DNA Viruses Flashcards

Question

What is the #1 cause of sensorineural hearing loss in children?

Answer 1

Immunosuppressed At risk of developing CMV pneumonia To detect CMV in transplant patients, perform a Buffy Coat Culture Buffycoat is part of blood that contains WBCs and platelets. Incubate these cells with Fluorescent Anti-CMV Antibodies and detect presence of the virus

Answer 2

Immunosuppressed AIDS patients are especially susceptible to CMV infection when CD4

Answer 3

You'll see Owl's Eye inclusion bodies

Answer 4

1st line = ganciclovir 2nd line = Foscarnet - used when virus has UL97 gene mutation that makes it resistant to ganciclovir

Answer 5

It is possible Most common presentation is CMV Mononucleosis Same symptoms as EBV mono (sore throat, lymphadenopathy, fatigue) but it is Monospot (-) on a pharyngeal swab.

Answer 6

Chicken pox

Answer 7

Respiratory transmission or from ruptured vesicles themselves Can have vertical transmission of VZV (TORCH)

Answer 8

from VZV One of the childhood exanthams Fever, HA "Dew drops on a rose" rash - a vesicular lesion with surrounding erythema Lesions will be in different stages of healing (some blisters, some healing scabs) - In smallpox it's very similar but the lesions are all at the same stage Tzank Smear shows multinucleated giant cells (can be HSV or VZV)

Answer 9

Adults with chicken pox are more likely to develop pneumonia or encephalitis (esp the immunocompromised) Pneumonia and encephalitis can happen in kids with VZV too, but adults who are immunocompromised are at much higher risk.

Answer 10

Live, attenuated for children

Answer 11

Acyclovir for kids 12+, adults, immunocompromised

Answer 12

VZV remains latent in nerves (specifically dorsal root ganglia) When people are under stress or are immunocompromised VZV can reactivate - usually in older people or immunocompromised When it becomes reactivated it has 2 names: Herpes Zoster or Shingles

Answer 13

Shingles has "Dew drops on a rose" appearance with a characteristic dermatomal distribution From Dorsal root ganglia, VZV travels down sensory nerve fibers to skin (hence the dermatomes) Usually lumbar and thoracic dermatomes Rarely crosses midline If it does cross the midline, we have disseminated VZV and is a RED FLAG for immunocompromised (if there is no history of chemo...test for HIV... something must be going on) The rash is extremely painful. Even when rash goes away, you can still have pain in a dermatomal distribution (Post-herpetic neuralgia) Normally thoracic dermatomes, but sometimes it an affect the trigeminal nerve, esp in immunocompromised hosts. Can lose vision (V1 affected) - Herpes Zoster Opthalmicus

Answer 14

Zoster vaccine Live attenuated Recommended for adults > 60. Don't give it to people who are actively immunocompromised (pregnant women, leukemia/lymphoma) Can still give to HIV patients if CD4 > 200

Answer 15

Acyclovir Famcyclovir (easier to dose) Valcyclovir

Answer 16

TORCH If pregnant woman gets VZV during Trimesters 1-2, the child can develop Congenital Varicella Syndrome: Limb hypoplasia Cutaneous dermatomal scarring Blindness

Answer 17

Roseola (Sixth Disease), AKA Exanthema Subitum

Answer 18

CD4+ Helper T Cells - it can cause immunosuppression by killing off these cells

Answer 19

HHV-6 (Exanthema Subitum) Primarily in children 6 months - 2 years old High Fever that lasts 3-4 days - can sometimes be high enough to cause seizures ( > 104 for seizures) The fever is followed by macular rash (diffuse except face) - lacy appearance, spares face Timing is very important: Fever is 4 days THEN as fever subsides the rash appears Roseola is usually self-limiting Tx is supportive (no FDA approved Tx) with cooling measures and adequate fluids

Answer 20

Measles does NOT spare the face Roseola does spare the face Measles has simultaneous fever and rash Roseola has fever THEN rash

Answer 21

Kaposi Sarcoma (an AIDS-defining illness)

Answer 22

Sexual contact (including kissing) especially in men who have sex with men

Answer 23

1) AIDS/immunocompromised 2) Elderly Russian men (present with lower extremity lesions) 3) People in areas of Africa where virus is endemic (the classic palatal lesions in adults, can be fatal in kids)

Answer 24

Erythematous violaceous lesions on nose, extremities, and mucous membranes. Lesions arise from primitive vasculature forming mesencymal cells. Newly created blood vessels (angiogenesis) within the lesions cause the purple color - REMEMBER - the color is from the proliferation of vasculature. The virus accomplishes this vasculature proliferation through the dysregulation of VEGF resulting in angiogenesis Lesions can occur on mucosal surfaces as well (ANYWHERE along GI tract - you can see on colonoscopy). Most common location of these plaques is hard palate HHV-8 can also infect B-cells and cause Primary Effusion Lymphoma (a B-cell lymphoma)

