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Infectious disease > Viral Infections I > Flashcards

Viral Infections I Flashcards

1
Q

what are the 3 virus classifications

A
  1. DNA viruses
    - Invade and replicate in host cell nucleus
  2. Single stranded RNA viruses
    - Invade and replicate in host cytoplasm
  3. Retroviruses
    - 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
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2
Q

steps of viral infection

A
  1. Virus attaches to host cell
  2. Viral DNA or RNA then enters the host cell and replicates inside host cell
  3. Creates viral particles inside the cell
  4. The host cell typically dies - releasing new viruses that move on to infect other host cells.
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3
Q

how can viruses be transmitted

A
  1. Respiratory secretions (airborne droplets)
  2. Enteric secretions (fecal-oral route)
  3. Sexual contact (direct mucosal contact, semen/body fluids)
  4. Blood (contaminated needles and blood products)
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4
Q

7 types of human herpesviruses

A
  1. Herpes simplex virus (HSV) type 1
  2. Herpes simplex virus (HSV) type 2
  3. Varicella zoster virus (VZV)
  4. Epstein-Barr virus (EBV)
  5. Cytomegalovirus (CMV)
  6. Human Herpesvirus (HHV) 6-7
    - Roseola infantum
  7. Human Herpesvirus (HHV) 8
    - Kaposi Sarcoma - Only in AIDS patients
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5
Q

which HSV affects the oral region

A

HSV1

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6
Q

which HSV affects the genitalia

A

HSV2

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7
Q

risk factors of HSV

A
  1. Female
  2. History of STDs
  3. Multiple sexual partners
  4. Contact with sex workers
  5. WSW
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8
Q

how is HSV transmitted

A
  1. Skin to skin contact
    - Fluid from vesicle releases HSV
    - Can transmit infection without actual presence of vesicles
  2. Once infected - lifelong
    - May lay dormant for months or years
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9
Q
  1. Vesicles forming crusts and moist ulcers
    - Singular or grouped
    - Lips (upper), nares, mouth
  2. Herpetic Whitlow
    - Digital vesicular lesions
A

HSV1

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10
Q

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

A

HSV2

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11
Q

HSV1 has associated symptoms with ?
such as…

A

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

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12
Q

when is the severity of HSV worst and longer?

A

initial outbreak

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13
Q

which HSV has associated symptoms of genital infection
- Pain, burning, tingling of skin
- Dysuria
- Cervicitis
- Urinary retention
- Swollen lymph nodes
- Fever, body ache

A

HSV2

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14
Q

after a HSV infection, what happens to the virus?

A
  • remains dormant in nerve ganglia
  • Periodic symptomatic reactivations = “flares”
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15
Q

triggers of HSV flares

A
  1. Febrile illness
  2. Hormonal changes (pregnancy, menstrual cycle)
  3. Physical or emotional stress
  4. Overexposure to sunlight
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16
Q

pt presenting with:
Initially present with blepharitis
Impaired visual acuity - can lead to blindness
Pain, sensation of something in eye, photophobia, unilateral

A

HSV Keratoconjunctivitis

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17
Q

transmission of HSV Keratoconjunctivitis

A
  1. Direct inoculation
    - Neonates
  2. Trigeminal nerve spread
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18
Q

what HSV is usually only seen in immunocompromised

A
  1. HSV Encephalitis
  2. Disseminated (Pneumonia)
  3. Esophagitis
  4. Proctitis (inflammation of the lining of the rectum)
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19
Q

how do you diagnose HSV

A
  1. Characteristic clinical appearance
  2. Cx
    - Vesicular fluid
    - Scrapings of crust/ulcer
  3. PCR
    - CSF for HSV encephalitis
  4. Tzanck smear: Presence of multinucleated 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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20
Q

how to diagnose HSV Keratoconjunctivitis

A

Diagnose with appearance of dendritic lesions on fluorescein stain and slit-lamp examination
(Immediate referral to Ophthalmologist)

