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TCM Exam 2 > Viruses > Flashcards

Viruses Flashcards

1
Q

What do viruses need?

A

Most have an envelope, a core = capsid, and RNA or DNA

Viral RNA-dependent RNA polymerase required for (–) reading frame

Retrovirus RNA is transcribed in a retrograde fashion requiring a viral reverse transcriptase (RNA-dependent DNA polymerase)

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2
Q

Retro virus characteristics

A

Diploid

nuclear reproduction: reverse transcriptase

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3
Q

What viruses use V RNA-dependent RNA polymerase?

A

Orthomyxo, Paramyxo, Filo, Bunya, Arena, Rhabdo.

Rhabdo is bullet-shaped. (rabies, e.g.)

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4
Q

Special stuff about Reo

A

+/- RNA, double stranded, not enveloped

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5
Q

Special stuff about pox

A

replicates in cytoplasm, DNA-dependent RNA polymerase, enveloped

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6
Q

Parvo virus

A

uses DNA, single strands, not enveloped

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7
Q

Major digestive viruses

A

Rotavirus- childhood gastroenteritis, vaccine preventable, number 1 worldwide

Norovirus (Norwalk), Gastroenteritis, number one in the US

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8
Q

Orthomyxovirus

A

= Influenza

Envelope with surface glycoproteins hemagglutinin (H) and neuraminidase (N)

Neuraminidase inhibitors

Type A can come from animals and can become pandemic. Types B and C not so bad.

antigenic drift–> small changes, epidemics
antigenic shifts –> big changes, pandemics

CHILD + FLU (or chickenpox) + ASPIRIN → REYE SYNDROME

Yearly inactivated vaccines

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9
Q

Paramyxoviruses

A
  • ssRNA with envelope:
  • Parainfluenza
  • Mumps
  • Measles
  • Respiratory syncytial virus
  • Human metapneumovirus (common cold)

Produce multinucleated giant cells (SYNCYTIA) via a cell fusing factor

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10
Q

Parainfluenza

A

a Paramyxovirus

Most common cause of croup laryngotracheobronchitis (barking cough, steeple sign)

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11
Q

Respiratory Syncytial Virus Rx

A

Paramyxovirus

major cause of bronchiolitis and pneumonia in infants

RX- Palivizumab against F-protein

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12
Q

Mumps Virus

A

Paramyxovirus

Enters from salivary secretions (intimate contact) via the pharynx or conjunctiva

Painful enlargement of the salivary glands

Epididymoorchitis in males, which can cause sterility

Prevention: - Immunize with MMR live vaccine

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13
Q

Measles Virus (Rubeola)

A

Paramyxovirus

Koplik spots of mouth precede T-cell mediated rash

Inclusion body encephalitis and/or with chronic infection
subacute sclerosing panencephalitis (SSPE)

93.3% vaccinated = herd immunity

DX- multinucleated measles giant cells (Warthin-Finkeldey cells)

Prevention: MMR live vaccine. Vaccination rate in CO: 86%

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14
Q

Hepatitis Viruses

A

Hep A: PicoRNAviridae (Fecal-Oral transmission). Mostly mild, jaundice.

Hep B: HepaDNAviridae. Dane particle- oncogenic transforming virus
parenteral/ sex transmission
enveloped
–> hepatocellular carcinoma

Hep C: Flaviviradae. Hepatocellular carcinoma
parenteral/ sex transmission
enveloped
–> hepatocellular carcinoma

Hep D: Unassigned virion. (delta antigen)
parenteral/ sex transmission
Onset: Abrupt w/ superinfection or hepatitis B
co-infection
enveloped (by Hep B)

Hep E: Enteric. HepEviridae, fecal-oral transmission

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15
Q

Prevention of various hepatitis viruses

A

Hep A vaccine

Hep B vaccine

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16
Q

Hepatitis - Viral Serology (know this down cold)

A

Acute B - HBsAg: Acute B, &D coinfection

HBcAb- Acute B

Anti-HDV- B& D Co-infection

Acute A- Anti-HAV IgM

Prior C- Anti-HCV
Acute C- Anti HCV
Chronic C- Anti Hcv
Hep E- Anti- HEV HEV RNA

HBsAb IgG with nothing else means they’ve been vaccinated against B.

