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MRCP: Infectious Diseases > Viruses > Flashcards

Viruses Flashcards

1
Q

What are the various presentations of Parvovarius B19?

A

Pancytopaenia
Aplastic crisis in sickle cell
Hydrops foetalis

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2
Q

How does hydrops foetalis occur?

A

Causes severe anaemia due to viral suppression of fetal erythropoiesis → heart failure secondary to severe anaemia → the accumulation of fluid in fetal serous cavities (e.g. ascites, pleural and pericardial effusions)

Treatment: Intrauterine blood transfusion

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3
Q

What type of virus is hepatitis B?

A

double-stranded DNA hepadnavirus

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4
Q

How is hepatitis B spread?

A

Blood
Bodily fluids
Vertical transmission to mother

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5
Q

What are the features of hepatitis B?

A

Fevers
Jaundice
Elevated liver transaminases

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6
Q

What are the complications of Hepatitis B?

A

Chronic hepatitis
Fulminant liver failure (1%)
hepatocellular carcinoma
Glomerulonephritis
Polyarteritis nodosa
Cryoglobulinaemia

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7
Q

What are the three antigens for Hep B? And their meaning

A

Surface antigen - HBsAB
Core antigen - HBcAg
DNA polymerase associated antigen HBeAg -

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8
Q

What does presence of HBsAG mean?

A

Early acute phase - actively infectious

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9
Q

What does presence of HBsAG and Anti-HBc mean?

A

Acute disease or chronic carrier

Antibody made against core antigen

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10
Q

What does presence of anti-HBs and anti-HBc mean?

A

Antibodies to surface and core

Suggests convalescing or immune to disease

May be immune from disease or vaccination

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11
Q

What does Anti-HBc mean?

A

Recent disease - taken after HBsAG disappeared and before anti-HBs made

Patient is considered infectious

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12
Q

What does an antibody level of Anti-HBs > 100 mean?

A

Adequate response
Booster only needed in 5 years

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13
Q

What does an antibody level of Anti-HBs 10-100?

A

Suboptimal response - one additional vaccine dose should be given. If immunocompetent no further testing is required

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14
Q

What does an antibody level of Anti-HBs <10?

A

Non-responder

Give further vaccine course (i.e. 3 doses again) with testing following.

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15
Q

How is hepatitis B treated?

A

Pegylated interferon-alpha (first one available) or other pegylated interferon

enofovir, entecavir and telbivudine (a synthetic thymidine nucleoside analogue)

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16
Q

What viruses causes Orf? How is it transmitted?

A

It is caused by the parapox virus.

Transmitted for sheep

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17
Q

What are features of off in humans?

A

Affects the hands and arms
Small, raised, red-blue papules
later may increase in size to 2-3 cm and become flat-topped and haemorrhagic

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18
Q

What does amantidine do? And its mechanism?

A

Anti-viral / Parkinsons disease

Inhibits uncoating (M2 protein) of virus in cell.

Also releases dopamine from nerve endings

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19
Q

What type of virus if hepatitis D?

A

Single stranded RNA virus

It is an incomplete RNA viruses and requires hepatitis B surface antigen for transmission cycle

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20
Q

What is a Hepatitis D “co-infection”?

A

Co-infection: Hepatitis B and Hepatitis D infection at the same time.

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21
Q

What is a Hepatitis D “superinfection”?

A

A hepatitis B surface antigen positive patient subsequently develops a hepatitis D infection.

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22
Q

How is Hepatitis D transmitted?

A

Fluids / Bodily fluid

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23
Q

What are the risks of a hepatitis D infection with hepatitis B?

A

fulminant hepatitis, chronic hepatitis status and cirrhosis.

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24
Q

What viruses cause genital warts?

A

HPV 6 and HPV 11

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25
Q

Management of genital warts?

A

First line: Podophyllum for multiple lesions and non-keronitonised

First line: Cryotherapy
Solitary keritonised lesions

Second line: Imiquimod

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26
Q

Which virus (and types) predispose to cervical cancer?

A

HPV 16, 18, 33

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27
Q

What type of virus is behind measles?

A

RNA paromyxovirus

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28
Q

What are the features of measles?

A

Prodromal phase
- irritable
- conjunctivitis
- fever

Koplik spots
- typically develop before the rash
- white spots (‘grain of salt’) on the buccal mucosa

Rash
- starts behind ears then to the whole body
- discrete maculopapular rash becoming blotchy & confluent
- desquamation that typically spares the palms and soles may occur after a week

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29
Q

Most common cause of death from measles?

