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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
Until when is varicella zoster virus infectious?
Until it has crusted over
26
How should you treat VAZ pneumonitis, encephalitis of eye disease
IV treatment
27
Name 3 viruses that are a major hazard for allogenic HSCT and certain solid organ transplants
'ACE' viruses: - Adenovirus - Cytomegalovirus - Epstein Barr Virus
28
What is CMV secreted in?
Saliva, urine and breast milk
29
Is CMV usually serious in children?
No- few symptoms and self limiting
30
What is the prevelance by age of CMV
15% of cases in under 5s | 85% of cases in over 65s
31
Where does CMV remain latent? When does it reactivate?
Blood and bone marrow | Reactivates in immunosuppression
32
Describe 3 ways that CMV manifests in the immunocompromised?
- Penumonitis (esp in HSCT) - Oesophagitis (transplant and HIV) - Retinitis (HIV)
33
When is a donor recipient at a high risk of primary CMV infection
- CMV donor status positive | - CMV recepient status negative
34
When is a donor recipient at a high risk of uncontrolled reactivation of CMV
- CMV donor status negative | - CMV recepient status positive
35
How do you diagnose a CMV infection?
- Pre transplant serology | - Post transplant monitoring of CMV viraemia
36
How is CMV disease different to CMV infection
There is evidence of end organ damage specific to CMV in disease Infection is laboratory evidence of virus activity
37
What pre-emptive therapy is available for CMV post transplant?
Monitoring of CMV activity after transplant and begin anti-viral therapy at first indication of active CMV replication
38
What prophylactic management is available for CMV post transplant?
Antiviral use post transplant to bridge the period with highest risk for CMV disease
39
What is the rationale behind pre-emptive treatment for CMV
- Reduced exposure to anti-viral
40
Who should have pre-emptive therapy for CMV
Bone marrow and SCT
41
Who should have CMV prophylaxis?
D+ R- | Pancreas, renal, liver, heart and lung transplant patients
42
What anti-viral is on offer for CMV
Ganciclovir
43
How is Epstein Barr virus spread
Saliva
44
What are the 2 main concerns of an immunocompromised individual contracting EBV
1- Post transplant lymphoproliferative disorder (PTLD) | 2- Lymphoma
45
When does PTLD usually occur
First year post tranplant
46
Which types of transplant carry higher risks for PTLD
Small Bowel | Heart/ lung, lung, pancreato-renal
47
State some risk factors for the development of PTLD
- Children <5 - Associated with prior infection - Anti-rejectin therapy
48
State the symptoms of PTLD
- Fever - GI upset - Lymphadenopathy (often retroperitoneal) - Tonsillar hypertrophy - Hepatosplenomegaly - Anaemia
49
Which common anti-viral is not effective in treating CMV and EBV in the immunosuppressed
Aciclovir
50
Which drug should be used to treat CMV in transplant recipients
Ganciclovir
51
What main 3 syndromes are seen in adenovirus when a healthy person is infected?
- Resp disease - Keratoconjunctivitis - Gastroenteritis
52
How does adenovirus manifest in the immunosupressed
``` Pneumonia Hepatitis Haemorrhagic cystitis Enterocolitis Encephalitis ```
53
Are children or adults more at risk of post transplant adenovirus?
Children
54
Which transplants are at a higher risk for adenovirus
Heart | Multivisceral solid organ transplant
55
How do you screen for adenovirus
Blood and urine PCR | If positive, go to other sites such as stool
56
How do you manage adenovirus in the immunosuppressed?
- Limited antiviral options: some weak evidence for cidofovir - Reduction in immune suppression beneficial - Adoptive virus- specific CTL most promising
57
What are the 2 major human polyomaviruses
JC virus and BK virus
58
How are polyomarivues shed
Via urine
59
What happens during the initial infection with polomavirus
- Initial viraemia and seeding of the kidney | - Latency
60
What happens (briefly) when polyomavirus is reactivated
Viruria Viraemia End- organ disease
61
Name the 3 main polyomavirus syndromes described
- BK Virus associated haemorrhagic cystitis - BK virus associated nephropathy - JC-PML
62
What patients is BK virus associated haemorrhagic cystitis seen
Allogenic HSCT Recipients

CSP 3 (9 decks)

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