Viremia Flashcards
1
Q
What are the four major diseases that viruses that cause circulatory infections cause?
A
- CA
- Birth defects
- Immunosuppression
- Cardiac dysfunction
2
Q
What is the state of viral infection for mono?
A
Productive, but disease due to immnopathology
3
Q
What is the state of viral infection for oral hairy leukoplakia?
A
Productive
4
Q
What is the state of viral infection for Burkitt’s lymphoma?
A
Latent
5
Q
What is the state of viral infection for Hodgkin’s disease?
A
Latent
6
Q
What is the state of viral infection for nasopharyngeal carcinoma?
A
Latent
7
Q
What is the state of viral infection for PTLD?
A
Latent
8
Q
What are the six diseases that the epstein Barr virus can present as?
A
- Mono
- Oral hairy leukoplakia
- Burkitt’s lymphoma
- Hodgkins lymphoma
- Nasopharyngeal carcinoma
- PTLD
9
Q
What is the family of EPV? Enveloped? Genome?
A
Herpesviridae
Enveloped
dsDNA
10
Q
What is the component of the complement that herpes viruses use to attach and enter into cells?
A
C3d
11
Q
What two types of cells do EPVs replicate in?
A
B cells
Epithelial
12
Q
What is the pathophysiology of EBV?
A
Infects B cells, causes them to reproduce and create heterophile antibodies
T cells come in to kill, but not perfect. leave memory B cells
13
Q
What is the first test for EBV?
A
Look for heterophile antibodies
14
Q
What cells contribute to EBV latency?
A
Memory B cells
15
Q
What are the genes associated in EBV carcinogenesis?
A
- Latent membrane protein 1
- LMP2
- EBV nuclear antigen-1
16
Q
What is LMP1? What does this protein lead to?
A
6 transmembrane domains protein with a CD40 homologue
Leads to high proliferation
17
Q
What is LMP2?
A
Protein that increases growth of B cells
18
Q
What is EBV nuclear antigen 1
A
Transactivation of EBV
inhibit apoptosis
19
Q
What is the primary mode of transmission for EBV?
A
Saliva
20
Q
What are the four major symptoms of mono?
A
- Fever, malaise etc
- Exudativepharyngitis
- Splenomegaly
- TTP lymphadenitis
21
Q
What is the biochemical markers for mono?
A
Heterophile antibodies
22
Q
What is the epidemiology of mono ( in the US)?
A
Young adulthood
23
Q
What is the major complication of mono?
A
Spleen rupture
24
Q
What is the pathogenesis of mono?
A
Immune targeting of the infected B cells
25
What is the treatment for mono?
1. Supportive
| 2. Avoid splenic rupture
26
Ampicillin treatment of EBV causes what?
A diffuse, petechial rash
27
How long are symptoms present with mono?
About a month
28
How long do atypical lymphocytes caused by EBV last?
About a month
29
How long does the heterophile titer remain elevated in EBV?
About a month
30
When does anti-EA production start in EBV infection?
about 10 days, and continues to end of the month of infx
31
When does anti-VCA production start in EBV mono infection?
day 10 to forever (IgM to IgG)
32
When do antibodies to the EBNA start?
Months later
33
How do you diagnose mono?
Mono spot test looking for heterophile antibodies agglutination to sheep or horse RBC
Antibodies to EBV
34
What are downey cells? What are the three characteristics of these cells?
Atypical T cells found in EBV infections
1. Have vacuoles
2. Altered nucleus
3. Indented cell margin
35
How can we prevent mono? Is there a vaccine?
No vaccine
| antivirals to inhibit the viral pol
36
Are antivirals effective in EBV?
Yes, but symptoms remain unchanged b/c of immune response
37
Who usually gets oral hairy leukoplakia?
Immunosuppressed population
38
What causes oral hairy leukoplakia?
EBV shedding
39
What is the treatment for oral hairy leukoplakia? (2)
1. Antiherpetic drugs
| 2. Podophyllin resin
40
What is Burkitt's lymphoma caused by?
EBV
41
Where in the body does Burkitt's lymphoma present? Symptoms?
B cells in the Jaw of children
CA of the jaw
42
Where is the world is Burkitt's lymphoma found?
Africa
43
What causes Burkitt's lymphoma?
Myc gene on ch14 translocated to ch8, changes E2F expression
44
What is the pathophysiology of Burkitt's lymphoma?
Increase in E2F d/t translocation of the Myc gene
45
What is the treatment for Burkitt's lymphoma?
Chemo
46
What are the two cofactors of Burkitt's lymphoma?
Chronic malaria
| Immune suppression
47
What is Hodgkin's disease?
EBV caused B cell disruption
48
What are the symptoms of Hodgkin's disease?
Nontender, lymphadenopathy in the neck and/or axilla
Fever, weight loss, night sweats
49
What is a Reed-sternberg cell? What is this diagnostic of?
A large cell with two or more nuclei or nuclear lobes, each of which has eosinophils
This is associated with Hodgkins' disease
50
What is the treatment for Hodgkin's?
Radiotherapy or chemo
51
What is the cause of nasopharyngeal carcinoma?
