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L74 Flashcards

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1
Q

What receptor confines the tropism of EBV?

A

CR2 receptor

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2
Q

Which tissues and cells does EBV infect?

A

B lymphocytes
Mouth & nose epithelium
Also an STI b/c in vaginal secretions from the cervical epi, but weird b/c no CR2Rs here

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3
Q

Can EBV have a lytic stage of infection?

A

Yes

In B cells & epithelium

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4
Q

Can EBV have a latent stage of infection?

A

Yes

More common in B cells

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5
Q

What genetic element allows EBV to become latent?

A

Episome

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6
Q

What is the worst case scenario of an EBV infection?

A

CANCER

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7
Q

What cancers are EBV associated?

A

B cell lymphoma - Burkitt
Nasopharyngeal carcinoma
Post transplant lympho-proliferative disorder (PTLPD)
Maybe other T & B lymphomas (Hodgkin’s)

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8
Q

Most common EBV disease in normal people.

A

Mono - aggultinin + !!

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9
Q

EBV transmission

A

Saliva
Blood product
Transplant
STI

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10
Q

How do you know staph vs EBV pharyngitis?

A

Present in clinic
Probably going to give penicillin (ampicillin)
EBV gets a RASH –> doesn’t get better

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11
Q

Which arm of the immune system is most important in controlling EBV latent infection?

A

T cells

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12
Q

What is a cue that a pt is EBV infected during the acute phase?

A

See atypical lymphocytes on peripheral blood smear

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13
Q

Describe the Ab response to EBV in terms of symptom progression.

A
  1. Before symptoms: IgM/IgG vs E antigens
  2. Symptomatic: IgM Abs that agglutinate!!!
  3. Resolving: Abs vs EBNA
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14
Q

What is EBNA?

A

Epstein Barr nuclear antigen

See Abs vs these - know infection is resolving

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15
Q

What is a neurologic disorder you might see with EBV in normal pts?

A

Guillain Barre - ascending paralysis

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16
Q

If an AIDs negative IC pt presents with falling CD4 ct + EBV infection, which clinical disease are you thinking of?

A 
B cell (Burkitt) lymphoma 
May present w/ malaria
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17
Q

Which EBV infection is most common in HIV pts?

A

Hairy oral leukoplakia

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18
Q

Which EBV infection is most common in transplant pts?

A

Post transplant lympho proliferative disorder

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19
Q

Describe the progression of PTLD.

A 
Early = benign growth that respond to anti-virals
Late = malignant growths
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20
Q

How does PTLD present on histo?

A

HISTO: multi-nucleated giant cells

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21
Q

Diagnose EBV

A
  1. PCR for EBV DNA

2. Immunocytochem for EBV proteins

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22
Q

EBV prophylaxis

Study These Flashcards
A

Acyclovir

Gancyclovir (valgan)

23
Q

Treat EBV mono

Study These Flashcards
A

Supportive

Severe: steroids - prevent spleen damage

24
Q

Can you treat EBV cancers with anti-virals?

Study These Flashcards
A

No you dummy

That’s why you don’t what to progress this far - need chemo

25
Treat PTLD
Non-specific immunoglobulin IFNa Chemo Rituximab (anti-CD20)
26
Name the 2 big diseases caused by VZV.
Chicken pox | Shingles
27
What does the chicken pox rash look like?
Infects EPI cells - duh, why its a rash! Blistering rash May also be pustular At all different levels of progression
28
Why does it matter that VZV is neurotropic?
Reactivate (Shingles) = painful lesions
29
When in the disease does the chicken pox rash occur?
2nd! Infection 1. Prodrome viremia = 9-13 days post-infection 2. Rash on face/scalp first, then trunk = 10-20 days post-infect
30
Where does VZV lie dormant?
DRG | CN ganglia
31
Who is most likely to get chicken pox complications?
IC pts: newborns, pregnant, transplant, AIDs
32
Complications of chicken pox
CNS Lungs: pneumonitis Liver Reye's syndrome - aka don't give aspirin to kids!!!
33
Hallmarks of Shingles rash
Vesiculopustular Painful Stops at midline
34
Shingles complications
Post-herpetic neuralgia | If CN 5 involvement --> encephalitis
35
What is the Shingles complication if there is geniculate ganglion involvement?
Ramsey Hunt Syndrome - 1 sided facial palsy - Lesions in ear - Loss taste ant 2/3 tongue
36
Immune response to VZV
IgM + IgG - limit spread | CD4 - resolve rash
37
You're probably diagnosing CP/Shingles clinically, but if you really wanted to what test would you order?
Pap smear of a lesion Direct fluorescent Ab PCR of CSF if neuro involvment
38
What is the chicken pox vaccine?
Live, attenuated 2 shots Prevents chicken pox in kids & decreases shingles in elderly
39
Which vaccine do you give to IC pts?
VZIG = immunoglobulin Ex: pregnant women who have been exposed to chicken pox Babies whose mothers have chicken pox
40
When and how do you treat chicken pox?
24 hrs of 1st lesion: PO acyclovir | Otherwise supportive
41
How do you treat IC pts with chicken pox?
Acyclovir IV
42
When and how do you treat Shingles in normal pts?
72hrs of 1st lesion: 7 day course of PO - Acyclovir - Famciclovir - Valacyclovir
43
Which shingles complication/presentation should you always treat?
Opthalmic zoster
44
How do you treat shingles in IC pts?
IV acyclovir | Goal: decrease severity + speed healing
45
When does HHV 6 infection occur in life in comparison to CMV and EBV?
Earlier in life!
46
Which skin disease is most common in kids due to HHV6?
Roseola = exanthem subitum 1. Fever Followed by 2. Red, raised rash w/o fever
47
Which conditions would clue you into an HHV 6 infection in kids AND adults?
Mono Seizures in kids Delayed bone marrow grafts in bone marrow transplant pts DRESS syndrome = drug rxn eosinophila w/ systemic symptoms
48
Diagnose HHV6 infection.
Clinical Serology: IgM & IgG PCR
49
What 3 characteristics are unique about HHV8?
1. Tumor promoting genes 2. Lympho AND angiotrophic 3. Has proteins homologous to cell proteins
50
Which tissues does HHV8 infect?
Uro & GI epithelium
51
How does HHV8 lie latent?
Episome - contributes to oncogenic reactivation
52
Where in the world are HHV8 infections most prevalent?
Mediterranean + Africa
53
HHV8 transmission
Sex*** Mom-baby Oral Blood

Viruses & Parasites (21 decks)

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