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MAD > Viruses > Flashcards

Viruses Flashcards

1
Q

HIV family

A

retroviridae

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2
Q

HIV structure

A

ss(+)RNA, enveloped, truncated conical capsid

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3
Q

HIV entry

A

viral gp120 protein binds to target CD4 and co-receptors CCR5 (macrophages) and CXCR4 (T-cells)
viral gp41 transmembrane protein for membrane fusion

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4
Q

HIV replication

A 
viral reverse transcriptase (RNA dependent DNA polymerase)
viral integrase (viral DNA integration into host DNA)
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5
Q

HIV assembly/egress

A

translation makes proteins, viral protease cleaves viral polyprotein

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6
Q

HIV genes

A

env gene- gp120 and gp41
gag gene- capsid protein and matrix protein
pol gene- RT, protease, integrase

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7
Q

HIV transmission

A

sexual contact, bloodborne, vertical (maternal-infant)

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8
Q

HIV clinical course

A

acute retroviral syndrome (flu-like), then asymptomatic

stages 1-3 depending on CD4+ T-cell counts (<200 is stage 3/AIDS)

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9
Q

HIV tip offs

A

fatigue, wt loss, lymphadenopathy, low grade fever, homosexual male, IV drug user, sexually active adult, decreased CD4 count, opportuinstic infections

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10
Q

AIDS prophylaxis

A

CD4 <200 = start pneumocystitis pneumonia (PCP) prophylaxis with TMP-SMX
CD4 <100 = start toxoplasmosis prophylaxis with TMP-SMX
CD4 <50 = start mycobacterium avlum complex (MAC) prophylaxis with azithromycin or clarithromycin

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11
Q

HIV testing

A

antigen/antibody tests: p24 AND anti HIV-1/HIV-2 IgM and IgG
CD4+ counts assess progression
10-33 day window period before HIV can be detected

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12
Q

HIV treatment

A

treat everyone with HIV; need continued treatment!!
nucleoside reverse transcriptase inhibitors (NRTIs)- binds reverse transcriptase at normal site of nucleoside
non-nucleoside reverse transcriptase inhibitors (NNRTIs)- binds reverse transcriptase elsewhere
integrase inhibitors (—tegravir)
protease inhibitors (–navir)
fusion inhibitors

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13
Q

HIV vaccines

A

none

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14
Q

HSV-1/2 family

A

herpesviridae

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15
Q

HSV-1/2 structure

A

dsDNA, enveloped, icosahedral

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16
Q

HSV-1/2 entry

A

tegument proteins unique to herpesviruses

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17
Q

HSV-1/2 replication

A

latency- alphaherpesvirus subfamily = neurotrophic
thymidine kinase- helps with early viral DNA replication by turning nucleosides into nucleotides by adding a phosphate group

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18
Q

HSV-1/2 assembly/egress

A

virus envelope comes from nuclear membrane

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19
Q

HSV-1/2 biology notes

A

reactivation from latency can occur by UV radiation, hyperthermia, stress and IMMUNOSUPPRESSION
T cell response is critical to control

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20
Q

HSV-1/2 epidemiology

A

most common cause of viral encephalitis

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21
Q

HSV-1/2 transmission

A

close personal contact (kissing, sexual contact), vertical

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22
Q

HSV-1/2 clinical course

A

HSV-1- cold sores, latent in trigeminal ganglion
HSV-2- painful genital vesicles, fever, malise, latent in sacral nerve ganglia
both- can cause encephalitits with focal temporal lesions, as well as severe neonatal herpes

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23
Q

HSV-1/2 testing

A

clinical diagnosis of characteristic lesions
encephalitis- CSF PCR
genital/skin lesions- PCR or immunoflourescence staining - Tzanck smear of vesicles, look for Cowdry inclusions

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24
Q

HSV-1/2 treatment

A

acyclovir (guanosine analog)- viral thymidine kinase converts acyclovir into a false nucleotide to block DNA synthesis by DNA polymerase

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25
Q

HSV-1/2 vaccine

A

none

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26
Q

varicella zoster virus (VZV) family

A

herpesviridae –> HHV-3

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27
Q

varicella zoster virus (VZV) structure

A

dsDNA, enveloped, icosahedral

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28
Q

varicella zoster virus (VZV) entry

A

tegument proteins unique to herpesviruses

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29
Q

varicella zoster virus (VZV) replication

A

latency- alphaherpesvirus subfamily = neurotropic
latent in dorsal root ganglion
thymidine kinase

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30
Q

varicella zoster virus (VZV) assembly/egress

A

virus envelope from nuclear membrane

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31
Q

varicella zoster virus (VZV) transmission

A

respiratory droplets from patient with chickenpox (very contagious)
contact with lesions from patients with shingles (not particularly contagious)

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32
Q

varicella zoster virus (VZV) clinical course

A

congenital varicella
chicken pox (primary infection)- asynchronous vesicular rash (lesions in different stages), fever, pharyngitis, malise, rhinitis, Raye syndrome
shingles- reactivation of latent VZV, pain/vesicles in dermatomal distribution, Ramsay hunt syndrome, herpes zoster ophthamicus
can cause severe disease in immunocompromised- pneumonia

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33
Q

varicella zoster virus (VZV) testing

A

PCR

old school = Tzanck smear of vesicle, look for Cowdry inclusions

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34
Q

varicella zoster virus (VZV) treatment

A

acyclovir (guanosine analog)- resistance if viral TK acquires mutation

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35
Q

varicella zoster virus (VZV) vaccines

A

live attenuated vaccine for all children

new inactivated VZV vaccine

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36
Q

cytomegalovirus (CMV) family

A

herpesviridae –> HHV-5

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37
Q

cytomegalovirus (CMV) structure

A

dsDNA, enveloped, icosahedral

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38
Q

cytomegalovirus (CMV) entry

A

receptor cellular integrins (heparan sulfate)

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39
Q

cytomegalovirus (CMV) replication

A

latency- betaherpesvirus subfamily = lymphotropic

thymidine kinase

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40
Q

cytomegalovirus (CMV) assembly/egress

A

virus envelope from nuclear membrane

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41
Q

cytomegalovirus (CMV) biology notes

A

infected cells have “owl eye” inclusions

latency in mononuclear cells

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42
Q

cytomegalovirus (CMV) transmission

A

saliva, sexual, blood products, vertical

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43
Q

cytomegalovirus (CMV) clinical course

A
  • mononucleosis (monospot negative)
  • most common cause of congenital infection- most asymptomatic, severe with jaundice, thrombocytic purpura (blueberry muffin), pneumonitis, CNS damage
  • immunocompromised/AIDS/transplant pt- CMV retinitis, interstitial pneumonitis, GI disease/esophagitis/colitis
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44
Q

cytomegalovirus (CMV) testing

A

PCR of blood, test urine in babies only

**screen blood and organ donors for CMV infection

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45
Q

cytomegalovirus (CMV) treatment

A

gancyclovir (guanosine analog)- used only for CMV and not HSV-1/2
cidofovir and foscarnet (viral DNA polymerase inhibitors)

