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Microbiology COPY > Exam #7: Viral Infections of the Circulatory, RES, & Lymphatic System > Flashcards

Exam #7: Viral Infections of the Circulatory, RES, & Lymphatic System Flashcards

1
Q

List the characteristics of EBV.

A
  • Herpesvirus (lytic & latent phases)
  • Enveloped
  • dsDNA
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2
Q

List the diseases that are associated with EBV. What patient populations are most likely to develop the different diseases associated with EBV?

A
  • Mononucelosis– adolescents & adults
  • Oral Hairy Leukoplakia–Immunocompromised
  • Burkitt’s Lymphoma–children in central Africa
  • Hodgkin’s Disease–Multiple populations
  • Nasopharyngeal Carcinoma–Southeast Asia & China
  • PTLD–Transplant patients
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3
Q

What diseases associated with EBV are caused by the productive phase?

A

Mononucleosis

Oral Hairy Leukoplakia

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4
Q

What diseases associated with EBV are associated with the latent phase?

A

Burkitt’s Lymphoma
Hodgkin’s Disease
Nasopharyngeal Carcinoma
PTLD

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5
Q

What does EBV use for attachment & entry?

A

The receptor for the C3d component of compliment, which is found on a limited number of cells, including B-cells & epithelial cells of the oro & nasopharynx

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6
Q

Where does EBV replicate?

A
  • Initially, EBV replicates with oral epithelial cells & causes lysis
  • After lysis of epithelial cells, EBV infects B-cells
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7
Q

How is EBV transmitted?

A

Saliva

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8
Q

Describe the pathology of EBV.

A
  • Initially, EBV replicates with oral epithelial cells & causes lysis
  • After lysis of epithelial cells, EBV infects B-cells
  • B-cell infection causes B-cells to differentiate into lymphoblasts
  • Lymphoblasts proliferation leads to high levels of antibodies that bind antigens other than EBV, called heterophile antibodies
  • In the first few days of infection, a robust cytotoxic T-cell immune response targets & kills EBV-infected immune cells, which leads to the symptoms of mononucleosis
  • Some EBV-infected B-cells evade cytotoxic T-cells & become memory B-cells that can be reactivated
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9
Q

What are the symptoms of EBV reactivation?

A

In healthy individuals, none–asymptomatic

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10
Q

What EBV genes are associated with carcinogenesis?

A

1) Latent Membrane Protein 1 (LMP1)= CD40 homologue that is constitutively active & results in increased growth & suppressed apoptosis
2) Latent Membrane Protein 2 (LMP2)= increased growth of B-cells
3) EBNA1= inhibits apoptosis

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11
Q

When are EBV primary infections most common worldwide, & in the US?

A 
World= <5 
US= teens
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12
Q

What are the symptoms of mononucleosis?

A 
Fever 
Malaise 
Exudative pharyngitis 
Splenomegaly 
Tender lymphadenitis
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13
Q

What biochemical marker is diagnostic for mononucleosis?

A

Heterophile antibodies

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14
Q

What complication is associated with mononucleosis?

A

Splenic rupture; thus, patients with mononucleosis are in instructed to refrain from physical exertion

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15
Q

What causes the symptoms of mononucleosis?

A

Cytotoxic T-cell response to EBV infected B-cells

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16
Q

What can happen when a patient with mononucleosis is given ampicillin?

A

Rash

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17
Q

How long is the typical incubation period in mononucleosis?

A

2 month incubation period

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18
Q

When are heterophile antibodies detected in mononucleosis?

A

A few days into symptomatic infection

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19
Q

What antibodies are associated with early EBV infection?

A

Anti-EA (Early Antigen)

Anti-VCA, IgM (Viral Capsid Antigen)

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20
Q

What antibodies are associated with late EBV infection?

A

Anti-EBNA (Epstein Barr Nuclear Antigen)

Anti-VCA, IgG

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21
Q

How is mononucleosis diagnosed?

A
  • Mono spot test= heterophile antibody agglutination of sheep or horse RBCs
  • Antibodies to EBV–mainly IgM to viral capsid antigen (VCA)
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22
Q

What are Downey cells?

A

Large atypical T-cells that have an indented cell margin are a classic feature of EBV infection

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23
Q

How is there a vaccine for mononucleosis?

A

No

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24
Q

How is mononucleosis treated?

A
  • Rest & hydration
  • Avoidance of strenuous activity

*Don’t want splenic rupture

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25
Q

What effect do antiviral drugs have on EBV infection?

A

None really–symptoms are due to the immune response to the virus, NOT the virus itself

*Acyclovir will inhibit the viral polymerase, but it does not have an impact on the clinical course of the disease

26
Q

What is Oral Hairy Leukoplakia?

A

Wart-like pattern on lateral surface of the tongue

- Seen in patients with immuosuppresion (~300 CD4+ T-cells)

27
Q

How is Oral Hairy Leukoplakia treated?

A
  • Antiherpetic drugs (acyclovir)

- Podophyllin resin

28
Q

What is Burkitt’s Lymphoma?

A

B-cell tumor often presenting in the jaw of children

29
Q

What genetic mutations are associated with Burkitt’s Lymphoma?

A
  • Translocation (8 x 14) of the c-myc oncogene being put under the control of a very active promoter e.g. immunoglobulin genes
  • Leads to high levels of c-myc activity & a high proliferative index

*This is the most rapidly progressing human tumor

30
Q

How is Burkitt’s Lymphoma treated?

