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Pathology by week > W20 - Opportunistic viral infections > Flashcards

W20 - Opportunistic viral infections Flashcards

1
Q

Define endogenous and exogenous opportunistic infections. Give 1 example of each

A

Endogenous = latent virus that reactivates in immunosuppressed

i.e. varicella zoster

Exogenous = new viral infection with increased severity in immunosuppressed

i.e. influenza

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2
Q

What is baltimore classification system of viruses?

A

It’s a system of classifying viruses based on their manner of mRNA synthesis

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3
Q

Define indirect and direct detection of viruses?

A

Indirect detection = response of immune system to virus (i.e. abs)

Direct detection = fragments of actual virus (i.e. viral protein via LFTs, viral genes via PCR)

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4
Q

How useful is serology testing once someone is immunocompromised?

A

Useless as their immune system is now non-functional!

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5
Q

If you are to induce immunosuppression in a patient (i.e. unergoing BM transplant), what should you do in terms of monitoring/treating viral infections?

A
  1. Screen prior to immunosuppression
    - Identify previous viral exposure that may reactivate
    - Guide the use of antiviral prophylaxis
  2. Monitor using PCR
    - Identify viral reactivation (i.e. CMV, EBV, HSV) promptly → Treatment
    - Detect infection
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6
Q

A 51-year-old with a recent HSCT is unwell. Which is the most appropriate test?

ALT = 800 IU/mL

A) EBV IgG/IgM

B) HBV sAb

C) Parvovirus PCR

D) HEV PCR

E) CMV IgG/IgM

A

Serology is useless in immunosuppressed patients

Parvovirus – rare cause of hepatitis

Correct ans = D (Parvovius PCR)

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7
Q

List the patients from highest to lowest risk of opportunistic viral infection

  • Solid organ transplant
  • Advanced HIV infection (CD4 depleted)
  • Cytotoxic chemotheapy
  • Allogeneic Stem cell transplant
  • Various monoclonal ab therapies
  • DMARDs and steroids
A

Allogeneic stem cell transplant > Advanced HIV > solid organ transplant > various monoclonal ab therapies > cytotoxic chemotherapy > DMARDs and steroids

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9
Q

What are the sources of viral infections in transplant recipients?

A
  1. Viruses acquired from the graft
  2. Viral reactivation from the host
  3. Novel infection from close contact with infected individual
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10
Q

Which type of immunosuppression carries the greatest relative risk of developing a viral infection?

A. Steroids

B. Solid organ transplant

C. Allogeneic stem cell transplant

D. Monoclonal antibody therapies

E. Cytotoxic chemotherapy

A

C. Allogeneic stem cell transplant

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11
Q

Herpes Simplex Type 1 and 2 infection in immunosuprressed - what are 4 issues?

A
  1. Increased freqeuncy of infection
  2. Increased severity of infection (i.e. risk of dissemination)
  3. More organs involved (esophagitis, pneumonitis, hepatitis)
  4. Increased risk of acyclovir resistance
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12
Q

Varicella zoster (VZV) infection - what are some complications of varicella in immunosuppressed? zoster in immunosuppressed?

A

Varicella (chicken-pox) in immunosuppressed:

  • Pneumonitis
  • Encephalitis
  • Hepatitis
  • Purpur fulminans in neonte

Zoster (shingles) in immunosuppressed:

  • Multi-dermatomal/disseminated
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13
Q

A patient who received a stem cell transplant 2 weeks ago presents with mouth ulcers.

Which of the following viruses would you test for on the mouth swab?

A.Enterovirus

B.Adenovirus

C. Herpes simplex type 1
D. Human herpesvirus 6

E. Human gammaherpesvirus 8,

A

C. Herpes simplex type 1 => HSV PCR

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14
Q

Describe how EBV can cause post-transplant lymphoproliferative disease (PTLD)

A

latently infected B cells => no immune regulation due to immunosuppression => polyclonal activation => predisposes to lymphoma

NB: should be suspicious on ribing EBV viral load

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15
Q

How should EBV monitoring be done in those immunosuppressed?

A
  1. Monitor EBV levels
  2. Investigate for lymphoma (i..e LN biopsies) as needed
  3. Treat with rituximab if needed, reduce immunosuppression if possible
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16
Q

Describe CMV infections (4) in HIV/IDS CD4 <50

A
  1. Retinitis (AIDS-defining)
  2. Polyradiculopathy
  3. Pneumonitis
  4. Gastroenteritis
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17
Q

Describe how CMV could be seen in SOT vs HSCT

A

SOT (i.e. renal transplant) => Donor + / recipient - => immunosuppressed patients get given some CMV for the first time

HSCT (i.e. BM transplant) => Donor - / recipient + => patient with CMVD has immune system replaced with one that hasn’t seen CMV

18
Q

Which of these is NOT an antiviral?

A.Sotrovimab

B.Valganciclovir

C.Foscarnet

D.Rituximab

E.Tenofovir

A

D.Rituximab

19
Q

Progressive multifocal leukoencephalopathy (PML) - symptoms (3)

A
  1. Cognitive disturbance
  2. personality change
  3. motor deficits
  4. other focal neurological signs

NB: demyelination of white matter => neurological deficits

20
Q

JC virus - John Cunningham

what does it cause in HIV+ patients?

A

In HIV patients it causes a CNS infection called PML (progressive multifocal leukoencephalopathy)

22
Q

What complication can BK virus cause post-SCT?

A

BK cystitis

23
Q

Hepatitis viruses - describe what happens in immunosupressed

  • Hep A
  • Hep B
  • Hep C
  • Hep E
A
  • Hep A = more severe, vaccinate
  • Hep B = re-activation, vaccinate/prophylaxis
  • Hep C = increased fibrosis(?), Tx with direct-acting antivirls
  • Hep E = chronic infection, reduce immunosuppression
24
Q

Hep B in the immunocompromised - name 2 things that could happen:

A
  1. Carriers may have flare of disease
  2. Those who have had past infection can reactivate
25
Q

Hepatitis B - name serological markers of disease (3) and serological markers of immunity (3)

A

serological markers of disease:

sAg (circulating virus)

cAb+ IgM (acute immune response)

eAg (circulating virus)

serological markers of immunity:

sAb (generated from virus or vaccine)

cAb IgG/total (prior infection)

eAb (generated from virus)

26
Q

If there is a risk (high, moderate, low) of HBV reactivation due to immunosuppression, what can be done?

A

high risk (i.e. chemotherapy, anti-CD20) = prophylactic antiviral therapy

moderate risk (i.e. anti-TNF treatment, low-dose steroids) = prophylactic antiviral therapy or on-demand (monitor)

low risk (i.e. steroids alone for a few days) = no prophylaxis

27
Q

Which patient has previously had Hepatitis B Infection?

sAg= Surface antigen cAb = core antibody sAb= Surface antibody

A.sAg+, cAb+, sAb-

B.sAg-, cAb-, sAb+ (100mIU/ml)

C.sAg-, cAb+, sAb-

D.sAg-, cAb-, sAb-

E.sAg+, cAb-, sAb-

A

C.sAg-, cAb+, sAb-

A = active Hep B

B = vaccinted!

D = never had it/never been vaccinated

E = ongoing chronic hep B

Pathology by week (70 decks)

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