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Clin Med 1B Exam 2 > Viral Infections I > Flashcards

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
Q

How does does HSV typically present?

A

Mucocutaneous lesions

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26
Q

Where does HSV 1 typically present?

A

vesicles form crusts and moist ulcers
can be singular or grouped
found in lips, nares, or mouth
Also found on fingers -Herpetic whitlow

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27
Q

Where does HSV 2 typically present?

A

genital region (external genitalia, vaginal canal, perianal)
multiple, grouped, painful vesicles
may have pain or lesions before appearance of lesions

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28
Q

What are the associated symptoms with HSV oral infection?

A

pain, burning, tingling of skin
pain with eating (if inside mouth)
swollen lymph nodes
low grade fever

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29
Q

What are the associated symptoms with genital infection?

A

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

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30
Q

How does HSV present clinically?

A

after initial infection, HSV remains dormant in nerve ganglia until flares occur

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31
Q

What are HSV periodic symptomatic reactivations called?

A

flares

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32
Q

How do HSV flares typically present?

A

febrile illness
hormonal changes (pregnancy, menstrual cycle)
Physical or emotional stress
Overexposure to sunlight

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33
Q

How does HSV Keratoconjunctivitis present?

A

often unilateral
initially present with blepharitis
impaired visual acuity-can lead to blindness
Pain, sensation of something in eye, photophobia

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34
Q

How is HSV Keratoconjunctivitis transmitted?

A

direct inoculation
-neonates
trigeminal nerve spread

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35
Q

What are some less common HSV presentations?

A

HSV encephalitis
Disseminated
Esophagitis
Proctitis (inflammation of rectum)

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36
Q

How do you diagnose HSV?

A

Characteristic clinical appearance
cultures-vesicular fluid or scraping of crust/ulcer
PCR- CSF for HSV encephalitis
Tzanck smear

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37
Q

What would you see on a Tzanck smear that clues you in to a herpetic infection?

A

presence of multinucelated giant cells- positive for herpetic infection
Can also be positive with Varicella; does not tell you if HSV 1 or 2

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38
Q

How do you diagnose Keratoconjunctivitis?

A

Appearance of dendritic lesions on fluorescein stain and slit-lamp examination

Requires immediate referral to Ophthalmologist!

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39
Q

What is the treatment for HSV?

A

-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

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40
Q

what are some topicals that can be used for HSV?

A

topical anesthetics (gingivostomatitis)
-dyclonine
-benzocaine
Rx viscous lidocaine rinse
AND
topical antibiotics (mupirocin, bacitracin)

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41
Q

How do you make lidocaine rinse (Magic mouthwash)

A

1/3 lidocaine/xylocaine
1/3 maalox
1/3 benadryl

3oz, 2R TID
baby safe (18 months +)

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42
Q

What antivirals are given as a tx for HSV?

A

acyclovir (PO, IV, liquid, and topical)
famciclovir (PO)
valacyclovir (PO)

topicals:
penciclovir
docosanol-OTC

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43
Q

What is the treatment for ophthalmic HSV keratitis?

A

trifluridine (viroptic)

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44
Q

What is the MOA for HSV antivirals?

A

inhibit herpes viral DNA synthesis and replication

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45
Q

What HSV antivirals are prodrugs? Where do they get converted into their active form?

A

valacyclovir and famciclovir are pro drugs
converted to active form in GI tract

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46
Q

Where is acyclovir (HSV antiviral) metabolized?

A

in the liver

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47
Q

how are HSV antivirals primarily excreted?

A

Renally!!

Use with caution in renal failure

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48
Q

What are some adverse reactions caused by HSV antivirals?

A

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

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49
Q

What pregnancy category are HSV antivirals in?

A

Cat B

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50
Q

When would you use foscarnet as a HSV antiviral?

A

only use in HSV if severe strain is resistant to acyclovir
M/C use for CMV infections in AIDS patients

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51
Q

When would you use ganciclovir and valganciclovir as an HSV antiviral?

A

only used for CMV (cytomegalovirus) infections in immunocompromised patients

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52
Q

What are some black box warnings for foscarnet, ganciclovir, and valganciclovir?

A

seizures
renal impairment causing toxicity-hematologic abnormalities
possible carcinogenic

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53
Q

What is the treatment for PRIMARY AND RECURRENT HSV genital infection?

A

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)

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54
Q

How would you treat Primary and recurrent HSV oral infection?

A

oral antivirals (same as for genital herpes)
Topical 1% hydrocortisone 5% acyclovir cream, penciclovir
OTC docosanol (Abreva)

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55
Q

What are some tx options for recurrent HSV prophylaxis?

A

acyclovir (400 mg BID)
valacyclovir (500mg QD)
famciclovir (250 mg TID)

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56
Q

What treatment would you use for keatitis?

A

topical trifluridine ophthalmic drops
oral acyclovir

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57
Q

what would you use to treat disseminated/neonatal disease?

A

IV acyclovir

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58
Q

How could you counsel a pt to prevent contracting HSV?