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17
Q

Retroviruses

A

use reverse transcriptase

Oncornaviruses: HTLV 1 , HTLV 2

HTLV-I –> T cell leukemia/ lymphomas, myelopathy

Lentiviruses are also retroviruses: HIV 1, HIV 2

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18
Q

Lentiviruses

A

are retroviruses

  • can cause multinucleated cells (cell to cell fusion of macrophages)

HIV 1, HIV 2

Can cause AIDS dementia, wasting syndrome

Attach to CD4 receptor & CCR5 (macrophage) or CXCR4 (TH cell) coreceptors

Western Blot (tests for antibodies against viral proteins),

Rx – Antiretrovirals

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19
Q

Important HIV genes

A

gag (early marker of infection from capsid)

pol (reverse transcriptase, integrase. Allows DNA integration into host)

env (binds CD4&CCR5 (macrophage) or CXCR$ (Th cell)

LTR

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20
Q

Herpes viruses

A

produce intranuclear inclusions and multinucleated giant cells
capable of latency

1 & 2 are neurotropic
CMV and EBV are lymphotropic

Types:

HHV 1- herpes simplex 1
HHV 2- herpes simplex 2
HHV 3- varicella zoster virus
HHV 4- Epstein Barr virus (oncogenic transforming virus)
HHV 5- Cytomegalovirus (oncogenic)

6th and 7th apparently cause 6th disease (rash)

HHV 8- Kaposi Sarcoma-associated herpesvirus (oncogenic)

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21
Q

Herpes Simplex

A

Have intranuclear acidophilic Cowdry type A (eosinophilic) inclusions w/ margination of the nuclear chromatin

1- cold sores, gingivostomatitis (–>oropharyngeal blister in kids), fatal sporadic encephalitis

2- genital region. Whitlows- erythematous lesions on toes or nail cuticle.

Rx- acyclovir

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22
Q

Varicella-Zoster

A

Chickenpox (varicella)

Usually transmitted by saliva
Rash: head & trunk –> extremities. asynchronous and centripetal spread)

Shingles (zoster)
Older individuals with reactivation of latent infection
Skin areas innervated by sensory nerves of the dorsal root ganglia
Trigeminal nerve is common distribution

prevention: 2 doses of varicella (VAR) (kids)
Zoster vaccine for older people

23
Q

Epstein-Barr Virus

A

Attach via CD21
= Complement receptor 2 = EBV receptor

Infectious mononucleosis

Atypical activated T-lymphocytes (Downey cells)

Hodgkin lymphoma, Burkitt lymphoma, central nervous system lymphomas, & nasopharyngeal carcinoma

dx- heterophile antibodies (monospot)

24
Q

Cytomegalovirus

A

Owl-eye basophilic intranuclear inclusions

Transmission:
Transplacental - primary infection pregnant mother
Neonatal - cervical or vaginal secretions during birth
Perinatal -breast milk from a mother who has active infection
Saliva – common during preschool years

CMV mononucleosis-syndrome with fever, fatigue and atypical lymphocytes
Congenital cytomegalovirus infection (cytomegalic inclusion disease of the newborn)-in utero infections with jaundice, purpura, hepatosplenomegaly and central nervous system development disorders

25
Q

Poxviridae

A

Replicate in the cytoplasm of host cell

Smallpox

Molluscum contagiosum
- Common self-limited viral disease caused by Poxvirus

look for cytoplasmic inclusions

26
Q

Papillomaviridae (p.k.a. Papovariedae)Human Papilloma Virus

A

Oncogenic transforming viruses:
Viral E6 inhibits p53 protein and E7 inhibits pRB protein

High-risk - types 16 and 18 responsible for most cancers and high grade dysplasias

prevention: vaccination (females) and physical barriers

27
Q

Polyomaviridae (p.k.a. Papovariedae)BK and JC Viruses

A

BK - Renal disease (failure) in AIDS or post-transplant patients
Dx - BKV DNA by PCR or urine cytology with decoy cells (basophilic nuclear inclusions)

JC - Progressive multifocal leukoencephalopathy in AIDS or post-transplant
Dx - JCV DNA by PCR

28
Q

Adenoviridae

A

Acute respiratory disease – serotypes 4,7 &21) upper respiratory infections in kids/young adults that can progress to pneumonia
Gastroenteritis - adenoviruses that lead to diarrhea
Pharyngoconjunctivitis – pink eye and sore throat

Prevention – live adenovirus vaccine

29
Q

Parvoviridae

A

Parvovirus B19
Naked ssDNA in segments (some positive, others negative)

Erythema infectiosum (fifth disease)
Fever, arthralgias and cheek rash children
Aplastic anemia (infects erythroblasts)
Can cause hydrops fetalis via in utero infection

30
Q

Viral Encephalitis

A

Western/ Eastern Equine Encephalitis (alpha virus)