A

Pneumonia

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30
Q

Most common complication post measles?

A

Otitis media

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31
Q

Complications post measles? (8)

A

Otitis media: the most common complication
Pneumonia: the most common cause of death
Encephalitis: typically occurs 1-2 weeks following the onset of the illness)
Subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
Febrile convulsions
Keratoconjunctivitis, corneal ulceration
Increased incidence of appendicitis
Myocarditis

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32
Q

An unvaccinated child comes into contact with measles, how is this best managed?

A

Give MMR
Vaccinate antibodies develop faster than active infection
Should be given within 72 hours

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33
Q

What investigation should be done for measles?

A

IgM antibody test

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34
Q

What is the mechanism of action of acyclovir?

A

Guanosine analogue

require phosphorylated by tyrosine thymidine kinase to work

Leads to inhibition of DNA polymerase

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35
Q

What antiviral agent should be used in HSV and VZ?

A

Acyclovir

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36
Q

What antiviral agent should be used in CMV?

A

Ganicyclovir

37
Q

What is the mechanism of action of ganicyclovir?

A

Guanosine analogue

requires phosphorylated by tyrosine thymidine kinase to work

Leads to inhibition of DNA polymerase

38
Q

What is the complication of acyclovir?

A

Crystalline nephropathy

39
Q

What is the complication of ganicyclovir?

A

Myelosuppression

40
Q

What antiviral is used in chronic hep C and RSV?

A

Ribavirin

41
Q

What is the mechanism of action of ribavirin?

A

Guanosine analogue

Inhibits IMP

Interferes with the capping of viral mRNA

42
Q

What is the complication of ribavirin?

A

Haemolytic anaemia

43
Q

What antiviral agent is used in Parkinson’s disease and influenza?

A

Amantadine

44
Q

What is the mechanism of action of amandtadine?

A

Inhibits uncoating (M2 protein) of virus in cell.
Also releases dopamine from nerve endings

45
Q

When is the antiviral agent foscarnet indicated? And its mechanism of action?

A

If HSV or CMV not responding to acyclovir

46
Q

What are the complications of foscarnet?

A

Nephrotoxicity, hypocalcaemia, hypomagnasaemia, seizures

47
Q

What is the indication for interferon alpha?

A

Chronic hepatitis B & C
Hairy cell leukaemia

48
Q

What is the mechanism of action of interferon alpha?

A

Human glycoproteins which inhibit synthesis of mRNA

49
Q

Side effects of interferon alpha?

A

Flu-like symptoms
Anorexia
Myelosuppression

50
Q

What antiviral agent does not require phosphorylation to work?

A

Cidofovir

51
Q

What is the indication for cidofovir?

A

CMV retinitis in HIV

52
Q

What viruses can cause glandular fever?

A

EBV ( most common)
CMV
HHV-6

53
Q

What is the classic triad of glandular fever?

A

Sore Throat

Cervical lymphadenopathy
*Anterior and posterior chain

Pyrexia

Please note: Tonsillitis typically give anterior china cervical lymphadenopathy - not posterior

54
Q

What other features can be found in glandular fever?

A

Malaise, anorexia, headache
palatal petechiae
Splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
hepatitis,
Transient rise in ALT
Lymphocytosis: presence of 50% lymphocytes with at least 10% atypical lymphocytes
Haemolytic anaemia secondary to cold agglutins (IgM)

Maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis

55
Q

What are the risk of varicella exposure to a pregnant mother?

A

Mother: Pneumonitis

Foetus:features of FVS include skin scarring, eye defects (microphthalmia), limb hypoplasia, microcephaly and learning disabilities

56
Q

Management of VZV exposure in pregnancy?

A

If any doubt regarding immune status - IgG Varicella should be checked

If < 20 weeks gestation not immune antibody status - Give Immunoglobulin

If > 20 weeks no immun antibody status - Acyclovir to be given 7-14 days AFTER exposure

If rash present:
>20 weeks oral aciclovir should be given if the pregnant women is ≥ 20 weeks and she presents within 24 hours of onset of the rash
if the woman is < 20 weeks the aciclovir should be ‘considered with caution’

57
Q

What malignancies are associated with EBV?

A

Burkitt’s lymphoma*
Hodgkin’s lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas

58
Q

What type of virus is EBV?

