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Pathology - Y5 > Opportunistic Viral Infections > Flashcards

Opportunistic Viral Infections Flashcards

1
Q

What are endogenous viral infections?

A

Latent viruses that reactivate in absence of immune system.

Acquired in past prior to immune suppression e.g. Varicella Zoster.

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2
Q

What are exogenous viral infections?

A

Viruses acquired from environment.

Increased severity in immunosuppressed e.g. Influenza, SARS-CoV-2.

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3
Q

What is indirect detection of a virus?

A

Response of the immune system to the virus.

These tests are useful to see if you have ever had the infection.

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4
Q

What is direct detection of a virus?

A

Fragments of the actual virus.

  • Viral proteins (lateral flow/antigen tests).
  • Viral genetic material (the virus genetic material present with patient sample.

Polymerase chain reaction.

These tests are useful to see if you have the infection now.

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5
Q

How is serology used to determine infection with a virus?

A

Measure levels of antibody in patients serum.

  • +++ IgM indicate Active or Resolving infection
  • +++ IgG indicates past infection > 6 weeks ago

Antibody levels ↓↓↓ reduced in Immunosuppressed.

Serological course may differ depending upon virus.

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6
Q

What does this mean?

A

Surface antibody declines in the future, core antibody remains high for Hep B.

Surface antibody indicates previous vaccination, core antibody is previous infection with the real thing.

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7
Q

If the immune system is compromised, what happens to serology?

A

Serology is useless.

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8
Q

Which antibodies are screened in serological screening?

A
  • HIV Ag/Ab
  • HBV surface antigen
  • HBV core antibody
  • HBV surface antibody
  • HCV antibody
  • EBV antibody
  • CMV antibody
  • HSV antibody
  • VZV antibody
  • HTLV antibody
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9
Q

What is monitored/prophylactically treated during immunosuppression?

A
  • CMV monitoring PCR or prophylaxis
  • EBV monitoring PCR
  • BK monitoring PCR (Renal & BMT)
  • Adenovirus monitoring PCR (Paediatric BMT)
  • HSV prophylaxis if indicated
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10
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

D. HEV PCR

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11
Q

What increases the risk of opportunistic infections, from highest to lowest?

A

Allogeneic stem cell transplant

Advanced HIV infection (CD4 dep)

Solid organ transplant

Various monoclonal antibody therapies

Cytotoxic chemotherapy

DMARDs and steroids

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12
Q

What are sources of viral infection from transplants?

A

Viruses acquired from graft: HBV

Viral reactivation from the host: HSV

Novel infection from infected individual: VZV

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13
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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14
Q

What is screened for in symptomatic screening in the CSF?

A
  • HSV
  • VZV
  • Enterovirus
  • EBV
  • CMV
  • Adenovirus
  • HHV6
  • JC virus
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15
Q

What is screened for in symptomatic screening in the blood?

A
  • CMV
  • EBV
  • Adeno
  • HHV6
  • Parvo
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16
Q

What is screened for in symptomatic screening in the respiratory system?

A
  • Flu A/B
  • Paraflu 1-4
  • Adenovirus
  • Enterovirus
  • RSV
  • HMPV
  • Rhinovirus
  • Coronaviruses
  • CMV in BAL
17
Q

What is screened for in symptomatic screening in the gut?

A
  • HSV
  • CMV
  • Adeno
18
Q

How are viral infections different in the immunocompromised?

A
  • Present differently
  • Disseminated
  • Different organs
  • More severe
  • Oncogenic
  • Lack of immune mediated symptoms.
19
Q

What are issues with HSV infections in immunocompromised patients?

A
  • Increased frequency
  • Increased severity /risk of dissemination
  • More organs can be involved (pneumonitis, eosophagitis, hepatitis); NB: not enceph!
  • Increased risk of acyclovir resistance
20
Q

What is the management of the HSV in immunocompromised patients?