Lt. Louis encephalitis virus (flavivirus) –> St Louis encephalitis

West Nile virus (flavivirus)

Dengue virus (flavivirus)

Colorado tick fever virus (reovirus) –> headaches behind the eyes, photophobia, rash

La Cross virus (bunyavirus)

Other viruses that can cause encephalitis: HSV, VZV, Influenza, Enteroviruses, Rabies, Mumps, Measles

31
Q

Arboviruses

A

Arthropod borne viruses

Togaviridae: WEE, EEE, VEE encephalitis, chikungunya & rubella

Flaviviradae
Yellow and dengue fevers, St. Louis and Japanese encephalitis, West Nile virus, hepatitis C

Bunyaviradae
California encephalitis, Rift Valley fever, hantavirus

32
Q

Togaviruses

A

Alphaviruses

Chikungunya: get viremia with acute febrile illness with malaise, rash and arthritis
Eastern and western equine encephalitis (EEE, WEE)

Rubivirus (no arthropod vector) – rubella (German measles)
	Congenital rubella (TORCH syndrome)

Flaviviruses (more to follow)
Yellow fever virus, Dengue virus, St. Louis encephalitis, Japanese encephalitis, West Nile virus, hepatitis C virus

Bunyaviruses
California encephalitis, Rift Valley fever, pappataci (sandfly) fever, hantavirus pulmonary syndrome (more in emerging pathogens slides)

33
Q

Rubella/Rubivirus

A

= German measles

Congenital rubella syndrome affects the eyes, heart and brain
Infection occurred during 1st trimester of pregnancy

34
Q

Flaviridae

A

Flaviviruses

Mosquitoes

St. Louis encephalitis (SLE): viremia (usually asymptomatic), in some CNS involvement causes encephalitis inflammation and neuronal degeneration

West Nile encephalitis (WNE): viremia (usually asymptomatic), mild, flu-like cases (“West Nile fever“), more severe “West Nile encephalitis” or “West Nile meningitis” which can lead to death

Yellow fever: viremia with severe systemic disease (fever, headache, nausea and vomiting) followed by liver damage and intestinal hemorrhages (jaundice, shock and death)

Dengue fever: virus replicates in the skin and then goes to lymphoid tissue followed by a viremia which results in fever and rash lasting 3-9 days (self-limited) but can get dengue hemorrhagic fever (immunopathologic processes produce extreme vascular permeability, shock and death and associated with serotype 2)

35
Q

Picornaviruses

A

Heparnavirus – discussed with hepatitis viruses

Rhinoviruses - Attach via ICAM-1 receptor to respiratory epithelial cells

Enteroviruses (Poliovirus, Coxsackievirus, Echovirus, etc.)
- spread fecal-oral

36
Q

Enteroviruses

A

Polioviruses

Prevention- Inactive (Salk vaccine), oral (Sabin vaccine)

Coxsackie A & B can cause aseptic meningitis. A
Group A - herpangina, acute hemorrhagic conjunctivitis & hand-foot-and-mouth disease
Group B - pleurodynia, myocarditis, pericarditis, and hepatitis

Echoviruses

37
Q

Rhabdoviridae/Rabies

A

bullet-shaped (think: shoot the rabid dog)

(encephalitis) via acetylcholine receptor with retrograde axoplasmic transport to dorsal root ganglia and spinal cord

Negri bodies (Neurons accumulate ribonucleoprotein as intracytoplasmic inclusions)

hydrophobia, anxiety, dilation of pupils

Once symptomatic death is almost certain despite optimal supportive care

Prevention: vaccines for dogs and cats

38
Q

Emerging Infections

A

cholera, cryptosporidiosis, Ebola hemorrhagic fever, dengue fever, hantavirus pulmonary syndrome, hep C, HIV/ AIDS, influenza, legionnaires’ disease and Pontiac fever, malaria, MRSA, SARS, VISA/ VRSA, Staph aureus, West Nile virus

Of Biodefense importance: Ehrlichiosis, Hep C and E, among many others.