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46
Q

cytomegalovirus (CMV) vaccine

A

none

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47
Q

human herpesvirus 6/7 (HHV 6/7) family

A

herpesviridae

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48
Q

human herpesvirus 6/7 (HHV 6/7) structure

A

dsDNA, enveloped, icosahedral

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49
Q

human herpesvirus 6/7 (HHV 6/7) entry

A

tegument proteins unique to herpesviruses

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50
Q

human herpesvirus 6/7 (HHV 6/7) replication

A

latency- betaherpesvirus subfamily = lymphotropic, latency in mononuclear cells
HHV 6 infects CD4+ T-helper cells

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51
Q

human herpesvirus 6/7 (HHV 6/7) assembly/egress

A

virus envelope form nuclear membrane

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52
Q

human herpesvirus 6/7 (HHV 6/7) transmission

A

respiratory droplets

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53
Q

human herpesvirus 6/7 (HHV 6/7) epidemiology

A

human reservoir

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54
Q

human herpesvirus 6/7 (HHV 6/7) clinical course

A

roseola- fever for 5 days, fever resolves followed by lacy body rash that spares the face –> caused commonly by HHV 6 (7 is less common)
high fever can cause seizures
one of the 5 classic childhood exanthems

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55
Q

human herpesvirus 6/7 (HHV 6/7) testing

A

clinical

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56
Q

human herpesvirus 6/7 (HHV 6/7) treatment

A

supportive

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57
Q

human herpesvirus 6/7 (HHV 6/7) vaccine

A

none

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58
Q

epstein-barr virus (EBV) family

A

herpesviridae –> HHV-4

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59
Q

epstein-barr virus (EBV) structure

A

dsDNA, enveloped, icosahedral

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60
Q

epstein-barr virus (EBV) entry

A

binds receptor CD21 (complement receptor 2)

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61
Q

epstein-barr virus (EBV) replication

A

latency- gammaherpesvirus subfamily = oncogenic

latent in B cells

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62
Q

epstein-barr virus (EBV) assembly/egress

A

virus envelope from nuclear membrane

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63
Q

epstein-barr virus (EBV) epidemiology

A

reservoir in humans

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64
Q

epstein-barr virus (EBV) transmission

A

respiratory secretions, saliva

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65
Q

epstein-barr virus (EBV) clinical course

A

mononucleosis (heterophile positive)- fatigue, fever, sore throat, lymphadenopathy, splenomegaly
lymphoproliferative disease in immunocompromised and cancer patients
lymphoma, nasopharyngeal carcinoma
Downey type 2 atypical lymphocytes up to 70% in blood

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66
Q

epstein-barr virus (EBV) testing

A

heterophile antibodies positive

PCR of blood

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67
Q

epstein-barr virus (EBV) treatment

A

supportive

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68
Q

epstein-barr virus (EBV) vaccines

A

none

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69
Q

HHV-8 family

A

herpesviridae –> kaposi sarcoma-associated herpesvirus

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70
Q

HHV-8 structure

A

dsDNA, enveloped, icosahedral

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71
Q

HHV-8 replication

A

latency- gammaherpesvirus subfamily = oncogenic

latency in B cells and glandular epithelial cells

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72
Q

HHV-8 assembly/egress

A

virus envelope from nuclear membrane

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73
Q

HHV-8 biology notes

A

gene turns on vascular endothelial growth factor (VEGF) –> leads to kaposi sarcoma

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74
Q

HHV-8 epidemiology

A

reservoir in humans

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75
Q

HHV-8 transmission

A

sexual contact, saliva, vertical, transplantation

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76
Q

HHV-8 clinical course

A

kaposi sarcoma- neoplasm of endothelial cells
seen in HIV/AIDS and transplant patients
dark plaques/nodules on skin
can affect GI tract and lungs
classic kaposi sarcoma- seen in elderly men, most often affects skin of the extremities

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77
Q

HHV-8 testing

A

antibody tests, PCR

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78
Q

HHV-8 treatment

A

no drugs, surgical, try to correct immunosuppression

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79
Q

HHV-8 vaccines

A

none

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80
Q

molluscum contagiosum family

A

poxiviridae

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81
Q

molluscum contagiosum strucure

A

dsDNA, enveloped, complex morphology, HUGE

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82
Q

molluscum contagiosum replication

A

replicates in the cytoplasm

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83
Q

molluscum contagiosum assembly/egress

A

makes its own envelope

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84
Q

molluscum contagiosum epidemiology

A

reservoir in humans

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85
Q

molluscum contagiosum transmission

A

direct contact, fomites

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86
Q

molluscum contagiosum clinical course

A

flesh colored papule with central umbilication

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87
Q

molluscum contagiosum testing

A

eosinophillic cytoplasmic inclusion bodies on biopsy

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88
Q

molluscum contagiosum treatment

A

supportive, disease is usually self-limited
treat underlying HIV
cimetidine as immune stimulant in children (histamine receptor antagonist–> stimulates delayed type hypersensitivity immunologic reaction)

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89
Q

molluscum contagiosum vaccines

A

none

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90
Q

variola (smallpox) family

A

poxviridae

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91
Q

variola (smallpox) structure

A

dsDNA, enveloped, complex morphology, HUGE

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92
Q

variola (smallpox) replication

A

replicates in the cytoplasm

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93
Q

variola (smallpox) epidemiology

A

eradicated using vaccine

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94
Q

variola (smallpox) transmission

A

respiratory transmission

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95
Q

variola (smallpox) clinical course

A

flu-like prodome followed by vesicular rash, mouth to extremities, can cover whole body in a day
synchronous rash- all vesicles are in the same stage (unlike chicken pox)

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96
Q

variola (smallpox) treatment

A

supportive

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97
Q

variola (smallpox) vaccine

A

live attenuated vaccine –> causes serious complications for immunocompromised patients and is not safe for pregnant women