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21
Q

tx for HSV

A
  1. Outbreaks self-limiting - 10 - 20 days with initial outbreak
    - 5 - 10 days with recurrences
  2. No cure
  3. Antivirals (oral & topical)
    - Shorten duration
    - Lessen severity
    - Start at first sign of outbreak
    - Patients with frequent recurrences can take as prophylaxis
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22
Q

Symptomatic Relief for HSV (topical)

A
  1. Topical anesthetics (Gingivostomatitis)
    - dyclonine (Sucrets)
    - benzocaine (Anbesol)
    - Rx viscous lidocaine rinse (Magic Mouthwash)
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23
Q

tx for Secondary Bacterial Infections of HSV

A

Topical antibiotics
- mupirocin
- bacitracin

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24
Q

antivirals for HSV

A
  1. acyclovir (Zovirax)
  2. famciclovir (Famvir)
  3. valacyclovir (Valtrex)
    all available in oral
  4. topicals
    - penciclovir (Denavir)
    - docosanol (Abreva) - OTC
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25
Q

which HSV antiviral is available in oral, liquid, IV, and topical

A

acyclovir

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26
Q

tx for HSV keratitis

A

trifluridine (Viroptic)

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27
Q

MOA of HSV antivirals

A

Inhibit herpes viral DNA synthesis and replication

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28
Q

which HSV antivirals are prodrugs - converted to active form in GI tract

A

valacyclovir (Valtrex) and famciclovir (Famvir)

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29
Q

which HSV antiviral is metabolized in the liver

A

acyclovir

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30
Q

HSV antivirals should be used cautiously with ?

A

renal patients

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31
Q

SE of HSV antivirals

A
  1. Most Common
    - GI symptoms
    - HA, dizziness, malaise
    - Arthralgia
  2. Most Serious
    - Leukopenia, thrombocytopenia
    - Neurologic manifestations - hallucinations, psychosis, seizures
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32
Q

HSV antivirals can cause an elevation in what lab values?

A

BUN/Cr - Check at baseline and monitor if prolonged use

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33
Q

which HSV antiviral is only used if severe strain resistant to acyclovir
MC use for CMV infections in AIDS patients

A

foscarnet (Foscavir)

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34
Q

which HSV antivirals is only used for CMV infections in immunocompromised (HIV) patients

A
  1. ganciclovir (Cytovene)
  2. valganciclovir (Valcyte)
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35
Q

what HSV antivirals have a BBW of seizures, renal impairment causing toxicity - hematologic abnormalities, possible carcinogenic

A
  1. foscarnet (Foscavir)
  2. ganciclovir (Cytovene)
  3. valganciclovir (Valcyte)
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36
Q

tx for Primary & Recurrent HSV genital infection

A
  1. antivirals
    - Oral acyclovir (Zovirax) 400 mg TID
    - valacyclovir (Valtrex) 500 - 1000 mg BID
    - famciclovir (Famvir) 250 mg TID
  2. Treat initial episode for 7-10 days
    - Recurrences often reduced to 3-5 days
  3. Treatment for initial episode should begin 48 hrs of onset (no more than 72hrs)
    - Recurrences should initiate treatment at first sx onset (within 24 hrs)
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37
Q

tx for Primary & Recurrent HSV oral infection (herpes labialis)

A
  1. Oral antivirals (same as for genital herpes)
  2. Topical 1% hydrocortisone 5% acyclovir cream (Zovirax ointment), penciclovir (Denavir)
  3. OTC docosanol (Abreva)
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38
Q

Recurrent HSV prophylaxis tx

A

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

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39
Q

recurrent Keratitis tx

A
  • Topical trifluridine (Viroptic) ophthalmic drops
  • Oral acyclovir
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40
Q

tx for HSV Disseminated/Neonatal Disease

A

IV acyclovir

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41
Q

prevention for HSV

A
  1. Barrier methods during sexual activity
  2. C-section for women with active genital lesions
  3. Sunscreen can reduce the occurrence of herpes labialis
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42
Q

Varicella zoster virus (VZV) causes?