39
Q

Enterovirus 68

A

not polio, but polio-like

acute flaccid myelitis, new outbreak in US 2014-2015

Appears to be related to enterovirus 68

40
Q

Zika Virus

A

Appears to be associated with development of Guillain-Barré syndrome
Appears to be associated with microcephaly, lissencephaly and other neurologic malformations with in utero infections (highest risk in second trimester)
Vector is aedes mosquito species

41
Q

Viral Hemorrhagic Fevers

A

RNA viruses

Arenaviridae – South American hemorrhagic fever viruses and Lassa Fever
Filoviridae – Ebola (4 subtypes) and Marburg viruses
Bunyaviridae – Rift Valley fever & Crimean-Congo hemorrhagic fever
Flaviviridae – Dengue hemorrhagic fever
Rhabdoviridae – Bas-Congo virus hemorrhagic fever

usually insect vector

42
Q

Ebola (hemorrhagic fever)

A

Person-to-person transmission via blood or body fluids (urine, saliva, sweat, feces, vomit, breast milk, and semen)

Symptoms appear 2 to 21 days after exposure
25-90% mortality

43
Q

Dengue Fever

A

Classic dengue fever, “break bone fever,” - acute onset of high fever 3–14 days after the bite, frontal headache, retro-orbital pain, myalgias, arthralgias, hemorrhagic manifestations, rash, and low white blood cell count

Dengue hemorrhagic fever - Fever lasting 2–7 days with any hemorrhagic manifestation, thrombocytopenia, evidence of increased vascular permeability. Can have severe abdominal pain, CNS symptoms, shock.

RX- supportive, IV fluids, Dextran 40

44
Q

Powassan virus

A

Tick (Ixodes) borne virus found mostly in Canada, northeast and Great Lakes regions, and Russia

1 week to 1 month incubation and infections range from asymptomatic to encephalitis and meningitis

Fever, headache, vomiting, weakness, confusion, loss of coordination, speech difficulties, and seizures
50% develop permanent neurologic deficits
10% die

45
Q

West Nile Virus

A

Vector - mosquito (lots of different species)
Human to human via blood or milk
Acute viremia
Usually subclinical infections or viral syndrome (20%)
Maculopapular rash in 50% with viral syndrome
Meningoencephalitis (

46
Q

Chikungunya Virus

A

Symptoms begin 3–7 days after being bitten by infected

Aedes mosquitos

Most common symptoms are fever and joint pain
Self limited (1 wk. most symptoms and months for joints)
47
Q

SARS Virus

A

Severe acute atypical respiratory syndrome due to a novel coronavirus

No cases since 2003 outbreak

48
Q

MERS Coronavirus

A

Middle East Respiratory Syndrome Coronavirus
Asymptomatic to severe acute respiratory syndrome (fever and pneumonia) in person coming from Arabian peninsula or in close contact with MERS patient

Spread via saliva, respiratory droplets

49
Q

Bunyaviridae

A

California encephalitis- California encephalitis virus via mosquitos in Kern and Marin counties, CA
La Crosse encephalitis- La Crosse virus via mosquitos in Eastern U.S.

Hantavirus – worldwide
Hemorrhagic fever with renal failure – Asia and Europe
Pulmonary syndrome - spread via aerosolized rodent excrement causing pulmonary edema with 40% mortality; in U.S. around “four corners” region (Arizona, Colorado, New Mexico and Utah)
Deer mice is carrier in Four Corners region

serology to “Sin Nombre” virus; p.k.a “Four Corners virus”

50
Q

Elizabethkingia spp.

A

Ubiquitous soil bacteria that also live in the gut of Anopheles gambiae mosquitos
Can colonize human respiratory tract

E. anopheles 2015-16 community acquired outbreak from unknown source in debilitated elderly around Milwaukee, Wisconsin has killed 15 (of 52 patients) as of March, 2016

51
Q

Bioterrorism CDC Categories

A

Category A - can be easily disseminated or transmitted from person to person; result in high mortality - anthrax, smallpox (variola major), Viral hemorrhagic fevers (arenaviruses, bunyaviruses - hantaviruses, rift valley fever, crimean congo hemorrhagic fever, flaviruses- dengue, filoviruses- ebola & marburg)

Category B - moderately easy to disseminate; result in moderate morbidity rates and low mortality rates; - Brucellosis (brucella species), Ricin toxin, water safety threats (vibrio cholerae, e.g.)

Category C - emerging pathogens that could be engineered for mass dissemination. Emerging infectious diseases such as Nipah virus and hantavirus. SARS and MERS.

52
Q

Anthrax and bioterrorism

A

Rx- 3 concurrent antimicrobials
Anthrasil (anthrax immune globulin intravenous [human]) for inhalational anthrax

vaccine: Ava/BioThrax (used for combatants)-

53
Q

Smallpox in bioterrorism

A

Smallpox
Variola virus

Respiratory transmission

Dx –Characteristic deep skin lesions with centrifugal pattern (mostly face and extremities) and synchronous development on individual areas of the body

Smallpox vaccine – live vaccinia virus preparation

TCM Exam 2 (15 decks)

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