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98
Q

human papilloma virus (HPV) family

A

papillomavirus

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99
Q

human papilloma virus (HPV) structure

A

dsDNA, naked, icosahedral

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100
Q

human papilloma virus (HPV) replication

A

replicates in the nucleus like all DNA viruses except pox

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101
Q

human papilloma virus (HPV) assembly/egress

A

infects basal layer of the skin/mucus membranes (has tropism)
malignacyl viral proteins E6 and E7 inhibit tumor suppressor genes p53 and Rb (respectively)

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102
Q

human papilloma virus (HPV) epidemiology

A

reservoir in human

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103
Q

human papilloma virus (HPV) transmission

A

direct contact, fomites

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104
Q

human papilloma virus (HPV) clinical course

A 
cutaneous warts mostly on hands (serotype 2&amp;4)
plantar warts on soles of feet, deep and painful (serotype 1)
anogenital warts (condyloma acuminata) (serotype 6&amp;11)
anal, vaginal, vulvar, penile and laryngeal cancer
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105
Q

human papilloma virus (HPV) testing

A

koilocytic cells in pap smear, PCR

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106
Q

human papilloma virus (HPV) treatment

A

cidofovir (antiviral), surgical, chemical, immune

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107
Q

human papilloma virus (HPV) vaccine

A

cancer vaccine, gardasil (inactivated subunit vaccine)

safe sex is important for protection

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108
Q

parvovirus B19 family

A

parvoviridae

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109
Q

parvovirus B19 structure

A

ssDNA (**only ssDNA virus), naked, icosahedral

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110
Q

parvovirus B19 entry

A

receptor is the P antigen on RBCs

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111
Q

parvovirus B19 replication

A

replicates in nucleus like all DNA viruses except pox

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112
Q

parvovirus B19 assembly/egress

A

infects immature erythroid progenitor cells causing lysis

can cause aplastic crisis in pts with sickle cells

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113
Q

parvovirus B19 epidemiology

A

human respiratory tract

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114
Q

parvovirus B19 transmission

A

respiratory, fomites, vertical

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115
Q

parvovirus B19 clinical course

A

childhood exanthem- flu-like symptoms followed by raised, indurated facial rash
arthralgias in adults
myocarditis in adults and children
fetus with severe anemia, heart failure, hydrops fetalis, spontaneous abortion

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116
Q

parvovirus B19 testing

A

antibody testing, PCR

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117
Q

parvovirus B19 treatment

A

supportive

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118
Q

parvovirus B19 vaccine

A

none

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119
Q

yellow fever virus family

A

flaviviridae

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120
Q

yellow fever virus strucutre

A

ss(+)RNA, enveloped, icosahedral

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121
Q

yellow fever virus replication

A

cytoplasmic, genome closely matches mRNA

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122
Q

yellow fever virus epidemiology

A 
arthropod borne (arbovirus)
mosquito vector, human and monkey reservoir
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123
Q

yellow fever virus transmission

A

mosquito bite

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124
Q

yellow fever virus clinical course

A

high fever, back pain, black vomitus, bloody stools, GI, liver, kidney and heart damage
jaundice

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125
Q

yellow fever virus testing

A

councilman bodies on liver biopsy (represents hepatocytes undergoing apoptosis)

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126
Q

yellow fever virus treatment

A

supportive

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127
Q

yellow fever virus vaccine

A

live attenuated vaccine

vector control is important in disease control

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128
Q

dengue virus family

A

flavivirus

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129
Q

dengue virus structure

A

ss(+)RNA, enveloped, icosahedral

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130
Q

dengue virus replication

A

cytoplasmic, genome closely matches mRNA

infects WBCs

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131
Q

dengue virus epidemiology

A

arthropod borne (arbovirus), mosquito vector, human and monkey reservoir

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132
Q

dengue virus transmission

A

mosquito bite

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133
Q

dengue virus clinical course

A

breakbone fever- rash, muscle and joint pain, retro-orbital headache, high fever
dengue hemorrhagic shock
thrombocytopenia and leukopenia on CBC

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134
Q

dengue virus treatment

A

supportive

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135
Q

dengue virus vaccine

A

limited usefulness, can make dengue fever worse in naive patients

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136
Q

dengue virus control notes

A

**antibody dependent enhancement –> once you get it once it gets worse the second time you get it

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137
Q

zika virus family

A

flaviviridae

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138
Q

zika virus structure

A

ss(+)RNA, enveloped, icosahedral

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139
Q

zika virus replication

A

cytoplasmic, genome closely matches mRNA

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140
Q

zika virus epidemiology

A

arthropod borne (arbovirus), mosquito vector, vertebrate reservoir

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141
Q

zika virus transmission

A

mosquito, sexual, vertical

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142
Q

zika virus clinical course

A

febrile illness with itchy rash and arthralgia, joint pain, conjunctivitis
usually mild and in most people asymptomatic
congenital- microcephaly, fetal demise

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143
Q

zika virus testing

A

PCR detection of viral RNA, antibody test

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144
Q

zika virus treatment

A

supportive

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145
Q

zika virus vaccine

A

none, vector control is important in disease control

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146
Q

rubella virus family

A

togaviridae

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147
Q

rubella virus structure

A

ss(+)RNA, enveloped, icosahedral

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148
Q

rubella virus replication

A

cytoplasmic replication

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149
Q

rubella virus epidemiology

A

respiratory droplets, human reservoir

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150
Q

rubella virus transmission

A

respiratory, vertical

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151
Q

rubella virus clinical course

A 
german measles (class childhood exanthem)
erythematous rash starts on face, proceeds to trunk, does not coalesce (vs measles)
postauricular and occipital lymphadenopathy
congenital rubella syndrome- fetus with cataracts, heart defects, developmental delay, hearing loss
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152
Q

rubella virus testing

A

antibody testing

screen all pregnant women for rubella immunity

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153
Q

rubella virus treatment

A

supportive

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154
Q

rubella virus vacine

A

live attenuated MMR vaccine- do give it to children, do NOT give it to pregnant women or immunocompromised

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155
Q

measles virus family

A

paramyxoviridae, also called rubeola virus

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156
Q

measles virus structure

A

ss(-)RNA, non-segmented, enveloped, helical

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157
Q

measles virus entry

A

fusion proteins appear as spikes on virus surface (F proteins)

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158
Q

measles virus replication

A

cytoplasmic replication

(-) RNA so needs a viral RNA dependent RNA polymerase protein that is viron associated

