VIRUSES Flashcards

Question

Aseptic Meningitis | Picorna (+) ssRNA

Answer 1

Causative organism: Coxsackie B Classic Clinical Presentation: headache, photophobia, fever, stiff neck; Encephalitis. Resolves in kids (approximately?). More complicated in adults. Transmission: Epi: summer, kids Pathogenesis: Method of Diagnosis: lumbar puncture, PCR of CSF Treatment/Interventions: self-limited, IV-IG (IV immunoglobulin) if recurrent Treatment mechanism/Adverse effects:

Answer 2

Causative organism: Coxsackie B (or Echovirus) Classic Clinical Presentation: Upper respiratory tract (URT) infection seeds to heart --> local necrosis, inflammation, can cause chronic heart failure (CHF) Transmission: Epi: child and teen males 2:1 Pathogenesis: Method of Diagnosis: Treatment/Interventions: IVIG (IV immunoglobulin) if bad; worst case: transplant Treatment mechanism/Adverse effects:

Answer 3

Causative organism: Enterovirus Classic Clinical Presentation: hepatic necrosis, sepsis-like symptoms, myocarditis, encephalitis, high fatality rates Transmission: perinatal transmission from mother Epi: newborns Pathogenesis: Method of Diagnosis: Treatment/Interventions: IVIG (IV immunoglobulin) Treatment mechanism/Adverse effects:

Answer 4

``` Causative organism: common symptoms enterovirus Classic Clinical Presentation: self-limited; most common symptoms of enterovirus infections Transmission: Epi: Pathogenesis: Method of Diagnosis: Treatment/Interventions: Treatment mechanism/Adverse effects: ```

Answer 5

Causative organism: Norovirus (aka Norwalk virus) Classic Clinical Presentation: 1-3 days; self-limited diarrhea, vomiting, maybe flu-like symptoms (especially cruises). causes blunting of jejunum villi. Transmission: feca-oral, fomites, aerosol-vomitus; food-borne outbreaks. HIGHLY CONTAGIOUS (10 particles!) Epi: causes 50% of viral gastroenteritis; cruise ships; point source outbreaks (foodborne); all ages because no immunity Pathogenesis: no envelope, encodes 4 peptides: helicase (unwind RNA), protease (cleaves mRNA peptide), RNA polymerase, capside; no toxin Method of Diagnosis: 1) clinical (vomiting + diarrhea > 50% of people infected); 2) RT-PCR (reverse transcriptase PCR) on stool or vomit Treatment/Interventions: supportive (rehydration) Treatment mechanism/Adverse effects: hard to find supportive care on a cruise ship

Answer 6

Causative organism: West Nile Virus Classic Clinical Presentation: Fever, headache, myalgias, lymphadenopathy, rash, acute flaccid paralysis Transmission: Mosquito; subacute infection in most; encephalitis in very young, old, immunocompromised Epi: all cause ENCEPHALITIS; need mosquito presence; summer in temperate climates, tropics Pathogenesis: hematogenous spread Method of Diagnosis: IgM in CSF, PCR Treatment/Interventions: supportive Treatment mechanism/Adverse effects:

Answer 7

Causative organism: St. Louis Encephalitis Virus Classic Clinical Presentation: Transmission: Mosquito; subacute infection in most; encephalitis in very young, old, immunocompromised Epi: all cause ENCEPHALITIS; need mosquito presence; summer in temperate climates, tropics Pathogenesis: Method of Diagnosis: Treatment/Interventions: Treatment mechanism/Adverse effects:

Answer 8

``` Causative organism: dengue virus Classic Clinical Presentation: Transmission: mosquito; subacute infection in most; encephalitis in very young, old, immunocompromised Epi: Pathogenesis: Method of Diagnosis: Treatment/Interventions: Treatment mechanism/Adverse effects: ```