A

HIV/AIDS: CD4 <200

Prophylaxis:

  • Test for HSV IgG
  • Bone marrow
  • 1 month (until engraftment)
  • Solid organ
  • 3-6 months
  • And if treated for rejection
21
Q

What can varicella cause in immunocompromised patients?

A
  • Pneumonitis
  • Encephalitis
  • Hepatitis
  • Purpura fulminans in neonate
22
Q

What can VZV cause in immunocompromised patients?

A

Zoster (shingles)

  • Multi-dermatomal/disseminated
  • Often a late presenting immunosuppression
23
Q

What is the prophylactic management for VZV?

A

Prophylaxis (prolonged if post-bone marrow)

PEP - Post-exposure prophylaxis

Vaccination

24
Q

What is the treatment for VZV?

A

Varicella:

  • Anti-viral for 7-10 days
  • IV until no new lesions; PO until all crusted

Zoster:

  • Anti-viral (IV if disseminated) + analgesia
  • If Ramsay-Hunt: Add steroids
  • If HZO: Add topical steroids
25
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

26
Q

What is EBV associated with?

A

Post-transplant lymphoproliferative disease (PTLD)

Latently infected B cells – polyclonal activation.

Predisposes to lymphoma.

Suspicion on rising EBV viral load (> 105 c/ml) and CT scan.

Confirmation with biopsy of lymph nodes.

27
Q

What are complications associated with EBV?

A

Oncogenesis:

  • B-cell latency, high turn-over
  • T-cells monitor/control this

B-cell lymphomas

PTLD (post-transplant lympho-proliferative disorder

28
Q

What is the management of EBV?

A

Monitor EBV levels

Investigate for lymphoma as needed

Rx:?Rituximab, reduce immunosuppression.

29
Q

What are complications associated with CMV?

A

HIV/AIDS: CD4 <50

  • Ocular (retinitis)
  • Polyradiculopathy
  • Pneumonitis
  • GI tract

Solid Organ Transplant

  • Allograft disease
  • GI tract (i.e. renal)
30
Q

What is the management for CMV?

A

Prophylaxis (i.e. lung transplant).

Pre-emptive treatment (i.e. renal transplant / HSCT).

Treat if disease (HIV/AIDS).

Rx: Ganciclovir/Valganciclovir, Reduce immunosuppression.

31
Q

What is the treatment of CMV in HSCT?

A

CMV viral load twice weekly, treat if virus reactivates until suppressed (pre-emptive therapy).

32
Q

What is the treatment of CMV in Solid Organ Transplant?

A

Valganciclovir prophylaxis for 100 days

33
Q

What is the treatment for CMV?

A
  • Ganciclovir (IV): Bone marrow suppression
  • Valganciclovir: Oral
  • Foscarnet (IV) (nephrotoxicity)
  • Cidofovir (nephrotoxicity)
  • IVIg (with another drug for pneumonitis).
34
Q

Which of these is NOT an antiviral?

A. Sotrovimab

B. Valganciclovir

C. Foscarnet

D. Rituximab

E. Tenofovir

A

D. Rituximab

35
Q

What is JC Virus (John Cunningham)?

A

JC virus is a polyomavirus.

Progressive multifocal leukoencephalopathy.

Effective antiretroviral therapy has drastically reduced PML incidence in HIV+ve patient.

PML can be seen in other types of immunosuppressed:

  • Humanised monoclonal antibodies
  • Natalizumab (for treatment of multiple sclerosis)
36
Q

What is progressive multifocal leukoencephalopathy (PML)?

A

Cognitive disturbance, personality change, motor deficits other focal neurological signs.

Demyelination of white matter → neurological deficits.

Diagnosis: MRI and PCR on CSF

37
Q

What is BK virus?

A
  • Polyomavirus
  • Double stranded DNA
  • BK cystitis post SCT
  • BK nephropathy post Renal Tx
38
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+

C. sAg-, cAb+, sAb-

D. sAg-, cAb-, sAb-

E. sAg+, cAb-, sAb-

A

C. sAg-, cAb+, sAb-

Pathology - Y5 (59 decks)

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