A

Chemotherapy, which has a 70-80% cure rate in children and young adults

31
Q

What co-factors are associated with Burkitt’s Lymphoma?

A

Immunosuppression is highly associated with Burkitt’s Lymphoma, which is partly why there is a high incidence in areas where chronic malaria is endemic (central Africa)

32
Q

What is Hodgkin’s Disease?

A

B-cell cancer that is NOT associated with any specific translocations vs. Burkitt’s lymphoma

33
Q

What is the typical presentation of Hodgkin’s Disease?

A
  • Nontender, palpable lymphadenopathy in neck, supraclavicular, or axilla
  • Mediastinal adenopathy
  • Fever, night sweats, & weight loss
34
Q

What is the hallmark of Hodgkin’s Disease?

A
  • Reed-Sternberg cell

- A large cell with two or more nuclei or nuclear lobes, each of which contains an eosinophilic nucleolus

35
Q

How is Hodgkin’s Disease treated?

A

Radiotherapy
Chemotherapy

*Not that localized Hodgkin’s Disease is cured in >90% of patients

36
Q

What is nasopharyngeal carcinoma?

A

Epithelial cancer that originates in the nasopharynx

37
Q

Where is nasopharyngeal carcinoma prevalent?

A

SE Asia

Africa

38
Q

What are the symptoms of nasopharyngeal carcinoma?

A
  • Facial pain
  • Feeling of fullness in the sinus or throat
  • Hearing loss
39
Q

How is nasopharyngeal carcinoma treated?

A

Radiotherapy

Chemotherapy

40
Q

What is PTLD?

A

Post-transplantation Lymphoproliferative Disorder

- abnormal proliferation of lymphoid cells in a transplant patient

41
Q

What are the symptoms of PTLD?

A

Fever
Fatigue
Weight loss
Progressive encephalopathy

42
Q

What is the major risk factor for PTLD?

A

EBV at the time of transplant

43
Q

How is PTLD diagnosed?

A
  • Histological analysis of tissue

- Detection of EBV genomes by in situ hybridization

44
Q

How is PTLD treated?

A

1st line= Reduce immunsuppression
2nd= Rituximab (anti-CD20 ab)
3rd= Conventional chemotherapy

45
Q

List the characteristics of CMV.

A

Herpesvirus
Enveloped
dsDNA

46
Q

What diseases can be caused by CMV? How are these disease states dependent on the immune status of the host?

A
  • Normal individuals = Mononuceolsis-like disease
  • Babies of seronegative mothers= Cytomogalic inclusion disease
  • AIDS & severely immunosuppressed= Multisite symptomatic disease
47
Q

How is CMV transmitted?

A

Bodily fluids

  • Saliva
  • Breast milk
  • Urine
  • Fomites
  • Sex
48
Q

How is CMV diagnosed?

A

Detection of viral DNA or virus culture from diseased tissue

49
Q

How is CMV treated?

A

1st Line:

  • Gancycloir= converted to viral polymerase inhibitor by CMV enzymes
  • Valganciclovir= converted to gangyclovir in the body that has an increased bioavaliablity

2nd Line:

  • Cidofovir= converted to viral polymerase inhibitor by cellular enzymes, but MORE TOXIC than gancyclovir
  • Foscarnet= direct inhibitor of the CMV polymerase, but associated with renal toxicity
50
Q

What toxicity is associated with Gancyclvir?

A

Bone marrow toxicity & drug-related neutropenia

51
Q

What is CMV Infectious Mononucleosis-Like Illness?

A

CMV infection of immunocompetent school-aged children & adults that results in mononucleosis-like disease

52
Q

What are the symptoms of CMV Infectious Mononucleosis-Like Illness? How can you tell the difference between CMV & EBV?

A

Fever
Fatigue
Pharyngitis
Downey Cells

  • No heterophile antibody production in CMV
  • *Exudative pharyngitis & cervical lymphadenopathy are rare in CMV
53
Q

What is Cytomegalic Inclusion Body Disease?

A

Disease of the newborn that is primarily seen in children born to mothers that suffered primary CMV infection in utero.

54
Q

What symptoms are associated with Cytomegalic Inclusion Body Disease?

A

Hepatosplenomgealy
Jaundice
Petechaie/ Rash

And,

  • Microcephaly
  • Growth retardation
55
Q

How is Cytomegalic Inclusion Body Disease prevented?

A

Interrupt CMV transmission in body fluids by:

  • Handwashing
  • Avoid sharing drinks & toothbrushes with young children
  • Avoid contact with saliva when kissing a young child

Maternal treatment with CMV immunoglobulin during pregnancy

56
Q

What is the most common viral pathogen complicating organ transplant?

A

CMV

57
Q

What is the CD4 T-cell count of an AIDS patient presenting with CMV related disease?

A

Between 50 & 100

58
Q

What diseases are caused by CMV that are seen in transplant recipients?

A
  • CMV pneumonitis
  • Ulceration of the GI Tract
  • Increased risk of Graft vs. Host Disease
59
Q

What diseases are caused by CMV in AIDS patients?

A

CMV Retinitis

60
Q

How is CMV infection prevented in transplant recipients?

A

Donor matching
Prophylaxis
CMV Ig

61
Q

How is CMV prevented in AIDS patients?

A

Maintenance therapy with antivirals when reaching threshold levels of CD4+ T-cells

62
Q

How is CMV treated?

A

IV antivirals

Microbiology COPY (49 decks)

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