Answer 9

``` Causative organism: Yellow fever virus Classic Clinical Presentation: Transmission: mosquito; subacute infection in most; encephalitis in very young, old, immunocompromised Epi: all cause ENCEPHALITIS; need mosquito presence; summer in temperate climates, tropics Pathogenesis: Method of Diagnosis: Treatment/Interventions: Treatment mechanism/Adverse effects: ```

Answer 10

Causative organism: Rubella virus Classic Clinical Presentation: deafness, cataracts, microcephaly, blueberry muffin rash, retards in-utero growth, cardiac defects Transmission: pregnant woman inhales in 1st-2nd trimester Epi: prenatal Pathogenesis: C, E1, E2. Virus replicates in lymph nodes, viremia --> delayed rash. Enveloped. Method of Diagnosis: IgM serology; PCR Treatment/Interventions: Prevention only; avoid live virus vaccine (if pregnant?) Treatment mechanism/Adverse effects: live vaccine can cause disease

Answer 11

Causative organism: Rubella virus Classic Clinical Presentation: posterior auricular lymph nodes inflamed (posterior auricular lymphadenopathy); low fever. Milder measles symptoms. Rash on head --> toe in 24 hours Transmission: inhalation Epi: kids Pathogenesis: C, E1, E2. Virus replicates in lymph nodes, viremia --> delayed rash. Enveloped. Method of Diagnosis: PCR, IgM serology (4 times titer inc 2 weeks apart). Treatment/Interventions: Vaccine: MMR Treatment mechanism/Adverse effects:

Answer 12

``` Causative organism: Alphavirus Classic Clinical Presentation: Transmission: mosquito Epi: Pathogenesis: Method of Diagnosis: Treatment/Interventions: Treatment mechanism/Adverse effects: ```

Answer 13

``` Causative organism: Coronavirus Classic Clinical Presentation: Transmission: Epi: Pathogenesis: Enveloped; propagated epidemic Method of Diagnosis: Treatment/Interventions: Treatment mechanism/Adverse effects: ```

Answer 14

Causative organism: Influenza A Classic Clinical Presentation: "Flu-like symptoms" 4-8 days --> fever, chills, headache, myalgias, arthralgias, dry cough, nasal discharge. Complications: bacterial pneumonia, bacterial superinfection, bacterial sepsis, myositis (muscle), Reye's syndrome Transmission: respiratory secretions Epi: genetic drift (random mutations, small change) & genetic shift (genome segments trade in co-infection, huge change) --> new strains annually Pathogenesis: Hemagluttanin, Neuraminidase, M2 (M2 is A-only, makes ion channel); infects & destroys columnar epithelial cells in upper respiratory tract (increased mucous, ciliary stasis) Method of Diagnosis: clinical, nasal secretions: culture, rapid antigen testing (PCR only used for H1N1). Check for pneumonia co-infection Treatment/Interventions: Amantadine (A-only: blocks M2); Neuraminidase inhibitors (oseltamavir, zanamavir); vaccines: TIV (dead > 6 months of age) or LAIV (live, nasal, 2-50 yo) Treatment mechanism/Adverse effects: decreased uncoating via M2 proteins, decreased budding

Answer 15

Causative organism: Influenza B Classic Clinical Presentation: "flu-like symptoms" 4-8 days --> fever, chills, headache, myalgias, arthralgias, dry cough, nasal discharge Complications: bacterial pneumonia, bacterial superinfection, bacterial sepsis, myositis (muscle), Reye's Transmission: respiratory secretions Epi: genetic drift (random mutation, small change) & shift (genome segments trade in co-infection, large change) --> new strains annually Pathogenesis: Hemagluttanin, Neuraminidase, M2 (M2 is A-only, makes ion channel); infects & destroys columnar epithelial cells in upper respiratory tract (increased mucous, ciliary stasis) Method of Diagnosis: clinical, nasal secretions: culture, rapid antigen testing, (PCR only used for H1N1). Check for pneumonia co-infection Treatment/Interventions: Amantadine (A only; blocks M2); Neuraminidase inhibitors (oseltamavir, zanamavir); vaccines: TIV (dead, > 6 months old) or LAIV (live, nasal, 2-50 yo) Treatment mechanism/Adverse effects: decreased budding

Answer 16