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159
Q

measles virus assembly/egress

A

buds from cell membrane

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160
Q

measles virus biology notes

A

causes cell-cell fusion to make giant cells
can escape immune detection
hemaglutinin is a virulence factor (clumps RBCs)

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161
Q

measles virus epidemiology

A

human reservoir

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162
Q

measles virus transmission

A

respiratory droplets

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163
Q

measles virus clinical course

A

4 C’s- cough, coryza, conjunctivitis, koplik spots on buccal mucosa
classic childhood exanthem of erythematous rash that starts on the head and progresses downward; rash can become confluent (unlike rubella)
complications- pneumonia, encephalitis, acute disseminated encephalomyelitis, subacute sclerosing panencephalitis

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164
Q

measles virus testing

A

antibody testing

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165
Q

measles virus treatment

A

supportive, vitamin A

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166
Q

measles virus vaccine

A

live attenuated MMR

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167
Q

mumps virus family

A

paramyxoviridae

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168
Q

mumps virus structure

A

ss(-)RNA, non-segmented, enveloped, helical, filamentous morphology

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169
Q

mumps virus entry

A

fusion proteins appear as spikes on virus surface (F proteins) –> F proteins cause cell-cell fusion to make giant cells

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170
Q

mumps virus replication

A

cytoplasmic replication

(-) RNA so needs a viral RNA dependent RNA polymerase protein that is virion associated

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171
Q

mumps virus assembly/egress

A

buds from cell membrane

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172
Q

mumps virus biology notes

A

can escape immune detection
hemagglutinin is a virulence factor (clumps RBCs)
neuraminidase is a virulence factor (allows for viral release from host cell)

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173
Q

mumps virus epidemiology

A

respiratory droplets, human reservoir

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174
Q

mumps virus transmission

A

respiratory

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175
Q

mumps virus clinical course

A

mumps- bilateral parotitis with fever, headache, malise
complications include orchitis (testicular inflammation), pancreatitis and meningioencephalitis
can cause sterility, especially if contracted after puberty

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176
Q

mumps virus testing

A

antibody testing
multinucleated giant cells (caused by F proteins) on microscopy
hemagglutination on assay

177
Q

mumps virus treatment

A

supportive

178
Q

mumps virus vaccine

A

live attenuated MMR vaccine –> do give to children, do NOT give to pregnant women or immunocompromised, patients with HIV should be vaccinated if their CD4+ count is >200

179
Q

ebola virus family

A

filoviridae

marburg virus = another filovirus that causes the same disease

180
Q

ebola virus structure

A

ss(-)RNA, enveloped, helical, filamentous morphology

181
Q

ebola virus replication

A

cytoplasmic replication

(-) RNA so needs a viral RNA dependent RNA polymerase protein that is virion associated

182
Q

ebola virus epidemiology

A

arthropod-borne (arbovirus), mosquito vector, human and bat reservoir

183
Q

ebola virus transmission

A

mosquito bite
contact with bodily fluids, fomites, dead bodies, infected bats/apes/monkeys
health care workers are at very high risk

184
Q

ebola virus clinical course

A

flu-like illness then fatigue, headaches, vomitting/diarrhea (fluid loss), bleeding by stool/mucosa, can have massive hemmorrhage, shock
rash and meningoencephalitis

185
Q

ebola virus disease notes

A

incubation period of 6-12 days (can be up to 21)

186
Q

ebola virus testing

A

rapid antigen test, PCR

187
Q

ebola virus treatment

A

supportive

188
Q

ebola virus vaccine

A

none; strict isolation of pts, travel restrictions, extreme isolation in healthcare settings to prevent spread

189
Q

JC and BK virus family

A

polyomavirus

190
Q

JC and BK virus structure

A

dsDNA

191
Q

JC and BK virus replication

A

replicates in nucleus like all DNA viruses except pox

192
Q

JC and BK virus biology notes

A

JC infects oligodendrocytes = demyelination

BK infects kidney

193
Q

JC and BK virus epidemiology

A

most people are infected with these viruses, usually harmless
disease in immunocompromised

194
Q

JC and BK virus transmission

A

JC- respiratory

BK- urine

195
Q

JC and BK virus clinical course

A

JC and progressive multifocal leukoencephalopathy (PML)- transplant or AIDS pt with progressive deterioration in mental function (due to inflammed/destroyed oligodendrocytes), usually fatal; clumsiness, progressive weakness and visual, speech and personality changes
BK and kidney disease- usually kidney transplant recipient with renal dysfunction and inflammation; causes nephropathy and kidney/urinary tract issues, hemorrhagic cystitis (manifests as blood in urine)

196
Q

JC and BK virus testing

A

PCR, antibody testing, PML will have characteristic MRI findings

197
Q

JC and BK virus treatment

A

supportive, reduce immunosupression

198
Q

JC and BK virus vaccines

A

none

199
Q

polio virus family

A

picornaviridae –> enterovirus

200
Q

polio virus structure

A

ss(+)RNA, non-segmented, naked, icosahedral

201
Q

polio virus entry

A

receptor CD155

202
Q

polio virus replication

A

cytoplasmic replication

(+) RNA, RNA dependent RNA polymerase

203
Q

polio virus biology notes

A

resistant to alcohol and detergents –>acid stable

3 polio serotypes (PV1, PV2, PV3)

204
Q

polio virus epidemiology

A

human reservoir only, strictly human pathogen

205
Q

polio virus transmission

A

fecal-oral transmission (enters GI tract)

206
Q

polio virus clinical course

A

often asymptomatic infection

fever, aseptic meningitis, paralytic polio (flaccid paralysis, asymmetric, no sensory loss)

207
Q

polio virus disease notes

A

virus targets anterior horn motor neurons

208
Q

polio virus testing

A

antibody test

209
Q

polio virus treatment

A

supportive

210
Q

polio virus vaccines

A

3 strains
- live vaccine (sabin)- results in IgG response, no risk of reverting to infectious form, preferred
- killed vaccine (salk)- results in IgG and IgA response, shed in the feces (transmissible via fecal oral route)
- activated vaccine (OPV)- by mouth, inactivated (IPV) by injection
OPV with vaccine associated paralytic poliomyelitis
herd protection- protection of unvaccinated by cocooning or being surrounded by vaccinated persons
herd immunity- actual transmission of attenuated vaccine strains to confer immunity

