist for life
78
What are some complications that can arise from EBV?
Splenomegaly/splenic rupture -rupture is rare -indication for hospitalization -avoid strenuous activity/contact sports Hepatitis -watch for s/sx: jaundice, N/V Indication for hospitalization Monitor LFTs CNS involvement-infrequent
79
What supportive treatment could you give a pt with EBV?
Fluids Antipyretics ANTIVIRALS NOT INDICATED ANTIBIOTICS NOT INDICATED hospitalize if severe splenomegaly, hepatitis, CNS involvement, severe thrombocytopenia, or other complications
80
What is the prognosis for someone with EBV?
Fever, sore through (resolves in 10 days) LAN, splenomegaly (resolves in 4 weeks) Fatigue-can linger for months Can rarely have a chronic EBV syndrome
81
What are some diseases associated with EBV?
Burkitt lymphoma, B-cell malignancies in Immunocompromised persons, Nasopharyngeal carcinomas
82
What is CMV?
Cytomegalovirus
83
How much of the population has CMV?
60-90% It's a (mostly) asymptomatic latent infection It's a severe illness confined to immunocompromised persons
84
How is CMV transmitted?
blood, bodily fluids, and *transplacentally*
85
What are the three CMV Clinical syndomes?
CMV inclusion disease-newborns Acute viral syndrome-immunocompetent persons CMV disease- immunocompromised person (HIV)
86
What clinical syndromes present from CMV inclusion disease in newborns?
Hepatitis, mental retardation, hearing loss, stillbirth
87
What clinical syndromes present from Acute viral syndrome-immunocompetent persons?
fever, malaise, arthralgias mono-like illness without the pharyngitis
88
What clinical syndromes present from CMV disease-immunocompromised persons (HIV)?
CMV retinitis GI (gastritis/colitis), Respiratory (pneumonitis), Neurologic (encephalitis), CMV
89
How do you diagnose CMV?
Serologic testing
90
How do you treat CMV?
*serious illness (CMV retinitis, encephalitis, etc) gangiclovir (zirgan) or valganciclovir (valcyte) foscarnet (foscavir)
91
How many genotypes of HPV are there?
over 100 different genotypes of the virus just infects epithelial tissue Many of the strains are transient some strains are lifelong
92
What strains of HPV cause genital warts?
HPV 6 and 11
93
What strains of HPV have been found to cause/be related to cervical cancers?
16** and 18
94
Gimme some facts about condyloma acuminata
sexually transmitted (vaginal, oral, anal) more common in women incubation period 3 weeks to 8 months most are transient and resolve in 2 years increase risk of malignancy Many are asymptomatic- but can still transmit the virus
95
How does condyloma acuminata present clinically?
scaly, raised, skin colored to pearly lesions -often occur in clusters -may be pedunculated Occur anywhere in genital, perineal, or anal region May have associated pruritus, burning, bleeding, or pain Large clusters can interfere with intercourse or defecation
96
How do you diagnose condyloma acuminata?
clinically determine extent of involvement: anoscopy, speculum, speculum exam, colposcopy
97
How do you treat HPV condyloma cuminata?
Chemical destruction (podophyllin/Podofilox or Imiquimod) Cryotherapy in office Systemic treatment (interferon) Laser surgery OR surgical excision
98
What are the steps in cancer development in regards to HPV?
HPV virus infection-sexually transmitted Persistence of HPV infection Progression of normal epithelial cells to precancerous cells Development of carcinoma
99
What cancers can HPV cause (5 total)
Cervical and Anogenital are the most prominent ones Oropharyngeal Vulvar Penile cancer
100
How does HPV and cervical/anogenital cancer?
typically asymptomatic Found on routine screening -pap smear
101
What is the treatment for cervical cancer?
laser ablation "cone biopsy"/LEEP surgery
102
What preventative measures can a patient take in regards to HPV?
Gardasil-protects against HPV strains 6, 11, 16, 18, 31, 33, 45, 52, and 58
103
Who is the HPV vaccine recommended for?
Females and males aged 11-12 Can be administered as young as 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 In 2012, ACIP also recommended routine immunizations in males aged 11-12
104
What causes the seasonal flu?
influenza virus A or B Everchanging strains -antigenic drift-slow, gradual change -antigenic shift-sudden change --little to no immunity/responsible for pandemics Occurs in outbreaks-primarily in winter months (Oct-March) Spread through infected persons via respiratory droplets -also by touching contaminated objects
105
What is the Flus incubation period?
1-4 days
106
What are the two strains for swine flu?
H1N1 (pandemic in 2009) H3N2v (outbreak in US in 2012)
107
What are the two strains for bird flu?
H5N1 china, Asia, Middle East "highly pathogenic" -60% mortality rate Highest rates in 2003 (dropping since) H7N9 China only
108
How does the flu present clinically?
sudden onset fever, chills, headache, myalgia, malaise Non-productive cough, sore throat, nasal discharge PE is unremarkable
109
Complications that can rise from the flu?
