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Infectious Disease > Week 10 > Flashcards

Week 10 Flashcards

1
Q

Acute Viral Hepatitis

A

Asymptomatic > symptomatic > fulminant liver failure > death

Nausea, vomiting, abdominal pain, loss of appetite, fever, diarrhea, light colored stools, dark urine, jaundice

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2
Q

Hepatitis A:

  • Main features
  • transmission
A

Picornavirus, (+)ss linear RNA, icosahedral, nonenveloped

Main cause of acute hepatitis in US

Low morbidity and mortality, older people tend to be more symptomatic

NO chronic infection

Transmission: fecal-oral transmission

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3
Q

Hepatitis A

Prevention?

A

pre/post exposure immunization

KILLED vaccine (one serotype)

Can give passive vaccination with antibodies (not recommended)

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4
Q

Hepatitis A

Diagnosis?

A

IgM anti-HAV (recent infection), Anti-HAV IgG (past infection or vaccine, lifelong immunity

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5
Q

Hepatitis B

Main features

A

hepadnavirus, enveloped

Partially DS circular DNA

Neutralizing abs to surface antigen protective (anti-HBsAg)

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6
Q

Hepatitis B

Replication cycle

A

occurs in nucleus

Host DNA repair machinery “fixes” partially ssDNA genome → cccDNA

Host DdRP Pol II transcribes cccDNA → RNA transcript transported into cytoplasm → HBV pre-genome RNA packaged

HBV pre-genome reverse transcribed by HBV reverse transcriptase → cDNA → virus buds and egresses
**convert to cDNA on the WAY OUT instead of the way in

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7
Q

Hepatitis B

Transmission

A

parenteral transmission - blood/blood-derived body fluids
Can have mother to infant transmission → chronic infection of infant (prevent infection of infant with active and passive immunization immediately at birth)

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8
Q

Hepatitis B

Prevention

A

pre/post exposure immunization, vaccine

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9
Q

Hepatitis B

Disease

A

acute liver disease, chronic liver disease, cirrhosis, HCC

Long incubation period

Chronic infection more likely in kids (<5 yrs), but acute illness LESS likely in younger people (vice versa for > 5 yrs)

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10
Q

HBV surface Ag

A

HBV surface Ag = antigen on surface of HBV → indicates Hep B infection

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11
Q

Anti-HBsAG antibodies

A

Anti-HBsAG antibodies→ antibody to HBsAg, indicate immunity to HepB

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12
Q

Anti-HB-core antibodies

A

Anti-HB-core antibodies → IgM (acute) IgG (chronic or prior infection)

IgM is sole marker of infection during window period

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13
Q

HBeAg

A

HBeAg = sign of infectivity → Anti-HBeAb = sign of low infectivity

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14
Q

Treatment of HepB (4)

A

1) INF-a
2) Nucleoside/Nucleotide Analogs
3) Acute infection = SUPPORTIVE
4) Neonate of HBsAg+ mother –> vaccinate

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15
Q

IFN-a

Mechanism in Hep B and C

A

inhibition of transcription and translation of viral genes

inhibition of glycosylation and maturation of viral proteins

inhibition of liberation of newly synthesized viral particles

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16
Q

IFN-a

ADRs

A

flu-like syndrome,bone marrow suppression, increased susceptibility to bacterial infections, unmask autoimmune disease

NOT given in pregnancy

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17
Q

Entecavir

A

nucleoSIDE analog

Inhibits DNA polymerase priming, reverse transcription, and DNA-dependent DNA synthesis

Competes with cellular dGTP for viral DNA polymerase activity

Also used in HIV

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18
Q

Tenofovir

A

nucleoTIDE analog

Also used in HIV

Must be phosphorylated by cellular kinases to active triphosphate form

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19
Q

Hepatitis C

Main features:

A

Flavivirus, (+)ss linear RNA, icosahedral, enveloped

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20
Q

Hepatitis C

Disease

A

Acute infections are usually subclinical
Chronic infection possible - 80% go on to chronic infection
Cirrhosis, liver failure, HCC

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21
Q

Hepatitis C

Transmission

A

parenteral - blood/blood-derived body fluids

22
Q

Hepatitis C

Treatment (5)

A

1) Simeprevir
2) Ribavirin
3) Sofosbuvir
4) Ledipasvir
5) Pegylated IFN-a

23
Q

Simeprevir - mechanism? ADRs?

