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Unit 6: Micro > Enteric Viruses 1 and 2 > Flashcards

Enteric Viruses 1 and 2 Flashcards

1
Q

Virology of reoviruses

A
  • Double protein capsid
  • dsRNA
  • Segmented genome
  • Environmentally rugged - fecal oral transmission
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2
Q

What are the human-infecting reoviruses and what do they cause?

A
  • Orthoreoviruses - cause mild GI Syx
  • Rotaviruses - Significant gastroenteritis
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3
Q

Cause of death associated with rotaviruses?

A

Death due to dehydration

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4
Q

Pathogenesis of rotavirus?

A
  • Primarily infects the cells of the small intestinal villi
  • Impaired villus function leads to impaired hydrolysis of carbs
  • Rotavirus nonstructural protein 4 - “Enterotoxin” that interferes w/ Na transport pumps, profuse watery diarrhea
  • Virus shed in stool
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5
Q

What demographic are typically infected by rotavirus?

A

Children b/w 4 and 24 months

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6
Q

What are the signs of rotavirus infection?

A
  • Dehydration - may be unremarkable
  • Hx of exposure to other children
  • N/V/F
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7
Q

Labs used for Rotavirus Dx?

A

Available but rarely used

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8
Q

Tx and Px for rotavirus?

A

Largely supportive Tx w/ rehydration: No soda, soup, milk, free water

Use Pedialyte

Px: Wash hands

Do not use antiemetics or antidiarrheal medications

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9
Q

Norovirus virology?

A
  • (+)ssRNA in the Caliciviridae family
  • Norwalk virus is prototype
  • Fecal oral
  • Highly contagious
  • Cruise ships and summer camps
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10
Q

Typical Syx of Norovirus?

A
  • Low fever
  • Anorexia, N/V - PROFUSE
  • Abdominal cramps
  • Watery diarrhea
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11
Q

Difference b/w rotaviruses and noroviruses?

A
  • Nausea more common in noroviruses
  • Dehydration more likely in rotaviruses
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12
Q

Similarities b/w rotaviruses and noroviruses?

A
  • Diarrhea
  • Fecal oral
  • Self-limited
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13
Q

Enterovirus virology?

A
  • Small naked icosahedral
  • (+)ssRNA
  • Environmentally rugged
  • Primary replication in the gut spread to regional lymph node
  • Possible dual tropism resulting in rare CNS manifestations
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14
Q

What are the enteroviruses?

A
  • Polioviruses
  • Coxsackie A
  • Coxsackie B
  • Echoviruses
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15
Q

What is different b/w rota/noroviruses and enteroviruses?

A
  • Rota/noros stay in gut and enteros have possible secondary replication outside the gut
  • Enteroviruses can rarely invade CNS
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16
Q

Similarities b/w rota, noro, and enteroviruses?

A
  • All replicate in gut
  • have RNA genomes
  • Fecal Oral
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17
Q

What immunity is protective against Polio?

A

IgA and IgG

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18
Q

Vaccines for Polio?

A
  • Inactivated - dead, Salk vaccine; Used in first world
  • Attenuated - weakened, Sabin vaccine, oral polio; Virus weakened and causes attenuated polio
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19
Q

Polioviruse pathogenesis?

A
  • Fecal oral enteric infection
  • uses CD155 receptor to enter and infect epithelial lymphoid cells
  • CD155 on gray matter in CNS cells
  • Can enter CNS and cause problems via lytic virus replication and immune response
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20
Q

What is post polio muscle atrophy?

A

Following acute polio attack, some of the neurons are killed off. If some of the cell bodies remain, remodeling and reinervation occurs. Later on, the nerves burn out with Syx of muscle weakness again.

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21
Q

Syx of polio infection on exam?

A

Nonparalytic or paralytic poliomyelitis

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22
Q

What tests are performed on exam?

A
  • Lumbar puncture
  • Virus recovery
  • MRI - inflammation of anterior horns
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23
Q

Polio Tx?

A

No specific Tx exists; Supportive care and possible positive pressure ventilation

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24
Q

What is postpolio syndrome?

A

New Hx of decreased muscle weakness/atrophy due to dysfunction in surviving motor neurons

25
Q

What conditions does Coxsackie A cause?

A
  • Herpangina
  • Hand-Foot-Mouth Disease
  • Acute Hemorrhagic Conjunctivitis
26
Q

Herpangina pathogenesis?

