Microbiology 13 - Opportunistic viral infection

Question 1

What is the Baltimore classification?

Answer 1

Virus classification system

Question 2

What class of viruses form latent infections?

Answer 2

DNA viruses

Question 3

How is most viral serology performed?

Answer 3

Indirectc ELISA

Question 4

Recall 3 reasons for immunosuppression

Answer 4

1. Solid organ transplant
2. Hematopoietic stem cell transplant (short term, or long term if they have significant GVHD)
3. HIV/AIDS

Question 5

Recall 4 types of immunosuppressing drugs

Answer 5

1. Steroids
2. Calcineurin inhibitors
3. Anti-proliferative agent (eg. Azothioprine/ mycophenolate)
4. Antibodies

Question 6

What is the most important opportunistic virus in transplant patients?

Answer 6

CMV

Question 7

What virus causes multifocal leukoencephalopathy?

Answer 7

JC virus

Question 8

What is a common re-activator of latent HSV?

Answer 8

Stressful situations

Question 9

What is HHV4?

Answer 9

EBV

Question 10

What is HHV8?

Answer 10

Kaposi’s sarcoma associated herpesvirus

Question 11

What drug would you give to someone who has CMV AND is immunosuppressed?

Answer 11

Valganciclovir

Question 12

For which hepatitis viruses are there vaccines?

Answer 12

Hep A and B

Question 13

Why is adenovirus particularly problematic in post-bone marrow transplant children?

Answer 13

You get disseminated disease

Question 14

What is the treatment for CMV virus?

Answer 14

Ganciclovir (IV) (can cause bone marrow suppression in 30% of patients)
PO Valganciclovir (Pro drug of ganciclovir)
Foscarnet (anti-dna polymerase) (IV) – nephrotoxicity
Cidofovir – nephrotoxicity

For SOT: give prophylaxis for 100 days (typically oral valganciclovir/ganciclovir)
For HSCT: pre-emptive treatment: regularly monitor CMV PCR and if you see a rise, give GCV/vGCV/foscarnet

Question 15

In which patients does JC virus cause PML?

Answer 15

AIDS patients

Question 16

What two conditions can BK virus cause in the immunosuppressed?

Answer 16

Haemorrhagic cystitis
Nephropathy

• Post HSCT – BK haemorrhagic cystitis- intravesical cidofovir (direct into bladder – avoid nephrotoxicity)
• Post renal Tx – BK nephropathy -can lead to graft rejection/failure of the raft- IVIG (cidofovir is nephrotoxic)

Question 17

What disease does parvovirus cause in a chronically immunosuppressed patient?

Answer 17

Anaemia

Question 18

In renal transplants, is risk of CMV transmission when the donor or recipient is positive?

Answer 18

Donor is pos

Question 19

In haematopoietic Stem Cell Transplants, is risk of CMV transmission when the donor or recipient is positive?

Answer 19

Donor is neg (recipient is pos) as patient with CMV has immune system replaced with one that is CMV-naive

Question 20

Describe the pattern of symptoms caused by varicella infection in the immunocompromised

Answer 20

Pneumonitis, encephalitis and hepatitis

In neonate: purpura fulminans

Question 21

What is the most common malignancy caused by EBV?

Answer 21

Post-transplant lymphoproliferative disorder

Question 22

What is the most common clinical syndrome caused by CMV infection?

Answer 22

Retinitis

Question 23

What CMV prophylaxis is offered, and to whom?

Answer 23

Ganciclovir

Given to all transplant patients

Question 24

What is the treatment for disseminated adenovirus?

Answer 24

Cidofovir