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CSP 3 > Viral infections in the immunocompromised > Flashcards

Viral infections in the immunocompromised Flashcards

1
Q

Define humoral immunity

A

Immunity mediated by antibodies produced by B cells

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2
Q

Define cell mediated immunity

A

Immunity mediated by phagocyes, T lymphocytes etc.

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3
Q

What consequences may viral infections have on immunocompromised hosts?

A

1) May develop severe acute infections
2) May reactive latent infections
3) May develop unusual manifestation of the disease

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4
Q

Is active hepatitis cell mediated or humoral in HBV. HCV

A

Cell mediated

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5
Q

State 3 types of immunocompromisation

A

1) Congenital
2) Acquired
3) Iatrogenic

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6
Q

State 4 classes of virus that commonly infect patients with cell mediated immune deficiency

A

1- Herpesviruses
2- Paramyxoviruses
3- Papillomaviruses
4- Polyomamaviruses

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7
Q

What is the purpose of drugs used in solid organ transplants

A

To prevent graft rejection

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8
Q

What drugs are used to solid organ transplants?

A

1) Calcineurin inhibitors
2) Antimetabolites
3) Steroids

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9
Q

What drugs are used in haemopoietic stem cell transplants?

A

Preventing graft v host disease

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10
Q

Name 5 drugs used in haemopoietic stem cell transplants?

A
  • Lymphocyte depleting drugs such as alemtuzumab
  • Methotrexate
  • MMF
  • Calcineurin inhibitors
  • Steroids
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11
Q

Which infections commonly occur within the month of a solid organ transplant?

A
  • MRSA
  • C. Diff
  • Donor derived infection (uncommon)- HSV, LCMV, rhabdovirus
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12
Q

Which infections commonly occur within 1-6 months of solid organ transplant?

A 
C diff colitis
HCV
Adenovirus, influenza
TB
Pneumocystitis
Herpes virus
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13
Q

Which infections commonly occur >6 months after a solid organ transplant?

A

CAP
UTI
CMV
Hepatitis

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14
Q

Which strand of Herpes Simplex virus causes cold sores

A

1

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15
Q

Which strand of herpes simplex virus causes genital warts

A

2 mainly (1 can too)

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16
Q

Describe the features of the primary infection of HSV

A

Frequently asymptomatic.

  • Pharyngitis
  • Fever
  • Ulceration
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17
Q

Describe the features of a recurrence of HSV

A

Prodromal tingling followed by localised painful blisters that resolve in a week

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18
Q

How is herpes simplex virus spread

A

By direct contact

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19
Q

How is herpes simplex virus treated

A

Aciclovir

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20
Q

What % of the UK population will have had past exposure to herpes simplex

A

90%

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21
Q

Describe the features of the primary infection of varicella zoster virus

A

Fever and generalised vesicular rash (chickenpox)

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22
Q

When is varicella zoster virus most infectious

A

1- 2 days prior to rash onset

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23
Q

What happens with varicella zoster virus reactivates

A

It reactivates as shingles

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24
Q

What complications can arise should an immunocompromised individual come into contact with varicella zoster virus

A
  • Shingles can be multidermatolmal
  • Encephalitis
  • Severe disease with pneumonitis and disseminated infection
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25
Q

Until when is varicella zoster virus infectious?

A

Until it has crusted over

26
Q

How should you treat VAZ pneumonitis, encephalitis of eye disease

A

IV treatment

27
Q

Name 3 viruses that are a major hazard for allogenic HSCT and certain solid organ transplants

A

‘ACE’ viruses:

  • Adenovirus
  • Cytomegalovirus
  • Epstein Barr Virus
28
Q

What is CMV secreted in?

A

Saliva, urine and breast milk

29
Q

Is CMV usually serious in children?

A

No- few symptoms and self limiting

30
Q

What is the prevelance by age of CMV

A

15% of cases in under 5s

85% of cases in over 65s

31
Q

Where does CMV remain latent? When does it reactivate?

A

Blood and bone marrow

Reactivates in immunosuppression

32
Q

Describe 3 ways that CMV manifests in the immunocompromised?