A

Herpesvirus

59
Q

What is swine flu?

A

H1N1
It is a subtype of influenza A

60
Q

What are the features of influenza?

A

fever greater than 38ºC
myalgia
lethargy
headache
rhinitis
sore throat
cough
diarrhoea and vomiting

61
Q

What is the treatment for H1N1? Mechanism?

A

Oseltamivir (Tamiflu)
Oral medication
a neuraminidase inhibitor which prevents new viral particles from being released by infected cells

Zanamivir
inhaled medication*
also a neuraminidase inhibitor

62
Q

What is the side effect of H1N1?

A

nausea, vomiting, diarrhoea and headaches

63
Q

What is the side effect of oseltamivir? And zanamivir?

A

Oseltamivir: nausea, vomiting, diarrhoea and headaches

Zanamivir: may induce bronchospasm in asthmatics

64
Q

How is measles spread?

A

Aerosol

65
Q

What is 5’ths disease?

A

Rose-red rash makes the cheeks appear bright red, hence the name ‘slapped cheek syndrome’.

e virus can affect an unborn baby in the first 20 weeks of pregnancy

66
Q

What test should be done in a pregnant mother with possible exposure to 5ths disease?

A

IgM
IgG

67
Q

What is the most common and serious complication of chickenpox in adults? How is this treated?

A

Varicella pneumonia

Treated with IV acyclovir

68
Q

What type of virus is hepatitis C?

A

RNA flavivirus

69
Q

How is hepatitis transmitted?

A

Vertical transmission
(higher risk with HIV)

70
Q

What are the features of heptatis C?

A

A transient rise in serum aminotransferases / jaundice
Fatigue
Arthralgia

71
Q

What is the best investigation for hepatitis C?

A

HCV RNA

72
Q

If a patient has an anti-HCV what does it mean?

A

Previous hepatitis C infection

73
Q

What percentage of people get chronic hepatitis C?
what classifies as chronic hepatitis C?

A

majority (55-85%) will develop chronic hepatitis C

Persistence HCV RNA for > 6 months

74
Q

Is there a vaccine for hepatitis C?

A

No

75
Q

What are the complications of chronic hepatitis C?

A

Rheumatological problems:
- arthralgia, arthritis
- eye problems: Sjogren’s syndrome
- cirrhosis (5-20% of those with chronic disease)

Hepatocellular cancer
Cryoglobulinaemia: typically type II (mixed monoclonal and polyclonal)
Porphyria cutanea tarda (PCT)
Membranoproliferative glomerulonephritis

76
Q

How is hepatitis C treated?

A

Aim of treatment is sustained virological response (SVR), defined as undetectable serum HCV RNA six months

Combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used

77
Q

What are the side effects of ribavirin?

A

Haemolytic anaemia
Cough
Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic

78
Q

What are the side effects of interferon alpha?

A

flu-like symptoms, depression, fatigue, leukopenia, thrombocytopenia

79
Q

What type of virus is hepatitis E? How is it spread?

A

RNA hepevirus
Faecal oral route

80
Q

What are the features in hepatitis E?

A

Severe hepatitis in a pregnant woman - think hepatitis E

81
Q

What are the features of Japanese encephalitis?

A

Headache, fever, seizures and confusion. Parkinsonian features indicate basal ganglia involvement. It can also present with acute flaccid paralysis

Basal ganglia inflammation

82
Q

What is the diagnosis of Japanese encephalitis?

A

Diagnosis is by serology or PCR.

83
Q

How is Lassa virus spread?

A

Excreta of infected African rats (Mastomys rodent) or by person-to-person spread.

84
Q

How is the Marburg virus spread?

A

Risk factors for transmissions include caves/bats and primates.

85
Q

How is hepatitis E spread?

A

Hepatitis E is associated with faecal-oral spread, commonly affecting shellfish and pork products.

86
Q

What are the features of HSV 1 and HSV 2 infection?

A

primary infection: may present with a severe gingivostomatitis
cold sores
painful genital ulceration

87
Q

How is gingivostomatitis managed? (HSV infection)?

A

oral aciclovir, chlorhexidine mouthwash

88
Q

How should coldsores HSV be managed?

A

topical aciclovir although the evidence base for this is modest

89
Q

How should you decide between dengue or chikungunya?

A

Absence of a rash makes chikungunya more likely than dengue.
Both have bone pain

MRCP: Infectious Diseases (15 decks)

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