Answer 25

Kaposi lesions look like many others Bacillary Angiomatosis is from Bartonella. Examine the lesion microscopically to tell them apart Kaposi: seen with lymphatic infiltrate (viral etiology) Bacillary: seen with neutrophilic infiltrate (bacterial etiology)

Answer 26

Start anti-retroviral therapy in patient who is HIV(+) and hasn't started it yet. Lesions should shrink in response to therapy

Answer 27

JC Virus | BK Virus

Answer 28

circular double stranded DNA - it's a circular virus

Answer 29

A polyomavirus John Cunningham Virus Causes progressive multifocal leukoencephalopathy (PML) Greater than 50% of population has JC Virus, but it doesn't cause problems if immune system is intact. When it is immunocompromised (HIV with CD4

Answer 30

Toxo: Brain lesions are ring-enhancing JC: Non-enhancing lesions

Answer 31

Type of polyomavirus Famous for causing nephropathy and other urinary tract problems like hemorrhagic cystitis Usually kidney and bone marrow transplant patients at risk

Answer 32

Polyomaviruses 1) JC with PML 40 yo HIV positive patient is complaining of weakness, visual changes, and difficulty with speech which has been getting worse over the last few weeks. CD4 = 158. CT/MRI shows multiple non-enhancing brain lesions. 2) BK 50 yo renal transplant patient taking immunosuppressants who presents with fever and gross hematuria

Answer 33

HPV - nearly all sexually active people will get HPV at some point.

Answer 34

Verruca vulgaris = cutaneous common wart Children get it on hands/feet Transmission requires physical contact

Answer 35

- Laryngeal papillomatosis = Recurrent respiratory papillomatosis Tumors (papillomas) develop in airway Typically in children 6 and 11 are typically contracted by kids during vaginal birth - Anogenital warts = condyloma acuminata Seen in sexually active individuals Acquired through sexual contact

Answer 36

Anogenital cancers - squamous cell carcinomas (cervical, vulvar, vaginal, penile, anal) - HPV infects squamous cells. 16 and 18 together cause 70% of cervical cancers HPV 31, 33 also associated with these cancers. Spreads through sexual contact. Condoms/Abstinence can prevent infection

Answer 37

Covers 6, 11, 16, 18 (NOT 31, 33) 16 and 18 cause 70% of cervical cancers Guardasil - inactivated subunit vaccine Recommended for women and men age 9-26 regardless of sexual activity.

Answer 38

HPV is able to disrupt regulation of the cell cycle Tumor suppressors p53 and RB inhibit transition from G1 to S phase. (RB = retinoblastoma protein) HPV encodes 2 proteins E6 and E7 that promote proteolysis of p53 and RB respectively HPV takes out tumor suppressors therefore increasing risk of cancer. Uninhibited cell growth leads to neoplasia Cervical cancer buzzword: Patient who complains of post-coital bleeding

Answer 39

Pap Smear lowers incidence of cervical cancer through early detection Samples cervical cells from area called the transformation zone. This is where squamous epithelium from outer cervix (ectocervix) comes in contact with columnar epithelium from inner portion (endocervix) Infected cells have morphological changes - Koilocytes (look like blue sunny-side eggs) - large, dense, wrinkled nucleus/maybe binucleate

Answer 40

Immunosuppression HIV(+)*** (may enhance E6 and E7 expression AND immunocompromised) Cervical/anal/penile cancers are AIDS-defining illnesses

Answer 41

Fifth Disease - "Slapped Cheek Fever"- Erythema Infectiosum

Answer 42

Low grade fever for 1 week Fever breaks and kid develops slapped cheek rash on face Then progresses to lacy, reticular pattern that travels down the body

Answer 43

Usually schoolteachers Joint pain, arthritis, edema In patients with Sickle Cell Disease: Aplastic anemia - caused by depletion of the bone marrow. When all cell lines are depleted the bone marrow is left with only adipocytes. When packed together they look like "cobwebs" - This is a transient effect and should fade as virus is cleared

Answer 44

It is the only single stranded DNA virus Smallest DNA virus

Answer 45

respiratory droplets Vertical (TORCH)

Answer 46

Baby in-utero exposed to parvovirus Exposure in Trimesters 1-2: Hydrops fetalis (severe fatal anemia that leads to fetal version of CHF) Same thing happens in alpha-thalessemia

Answer 47

Adenovirus

Answer 48

Respiratory droplets Fecal-oral

Answer 49

Live attenuated ONLY for military recruits

Answer 50

Common in little children, military recruits, and those who frequent public pools - outbreaks in military barracks and public pool swimmers Causes hemorrhagic cystitis - bladder infection leading to gross hematuria Also a cause of viral conjunctivitis (pink eye)

