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viruses Flashcards

1
Q

distinguish those numbered diseases…

A

first = measles
second = scarlet fever = strep. pyogenes
third = rubella
fourth = ?SSSS
fifth = parvo = erythema infectiosum
sixth = roseola infantum = HHV6

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2
Q

specific rashes
- parvo
- measles
- rubella
- congenital rubella
- measles

A

parvo = slapped cheek, rash worse with sun/heat, and LACY rash!
rubella = pinpoint petechiae on soft palate
congenital rubella= blueberry muffin rash
measles = koplik spots, maculopapular cephalocaudal rash

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3
Q

which viruses can be reactivated with a transplant

A

hhv6 (latency in monocytes and macrophages)
EBV
CMV
HSV
VZV
adenovirus

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4
Q

parvovirus: when infectious

A

days prior to rash/arthropathy - those are immune mediated in response to infection

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5
Q

parvovirus: main complications

A
  1. transient aplastic crisis - goes to bone marrow and affects erythroid progenitor&raquo_space; chronic haemolytic anaemia
  2. arthropathy
  3. hydrops fetalis
  4. neurological e.g. GBS
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6
Q

HHV6: higher rate of what??

A

1/3 feb covulsion
complex seizures inc. post ictal paralysis

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7
Q

HHV8 causes what??

A

Kaposi sarcoma = multifocal angiogenic lesions in skin/mucous membranes

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8
Q

rubella vaccinations

A

Given at 12 months (MMR) and 18 months (MMR-V)
- Not given to immunocompromised patients

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9
Q

complications of rubella (non-congenital)

A

arthralgia
encephalitis ** RARE, but severe
thrombocytopaenia

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10
Q

measles: main complications

A

it suppresses the immune system for up to 6 weeks so can get:
1) OM (most common)
2) pneumonia
3) encephalitis
4) a decade later: subacute sclerosing panencephalitis

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11
Q

Warthin Finkeldey giant cells = what disease???

A

measles

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12
Q

public health things about measles

A

vaccinate contacts within 72h of exposure
- exclude school for 14 days if vax declined
90% household contacts will get it
2 vax - 12mo and 18mo

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13
Q

classic lymphadenopathy pattern rubella

A

post-auricular and suboccipital lymphadenopathy.

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14
Q

measles vax vs flu vax can be given to which people?

A

measles can given with egg allergy!

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15
Q

mumps: main complications

A
  1. parotitis
  2. SNHL
  3. orchitis/EO
  4. meningitis
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16
Q

features of congenital varicella

A
  • Cicatricial skin scarring
  • Limb hypoplasia
  • neuro stuff e.g microcephaly, seizures
  • Eyes – chorioretinitis, microphthalmia, cataracts
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17
Q

shingles - explain

A

herpes zoster = shingles:
varicella dormant in dorsal root ganglia
if IC/aging
reactivates > travels to dermatome
post-herpetic neuralgia = pain in dermatoma which can last up to 3 months

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18
Q

why is aspirin CI in VZV / influenza

A

Reye syndrome = rapidly progressive encephalopathy with hepatic dysfunction esp a/w VZV/influenza

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19
Q

exposure during the foetal/neonatal period for varicella - what to do?

A

For mum:
past infection / immunisation - no action
If seronegative:
i. Exposure <= 96 hours earlier = ZIG
ii. Exposure >= 96h = no ZIG, consider oral aciclovir PEP

For foetus:
<28/40 = VZIG
>28/40 = VZIG if no maternal Ab

<1 week old = VZIG if from mum. If not from mum, VZIG if no maternal Ab

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20
Q

what is ramsay hunt syndrome?

A

herpes zoster oticus:
reactivation of VZV in geniculate ganglion > facial nerve palsy, deafness and vertigo with vesicles and pain in the auditory canal

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21
Q

HSV1 vs HSV2

A

HSV 1
- oral infection, can cause genital
- decreased risk of recurrent infection

HSV2
- Genital infection, can cause oral
- Increased risk of recurrent infection

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22
Q

where does HSV lie latent?

A

trigeminal or sacral ganglia

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23
Q

clinical manifestations possible with HSV (outside of neonates)

A
  1. gingivostomatittis
  2. encephalitis
  3. eyes: keratoconjunctivitis, branching dendritic lesion on cornea
  4. skin: herpes labialis (cold sores), herpes whitlow
  5. genital herpes
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24
Q

PCR vs serology: what is the more useful test in detecting CMV acute infection, and why?

A

PCR:
- MOST of the population is IgG positive
- IgM only develops after 4-16 weeks
- Avidity of IgG is typically LOW for the first 4-5 months following infection

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25
Q

treatment of varicella contacts

A

1mo-1yo: if complications, VZIG.
>1yo: VZV vax within 5 days (prevents and modifies disease)

26
Q

acute EBV illness i.e. mono: clinical signs/symptoms

A
  1. Fever 1-2 weeks
  2. pharyngitis / tonsillitis
  3. Lymphadenopathy (particularly epitrochlear + posterior cervical LN)
  4. fatigue
  5. Hepato-splenomegaly
  6. Eyelid edema (MCQ)
  7. palatal petechiae
27
Q

complications of EBV infection

A
  1. splenic rupture
  2. lymphoproliferative disorders: HLH, PTLD
  3. malignancy: burkitt’s, hodgkin’s, leiomyosarcoma, nasopharyngeal
  4. in immunocompromised: Oral hairy leukoplakia and Lymphoid interstitial pneumonitis
28
Q

lab test for EBV

A

MONOSPOT – tests for Heterophile antibody (made by infected B cell), usually +ve after 2-9 weeks after infection

younger kids: EBV specific Abs (EBNA = latent infection, IgM VCA)

29
Q

two common reasons for false negative monospot

A
  1. too early (25% neg in first week)
  2. too young (<4yo, B cell won’t make the heterophile Ab)
30
Q

what is the only respiratory virus with a mAb to treat? when to treat?

