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Pathology (Guide) > Microbiology - Virology > Flashcards

Microbiology - Virology Flashcards

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1
Q

What is the virology of HSV?

A
  • Enveloped dsDNA genoma
  • Lies latent in sensory neurones
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2
Q

What is the clinical picture of Herpes labialis (cold sores - HSV1)?

A
  • Incubation: 2-12/7
  • Severe painful ulceration
  • Tendency to coalesce
  • Erythematous base
  • Fever
  • Submandibular lymphadenopathy
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3
Q

What is the clinical picture of HSV2 (genital ulceration)?

A
  • Incubation: 4-7/7
  • Fever
  • Dysuria
  • Malaise
  • Inguinal lymphadenopathy
  • Painful
  • Vesicular rash
  • Herpes meningitis 1-2/52 later in <8% of primary genital herpes
  • SACRAL RADICULOMYELITIS (urinary retention) = self-limiting
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4
Q

How does HSV present in an immunocompromised patient?

A
  • Cutaneous dissemination
  • Oesophagitis
  • Hepatitis
  • Viraemia
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5
Q

How does HSV present in a congenital infection?

A

Neurological:
- Microcephaly
- Encephalomalacia
- Hydranencephaly

Skin:
- Scarring
- Active lesions
- Hypo- + hyperpigmentation

Eyes:
- Microphthalmia
- Retinal dysplasia
- Optic atrophy +/- chorioretinitis

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6
Q

What is the treatment of HSV?

A
  • Aciclovir = guanosine analogue
    OR
  • Valaciclovir
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7
Q

What is the MoA for aciclovir?

A
  • Guanosine analogue
  • Competitively inhibits viral DNA polymerase by acting as analogue to deoxyguanosine triphosphate (dGTP)
  • Incorporation of aciclovir triphosphate into DNA results in chain termination
  • Absence of 3’ hydroxyl group prevents attachment of additional nucleosides
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8
Q

What is the virology of VZV?

A
  • Enveloped dsDNA genoma
  • Lies latent in sensory neurones, hence dermatomal distribution when reactivated
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9
Q

How does chicken pox present?

A
  • Fever
  • Malaise
  • Headache
  • Crops of rash follow prodromal Sx (Dew on rose petal)
  • Lesions scab after 1/52 (no longer contagious)
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10
Q

What are some complications of chicken pox?

A

General:
- Scarring
- Pneumonitis
- Haemoorrhage
- Eye involvement
- Reye’s syndrome

Neurological:
- Acute cerebellar ataxia
- Guillain Barre
- Ramsey Hunt syndrome (facial palsy + vesicles in ear)
- Geniculate ganglion of CNVII (hearing loss + vertigo)
- Encephalitis (vasculopathy)
- Post-herpetic neuralgia (pain in dermatome)

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11
Q

How does shingles present?

A
  • Reactivation caused stress or decreased immunity (e.g. immunocompromised or >50yrs)
  • Painful rash in specific dermatome
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12
Q

How does VZV present in an immunocompromised patient?

A
  • Rare complications more likely
  • Acute retinal necrosis
  • Progressive outer retinal necrosis (PORN)
  • Mutlidermatomal shingles
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13
Q

How does VZV present as a congenital infection?

A

Eyes:
- Chorioretinitis
- Cataracts

Neurological:
- Microcephaly
- Cortical atrophy

MSK/Skin:
- Limb hypoplasia
- Cutaneous scarring

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14
Q

How does VZV present in a neonate?

A
  • Purpura fulimans
  • Visceral infection
  • Pneumonitis
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15
Q

Why are vesicles on the nose concerning for a patient with shingles?

A

Risk of ophthalmic herpes zoster which is a medical emergency

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16
Q

What are vesicles on the ears indicative of for a patient with shingles?

A

Risk of Ramsey Hunt Syndrome

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17
Q

What is the management for a patient with chicken pox?

A

Aciclovir 800mg PO 7/7 OR Valaciclovir 1g TDS IF:
- Adults with chickenpox (risk of complications)
- Neonates
- immunocompromised
- Eye involvement
- Pts presenting with pain

Post-exposure prophylaxis = VZIG IF:
- Pregnant woman
- Immunocompromised

Live vaccine against varicella = attenuated
- Oka strian (CI = pregnancy)

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18
Q

What is the treatment for shingles and when is it indicated?