A

Herpes Zoster (Shingles)

43
Q

the initial infection of Varicella zoster virus (VZV) causes?

A

chickenpox

44
Q

the risk of Herpes Zoster (Shingles) increases with age ? and what kind of pt?

A

60+
immunocompromised

45
Q
  • macules -> papules -> vesicles -> crusts
  • Lesion sits atop an erythematous base “dew drop on rose petal”
  • Severe pain commonly precedes rash
A

Herpes Zoster (Shingles)

46
Q
  1. Follows dermatome
    - Typically a single, unilateral dermatome
  2. MC thorax and lumbar regions
A

Herpes Zoster (Shingles)

47
Q

shingles can have trigeminal nerve involvement which could result with:

A
  1. Herpes Zoster Ophthalmicus - most serious
  2. Lesions in corner of eye and side of nose (Hutchinson’s sign)
  3. Can cause blindness with severe eye involvement
48
Q

complications with shingles

A
  1. Post-herpetic neuralgia
    - Occurs in 30-40% of patients > 60 years of age
    - Prolonged debilitating pain
  2. Bacterial secondary skin infections
  3. Vision loss (Herpes Zoster Ophthalmicus)
  4. Bell’s palsy
49
Q

tx goals for shingles

A
  1. Reduce duration
  2. Lessen severity of symptoms
  3. Reduce risk of post-herpetic neuralgia
50
Q

antivirals for shingles

A
  1. acyclovir (Zovirax)
  2. valacyclovir (Valtrex)
  3. famciclovir (Famvir)

tx should be started within 72 hours of onset of symptoms

51
Q

tx for Herpes Zoster Ophthalmicus

A
  1. Admit for IV acyclovir
  2. Topical steroids
    emergency!
52
Q

tx for post-herpetic neuralgia

A
  1. Pain management
    - Opioids
    - TCA’s
    - gabapentin (Neurontin)
53
Q

prevention for shingles

A
  1. Recombinant vaccine “zoster vaccine” (RZV or Shingrix)
    + 50< years of age
    - 2 vaccines required 2-6 months apart whether or not they received Zostavax
    + immunosuppressed or immunodeficient 19< years of age should receive 2 doses of RZV
    + lasts at least 4 years after vaccination

To prevent Post-Herpetic Neuralgia

54
Q

Human herpesvirus 4
Causative agent for Infectious Mononucleosis

A

Epstein-Barr Virus

55
Q

transmission of EBV

A
  1. Saliva, blood products
  2. Mono = “Kissing Disease”
56
Q

posterior cervical LN
Splenomegaly (50% of pt)
Palatal petechiae
Maculopapular rash (20% of pt)

A

EBV

57
Q

pt with EBV can experience a worse Maculopapular rash bc?

A

if given ampicillin - rash seen in >90%

58
Q

diagnosis of EBV

A
  1. Mononucleosis spot test (Monospot)
    - Heterophile agglutination (HA) antibody test
  2. Blood smear
    - Atypical large lymphocytes
  3. CBC
    - Leukopenia, lymphocytosis
  4. EBV antibodies
59
Q

if you’re testing for EBV antibodies, which one comes up for an acute infection

A
  • IgM antibodies
  • IgG antibodies to EBV persist for life
60
Q

complications from EBV

A
  1. Splenomegaly/splenic rupture
    - rare
    - Avoid strenuous activity / contact sports
  2. Hepatitis
    - Watch for s/sx: jaundice, N/V
    - Monitor LFTs
  3. CNS involvement - infrequent
61
Q

tx for EBV

A
  1. Supportive
    - Fluids
    - Antipyretics
  2. hospital
    - severe splenomegaly
    - hepatitis
    - CNS involvement
    - severe thrombocytopenia

Antivirals NOT indicated
Antibiotics NOT indicated

62
Q

someone with EBV their fever and sore throat should resolve when?