211
Q

west nile virus family

A

flaviviridae

212
Q

west nile virus structure

A

ss(+)RNA, enveloped, icosahedral

213
Q

west nile virus replication

A

cytoplasmic, genome closely matches mRNA

214
Q

west nile virus epidemiology

A

arthropod borne (arbovirus) like most flaviviruses in humans, mosquito vector, bird reservoir

215
Q

west nile virus transmission

A

mosquito bite

216
Q

west nile virus clinical course

A

west nile fever- fever, headache, myalgias, V/D, rash, stiff neck (meningitis)
summer encephalitis- disorientation/confusion, stupor/coma, tremors, seizures, partial paralysis or weakness
muscle weakness can be permanent
**viral encephalitis accompanied by flaccid paralysis

217
Q

west nile virus testing

A

antibody test (blood and CSF), CSF PCR

218
Q

west nile virus treatment

A

supportive

219
Q

west nile virus vaccines

A

none, vector control is important in disease control

220
Q

st. louis encephalitis virus family

A

flavivirus

221
Q

st. louis encephalitis virus structure

A

ss(+)RNA, enveloped, icosahedral

222
Q

st. louis encephalitis virus replication

A

cytoplasmic, genome closely matches mRNA

223
Q

st. louis encephalitis virus epidemiology

A

arthropod-borne (arbovirus) like most flaviviruses, mosquito vector, bird reservoir

224
Q

st. louis encephalitis virus transmission

A

mosquito bites

225
Q

st. louis encephalitis virus clinical course

A

most infections are just mild illnesses
fever, headache, neck stiffness (meningitis)
summer encephalitis- disorientation/confusion, stupor/coma, tremors, seizures, spastic paralysis, can be fatal

226
Q

st. louis encephalitis virus testing

A

antibody test (blood and CSF)

227
Q

st. louis encephalitis virus treatment

A

supportive

228
Q

st. louis encephalitis virus vaccine

A

none; vector control is important in disease control

229
Q

japanese encephalitis virus family

A

flavivirus

230
Q

japanese encephalitis virus structure

A

ss(+)RNA, enveloped, icosahedral

231
Q

japanese encephalitis virus replication

A

cytoplasmic, genome closely matches mRNA

232
Q

japanese encephalitis virus epidemiology

A 
arthropod borne (arbovirus), mosquito vector, bird and pig reservoir, common in south/east/southeast asia
leading cause of viral encephalitis in asia
233
Q

japanese encephalitis virus transmission

A

mosquito bite

234
Q

japanese encephalitis virus clinical course

A

most infections are asymptomatic
fever, headache, malaise, severe rigors, neck rigidity, hemiparesis, seizures, brain damage with neurodevelopmental delay, deafness and hemiparesis can persist

235
Q

japanese encephalitis virus testing

A

antibody test (blood and CSF)

236
Q

japanese encephalitis virus treatment

A

supportive

237
Q

japanese encephalitis virus vaccine

A

live attenuated and inactivated vaccines available in endemic areas; vector control is important in disease control

238
Q

alphaviruses examples

A

eastern equine encephalitis, western equine encephalitis, venezuelan equine encephalitis, chikungunya virus

239
Q

alphaviruses family

A

togavirus

240
Q

alphaviruses structure

A

ss(+)RNA, enveloped, icosahedral

241
Q

alphaviruses replication

A

cytoplasmic replication

242
Q

alphaviruses epidemiology

A

arboviruses
equine encephalitis group- mosquitoes and horses
chikungunya- mosquitoes and primates, birds, rodents

243
Q

alphaviruses transmission

A

mosquito bites

244
Q

alphaviruses clinical course

A

encephalitis (EEEV very bad, WEEV milder)

chikungunya causes fever, joint pain, headache, rash; doesn’t really cause encephalitis

245
Q

alphaviruses testing

A

antibody testing

246
Q

alphaviruses treatment

A

supportive

247
Q

alphaviruses vaccines

A

none

248
Q

california encephalitis virus family

A

bunyavirus

249
Q

california encephalitis virus structure

A

ss(-)RNA, 3 segments, enveloped, helical

250
Q

california encephalitis virus replication

A

cytoplasmic replication

(-)RNA so needs a viral RNA dependent RNA polymerase protein that is virion associated

251
Q

california encephalitis virus epidemiology

A

arthropod borne (arbovirus)

252
Q

california encephalitis virus transmission

A

mosquito bite

253
Q

california encephalitis virus clinical course

A

most infections are just mild illness
fever, headache, neck stiffness (meningitis)
summer encephalitis- disorientation/confusion, stupor/coma, tremors, seizures, paralysis, can be fatal

254
Q

california encephalitis virus testing

A

PCR

255
Q

california encephalitis virus treatment

A

supportive

256
Q

california encephalitis virus vaccine

A

none

257
Q

rabies virus family

A

rhabdovirus

258
Q

rabies virus structure

A

ss(-)RNA, non-segmented, enveloped, helical, bullet shaped

259
Q

rabies virus entry

A

receptor the nicotinic AChR (ascetylcholine receptor)

260
Q

rabies virus replication

A

cytoplasmic, genome closely matches mRNA

261
Q

rabies virus epidemiology

A

US most cases are wild animals (bats, raccoons, foxes, skunks), but worldwide is mostly dogs

262
Q

rabies virus transmission

A

bite or contact with infected animal

263
Q

rabies virus clinical course

A

starts with flu-like illness, then neurological symptoms of hydrophobia, seizures, disorientation, hallucination, coma and death

264
Q

rabies virus testing

A

negri bodies (intracytoplasmic inclusion bodies on path of brain biopsy), DFA of smears of corneal epithelial cells, PCR

265
Q

rabies virus treatment

A

supportive for advanced disease

immunotherapy in suspected disease

266
Q

rabies virus vaccine

A

after bite give 1 dose human rabies immunoglobulin (hRIB) and 4 dose series of rabies vaccine
killed virus vaccine
vaccine for high risk people and for domestic animals

267
Q

lymphocytic choriomeningitis virus (LCV) family

A

arenavirus

268
Q

lymphocytic choriomeningitis virus (LCV) structure

A

ssRNA, ambisense, segmented, enveloped, helical nucleocapsid

269
Q

lymphocytic choriomeningitis virus (LCV) replication

A

cytoplasmic replication, needs virion-associated polymerase

ambisense- RNA strands code proteins in both reading directions

270
Q

lymphocytic choriomeningitis virus (LCV) epidemiology

A

RODENTS!! mice are the reservoir

271
Q

lymphocytic choriomeningitis virus (LCV) transmission

A

contact with mice/hamsters, transmission via aerosolized particles of rodent urine, feces or saliva, or by ingesting contaminated food