A

Indications: (IF <24hrs of rash)
- Symptomatic children
- Healthy adult smokers
- Chronic lung disease
- >20/40 gravid

Tx:
- Aciclovir 800mg PO 5x daily
- Famaciclovir 250mg PO TDS
- Valaciclovir 1g PO TDS
- Topical eye drops + oral for ophthalmic
- PEP 7-9/9 for immunocompromised (IVIG)

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19
Q

How is VZV diagnosed?

A

Exam:
- vesicles

Cytology:
- Scrapings for multinucleated giant cells (Tzanck cells)

Immunofluorescence Cytology:
- Cells from vesicles

PCR:
- Especially if rash is old, CNS + ocular disease

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20
Q

What is the virology of HCMV (human cytomegalovirus)?

A
  • Enveloped dsDNA genome
  • Lies latent in monocytes + dendritic cells
  • CMV cells = OWLS EYE INCLUSIONS
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21
Q

How does HCMV (human cytomegalovirus) present in an immunocompromised patient?

A

ERPC (M):
1. E: Encephalitis
2. R: Retinitis
3. P: Pneumonitis
4. C: Colitis
(5. Marrow Suppression)

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22
Q

How does HCMV (human cytomegalovirus) present as a congenital infection?

A
  • Ears: Sensorineural deafness
  • Eyes: Choreoretinitis
  • Heart: Myocarditis
  • Neurology: Microcephaly, Encephalitis
  • Lung: Pneumonitis
  • Liver: Hepatitis, Jaundice, Hepatosplenomegaly
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23
Q

What is the treatment for HCMV (human cytomegalovirus)?

A
  1. Ganciclovir IV / Valganciclovir PO
  2. Foscarnet IV
  3. Cidofovir IV

IVIG = adjunct in pneumonitis

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24
Q

What is the mechanism of action of ganciclovir?