A

in 10 days

63
Q

EBV
LAN, splenomegaly should resolve when?

A

in 4wks

64
Q

associated disorders with EBV

A
  1. Burkitt Lymphoma
  2. B-cell malignancies in immunocompromised persons
  3. Nasopharyngeal carcinomas
65
Q

how can Cytomegalovirus (CMV) be transmitted?

A

blood, body fluids, and transplacentally

66
Q

unless youre immunocompromised, most ppl with Cytomegalovirus are ___

A

asymptomatic
60-90% population - Asymptomatic latent infection

67
Q

3 clinical syndromes of Cytomegalovirus - CMV
presentations?

A
  1. CMV inclusion disease - newborns
    - Hepatitis, mental retardation, hearing loss
    - Stillbirth
  2. Acute viral syndrome - immunocompetent persons
    - Fever, malaise, arthralgias - Mono-but without the pharyngitis
  3. CMV disease - immunocompromised persons (HIV)
    - CMV Retinitis
    - GI (gastritis/colitis), Respiratory (pneumonitis), Neurologic (encephalitis) CMV
68
Q

diagnostic testing for CMV

A

serologic testing

69
Q

tx for CMV

A
  1. ganciclovir (Zirgan) or valganciclovir (Valcyte)
  2. foscarnet (Foscavir)

ONLY for serious illnesses (CMV retinitis, encephalitis, etc)

70
Q

Condyloma acuminata is from what HPV strains

A

HPV 6 and 11

71
Q

HPV 16 and 18 is responsible for 70% of this disease

A

cervical cancer

72
Q

Scaly, raised, skin colored to pearly lesions
Often occur in clusters
May be pedunculated
May have associated pruritus, burning, bleeding, or pain

A

Condyloma acuminata
(genital warts)

73
Q

how do you diagnose Condyloma acuminata

A
  1. Clinical
  2. Determine extent of involvement:
    - Anoscopy, speculum exam, colposcopy

no need for bx

74
Q

tx for Condyloma acuminata

A
  1. Chemical destruction
    - Podophyllin/Podofilox
    - Imiquimod (Aldara)
  2. Cryotherapy (office)
  3. Systemic treatment
    - Interferon
  4. Laser surgery
    OR
  5. Surgical excision
75
Q

how does HPV turn into cancer?

A
  1. HPV virus infection - sexually transmitted
  2. Persistence of HPV infection
  3. Progression of normal epithelial cells to precancerous cells
  4. Development of carcinoma
76
Q

besides cervical cancer, what other cancers can HPV cause?

A

oropharyngeal, vulvar, and penile cancer

77
Q

how do you diagnose Cervical/ Anogenital Cancer

A

bx
found on routine pap smear

78
Q

tx for cervical cancer

A
  1. Laser ablation
  2. “Cone biopsy”/LEEP
  3. Surgery
79
Q

prevention for cervical cancer

A
  1. Vaccines
    - Gardasil - protects against HPV strains 6, 11, 16, 18, 31, 33, 45, 52, and 58
    - administered 9-26(F)/21(M), then 45
    Goal for vax: start before female/male is sexually active
80
Q

how do you describe a virus that shows slow, gradual change

A

Antigenic drift

81
Q

how do you describe a virus that shows sudden change

A

antigenic shift
Little to no immunity/responsible for pandemics

82
Q

what are the other strains of influenza

A
  1. “Swine flu”
    * H1N1
    * H3N2v
  2. “Bird flu”
    * H5N1
    - China, Asia, Middle East
    - “Highly pathogenic” - 60% mortality rate
    * H7N9
    - China only
83
Q

if a pt presents with
- Sudden onset fever, chills, headache, myalgia, malaise
- Non-productive cough, sore throat, nasal discharge
- Physical examination is typically unremarkable
what is the infection?