A

barrier methods during sex
c-section for women with active genital lesions
sunscreen can reduce the occurrence of herpes labialis

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59
Q

What is the etiology for Herpes Zoster (shingles)

A

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
Q

What are some CDC facts about shingles (probz not testable)

A

1 out of 3 people will develop shingles in their lifetime
1 million people treated annually

61
Q

How does Shingles present?

A

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
Q

What part of the body are shingles typically most common?

A

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
Q

What complications are seen with herpes zoster?

A

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
Q

What are some treatment options for Herpes Zoster?

A

Typically Self limiting
Treatment Goals
Medications
-acyclovir, valacyclovir, famciclovir
Treatment should be started within 72 hours of of onset of symptoms

65
Q

What are the treatment goals for shingles?

A

reduce duration
lessen severity of symptoms
reduce risk of post-herpetic neuralgia

66
Q

What medications are used for the treatment of herpes zoster?

A

acyclovir, valacyclovir, famciclovir
Treatment should be started within 72 hours of onset of symptoms

67
Q

How would you treat Herpes Zoster Ophthalmicus

A

Emergency
Admit for IV acyclovir
Topical steroids

68
Q

How would you treat Post-herpertic neuralgia?

A

Pain management
(opioids, TCA’s, gabapentin)

69
Q

What are some ways you can counsel someone about shingles virus prevention?

A

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
Q

What is the primary reason to vaccinate someone against the shingles vaccine?

A

POST-HERPETIC NEURALGIA

71
Q

What is human herpesvirus 4 also known as?

A

EPV

72
Q

What is the causative agent for Monocucleosis?

A

EPV

73
Q

Do all mono carriers show symptoms?

A

Nope!! You can be an asymptomatic carrier!!
>90% of adult population worldwide have virus
It persists for a lifetime!

74
Q

How is mono/EBV transmitted?

A

Saliva, blood products

75
Q

What are some symptoms for EBV?

A

malaise/fatigue
sore throat
tonsillar enlargement
myalgia

76
Q

What are some signs for EBV?

A

lymphadenopathy
Phayngeal irritation
Splenomegaly (50% of patients)
Palatal petechiae
Maculopapular rash (20% of patients)
-if given ampicillin (incorrectly)-rash seen in >90%

77
Q

How do you diagnose mono/EBV?

A

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
Q

What are some complications that can arise from EBV?

A

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
Q

What supportive treatment could you give a pt with EBV?

A

Fluids
Antipyretics
ANTIVIRALS NOT INDICATED
ANTIBIOTICS NOT INDICATED
hospitalize if severe splenomegaly, hepatitis, CNS involvement, severe thrombocytopenia, or other complications

80
Q

What is the prognosis for someone with EBV?

A

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
Q

What are some diseases associated with EBV?

A

Burkitt lymphoma, B-cell malignancies in Immunocompromised persons, Nasopharyngeal carcinomas

82
Q

What is CMV?

A

Cytomegalovirus

83
Q

How much of the population has CMV?

A

60-90%
It’s a (mostly) asymptomatic latent infection
It’s a severe illness confined to immunocompromised persons

84
Q

How is CMV transmitted?

A

blood, bodily fluids, and transplacentally

85
Q

What are the three CMV Clinical syndomes?

A

CMV inclusion disease-newborns
Acute viral syndrome-immunocompetent persons
CMV disease- immunocompromised person (HIV)

86
Q

What clinical syndromes present from CMV inclusion disease in newborns?

A

Hepatitis, mental retardation, hearing loss, stillbirth

87
Q

What clinical syndromes present from Acute viral syndrome-immunocompetent persons?

A

fever, malaise, arthralgias
mono-like illness without the pharyngitis

88
Q

What clinical syndromes present from CMV disease-immunocompromised persons (HIV)?

A

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

89
Q

How do you diagnose CMV?

A

Serologic testing

90
Q

How do you treat CMV?

A

*serious illness (CMV retinitis, encephalitis, etc)
gangiclovir (zirgan) or valganciclovir (valcyte)
foscarnet (foscavir)

91
Q

How many genotypes of HPV are there?

A

over 100 different genotypes of the virus
just infects epithelial tissue
Many of the strains are transient
some strains are lifelong

92
Q

What strains of HPV cause genital warts?

A

HPV 6 and 11

93
Q

What strains of HPV have been found to cause/be related to cervical cancers?

A

16** and 18

94
Q

Gimme some facts about condyloma acuminata

A

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
Q

How does condyloma acuminata present clinically?

A

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
Q

How do you diagnose condyloma acuminata?

A

clinically
determine extent of involvement:
anoscopy, speculum, speculum exam, colposcopy

97
Q

How do you treat HPV condyloma cuminata?

A

Chemical destruction (podophyllin/Podofilox or Imiquimod)
Cryotherapy in office
Systemic treatment (interferon)
Laser surgery OR surgical excision

98
Q

What are the steps in cancer development in regards to HPV?