A
  • Acute febrile
  • Small vesicular/ulcerative lesions on posterior oropharyngeal structures
  • Summer
  • Self-limiting
27
Q

Labwork for herpangina?

A

Typically not required

28
Q

Tx for Herpangina?

A

Supportive Tx - NO aspirin for kids

29
Q

Hand foot mouth disease pathogenesis?

A
  • Fecal-oral route/contact w/ skin lesions/oral secretions
  • Syx follow invasion of mucous membranes
  • Widespread apoptosis = characteristic lesions
30
Q

Lab tests for HFM disease?

A

Usually unnecessary

31
Q

Tx of HFM disease?

A
  • Supportive
  • Ensure adequate fluid intake
32
Q

Pathogenesis of acute hemorrhagic conjunctivitis?

A
  • Coxsackie virus A24
  • Rapid onset of painful conjunctivitis
33
Q

What should be avoided when treating acute hemorrhagic conjunctivitis?

A

Tx w/ topical steroids should be avoided!

34
Q

What is the major complication associated with Coxsackie B infection?

A

Myocarditis

35
Q

Describe pathogenesis of Coxsackie B virus

A
  • Myocarditis - pump failure
  • INflammation - edema and congestive HF
  • Infants/pregnant at higher risk
36
Q

Mild presentation of Coxsackie B? Severe?

A
  • Mild - few/no Syx
  • Severe - acute cardiac decompensation
37
Q

What are findings on the Hx that may lead you to viral myocarditis Dx?

A
  • Recent, nonspecific, flulike illness, gastrointestinal Syx
38
Q

What labs should be performed if viral myocarditis is suspected?

A
  • CBC - determine presence of anemia
  • Sedimentation rate and C-reactive protein - markers of inflamm
  • Creatine kinase-MB isozyme and Troponin I: Markers of myocardial damage
39
Q

Best test to evaluate myocardial function?

A

Echocardiography

40
Q

Utility of endomyocardial biopsy for viral myocarditis? Risks?

A
  • Establishes Dx and classifies disease stage
  • Safe and effective in older children
  • Risk for very sick and infants
41
Q

Viral myocarditis Tx?

A
  • Admit to hospital if only mild signs of respiratory distress or congestive heart failure -rapid progression may occur
  • Bed rest necessary
42
Q

Medications for viral myocarditis?

A
  • Immunosuppresives controversial
  • Pleconaril being tested
43
Q

Disease caused by coxackievirus B resulting in sudden occurrence of lancinating chest pain, fever, malaise and headache?

A

Pleurodynia

44
Q

Target of coxsackievirus B in Pleurodynia?

A

Striated muscle in the chest causing lancinating chest pain

45
Q

Exam findings of Pleurodynia?

A
  • Headache fever malaise
  • N/V/D and abd. pain in children
  • Herpangina
  • Pleural friction rub on stethoscoope exam
46
Q

Findings on CXR for pleurodynia?

A

Typically normal

47
Q

Patient most susceptible to Pleurodynia?

A

Newborn

48
Q

Tx for pleurodynia?

A

No specfic Tx; Supportive care and follow up

49
Q

What is aseptic meningitis?

A

Inflammation of the leptomeninges

50
Q

What must be done when considering aseptic meningitis in DDx?

A

Rule out infection by bacteria or fungi: untreated outcomes are severe

51
Q

What are the findings of aseptic meningitis on exam?

A
  • Adults: Fever, meningismus, irritability, photophobia
  • Neck stiffness, headache
52
Q

Typical exam findings of a pediatric patient with aseptic meningitis?

A
  • Less obvious Syx of fever, cold hands/feet, refusing food, fretful, blank stare, stiff neck
53
Q

Specific infection signs of enteroviruses?

A
  • Pharyngitis
  • Pleurodynia
  • Gastroenteritis
54
Q

Common signs of measles and enterovirus infection?

A

Maculopapular rash

55
Q

Signs of infection of Coxsackie A?

A

Herpangina

56
Q

What test differentiates viral from bacterial meningitis?

A

CSF Tests

57
Q

Tx for viral meningitis?

A

Mostly supportive care: Rest, hydration, antipyretics, pain and anti-inflammatory medications

58
Q

What is the plan of action to treat infants with meningitis?

A

Broad-spectrum ABs and acyclovir

Unit 6: Micro (13 decks)

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