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Flashcards in Viremia Deck (100):
1

What are the four major diseases that viruses that cause circulatory infections cause?

1. CA
2. Birth defects
3. Immunosuppression
4. Cardiac dysfunction

2

What is the state of viral infection for mono?

Productive, but disease due to immnopathology

3

What is the state of viral infection for oral hairy leukoplakia?

Productive

4

What is the state of viral infection for Burkitt's lymphoma?

Latent

5

What is the state of viral infection for Hodgkin's disease?

Latent

6

What is the state of viral infection for nasopharyngeal carcinoma?

Latent

7

What is the state of viral infection for PTLD?

Latent

8

What are the six diseases that the epstein Barr virus can present as?

1. Mono
2. Oral hairy leukoplakia
3. Burkitt's lymphoma
4. Hodgkins lymphoma
5. Nasopharyngeal carcinoma
6. PTLD

9

What is the family of EPV? Enveloped? Genome?

Herpesviridae
Enveloped
dsDNA

10

What is the component of the complement that herpes viruses use to attach and enter into cells?

C3d

11

What two types of cells do EPVs replicate in?

B cells
Epithelial

12

What is the pathophysiology of EBV?

Infects B cells, causes them to reproduce and create heterophile antibodies

T cells come in to kill, but not perfect. leave memory B cells

13

What is the first test for EBV?

Look for heterophile antibodies

14

What cells contribute to EBV latency?

Memory B cells

15

What are the genes associated in EBV carcinogenesis?

1. Latent membrane protein 1
2. LMP2
3. EBV nuclear antigen-1

16

What is LMP1? What does this protein lead to?

6 transmembrane domains protein with a CD40 homologue

Leads to high proliferation

17

What is LMP2?

Protein that increases growth of B cells

18

What is EBV nuclear antigen 1

Transactivation of EBV

inhibit apoptosis

19

What is the primary mode of transmission for EBV?

Saliva

20

What are the four major symptoms of mono?

1. Fever, malaise etc
2. **Exudative**pharyngitis
3. Splenomegaly
4. TTP lymphadenitis

21

What is the biochemical markers for mono?

Heterophile antibodies

22

What is the epidemiology of mono ( in the US)?

Young adulthood

23

What is the major complication of mono?

Spleen rupture

24

What is the pathogenesis of mono?

Immune targeting of the infected B cells

25

What is the treatment for mono?

1. Supportive
2. Avoid splenic rupture

26

Ampicillin treatment of EBV causes what?

A diffuse, petechial rash

27

How long are symptoms present with mono?

About a month

28

How long do atypical lymphocytes caused by EBV last?

About a month

29

How long does the heterophile titer remain elevated in EBV?

About a month

30

When does anti-EA production start in EBV infection?

about 10 days, and continues to end of the month of infx

31

When does anti-VCA production start in EBV mono infection?

day 10 to forever (IgM to IgG)

32

When do antibodies to the EBNA start?

Months later

33

How do you diagnose mono?

Mono spot test looking for heterophile antibodies agglutination to sheep or horse RBC

Antibodies to EBV

34

What are downey cells? What are the three characteristics of these cells?

Atypical T cells found in EBV infections

1. Have vacuoles
2. Altered nucleus
3. Indented cell margin

35

How can we prevent mono? Is there a vaccine?

No vaccine
antivirals to inhibit the viral pol

36

Are antivirals effective in EBV?

Yes, but symptoms remain unchanged b/c of immune response

37

Who usually gets oral hairy leukoplakia?

Immunosuppressed population

38

What causes oral hairy leukoplakia?

EBV shedding

39

What is the treatment for oral hairy leukoplakia? (2)

1. Antiherpetic drugs
2. Podophyllin resin

40

What is Burkitt's lymphoma caused by?

EBV

41

Where in the body does Burkitt's lymphoma present? Symptoms?

B cells in the Jaw of children

CA of the jaw

42

Where is the world is Burkitt's lymphoma found?

Africa

43

What causes Burkitt's lymphoma?

Myc gene on ch14 translocated to ch8, changes E2F expression

44

What is the pathophysiology of Burkitt's lymphoma?

Increase in E2F d/t translocation of the Myc gene

45

What is the treatment for Burkitt's lymphoma?

Chemo

46

What are the two cofactors of Burkitt's lymphoma?

Chronic malaria
Immune suppression

47

What is Hodgkin's disease?

EBV caused B cell disruption

48

What are the symptoms of Hodgkin's disease?

Nontender, lymphadenopathy in the neck and/or axilla

Fever, weight loss, night sweats

49

What is a Reed-sternberg cell? What is this diagnostic of?

A large cell with two or more nuclei or nuclear lobes, each of which has eosinophils



This is associated with Hodgkins' disease

50

What is the treatment for Hodgkin's?

Radiotherapy or chemo

51

What is the cause of nasopharyngeal carcinoma?

EBV

52

What are the symptoms of nasopharyngeal carcinoma?