``` Causative organism: Classic Clinical Presentation: Transmission: Epi: Pathogenesis: Method of Diagnosis: Treatment/Interventions: Treatment mechanism/Adverse effects: ```

Answer 17

Causative organism: RSV (Respiratory Synctial Virus) Classic Clinical Presentation: upper respiratory tract infection symptoms --> lower respiratory tract infection (50%) --> bronchiolitis (croup) or pneumonia (alveoli) --> edema, necrosis, atelectasis (mini lung collapse) Transmission: respiratory secretions or fomites; reinfections frequent Epi: HAI, all kids by 2 yo; severe disease if premature baby, immunosuppressed, chronic heart disease (CHD?), neonate; winter Pathogenesis: G, F=fusion (forms syncytia); can survive on fomites Method of Diagnosis: clinical viral culture, rapid antigen test if hospitalized Treatment/Interventions: supportive; if high risk: prophylactic Palvizumab (Ig for Fusion protein) > RSV-IgIV Treatment mechanism/Adverse effects: bronchodilators, steroids, antivirals don't help

Answer 18

Causative organism: Rubeola virus Classic Clinical Presentation: measles rash (face --> body, maculopapular), conjunctivitis, Koplik's spots (oral lesions), otitis media (OM?), croup. Complications: encephalitis, sclerosing panencephalitis (years later: degenerative CNS disease) Transmission: inhalation Epi: kids without vaccines (especially in 6 months-1 yo) Pathogenesis: H (hemagluttanin), F (fusion), M (matrix) proteins; Viremia --> rash 2 weeks later Method of Diagnosis: Serology: IgM-IgG titer (4x increase) Treatment/Interventions: vaccine (live attenuated) at 1 yo; Ribavarin: report to DOH Treatment mechanism/Adverse effects: don't give vaccine if immunosuppressed

Answer 19

Causative organism: Mumps virus Classic Clinical Presentation: parotid gland inflammation, fever, morbilliform rash (maculopapular), orchitis (inflammation of testes), meningitis, in utero heart defects Transmission: inhalation Epi: religious brooklyn population, anyone without vaccine Pathogenesis: HN (hemagluttanin, neuraminidase), F (fusion), 7 structural 20 day incubation, viremia --> seeds CNS, testes, salivary glands Method of Diagnosis: IgM-IgG titer (4x increase), PCR Treatment/Interventions: MMR vaccine Treatment mechanism/Adverse effects: vaccine not 100% effective

Answer 20

Causative organism: rabies virus Classic Clinical Presentation: encephalitis, delirium, hypersalivation, hydrophobia (pharyngeal muscles spasms) --> coma, flaccid paralysis, death (infects PNS, CNS, innervated organs) Transmission: bite from dog or wild animal, exposure to bats Epi: active (?) incubation 1-2 months (long!) distal from bite to brain (approximate time to symptoms) Pathogenesis: replicate in NMJ; infect motor neurons in PNS --> CNS --> PNS again; replicate in salivary glands where sensory nerves end Method of Diagnosis: RT-PCR (reverse transcriptase PCR) of saliva, skin biopsy neckline (lots of nerves); Negri bodies in brain, Ig in CSF Treatment/Interventions: Pre-exposure: inactive vaccine; post-exposure: RIG (rabies immunoglobulin, passive immunity) in wound & active vaccine HDCV Treatment mechanism/Adverse effects: if you have symptoms, you're pretty much dead