272
Q

lymphocytic choriomeningitis virus (LCV) clinical course

A

2 phase disease- starts with fever, headache, malaise, muscle pain, n/v, sore throat, parotid pain; then better, the second phase of aseptic meningitis or encephalitis (stiff neck, fever, headache, confusion)
congenital LCMV- can lead to spontaneous abortions, brain abnormalities, optic abnormalities, neurological deficits

273
Q

lymphocytic choriomeningitis virus (LCV) testing

A

antibody test, PCR of CSF

274
Q

lymphocytic choriomeningitis virus (LCV) treatment

A

supportive

275
Q

lymphocytic choriomeningitis virus (LCV) vaccine

A

none; mice (vector) control to help control disease

276
Q

influenza A/B family

A

orthomyxovirus

277
Q

influenza A/B structure

A

ss(-)RNA, segmented, enveloped, helical, hemagglutinin and neuraminidase proteins on surface

278
Q

influenza A/B entry

A

hemagglutinin glycoprotein mediates binding to cell and entry

279
Q

influenza A/B replication

A

RNA virus that replicates nucleic acid in nucleus (***an exception)
M2 protein- allows for uncoating of the virus

280
Q

influenza A/B assembly/egress

A

neuraminidase glycoprotein involved in the release of progeny virus from cells, cleaves sugars that bind mature virus particles (–> good target for drugs)

281
Q

influenza A/B epidemiology

A

influenza A- reservoir in birds, pigs, humans (shift and drift)
influenza B- reservoir in humans only (no shift, just drift)

282
Q

influenza A/B transmission

A

respiratory droplets, direct contact, fomites

283
Q

influenza A/B clinical course

A

headache, malaise, fever, chills, myalgias, anorexia
in younger children- bronchiolitis, croup, otitis media, vomitting
pneumonia- secondary bacterial infections
complicated by Reye syndrome (encephalopathy with liver toxicity- NO ASPIRIN) or guillain barre syndrome

284
Q

influenza A/B testing

A

rapid antibody/antigen testing, PCR of nasal secretions

285
Q

influenza A/B treatment

A

amantadine/rimantadine (inhibit viral uncoating)

zanamavir/oseltamivir (neuraminidase inhibitors)

286
Q

influenza A/B vaccines

A

killed vaccine (recommended), live attenuated vaccine

287
Q

adenovirus family

A

adenovirus

288
Q

adenovirus structure

A

dsDNA, naked, icosahedral

289
Q

adenovirus entry

A

entry via endosome

290
Q

adenovirus replication

A

replicates in the nucleus
early and late genes (early ones are regulatory proteins)
early gene E1A binds retinoblastoma tumor suppressor to cause cancer in animals (not currently known to cause cancer in humans though)

291
Q

adenovirus biology notes

A

can be lytic in permissive cells, can be latent or oncogenic in non-permissive cells

292
Q

adenovirus epidemiology

A

ubiquitous in humans/animals, very stable, prolonged survival in the envrionment

293
Q

adenovirus transmission

A

respiratory, fecal/oral (naked), direct contact

294
Q

adenovirus clinical course

A

acute respiratory disease and pneumonia in spring/winter
pharyngoconjunctival fever (pharyngitis & conjunctivitis/ pink eye) with lymphadenopathy, cough, sore throat
“pool fever”
acute hemorrhagic cystitis usually boys 5-15 with dysuria and hematuria
myocarditis

295
Q

adenovirus testing

A

antibody testing

296
Q

adenovirus treatment

A

cidofovir (viral DNA polymerase inhibitor) for very immunocompromised pts
mostly just supportive care

297
Q

adenovirus vaccine

A

oral vaccine given to military recruits (live non-attenuated vaccine)

298
Q

coxsackievirus A family

A

picornavirus –> enterovirus

299
Q

coxsackievirus A structure

A

ss(+)RNA, non segmented, naked, icosahedral

300
Q

coxsackievirus A replication

A

cytoplasmic replication, acid stable

301
Q

coxsackievirus A transmission

A

fecal-oral

302
Q

coxsackievirus A clinical course

A

skin/mucous membranes- herpanginia (painful mouth blisters), acute hemorrhagic conjunctivitis, hand foot and mouth disease, common cold
fever, rashes, upper respiratory disease, aseptic meningitis

303
Q

coxsackievirus A testing

A

clinical diagnosis or PCR of nasal swab or blood

304
Q

coxsackievirus A treatment

A

supportive

305
Q

coxsackievirus A vaccine

A

none, can prevent by handwashing

306
Q

coxsackievirus B family

A

picornavirus –> enterovirus

307
Q

coxsackievirus B structure

A

ss(+)RNA, non segmented, naked, icosahedral

308
Q

coxsackievirus B replication

A

cytoplasmic

309
Q

coxsackievirus B transmission

A

fecal-oral

310
Q

coxsackievirus B clinical course

A

organ involvement- heart, pancreas, liver to cause myocarditis, pericarditis, dilated cardiomyopathy, hepatitis
bornholm disease (devils grip)- pleurodynia (excruciating chest pain)- usually a summer disease
common cold
fever, rashes, upper respiratory disease and aseptic meningitis

311
Q

coxsackievirus B testing

A

clinical diagnosis or PCR of nasal swab or blood

312
Q

coxsackievirus B treatment

A

supportive

313
Q

coxsackievirus B vaccine

A

none, prevent by handwashing

314
Q

echovirus family

A

picornavirus –> enterovirus; enteric cytopathic human orphan

315
Q

echovirus structure

A

ss(+)RNA, naked, non segmented, icosahedral

316
Q

echovirus replication

A

cytoplasmic

317
Q

echovirus epidemiology

A

disproportionately seen in males and children

318
Q

echovirus transmission

A

fecal-oral

319
Q

echovirus clinical course

A

acute febrile illness in infants and young children, often with rash
aseptic meningitis
neonatal sepsis with liver failure and/or myocarditis
myocarditis

320
Q

echovirus testing

A

clinical diagnosis or PCR of nasal swab or blood

321
Q

echovirus treatment

A

supportive

322
Q

echovirus vaccine

A

none, prevent by handwashing

323
Q

rhinovirus family

A

picornavirus

324
Q

rhinovirus structure

A

ss(+)RNA, non segmented, naked, icosahedral

325
Q

rhinovirus entry

A

ICAM-1 cellular receptor (intracellular adhesion molecule 1)