Facial pain/fullness

hearing loss

53

What cells are affected in nasopharyngeal carcinoma?

Epithelial cells

54

What is the treatment for nasopharyngeal carcinoma?

Chemo/radiation

55

What is PTLD (post transplantation lymphoproliferation disorder)?

Abnormal proliferation of lymphoid cells in a transplant pt d/t EBV

56

What are the symptoms of PTLD?

Fever, weight loss, progressive encephalopathy

57

What is the major risk factor for PTLD?

EBV infection at the time of transplant

58

How do you diagnose PTLD?

Histological analysis

59

What is the treatment for PTLD? (3)

1. reduce immunosuppression
2. Rituximab (binds CD20)
3. Conventional chemo

60

What is the family of CMV? Enveloped? Genome?

Herpesviridae
Enveloped
dsDNA

61

Most infections with CMV lead to what?

Asymptomatic to mono-like

62

CMV infections with AIDs pts result in what?

Mutlisite symptomatic disease

63

Primary CMV infections of new mothers lead to what?

Developmental problems (cytomegalic inclusion disease)

64

Where does the CCMV replicate? Where is it latent?

Mucosal epi/viremia

Latet in monocytes

65

Reactivation of CMV is (always/rarely) symptomatic in immunocompetent pts?

Rarely

66

How is CMV transmitted?

Saliva
Breast milk
Urine
Fomites
Sex

67

How do you diagnose CMV?

1. Detection of viral DNA in diseases tissue
2. Seroconversion

68

Why is it hard to diagnose CMV?

virus can shed for year after initial infection during other infections

69

What is the 1st line treatment for CMV?

1. Gancyclovir
2. Valganciclovir

70

What is the MOA of Ganciclovir?

Converted to viral pol inhibitor by CMV enzymes

71

What is the MOA of valganciclovir?

Converted to ganciclovir within the body

72

What is the toxicity associated with Ganciclovir?

Bone marrow toxicity
Neutropenia

73

What is the 2nd line treatment for CMV? Why are they second line?

1. Cidofovir
2. Foscarnet

2nd b/c IV, and renal toxic

74

What is the MOA of cidofovir?

Converted to a viral pol inhibits by cellular enzymes

75

What is the MOA of Foscarnet?

Direct inhibitor of the CMV pol

76

What is the primary disease caused by CMV

CMV mono-like illness

77

What are the symptoms of CMV IM-like illness?

fever, fatigue

NON-exudative pharyngeitis

78

What is the etiology of CMV IM-like illness?

Primary infection with CMV

79

Is there heterophile antibody production with CMV IM-like illness?

no

80

How do you differentiate between CMV IM-like illness and IM caused by EBV? (2)

EBV has exudative pharyngitis and heterophile production

CMV IM-like illness does not

81

When is CMV inclusion body disease found in babies? Does it cross the placenta

Most common with primary infections of mother during prego

Crosses placenta

82

What are the symptoms of CMV inclusion body disease in newborns?

1. Hepatosplenomegaly
2. Jaundice
3. Petechial rash

83

What is the most common congenital viral infection in the US?

CMV inclusion body disease

84

How does congential CMV infection occur? How often is this passed on from mothers?

Mother exposure to primary CMV virus

33% of the time passed onto child

85

How do you prevent CMV inclusion disease?

Prevent seronegative pregnant women from coming into contact with babies or other infected with CMV

86

What is the treatment for maternal treatment with CMV?

CMV immunoglobin

87

What is the most common viral pathogen complicating organ transplant?

CMV

88

When do AIDS patient present with CMV diseases?

between 50-100 CD4 count

89

What are the symptoms of CMV in immunocompromised pts?

Spiking fever, followed by hypothermia

90

What are the two ways that transplantation result in a CMV infection?

Reactivation d/t immunosuppression

From organ

91

What are the usual diseases associated with CMV transplantation? For HIV pts?

CMV penumonitis = transplant
GI tract illness = HIV, CMV retinitis

92

What is the complication risk in CMV transplant infection?

Perforation and hemorrhage of GI epithelium

Graft vs host disease

93

What are the symptoms of CMV in AIDS pts?

CMV retinitis, GI tract illnesses

94

What are the symptoms of CMV retinitis?

1. Blurred vision
2. Floaters
3. White, necrotic lesions on fundoscopic exam

95

How do you prevent CMV in organ transplants?

Seronegative matching donors

96

How do you diagnose CMV retinitis?

Fundoscopic exam seeing necrotic lesions

97

What is the treatment for CMV in immunocompromised pts?

Prophylaxis with antivirals

98

What are the general characteristics of viral diseases of the systemic circulation?

Hide and lay dormant

99

What abx is associated with a rash if given to pts with mono?

Ampicillin

100

What is the CA caused by EBV that is the result of a translocation of a gene: Hodgkin's lymphoma, or Burkitt's lymphoma? What is the gene that is translocated?

Burkitt's lymphoma

Gene for E2F translocated to Chromosome 8 to 14