A

RSV and palivizumab (monthly injections);
1. CLD
2. Congenital heart disease if < 2
3. Extremely premature < 28 weeks

31
Q

RSV most often co-infects with what virus

A

human metapneumovirus

32
Q

unlike influenza, what can RSV not do?

A

no antigenic shift!

33
Q

most common cause of a common cold in a child?

A

rhinovirus!

34
Q

major clinical manifestations of adenovirus to know about

A
  1. resp - bronch, pneumonia
  2. eyes - conjunctivitis (pink eye)
  3. GI - diarrhoea
  4. haemorrhagic cystitis
  5. disseminated
35
Q

what are the 4 enteroviruses?

A

PEEC:
polio
echo
entero
coxackie

36
Q

the major clinical manifesatations of enteroviruses, and which ones are implicated

A
  1. non-specific viral
  2. HFM = coxsackie A16 (+ enterovirus 71)
  3. herpangina = Coxsackie A and enterovirus 71
  4. Acute haemorrhagic conjunctivitis = enterovirus 70 + coxsackie virus A25
  5. Myocarditis/ pericarditis = coxsackie B
  6. meningitis = enterovirus 71, coxsackie B
  7. polio = coxsackie A7, poliovirus, enterovirus 71
37
Q

coxsackie A vs B generally affect what?

A

coxsackie A = skin stuff (HFM, conjunctivitis)
coxsackie B = internal stuff (pericarditis, myocarditis, gastro, encephalitis, aseptic meningitis)

38
Q

enterovirus 71 causes what important things

A

HFM
herpangina
aseptic meningitis
paralytic poliomyelitis

39
Q

most common viral cause of viral meningitis

A

enterovirus - most coxackie B / echo

40
Q

incidence of paralysis with polio infection

A

1/1000

41
Q

prognosis of polio virus infection

A

dependent on type
a. Abortive polio + aseptic meningitis = usually benign
b. Severe bulbar poliomyelitis = mortality rates up to 60%

42
Q

which polio vax causes vaccine derived polio virus?

A

OPV i.e. Sabin (therefore we prefer Salk)

43
Q

antigenic shift vs antigenic drift

A

antigenic shift = point mutation = variant “shift = seasonal”
antigenic drift = sudden new HA subtype +/- NA = no recognition by immune response = PANDEMIC (e.g. H1N1) - only happens with flu A

44
Q

what are the surface proteins we care about for influenza

A
  1. haemagluttinin
  2. neuraminidase = releases virus from cells
  3. membrane channel protein M2
45
Q

oseltamivir MOA

A

neuraminidase inhibitor

46
Q

human metapneumovirus vs paraflu - more bronch or croup?

A

human metapneumo: bronch > croup
paraflu: croup > bronch

47
Q

rotavirus vax - major rare side effect

A

intussusception - in first 3 weeks post vax. Risk increases if doses are delayed

48
Q

hpv cause what cancers, and which types cause what manifestations

A
  • Genital warts and laryngeal papillomatosis (types 6, 11)
  • Cervical cancer (types 16, 18); vulval and vaginal cancer
49
Q

how can HIV be transmitted

A
  1. vertical (intra-uterine, intra-partum, post-partum breastfeeding is not common in industrialised nations)
  2. blood transfusion
  3. sexual transmission
50
Q

rotavirus vaccine efficacy

A

85% only

51
Q

how does HIV infect?

A

-targets CD4 T cells
-binds to the T cell using gp120. needs to bind to the T cell co-receptors (CXCR4 or CCR5) for entry
-RNA reverse transcribes > DNA moves into host nucleus and integrates into host DNA

52
Q

natural history of HIV

A
  1. primary infection with seroconversion: like mono
  2. clinical latency by 12 weeks - but virus replicating and T cells reducing
  3. 200-500 cell count: constitutional symptoms, candidiasis, leukoplakia, lymphadenopathy
  4. <200 adults; <1500 in <1yo: AIDS
53
Q

what is wasting syndrome?

A
  • Persistent weight loss >10% of baseline OR downward crossing of 2 or more major centile lines
  • an AIDS defining condition
54
Q

when to treat HIV positive children

A

treat at any CD4 count
all <1yo
all infants also need PJP prophylaxis

55
Q

Meds for HIV - the 4 MOA

A
  1. prevent viral entrance
    - gp41 binder = enfuvirtide
    - CCR4 receptor blocker = maraviroc
  2. reverse transcriptase inhibitor
    - NRTI
    - NNRTI
  3. protease inhibitor
  4. inhibit integration of virus into human DNA
56
Q

classic side effects of NRTIs

A

lactic acidosis + hepatic steatosis (zidovudine also causes lipodystrophy)

57
Q

how do you manage BK induced transplant nephropathy

A

reduce immunosuppression

58
Q

human t lymphotrophic virus

A

i. Myelopathy
ii. Arthropathy
iii. Uveitis
iv. (adult) T cell leukaemia/ lymphoma
v. Hairy cell leukaemia

59
Q

exams: rabies = ?? symptoms

A

aerophobia
hydrophobia

60
Q

compare the 5 maculopapular rashes of childhood

A
  1. VZV: itchy AF. 1-3d prodrome fever. vesicles.
  2. roseola: not itchy, but high as fuck fever
  3. measles: not itchy, but got them 3C’s and koplick spots with cephalocaudal rash.
  4. rubella: itchy. starts on face. can get blueberry muffin.
  5. parvo: usually not itchy. fever 3 days prior to rash. slapped cheek. aplastic crisis/fetal hydrops.

ID (9 decks)

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