A

influenza

84
Q

complications with influenza

A
  1. Secondary bacterial infections - pneumonia, sinusitis
  2. Rhabdomyolysis, myositis
  3. CNS involvement - encephalitis, aseptic meningitis
  4. Cardiac complications
85
Q

diagnostic testing with influenza

A
  1. Rapid Influenza Diagnostic Test (RIDTs)
    - NP swab, nasal aspirate
    - Detects both A and B within several minutes
    - Problem - high false negative rate
  2. 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
86
Q

tx for influenza

A
  1. Supportive Care
    - Antipyretics
    - Fluids
    - Analgesics
  2. Antivirals
    - Neuraminidase Inhibitors - oseltamivir (Tamiflu), zanamivir (Relenza), peramivir (Rapivab)
    - NMDA Receptor Antagonists - amantadine, rimantadine
87
Q

which influenza antiviral class is the FDA approved to treat seasonal influenza, covering both influenza A and B

A

Neuraminidase Inhibitors

88
Q

which influenza antiviral class cover influenza A only

A

NMDA Receptor Antagonists

89
Q

what influenza antiviral is used for tx only

A

peramivir (Rapivab)
everything else can be used for treatment and prophylaxis

90
Q

when should influenza antivirals be started?

A

within 48 hrs of symptoms

91
Q

dosage for oseltamivir (Tamiflu)

A

75 mg po BID x 5 days
- Tx = all ages
- prophylaxis = 3 months and older only

92
Q

pt with a lung disorder presenting with influenza should not be given what antiviral?

A

zanamivir (Relenza)

93
Q

SE of Neuraminidase Inhibitors

A
  1. N/V/D, HA (MC)
  2. Most Serious
    - Bronchospasm with Zanamivir (Relenza)
    - Can cause behavioral disturbances (rare)
94
Q

prevention for influenza

A
  1. vax
    - Routine annual vaccinations of all persons aged 6 months and older
    - Should receive vaccine in October
95
Q

flu vaccination particularly important for who?

A
  1. Young children
  2. Persons >50
  3. Persons with chronic cardiopulmonary disease
  4. Persons with immunodeficiency
  5. Pregnant women
  6. Healthcare personnel (HCP)
  7. Persons who live with or care for persons at high risk
96
Q

types of flu vaccines

A
  1. Inactivated Influenza Vaccine (IIV)
    - “flu shot”
  2. Live Attenuated Influenza Vaccine (LAIV)
    - Intranasal inhalation
97
Q

what are the causative agents in adults for viral pneumonia

A
  1. Influenza
  2. Respiratory syncytial virus (RSV)
    - Also causes pneumonia and bronchiolitis in children
  3. Parainfluenza virus
    - Also causes laryngotracheobronchitis (Croup) in children
  4. Adenovirus
    - Also a cause of the “common cold”
  5. Coronaviruses
98
Q

if a pt presents with:
1. Fever, chills, myalgias
2. Nonproductive cough
3. rhonchi on PE
4. CXR nondiagnostic
what could be their diagnosis?

A

viral pneumonia

99
Q

tx for viral pneumonia

A
  1. supportive
    - fluids
    - antipyretics
  2. deep suctioning - for rhonchi
100
Q

pathophys of rabies

A
  1. Travels from site of bite through nervous system
  2. Affects the brain = Encephalitis
    - Lead to death of untreated
101
Q

clinical presentation of rabies

A
  1. Initial presentation: flu-like illness
    - Lasts for 2-3 days
  2. After 2-10 days: acute neurologic disease
    - Initially: anxiety, confusion, agitation
    - Progresses: delirium, abnormal behavior, hallucinations, insomnia

Once a person exhibits signs of neurologic disease - survival is rare

102
Q

management for rabies

A
  1. Wash wound immediately
  2. 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
103
Q

what abx should be avoided for EBV

A

ampicillin, amoxicillin

Infectious disease (15 decks)

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