326
Q

rhinovirus replication

A

cytoplasmic

327
Q

rhinovirus notes

A

acid labile (destroyed by stomach acid)

328
Q

rhinovirus epidemiology

A

september to april, people indoors, together in schools

over 100 serotypes with practically no cross protection between serotypes

329
Q

rhinovirus transmission

A

respiratory droplets or fomites, can survive for 3 hours outside of human host

330
Q

rhinovirus clinical course

A

common cold, peaks in summer/fall

sore throat, rhinorrhea, nasal congestion, cough, mild fever

331
Q

rhinovirus testing

A

clinical diagnosis or PCR of nasal swab

332
Q

rhinovirus treatment

A

supportive

333
Q

rhinovirus vaccine

A

none, can protect by handwashing

334
Q

coronavirus family

A

coronavirus –> SARS (severe acute respiratory syndrome), MERS (middle eastern respiratory syndrome)

335
Q

coronavirus structure

A

ss(+)RNA, non segmented, enveloped, helical, HA molecules on viral surface to give shape like sun

336
Q

coronavirus replication

A

cytoplasmic replication

337
Q

coronavirus epidemiology

A

coronavirus- common cold, endemic, winter/spring
SARS- bird/small mammal reservoir
MERS- bat and camel reservoir

338
Q

coronavirus transmission

A

respiratory droplets

SARS and MERS also in urine, sweat, feces

339
Q

coronavirus clinical course

A 
common cold (#2 cause)
SARS/MERS- severe acute respiratory syndrome with atypical pneumonia, fever, flu like illness, dry cough, dyspnea, progressive hypoxia
340
Q

coronavirus testing

A

antibodies, PCR

travel to endemic areas is important in diagnosis

341
Q

coronavirus treatment

A

supportive

342
Q

coronavirus vaccines

A

none

343
Q

respiratory syncytial virus (RSV) family

A

paramyxovirus

344
Q

respiratory syncytial virus (RSV) structure

A

ss(-)RNA, non segmented, enveloped, helical

345
Q

respiratory syncytial virus (RSV) entry

A

F and G proteins on viral surface (target for monoclonal antibodies/prevention)

346
Q

respiratory syncytial virus (RSV) replication

A

cytoplasmic replication, needs a viral RNA dependent RNA polymerase that is virion associated

347
Q

respiratory syncytial virus (RSV) assembly/egress

A

buds from cell membrane, restricted to superficial cells of respiratory epithelium
buds at apical membrane (may be a strategy for immune evasion)

348
Q

respiratory syncytial virus (RSV) transmission

A

direct contact, respiratory transmission

349
Q

respiratory syncytial virus (RSV) clinical course

A

adults- common cold
infants- bronchiolitis, necrosis of bronchioles, atypical pneumonia (low fever, tachypnea, tachycardia, expiratory wheeze

350
Q

respiratory syncytial virus (RSV) testing

A

PCR of nasal secretions

351
Q

respiratory syncytial virus (RSV) treatment

A

supportive

352
Q

respiratory syncytial virus (RSV) vaccines

A

none, monoclonal antibody palvizumab blocks fusion (F) protein, used for prophylaxis in premature infants and high risk infants

353
Q

parainfluenza viruses 1-4 family

A

paramyxovirus

354
Q

parainfluenza viruses 1-4 structure

A

ss(-)RNA, non segmented, enveloped, helical

355
Q

parainfluenza viruses 1-4 replication

A

cytoplasmic, needs a virion associated RNA dependent RNA polymerase

356
Q

parainfluenza viruses 1-4 transmission

A

direct contact, respiratory transmission, can remain viable on surfaces for 1 hour

357
Q

parainfluenza viruses 1-4 clinical course

A

type 1- croup (subglottal swelling, hoarse barking cough)
type 2- croup and other upper/lower respiratory disease
type 3- bronchiolitis, pneumonia
type 4- mild/asymptomatic
immunocompromised can get severe/fatal pneumonia
aseptic meningitis

358
Q

parainfluenza viruses 1-4 testing

A

PCR of nasal secretions

359
Q

parainfluenza viruses 1-4 treatment

A

supportive, steroids and nebulizer treatments for croup, ribavirin in severe HPIV-3 in immunocompromised

360
Q

human metapneumovirus family

A

pneumovirus

361
Q

human metapneumovirus structure

A

ss(-)RNA, non segmented, enveloped, helical

362
Q

human metapneumovirus replication

A

cytoplasmic regulation, virion associated RNA dependent RNA polymerase

363
Q

human metapneumovirus transmission

A

direct contact, respiratory transmission

364
Q

human metapneumovirus clinical course

A

common cold, reinfections common, severe disease in premature infants and immunocompromised, asthma patients and COPD patients
commonly mistaken for RSV

365
Q

human metapneumovirus testing

A

PCR of nasal secretions

366
Q

human metapneumovirus treatment

A

supportive

367
Q

human metapneumovirus vaccines

A

none

368
Q

hantavirus family

A

bunyavirus

369
Q

hantavirus structure

A

ss(-)RNA, enveloped, helical, segmented

370
Q

hantavirus replication

A

cytoplasmic replication, needs a virion associated RNA dependent RNA polymerase

371
Q

hantavirus epidemiology

A

contact with rodent saliva, feces, urine; rodent reservoir

372
Q

hantavirus transmission

A

respiratory route –> rat poop

373
Q

hantavirus clinical course

A

hemorrhagic fever with renal syndrome- headaches, back abdominal pain, fever, chills, nausea, blurred vision, rash, then low BP, shock, vascular leakage
pulmonary syndrome- often fatal pulmonary disease, flu like symptoms (fever, cough, myalgias, headache, SOB, pulmonary edema)

374
Q

hantavirus testing

A

PCR

375
Q

hantavirus treatment

A

supportive

376
Q

hantavirus vaccine

A

none, control of rodent vectors

377
Q

norwalk virus family

A

calicivirus –> noro like virus

378
Q

norwalk virus structure

A

ss(+)RNA, non segmented, naked, icosahedral

379
Q

norwalk virus entry

A

receptor mediated endocytosis in gut

380
Q

norwalk virus replication

A

cytoplasmic replication, polyprotein is cleaved by viral proteases

381
Q

norwalk virus epidemiology

A

most common cause of viral gastroenteritis, 12-48 hour incubation period, common in winter
commonly associated with cruise ships, closed communities, food like shellfish