Answer 51

Inside AND outside of nucleus

Answer 52

It is circular and partially double-stranded - It becomes fully double stranded during replication. Goes from partially dsDNA --> ssRNA intermediate --> dsDNA Carries a reverse transcriptase Does not integrate into host chromosome so it is NOT a retrovirus like HIV

Answer 53

Sex, sharing blood products, sharing drug needles, vertical (TORCH)

Answer 54

Low transmission. Happens during delivery, not across placenta (the virus is too big) Requires mixing of blood during delivery

Answer 55

1) Hepatitis: RUQ pain, jaundice Some acute and some chronic (less likely than in Hep C tho - 5-10% of patients) Younger kids are more likely to develop chronic infection - newborns infected have a 90-95% chance of becoming chronic 2) Extra-hepatic manifestations of Hep B 1) Prodromal serum sickness type illness with rash and arthralgias - purpural rash with non-blanching dark macules 2) Polyarteritis nodosa - systemic vasculitis that affects medium to small arteries, small aneurysms forming in the arteries have a "beads on a string" appearance. Polyarteritis nodosa causes kidney damage (low GFR, HTN) by affecting vessels leading to the kidney 3) Membranous glomerular nephritis 4) Membranoproliferative glomerular nephritis

Answer 56

Viral hepatitis causes higher liver enzymes - ALT > AST Hepatitis from alcohol raises enzymes too - AST > ALT ALT is normal early on in neonatal hepatitis

Answer 57

Hep B surface antigen Marker for active disease First to be clinically measurable (+) = active infection - acute or chronic Pt has symptoms

Answer 58

Hep B Antigen that appears after HBsAg Correlates with infectivity (+) = infective Pt has symptoms

Answer 59

Core antibody for Hep B (+) during window period First antibody detected

Answer 60

Antibody to E antigen in HepB If this is presence there is low infectivity

Answer 61

HepB Indicates recovery Pt no longer has infection (acute OR chronic) This is always the value to check for immunity

Answer 62

``` HBsAg HBeAg Anti-HBc Anti-HBe Anti-HBs ```

Answer 63

Immunized person would be (+) for Anti-HBs - This is the only thing you'd see for vaccination. If you also see Anti-HBc or Anti-HBe this would indicate that the person was infected at one point in the past.

Answer 64

Long-term sequelae: 1) Cirrhosis 2) Hepatocellular carcinoma (higher risk)

Answer 65

Cannot cause infection without Hep B Hep D is an RNA virus that is: 1) enveloped 2) RNA (-) Sense 3) Circular RNA genome Requires HBsAg to be infectious 2 types of Hep D: 1) Co-infection - when both viruses are transmitted simultaneously 2) Superinfection - when Hep D is transmitted on top of existing Hep B infection - worse outcomes

Answer 66

Acute - will most likely clear up on its own. Pregnant women and people who have progressed to chronic should seek Tx Tx will not eradicate - it minimizes damage by preventing replication Antivirals like Lamivudine and other NRTIs Also interferon alpha Give at risk kids anti-HepB immunoglobulins (IgG) - If mom is Hep B (+) you must give immunoglobulins and Hep B vaccine to newborn for both active and passive immunity

Answer 67

It is the only DNA virus that completely replicates in the cytoplasm It comes with everything it needs inside it already - makes its own envelopes (doesn't take it from host) It packs its own RNA Polymerase that reads DNA - so it can just make mRNA right in the cytoplasm and get it processed by local ribosomes into proteins. It makes all the proteins it needs, even its own DNA Polymerase

Answer 68

Pox forms Type B inclusions (Guarnierni Bodies) - sites of viral replication in cytoplasm Intracytoplasmic is diagnostic for Pox

Answer 69

Cowpox Smallpox Molluscum Contagiosum

Answer 70

A type of Pox virus Transmitted via contact with infected cow utters The source of smallpox vaccine

Answer 71

Vareola - a type of pox virus Only exists in labs that study it - can be a bio weapon Causes raised blisters on skin and mucosal surfaces Lesions are all the same age/stage of healing

Answer 72

Type of pox virus Flesh-colored, dome-shaped, umbilicated (has little dimple in the middle) skin lesions - looks like snail shell Mostly seen in children Can be anywhere but palms/soles - mainly seen in trunk, axilla, antecubital fossa, popliteal fossa In adults, it's related to sexual transmission - single, umbilicated lesion - if it spreads diffusely person probably has HIV and is immunocompromised.

Answer 73

It is the largest DNA virus! Its core is dumbbell shaped

DNA Viruses Flashcards

(98 cards)