A

NS3/4A HCV protease inhibitor, prevents viral replication

ADRs: photosensitivity reactions, rashes

Used in conjunction with peginterferon and oral ribavirin or sofosbuvir

24
Q

Ribavirin

A

purine nucleoside analog

ADRs: hemolytic anemia, NOT given in pregnancy

25
Q

Sofosbuvir

A

inhibits HCV RNA-dependent RNA polymerase (NS5B) → chain termination
Used in combination with Ledipasvir

ADRs: fatigue, headache, nausea

26
Q

Ledipasvir

A

inhibits NS5A HCV protein essential for HCV assembly, replication, secretion

Used in combination with Sofosbuvir

27
Q

Hepatitis D

Main features

A

Delta virus, ss (-) circular RNA virus, enveloped

28
Q

Hepatitis D

Disease

A

requires concurrent Hep B infection (particles packaged with HBVsAg)
Increases severity of hepatitis

HDV becomes chronic and persists along with HBV

29
Q

Hepatitis D

Transmission

A

percutaneous, permucosal, blood/blood-derived body fluids

HBV vaccine also prevents HDV

30
Q

Hepatitis E

Main features:

A

Hepevirus - naked, icosahedral (+) ssRNA

31
Q

Hepatitis E

Transmission

A

fecal-oral transmission

**reservoir in pigs/swine = zoonotic

32
Q

Hepatitis E: Disease?

A

fulminant hepatitis in pregnant women** (20% mortality)

In other people is acute, self-limiting hepatitis

33
Q

Hepatitis E

Diagnosis

A

IgM anti HEV or RT-PCR

34
Q

Hepatitis E

Prevention

A

no FDA approved vaccine (vaccine used in China)

35
Q

Meningitis in newborns (0-6 months) (3)

A

1) Group B strep
2) E. Coli
3) Listeria

36
Q

Meningitis in Children (6 months - 6 years) (4)

A

1) Strep pneumoniae
2) Neisseria meningitidis
3) Haemophilus influenzae type B
4) Enteroviruses

37
Q

Meningitis in Adults (6-60 years) (4)

A

1) N. Meningitidis
2) Enteroviruses
3) S. Pneumoniae
4) HSV

38
Q

Meningitis in Older Adults (60+ years) (3)

A

1) S. Pneumoniae
2) Gram negative rods
3) Listeria

39
Q

HAV vaccine vs. HBV vaccine

A

HAV vaccine: passive human Ig and active (KILLED vaccine)

HBV vaccine: passive (HBIG) and recombinant SUBUNIT (HBsAg) vaccine

40
Q

Droplet precautions

A

Isolation of patients infected with organisms that can be transmitted via droplets than can be generated by patient during coughing, sneezing, talking, or during procedures

Private room + mask + hand hygiene

Influenza, RSV, Neisseria meningitidis

41
Q

Airborne precautions

A

Isolation of patients with organisms spread via airborne droplet nuclei

Private room + negative pressure + > 6-12 air changes per hour

N-95 mask worn by all persons entering the room

Used for M. TB, measles, primary infection for VZV

42
Q

Contact precautions

A

Private room

Use of hand hygiene

Gloves and gowns prior to entry into patient room

Used to prevent spread of MDR organisms (VRE, MRSA, MDR acinetobacter, C. diff)

43
Q

Dysbiosis

A

abnormal composition of a microbiome

EX) IBS, antibiotic associated diarrhea, obesity, bacterial vaginosis, “non-bacterial” prostatitis, pouchitis, T1DM, Mother-to-child HIV transmission, MRSA colonization and infection

  • Bacterial vaginosis - caused by loss of protective species (lactobacilli) and gain of anaerobes (prevotella, gardnerella)
  • Crohn’s Disease: diminished levels of Clostridium and bacteroides species in the gut
44
Q

Environmental factors that influence patterns of colonization in infants

A

1) Mode of delivery (C-section vs. Vaginal)

2) Feeding (breast milk vs. formula)

45
Q

Infant microbiome

A

Infants born sterile but are quickly colonized by diverse microorganisms

Within weeks, baby has bacterial load of typical adult

Development of immune system occurs in parallel → likely influenced by microbiome

46
Q

Gut microbiome in human nutrition

A

Evidence for obesity-predisposing microbiome

Metabolic function of microbiome =

  • Ferment non-digestible polysaccharides and mucus
  • Synthesize vitamins (B3, B5, B6, B12, K, Biotin, Folate)
  • Sequester metals
47
Q

Pathogen exclusion

A

commensals compete with pathogens → limit infectivity

Nutrient, receptor competition

Antimicrobial products of commensals (lactic acid, H2O2, pH, bacteriocins)

EX) C. Diff infection after antibiotic use

48
Q

Immune homeostasis

A

balance between hyper-reactive / unresponsive immune system

49
Q

Commensal vs. Parasite vs. Mutualist

A

Commensal: interaction between two species in which one benefits and one is unaffected

Mutualist: interaction between two species in which both species benefit

Parasite: interaction between two species in which one benefits and one is harmed

50
Q

Gnotobiotic

A

growth in a germ-free environment

51
Q

Microbiome

A

community of microorganisms inhabiting a particular niche

Aka “commensals’

Neutral or beneficial functions

Found on all exposed surfaces

10 microbes per human cell (10^14 microbes colonize a person), collective microbial genome is 100x human genomes

Infectious Disease (9 decks)

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