A

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

99
Q

What cancers can HPV cause (5 total)

A

Cervical and Anogenital are the most prominent ones
Oropharyngeal
Vulvar
Penile cancer

100
Q

How does HPV and cervical/anogenital cancer?

A

typically asymptomatic
Found on routine screening
-pap smear

101
Q

What is the treatment for cervical cancer?

A

laser ablation
“cone biopsy”/LEEP
surgery

102
Q

What preventative measures can a patient take in regards to HPV?

A

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

103
Q

Who is the HPV vaccine recommended for?

A

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
Q

What causes the seasonal flu?

A

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
Q

What is the Flus incubation period?

A

1-4 days

106
Q

What are the two strains for swine flu?

A

H1N1 (pandemic in 2009)
H3N2v (outbreak in US in 2012)

107
Q

What are the two strains for bird flu?

A

H5N1
china, Asia, Middle East
“highly pathogenic” -60% mortality rate
Highest rates in 2003 (dropping since)

H7N9
China only

108
Q

How does the flu present clinically?

A

sudden onset fever, chills, headache, myalgia, malaise
Non-productive cough, sore throat, nasal discharge
PE is unremarkable

109
Q

Complications that can rise from the flu?

A

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

110
Q

How do you diagnose the flu?

A

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
Q

What is the treatment for the flu?

A

Antipyretics
Fluids
Analgesics
Antiviral medications

112
Q

What are some antivirals that you can use on the flu?

A

Neuraminidase inhibitors (FDA approved to treat seasonal flu, Covers A and B strain)
NMDA Receptor antagonists (cover influenza A only)

113
Q

What antivirals cover both influenza A and B?

A

Neuraminidase inhibitors
oseltamivir (Oral)
Zanamivir (Inhalation)
Peramivir (IV)

114
Q

What are some antivirals that only cover influenza A?

A

NMDA Receptor antagonists
Amantadine
rimantadine

115
Q

What neuraminidase inhibitor information should we know for the flu?

A

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
Q

What are some AE from using Neuraminidase inhibitors (to treat the flu)?

A

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
Q

How do we counsel a patient on flu prevention?

A

Routine annual vaccinations of all persons aged 6 months and older
Should receive vaccine in October

118
Q

Who is the flu vaccine particularly important for?

A

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
Q

What are the two types of flu vaccine?

A

Inactivated Influenza Vaccine (IIV)
-flu shot
Live Attenuated Influenza Vaccine (LAIV)
-intranasal inhalation

120
Q

What can cause viral pneumonia?

A

flu
respiratory syncytial virus (RSV)
Parainfluenza virus
adenovirus
coronavirus

121
Q

How does viral pneumonia present clinically?

A

fever, chills, myalgias
non productive cough
may have rhonci on PE
CXR nondiagnostic

122
Q

What are some causes of respiratory diseases?

A

Rhinovirus
the common cold
self limiting

Adenovirus
Respiratory illness (cold)
Viral pneumonia
diarrhea
conjuctivitis
Phayngitis
Mild, self-limiting

123
Q

What are some common GI viruses?

A

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
Q

How are these GI viruses trasmitted?

A

Airborne droplets
Fecal-oral route

125
Q

How do GI viruses clinically present?

A

NVD

126
Q

How do you treat GI viruses?

A

Supportive (maybe an IV if pt is dehydrated)

127
Q

What viruses spread with the arbovirus vector?

A

West nile virus
la crosse encephalitis
Zika Virus

128
Q

What virus spreads with rhabdovirus?

A

rabies

129
Q

How is west nile virus transmitted? Where is it most common?

A

Mosquito transmission
Africa, Asia, Middle east

130
Q

How does west nile virus present clinically?

A

Mild illness- will go away on its own for 20% of those infected

dun dun dun

can lead to more severe neurologic illnesses

131
Q

What are some mild ways in which west nile virus presents clinically?

A

Fever, HA
Body Aches
N/V/D
Rash

132
Q

What are some serious ways in which west nile virus presents clinically?

A

high fever
severe HA/stiff neck
Confusion
Stupor/coma
seizures
Muscles weakness
Paralysis

133
Q

How do you diagnose West Nile?

A

Serologic testing
(LP with CSF analysis)

134
Q

How would you treat west nile virus?

A

supportive

135
Q

How can you try to prevent west nile virus?

A

mosquito control

136
Q

How is la crosse transmitted?

A

mosquito

137
Q

How does la crosse present?

A

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
Q

How is la crosse virus treated?

A

supportive

139
Q

How is la cross virus prevented?

A

mosquito control

140
Q

Who are some reservoirs of rabies virus?

A

bats
raccoons
skunks
foxes
woodchunks
coyotes

141
Q

How can humans get rabies?

A

bite from infected animal

142
Q

What is rabies pathophysiology?

A

travels from site of bite through nervous system
affects the brain (encephalitis)
-lead to death of untreated

143
Q

How does rabies present?

A

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
Q

After what point in time is rabies survival very rare?

A

after presentation of neurologic disease

145
Q

How do you treat prophylactically in rabies?

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

Clin Med 1B Exam 2 (2 decks)

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