Secondary bacterial infections-pneumonia, sinusitis Rhabdomyolysis, myositis CNS involvement-encephalitis, aseptic meningitis Cardiac complications
110
How do you diagnose the flu?
Rapid Influenza Diagnositc test (RIDTs) NP swab, nasal aspirate detects both A and B within minutes Problem-high false negative rate 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
111
What is the treatment for the flu?
Antipyretics Fluids Analgesics Antiviral medications
112
What are some antivirals that you can use on the flu?
Neuraminidase inhibitors (FDA approved to treat seasonal flu, Covers A and B strain) NMDA Receptor antagonists (cover influenza A only)
113
What antivirals cover both influenza A and B?
Neuraminidase inhibitors oseltamivir (Oral) Zanamivir (Inhalation) Peramivir (IV)
114
What are some antivirals that only cover influenza A?
NMDA Receptor antagonists Amantadine rimantadine
115
What neuraminidase inhibitor information should we know for the flu?
used for treatment and prophylaxis of flu (except peramivir-treatment only) need to start medication within 48 hrs of symptoms ***Oseltamivir 75mg po BID x5 days safe for all ages (birth and up, but prophylaxis 3 months and older only, dosage based on age and weight***
116
What are some AE from using Neuraminidase inhibitors (to treat the flu)?
MC: N/V/D, headache Most serious: Bronchospasm with Zanamivir can cause behavioral disturbances (Rare) Very few drug interactions Oseltamivir primarily renally excreted (Adjust for renal failture)
117
How do we counsel a patient on flu prevention?
Routine annual vaccinations of all persons aged 6 months and older Should receive vaccine in October
118
Who is the flu vaccine particularly important for?
Young children Person >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
119
What are the two types of flu vaccine?
Inactivated Influenza Vaccine (IIV) -flu shot Live Attenuated Influenza Vaccine (LAIV) -intranasal inhalation
120
What can cause viral pneumonia?
flu respiratory syncytial virus (RSV) Parainfluenza virus adenovirus coronavirus
121
How does viral pneumonia present clinically?
fever, chills, myalgias non productive cough may have rhonci on PE CXR nondiagnostic
122
What are some causes of respiratory diseases?
Rhinovirus the common cold self limiting Adenovirus Respiratory illness (cold) Viral pneumonia diarrhea conjuctivitis Phayngitis Mild, self-limiting
123
What are some common GI viruses?
Rotavirus (Children, fecal oral route-non inflammatory gastroenteritis. Vaccination against rotavirus has greatly reduced this number) Norovirus (older children and adults) Adenovirus & Coronavirus (infants and young children)
124
How are these GI viruses trasmitted?
Airborne droplets Fecal-oral route
125
How do GI viruses clinically present?
NVD
126
How do you treat GI viruses?
Supportive (maybe an IV if pt is dehydrated)
127
What viruses spread with the arbovirus vector?
West nile virus la crosse encephalitis Zika Virus
128
What virus spreads with rhabdovirus?
rabies
129
How is west nile virus transmitted? Where is it most common?
Mosquito transmission Africa, Asia, Middle east
130
How does west nile virus present clinically?
Mild illness- will go away on its own for 20% of those infected dun dun dun can lead to more severe neurologic illnesses
131
What are some *mild* ways in which west nile virus presents clinically?
Fever, HA Body Aches N/V/D Rash
132
What are some *serious* ways in which west nile virus presents clinically?
high fever severe HA/stiff neck Confusion Stupor/coma seizures Muscles weakness Paralysis
133
How do you diagnose West Nile?
Serologic testing (LP with CSF analysis)
134
How would you treat west nile virus?
supportive
135
How can you try to prevent west nile virus?
mosquito control
136
How is la crosse transmitted?
mosquito
137
How does la crosse present?
asymptomatic acute febrile illness -fever, HA, N/V/D, fatigue Neuroinvasive disease (encephaliis) -seizures, coma, paralysis can lead to long term disability and death Most severe disease occurs in pts <16
138
How is la crosse virus treated?
supportive
139
How is la cross virus prevented?
mosquito control
140
Who are some reservoirs of rabies virus?
bats raccoons skunks foxes woodchunks coyotes
141
How can humans get rabies?
bite from infected animal
142
What is rabies pathophysiology?
travels from site of bite through nervous system affects the brain (encephalitis) -lead to death of untreated
143
How does rabies present?
flu-like illness lasting 2-3 days after 2-10 days: acute neurologic disease Initially: anxiety, confusion, agitation progresses: delirium, abnormal behavior, hallucinations, insomnia, hydrophobia, seizures
144
After what point in time is rabies survival very rare?
after presentation of neurologic disease
145
How do you treat prophylactically in rabies?
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