A

guanosine analogue chain terminator

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25
What is the mechanism of action of foscarnet?
- Non-competitive inhibitor of viral DNA polymerase - Pyrophosphate analogue, inhibits nucleic acid synthesis without requiring activation - NEPHROTOXIC
26
What is the mechanism of action of cidofovir?
- Cytidine analogue chain terminator
27
What is the virology of EBV (Epstein-Barr Virus)?
- Enveloped dsDNA genome - Lies latent in B cells - Not dangerous in pregnancy
28
How does EBV generally present?
1. Glandular fever: TRIAD (FEVER, PHARYNGITIS, LYMPHADENOPATHY) + splenomegaly + maculopapular rash 2. Predisposes to Burkitt's lymphoma
29
How is glandular fever diagnosed?
- Blood Film - Monospot agglutination - EBV Abs
30
How does EBV present in an immunocompromised patient?
- Post-transplant lymphoproliferative disease (predisposed to lymphoma)
31
What is the treatment for EBV in post-transplant lymphoproliferative disease in immunocompromised patients?
- Reduce immunosuppression - Rituximab (anti-CD20 monclonal Ab)
32
What is the treatment for glandular fever?
- Supportive care - Avoid high-contact sports - Avoid penicillins = maculopapular rash
33
What is the virology of HHV 6/Roseola Virus (Human Herpesvirus 6)?
Latent in monocytes/lymphocytes
34
What is the clinical presentation of HHV 6 / Roseola Virus?
Roseola Infantum (Exanthum Subitum, Sixth disease) - 3/7 fever THEN sudden maculopapular rash - Rash starts on trunk then spreads to face + extremities - Rarely causes encephalitis - Most common cause: febrile convulsions
35
What is the route of transmission for HHV6 (Roseola Virus)?
Droplet infection
36
What is the management for roseola infantum?
- Sx treatment = fluids
37
How is roseola infantum diagnosed?
- Clinical Dx - Blood PCR
38
What is the virology of HHV / Kaposi's Sarcoma (Human Herpesvirus 8)?
- Enveloped dsDNA genome
39
What is the transmission of HHV8/Kaposi's sarcoma?
Genitally
40
How does HHV8 present in an immunocompromised patient?
- Kaposi's sarcoma (pathognomonic for HIV) - Primary effusion lymphoma (a/w EBV coinfection) - Castleman''s disease (non-cancerous growth in LNs)
41
How is HHV8/Kaposi's sarcoma treated?
- Chemoradiotehrapy - Surgical excision - Initiation of HAART (highly active anti-retroviral treatment) for causative HIV infection
42
What are the polyomaviridae viruses?
- JC virus - BK virus
43
What is the virology of JC virus?
- Unenveloped dsDNA genome
44
How does JC virus present in an immunocompromised patient (especially AIDs)
1. Progressive multifocal leukoencephalopathy 2. Rapidly demyelinating disease + neurological deficits
45
What is the treatment for JC Virus?
Anti-retroviral therapy for HIV
46
What is the virology of BK virus?
- Unenveloped dsDNA genoma
47
How does BK virus present in an immunocompromised patient (especially post-transplant)?
1. BK haemorrhagic cystitis 2. BK nephropathy
48
What is the treatment for BK virus?
Cidofovir (cytidine analogue chain terminator)
49
What are the respiratory viruses?
- Influenza - Adenovirus - Coronavirus
50
What is the virology of the influenza virus?
- Enveloped, negative sense segmented genome - 8 segments
51
How does the influenza virus present?
- URTI - Systemic features inc. muscle aches
52
What is the treatment for the influenza virus?
1. Oseltamivir (Tamiflu) = inhibits NA, blocks virion release
53
What is the virology of adenovirus?
Unenveloped dsDNA genoma
54
How does adenovirus present in an immunocompromised patient (especially transplant)?
1. Encephalitis (meningoencephalitis) 2. Pneuomonitis 3. Colitis 4. Haemorrhagic cystitis
55
What is the treatment for adenovirus?
- Usually self-limiting - Supportive care in ITU/HDU In multi-organ involvment: - Cidofovir - IVIG
56
What is the virology of coronaviruses?
- Positive sense ssRNA genomes - Causative organisms for SARS + MERS pandemics
57
How does coronavirus present?
- URTI - Sometimes has systemic infections Severe infection can cause: - ARDS - Respiratory failure - Shock - Multi-organ dysfunction
58
What is the treatment for coronavirus?
- Self limiting IF severe/hospital admission: - Dexamethasone - Remdesivir
59
What is the virology of Hep A?
- Unenveloped picornavirus - Positive sense ssRNA genome
60
How does Hep A present and how is it diagnosed?
Acute Hepatitis: - 2-6wk incubation - Severe in elderly - Jaundice - Hepatitis - Cholestasis - Malaise - Dx: - Acute: Anti-HAV IgM (persists <14wks)
61
What is the transmission of Hep A?
Faeco-oral
62
What is the treatment for Hep A?
- Supportive care (resolves in 2 months) - Vaccine (live attenuated + inactivated)
63
What is the virology of Hep B?
- Enveloped hepadnavirus (reversivirus) - Hybrid genome - Mostly DNA with an associated RNA species
64
What are the features of Hep B?
1. Acute + chronic diseaase 2. Transmission by bodily fluids: Sexual, vertical, blood products 3. Virus cleared in majority of individuals (90% clearance> 5 y.o; 10% clearance in neonates) 4. Lasts ~6 months
65
How is Hep B treated?