EBV
52
What are the symptoms of nasopharyngeal carcinoma?
Facial pain/fullness
hearing loss
53
What cells are affected in nasopharyngeal carcinoma?
Epithelial cells
54
What is the treatment for nasopharyngeal carcinoma?
Chemo/radiation
55
What is PTLD (post transplantation lymphoproliferation disorder)?
Abnormal proliferation of lymphoid cells in a transplant pt d/t EBV
56
What are the symptoms of PTLD?
Fever, weight loss, progressive encephalopathy
57
What is the major risk factor for PTLD?
EBV infection at the time of transplant
58
How do you diagnose PTLD?
Histological analysis
59
What is the treatment for PTLD? (3)
1. reduce immunosuppression
2. Rituximab (binds CD20)
3. Conventional chemo
60
What is the family of CMV? Enveloped? Genome?
Herpesviridae
Enveloped
dsDNA
61
Most infections with CMV lead to what?
Asymptomatic to mono-like
62
CMV infections with AIDs pts result in what?
Mutlisite symptomatic disease
63
Primary CMV infections of new mothers lead to what?
Developmental problems (cytomegalic inclusion disease)
64
Where does the CCMV replicate? Where is it latent?
Mucosal epi/viremia
Latet in monocytes
65
Reactivation of CMV is (always/rarely) symptomatic in immunocompetent pts?
Rarely
66
How is CMV transmitted?
```
Saliva
Breast milk
Urine
Fomites
Sex
```
67
How do you diagnose CMV?
1. Detection of viral DNA in diseases tissue
| 2. Seroconversion
68
Why is it hard to diagnose CMV?
virus can shed for year after initial infection during other infections
69
What is the 1st line treatment for CMV?
1. Gancyclovir
| 2. Valganciclovir
70
What is the MOA of Ganciclovir?
Converted to viral pol inhibitor by CMV enzymes
71
What is the MOA of valganciclovir?
Converted to ganciclovir within the body
72
What is the toxicity associated with Ganciclovir?
Bone marrow toxicity
| Neutropenia
73
What is the 2nd line treatment for CMV? Why are they second line?
1. Cidofovir
2. Foscarnet
2nd b/c IV, and renal toxic
74
What is the MOA of cidofovir?
Converted to a viral pol inhibits by cellular enzymes
75
What is the MOA of Foscarnet?
Direct inhibitor of the CMV pol
76
What is the primary disease caused by CMV
CMV mono-like illness
77
What are the symptoms of CMV IM-like illness?
fever, fatigue
NON-exudative pharyngeitis
78
What is the etiology of CMV IM-like illness?
Primary infection with CMV
79
Is there heterophile antibody production with CMV IM-like illness?
no
80
How do you differentiate between CMV IM-like illness and IM caused by EBV? (2)
EBV has exudative pharyngitis and heterophile production
CMV IM-like illness does not
81
When is CMV inclusion body disease found in babies? Does it cross the placenta
Most common with primary infections of mother during prego
Crosses placenta
82
What are the symptoms of CMV inclusion body disease in newborns?
1. Hepatosplenomegaly
2. Jaundice
3. Petechial rash
83
What is the most common congenital viral infection in the US?
CMV inclusion body disease
84
How does congential CMV infection occur? How often is this passed on from mothers?
Mother exposure to primary CMV virus
33% of the time passed onto child
85
How do you prevent CMV inclusion disease?
Prevent seronegative pregnant women from coming into contact with babies or other infected with CMV
86
What is the treatment for maternal treatment with CMV?
CMV immunoglobin
87
What is the most common viral pathogen complicating organ transplant?
CMV
88
When do AIDS patient present with CMV diseases?
between 50-100 CD4 count
89
What are the symptoms of CMV in immunocompromised pts?
Spiking fever, followed by hypothermia
90
What are the two ways that transplantation result in a CMV infection?
Reactivation d/t immunosuppression
From organ
91
What are the usual diseases associated with CMV transplantation? For HIV pts?
CMV penumonitis = transplant
| GI tract illness = HIV, CMV retinitis
92
What is the complication risk in CMV transplant infection?
Perforation and hemorrhage of GI epithelium
Graft vs host disease
93
What are the symptoms of CMV in AIDS pts?
CMV retinitis, GI tract illnesses
94
What are the symptoms of CMV retinitis?
1. Blurred vision
2. Floaters
3. White, necrotic lesions on fundoscopic exam
95
How do you prevent CMV in organ transplants?
Seronegative matching donors
96
How do you diagnose CMV retinitis?
Fundoscopic exam seeing necrotic lesions
97
What is the treatment for CMV in immunocompromised pts?
Prophylaxis with antivirals
98
What are the general characteristics of viral diseases of the systemic circulation?
Hide and lay dormant
99
What abx is associated with a rash if given to pts with mono?
Ampicillin
100
What is the CA caused by EBV that is the result of a translocation of a gene: Hodgkin's lymphoma, or Burkitt's lymphoma? What is the gene that is translocated?
Burkitt's lymphoma
Gene for E2F translocated to Chromosome 8 to 14