Answer 21

``` Causative organism: Ebola virus Classic Clinical Presentation: hemorrhagic fever, encephalitis Transmission: Epi: Pathogenesis: Method of Diagnosis: Treatment/Interventions: Treatment mechanism/Adverse effects: ```

Answer 22

Causative organism: HIV-1 Classic Clinical Presentation: Acute: asymptomatic, flu-like/mono-like symptoms, GALT loss (bacteremia). Antibodies by 6-12 weeks Established: low viremia, NOT latent. Asymptomatic for years. Prone to HSV zoster, TB, Kaposi's sarcoma, pneumonia. AIDS: CD4 < 200; Opportunistic Infection: CD4 < 300 Opportunistic Infections: PCP, toxoplasmosis, TB, CMV, MAC, IRIS, cryptococcus, PML, lymphoma, peripheral neuropathy, dementia Transmission: person-to-person via sex, mom to fetus or breastmilk, blood-to-blood contact (IV drug users) Epi: MSM, IV drug users; ave patient; VLSPn is about 30,000 HIV RNA/mL at six months Pathogenesis: gp120 binds CD4+ R5/X4, gp41 mediates fusion, DNA integrates into genome of CD4. Homozygous CCR5- (negative) 32 deletion = immune to R5 (strain of HIV); heterozygous HLA = controller Method of Diagnosis: Acute: Plasma HIV RNA culture or PCR, follow up with antibody test. Established: ELISA + WB to confirm AIDS if CD4 < 200 (normal 800-1200) Treatment/Interventions: if CD4 <500: HAART: 2 nucleoside reverse transcriptase inhibitors (NRTI) + (NNRTI=non-nucleoside reverse transcriptase inhibitors or INSTI=integrase inhibitor or PI=protease inhibitor + Ritonavir); New York State: treat at any CD4 level Treatment mechanism/Adverse effects: Calculate CD4: WBC x lymph% x CD4%

Answer 23

``` Causative organism: HTLV (human T lymphotropic virus) Classic Clinical Presentation: strongyloides hyperinfection Transmission: Epi: Pathogenesis: Method of Diagnosis: Treatment/Interventions: Treatment mechanism/Adverse effects: ```

Answer 24

``` Causative organism: Sin Nombre virus Classic Clinical Presentation: Transmission: Epi: southwestern U.S. Pathogenesis: Method of Diagnosis: Treatment/Interventions: Treatment mechanism/Adverse effects: ```

Answer 25

Causative organism: Prions (HuPrPSc) Classic Clinical Presentation: Spongiform encephalopathy, dementia, ataxia, death Transmission: eat cow that ate offal Epi: Brit that eats beef Pathogenesis: normal prion protein PrPc gets converted to Beta-pleated form, which forms plaques in brain Method of Diagnosis: holes in brain WITHOUT INFLAMMATION Treatment/Interventions: Treatment mechanism/Adverse effects:

Answer 26

Causative organism: Bacillus Anthracis Classic Clinical Presentation: ALL: sepsis, meningitis (esp inhaled). Cutaneous: painless vesicles --> ulcers --> painless black eschars; Inhaled: pleural effusion, necrotizing mediastinitis, respiratory failure; Intestinal: local necrosis, lymphadenitis, ascites, peritonitis; Injected: severe soft tissue infection Transmission: cutaneous, inhalation, ingestion (undercooked or contaminated meat)-working with animal hides, drums. Spores phagocytized by macrophages. Epi: Pathogenesis: spores (viable for years) enter body; 3 exotoxins (LT = PA + LF; ET = PA + EF)...(PA=protective antigen; EF=edema factor; LF=lethal factor) --> phagocytosis by macrophages --> local necrosis, regional lymphadenitis, septicemia, seeds organs, meningitis, death (20-60%). Method of Diagnosis: Cutaneous: skin biopsy best (PCR)/vesicular fluid aspiration; Inhalation: chest xray (CXR) to assess for adenopathy/effusions; PCR blood, CSF, sputum Treatment/Interventions: Ciprofloxacin (quinolone) + doxycycline (or meropenem, ampicillin, or vancomycin) for 60 days, or 10 days cutaneous; clindamycin for toxin production; Anthrax Ig for very sick patients; mortality high for inhaled! Treatment mechanism/Adverse effects:

Answer 27

Causative organism: Mycobacterium avium Classic Clinical Presentation: fever, weight loss, anemia and diarrhea, hepatosplenomegaly Transmission: ingest from soil, water Epi: AIDS CD4 < 50 Pathogenesis: Method of Diagnosis: biopsy of infected organs, blood culture Treatment/Interventions: azithromycin + ethambutol Treatment mechanism/Adverse effects:

VIRUSES Flashcards

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