1. Interferon α 2. TENOFOVIR (nuceloTide analogue) 3. Lamivudine (nuceloside analogue) 4. Entecavir (nucleoside analogue) 5. Telbivudine (nucleoside analogue)
66
What are the treatment goals for Hep B?
- Prevent progression to cirrhosis + HCC - Maintain serum HBV DNA level as low as possible
67
What is the Hep B vaccine comprised of?
- Recombinant vaccine - Purified HbSAg
68
What is the virlogy of Hep C?
- Enveloped flavivirus - Positive sense ssRNA genome
69
What are the general features of Hep C?
1. Acute + chronic disease 2. Mainly blood product spread (60-80% chronicity) 3. Transmission = bodily fluids + vertically 4. Mostly symptomatic
70
What are some complications of Hep C?
- Cirrhosis - Cryoglobulin Ax disease - Glomerulonephritis
71
What are the most common Genotypes for Hep C?
Genotypes 1 (treatment less successful than 2 + 3)
72
How is Hep C diagnosed?
- Measure of HCV RNA (confirms infection)
73
What is the treatment for Hep C?
Direct Acting Antivirals = curative: - NS3/4 protease inhibitors (-previrs) = block translation - NS5A inhibitors (-asvirs) = block release - Direct polymerase inhibitors -buvirs) = block replication OR: - Interferon α therapy
74
What is the virology of Hep D?
- Deltavirus - Enveloped virus - Negative Sense - Single-stranded circular RNA
75
What are the clinical features of Hep D?
1. Simultaneous co-infection with Hep B 2. Superinfection (on top of) Hep B = more severe (cirrhosis in 2-3yrs) 3. Transmission = sexual, parental, perinatal
76
What is the treatment for Hep D?
Peginterferon-α
77
What is the virology of Hep E?
Unenveloped positive sense SSRNA genome
78
What are the clinical features of Hep E?
1. Acute hepatitis = India 2. Faeco-oral transmission 3. High risk in pregnant women Sx: - Jaundice - Hepatitis - Cholestasis - Malaise
79
What are some rare complications of Hep E?
- CNS disease: Bell's palsy, Guillain Barre, other - Chronic infection
80
What is the treatment for Hep E?
- Supportive care - Resolves in 2 months Vaccine = recombinant HEVg1
81
What are some paediatric infections?
- Rubella virus - Human parvovirus B19 - Morbillivirus - Zika virus
82
What is the virology of rubella virus?
- Enveloped virus - Positive sense ssRNA genome
83
How does rubella present in a child?
German Measles: - Maculopapular rash - Lymphadenopathy - Fever - Lesions on soft palate (FORCHHEIMER SIGN)
84
What is the treatment for rubella?
- No antiviral therapy available - MMR VACCINE
85
How does congenital rubella syndrome present?
Triad: Sensorineural deafness, cataracts, heart deformity (PDA) Ears: SENSORINEURAL DEAFNESS Eyes: CATARACTS, glaucoma, retinopathy, microphthalmia Heart: PDA, VSD Neurology: microcephaly, psychomotor retardation Pancreas: Insulin dependent DM (late)
86
What are the risks to rubella infection throughout pregnancy?
- <8 wks = 20% chance of spontaneous abortion - 13-18wks = hearing defects + ?retinopathy - >20 wks = No documented risk
87
What is the virology of human parvovirus B19?
- Unenveloped - dsDNA genome
88
How does human parvovirus B19 present as slapped cheek (Fifth Disease)?
- Erythema infectiosum - Transient aplastic crisis - Arthralgia - Fever + malaise
89
What other conditions can human parvovirus B19 present as?
Viral myocarditis
90
How can human parvovirus B19 present congenitally?
- Foetal anaemia - Leads to cardiac failure - Leads to hydrops foetalis
91
What is the the treatment for a congenital human parvovirus B19 infection?
Intrauterine blood tranfusion
92
What is the virology of Morbilivirus?
- Enveloped - Negative sense ssRNA genome
93
What condition is associated with Morbilivirus and how does it present?
Measles - Fever + malaise - Cough, coryzal Sx + conjunctivitis - Koplik's spots (buccal mucosa) - Maculopapular rash
94
How does Morbilivirus present as a congenital infection?
- No foetal abnormalities - Foetal loss, preterm delivery
95
What is the virology of zika virus?
- Enveloped falvivirus - Positive sense ssRNA genome
96
How does Zika virus present congenitally?
- Severe microcephaly + skull deformity - Decreased brain tissue, subcrotical calcification - Retinopathy, deafness - Talipes (feet turned in like club foot), contractures - Hypertonia
97
What is the serology of Hep A?
Acute Infection: - IgM = +ve - IgG = -ve Previous Infection: - IgM = -ve - IgG = +ve Vaccinated: - IgM = -ve - IgG = +ve
98
What is the serology of Hep B?
Acute Infection: - IgM = +ve - HBsAg = +ve - Anti-HBc = +ve - Anti-HBs = -ve Chronic Infection: - IgM = -ve - HBsAg = +ve - Anti-HBc = +ve - Anti-HBs = -ve Previous Infection: - IgM = -ve - HBsAg = -ve - Anti-HBc = +ve - Anti-HBs = +ve Vaccinated: - IgM = -ve - HBsAg = -ve - Anti-HBc = -ve - Anti-HBs = +ve
99
What is the serology of Hep C?
Acute Infection: - IgG = -ve - HCV RNA = +ve Chronic Infection: - IgG = +ve - HCV RNA = +ve Previous Infection: - IgG = +ve - HCV RNA = -ve
100
What is the serology of Hep E?
Acute Infection: - IgM = +ve - IgG = -ve Previous Infection: - IgM = -ve - IgG = +ve

Pathology (Guide) (84 decks)

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