382
Q

norwalk virus transmission

A

fecal-oral, person-to-person contact, contaminated surfaces

383
Q

norwalk virus clinical course

A

n/v, watery diarrhea, abdominal pain, lethargy, weakness, myalgias, fever possible
severe illness is rare and most recover in 2-3 days

384
Q

norwalk virus testing

A

PCR of stool

385
Q

norwalk virus treatment

A

supportive

386
Q

norwalk virus vaccine

A

none, best to use soap and water to prevent

387
Q

rotavirus family

A

reovirus

388
Q

rotavirus structure

A

dsRNA, segmented, naked, icosahedral

389
Q

rotavirus entry

A

receptor mediated endocytosis in gut

390
Q

rotavirus replication

A

cytoplasmic replication

391
Q

rotavirus biology notes

A

produces NSP4 toxin- an enterotoxin which increases gut chloride permeability leading to diarrhea

392
Q

rotavirus transmission

A

fecal-oral, person to person contact, contaminated surfaces, aerosolized
particles can remain viable in water 10-20 days

393
Q

rotavirus clinical course

A

n/v, watery diarrhea, abdominal pain, subsequent rotavirus illnesses are less severe

394
Q

rotavirus testing

A

PCR of stool, antigen in stool

395
Q

rotavirus treatment

A

supportive

396
Q

rotavirus vaccine

A

live attenuated vaccine recommended for all children

early vaccines were linked with bowel intussuception

397
Q

hepatitis A virus family

A

picornavirus

398
Q

hepatitis A virus structure

A

ss(+)RNA, naked, icosahedral

399
Q

hepatitis A virus replication

A

cytoplasmic replication

400
Q

hepatitis A virus epidemiology

A

2-6 week incubation, shellfish, travelers, daycare, human reservoir, NO chronic carriers known

401
Q

hepatitis A virus tranmission

A

fecal-oral, blood transmission (RARE), men who have sex with men at high risk

402
Q

hepatitis A virus clinical course

A

often asymptomatic, self limiting
fever, nausea, fatigue, anorexia, diarrhea, abdominal pain, jaundice, dark amber urine, elevated ALT and AST in blood
symptoms can last 2-6 months
smokers develop an aversion to smoking

403
Q

hepatitis A virus testing

A

antibody test, IgM

404
Q

hepatitis A virus treatment

A

supportive

405
Q

hepatitis A virus vaccine

A

inactivated Hep A vaccines in US

406
Q

hepatitis E virus family

A

hepevirus

407
Q

hepatitis E virus structure

A

ss(+)RNA, non segmented, naked, icosahedral

408
Q

hepatitis E virus epidemiology

A

3-8 week incubation, outbreaks after heavy rain/monsoons, domestic animal reservoir (esp pigs)

409
Q

hepatitis E virus transmission

A

fecal-oral, especially waterborne and also foodborne (contaminated meat)

410
Q

hepatitis E virus clinical course

A

often acute and self-limiting
fever, nausea, fatigue, anorexia, diarrhea, abdominal pain, jaundice, dark amber urine, fulminant liver failure in pregnant women (especially in 3rd trimester)
elevated AST and ALT in blood

411
Q

hepatitis E virus testing

A

antibody test, IgM

412
Q

hepatitis E virus treatment

A

ribavirin?

413
Q

hepatitis E virus vaccine

A

no effective

414
Q

hepatitis B virus family

A

hepadnavirus, adenovirus

415
Q

hepatitis B virus structure

A

DNA, only partially double stranded, enveloped, icosahedral

416
Q

hepatitis B virus entry

A

entry via endosome

417
Q

hepatitis B virus replication

A

replicates in nucleus, makes a covalently closed circular DNA form in nucleus, replication in hepatocytes
uses reverse transcriptase
dane particles = infectious virions

418
Q

hepatitis B virus transmission

A

blood, body fluid, sexual contact, vertical transmission

419
Q

hepatitis B virus clinical course

A

fever, nausea, fatigue, anorexia, diarrhea, abdominal pain, acute jaundice, dark urine, sometimes causes chronic infection

420
Q

hepatitis B virus testing

A

antibody testing –> antibodies to various hepatitis B proteins distinguish acute vs. chronic infection

421
Q

hepatitis B virus vaccine

A

recombinant HBsAg given at birth and series follows

422
Q

hepatitis B virus treatment

A

nucleoside analog drugs- lamivudine, entecavir, telbivudine, tenofovir, adefovir

423
Q

hepatitis C virus family

A

flavivirus

424
Q

hepatitis C virus structure

A

ss(+)RNA, enveloped, icosahedral

425
Q

hepatitis C virus replication

A

cytoplasmic, genome closely matches mRNA

error prone polymerase with no 3’ to 5’ exonuclease activity leads to constant antigen evolution

426
Q

hepatitis C virus transmission

A

blood borne, IV drug use, transfusions (before ‘90), needle stick injury, vertical transmission, NOT SEX

427
Q

hepatitis C virus clinical course

A

fever, nausea, fatigue, anorexia, diarrhea, abdominal pain
jaundice NOT common
chronic infection- mostly no symptoms for several decades but then cirrhosis and liver failure
cryoglobulinemia (aggregates of immunoglobulins that are insoluble at low temperatures)

428
Q

hepatitis C virus testing

A

antibody tests, PCR of blood, liver biopsy to assess damage

429
Q

hepatitis C virus treatment

A

protease inhibitors, polymerase inhibitors, direct acting antivirals (interfere with viral enzymes), ribavirin, interferon, treatment is very expensive

430
Q

hepatitis C virus vaccine

A

none

431
Q

hepatitis D virus family

A

a viroid or subviral satelite

432
Q

hepatitis D virus structure

A

ss(-)RNA, self complementary, enveloped, contains hep B proteins in envelope

433
Q

hepatitis D virus entry

A

via endosome

434
Q

hepatitis D virus replication

A

no viral polymerase at all, produces one protein (HDAg)- true viroids produce none, can only replicate in HBV infected cells

435
Q

hepatitis D virus transmission

A

blood, body fluid, sexual contact, pretty much only in patients at high risk for Hep B

436
Q

hepatitis D virus clinical course

A

more severe complications with hep B and hep D than Hep B alone
liver failure, cirrhosis, liver cancer
coinfection = hep B and hep D together
superinfection = hep D infects after hep B

437
Q

hepatitis D virus testing

A

antibody testing

438
Q

hepatitis D virus treatment

A

no specific antivirals, interferons used

439
Q

hepatitis D virus vaccine

A

vaccine for hep B protects

MAD (7 decks)

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