3.26.14* Ryan - Viral Hematology Flashcards Preview

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Flashcards in 3.26.14* Ryan - Viral Hematology Deck (19):
1

CMV, EBV, KSHV (HHV-8) are what kind of virus

a. subsets of herpes virus, enveloped dsDNA.
all attack lymphocytes

2

what are oncogenic the viruses

EBV
KSHV

3

MOA of antiviral drugs

inhibit replication. Can still lead to oncogenesis due to latency.

4

What are the steps of CMV infection?

a. infect/replicate in epithelial cells
b. spread to lymphoid tissue
c. become latent in B and T cels and monocytes
d. childhood infections are asymptomatic, adult infects may lead to mono/fever. AIDs patients may get retinitis, colitis, and pneumonia

5

CMV VS TRANSPLANT PATIENTS

Infection can occur by receipt of CMV+ organ or by reactivation of CMV+ recipient/ Most severe outcome is pneumonia about 1-4 months after transplant (preceded by fever).

6

CMV: Diagnosis and Treatment

Detection of large lymphocytes
Diagnosed by ELISA, PCR or shell vial assay.
Treatment: Selective prophylaxis with CMV Ig and ganciclovir-

7

EBV infection

a. 90% of population. Teens get mono.

8

EBV in AIDs patients

hairy leukoplakia

9

EBV in transplant patients

posttransplant lymphoproliferative disease

10

EBV in normal patients

Burkitt lymphoma and nasopharyngeal carcinoma

11

EBV

a. Spread through saliva. Incubation period is several weeks. Initial replication in oropharyngeal epithelium, spread to lymphocytes and then liver and spleen. EBV remains latent in throat epithelia and B cells, there can be oral shedding for weeks.

12

HAIRY LEUKOPLAKIA

Productive infection of tongue epithelial cells. Rarely seen except in AIDS patients.

13

How to diagnosis EBV infectious mononucleosis:

a. Diagnosed by symptoms and >50% atypical, large lymphocytes
b. Diagnostic markers
-EB nuclear antigens (EBNAs) assist in transcription and genome replication
-Viral capsid antigen (VCA) is produced during lytic replication
Because anti-VCA rises before anti-EBNA:
An anti-VCA+, anti-EBNA- patient is considered to have a primary infection
An anti-VCA+, anti-EBNA+ patient has had a past infection

14

Posttransplant lymphoproliferative disease

Caused by EBV infection leaking to B cell lymphoma in transplant patients. Highest risk among seronegative recipients during the first year posttransplant
Treatment: stop immunosuppression

15

Burkitt’s lymphoma

Neoplasm of B-cells that affects bones of the jaw. Nearly all have overproduction of MYC.
Endemic in central Africa, typically young children

16

Compare CMV/EBV

Both can cause mono and are latent in B cells. Both can cause post-transplant complications, but presentation is different. CMV is sexually-transmitted and a source of congenital infections. CMV is always heterophile antibody negative. EBV is a known oncogenic virus.

17

KSHV (HHV-8)

Necessary but not sufficient to cause Kaposi’s sarcoma (KS)
a. DNA can be amplified from B-cells of classical KS and AIDS KS patients
Sexually-transmitted.
Now, 95% of infections are asymptomatic, can be mild when symptomatic.
Tumor-specific treatment or target HIV, but not HHV-8.

18

KSHV cancers

Kaposi's sarcoma
primary effusion lymphoma
multicentric Castleman's disease

19

symptoms of infectious mononucleosis

Sore throat
Fever for 1-2 weeks
Malaise
Lymphadenopathy
Recovery is uneventful