A
  • Penumonitis (esp in HSCT)
  • Oesophagitis (transplant and HIV)
  • Retinitis (HIV)
33
Q

When is a donor recipient at a high risk of primary CMV infection

A
  • CMV donor status positive

- CMV recepient status negative

34
Q

When is a donor recipient at a high risk of uncontrolled reactivation of CMV

A
  • CMV donor status negative

- CMV recepient status positive

35
Q

How do you diagnose a CMV infection?

A
  • Pre transplant serology

- Post transplant monitoring of CMV viraemia

36
Q

How is CMV disease different to CMV infection

A

There is evidence of end organ damage specific to CMV in disease
Infection is laboratory evidence of virus activity

37
Q

What pre-emptive therapy is available for CMV post transplant?

A

Monitoring of CMV activity after transplant and begin anti-viral therapy at first indication of active CMV replication

38
Q

What prophylactic management is available for CMV post transplant?

A

Antiviral use post transplant to bridge the period with highest risk for CMV disease

39
Q

What is the rationale behind pre-emptive treatment for CMV

A
  • Reduced exposure to anti-viral
40
Q

Who should have pre-emptive therapy for CMV

A

Bone marrow and SCT

41
Q

Who should have CMV prophylaxis?

A

D+ R-

Pancreas, renal, liver, heart and lung transplant patients

42
Q

What anti-viral is on offer for CMV

A

Ganciclovir

43
Q

How is Epstein Barr virus spread

A

Saliva

44
Q

What are the 2 main concerns of an immunocompromised individual contracting EBV

A

1- Post transplant lymphoproliferative disorder (PTLD)

2- Lymphoma

45
Q

When does PTLD usually occur

A

First year post tranplant

46
Q

Which types of transplant carry higher risks for PTLD

A

Small Bowel

Heart/ lung, lung, pancreato-renal

47
Q

State some risk factors for the development of PTLD

A
  • Children <5
  • Associated with prior infection
  • Anti-rejectin therapy
48
Q

State the symptoms of PTLD

A
  • Fever
  • GI upset
  • Lymphadenopathy (often retroperitoneal)
  • Tonsillar hypertrophy
  • Hepatosplenomegaly
  • Anaemia
49
Q

Which common anti-viral is not effective in treating CMV and EBV in the immunosuppressed

A

Aciclovir

50
Q

Which drug should be used to treat CMV in transplant recipients

A

Ganciclovir

51
Q

What main 3 syndromes are seen in adenovirus when a healthy person is infected?

A
  • Resp disease
  • Keratoconjunctivitis
  • Gastroenteritis
52
Q

How does adenovirus manifest in the immunosupressed

A 
Pneumonia
Hepatitis
Haemorrhagic cystitis
Enterocolitis
Encephalitis
53
Q

Are children or adults more at risk of post transplant adenovirus?

A

Children

54
Q

Which transplants are at a higher risk for adenovirus

A

Heart

Multivisceral solid organ transplant

55
Q

How do you screen for adenovirus

A

Blood and urine PCR

If positive, go to other sites such as stool

56
Q

How do you manage adenovirus in the immunosuppressed?

A
  • Limited antiviral options: some weak evidence for cidofovir
  • Reduction in immune suppression beneficial
  • Adoptive virus- specific CTL most promising
57
Q

What are the 2 major human polyomaviruses

A

JC virus and BK virus

58
Q

How are polyomarivues shed

A

Via urine

59
Q

What happens during the initial infection with polomavirus

A
  • Initial viraemia and seeding of the kidney

- Latency

60
Q

What happens (briefly) when polyomavirus is reactivated

A

Viruria
Viraemia
End- organ disease

61
Q

Name the 3 main polyomavirus syndromes described

A
  • BK Virus associated haemorrhagic cystitis
  • BK virus associated nephropathy
  • JC-PML
62
Q

What patients is BK virus associated haemorrhagic cystitis seen

A

Allogenic HSCT Recipients

CSP 3 (9 decks)

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