Viruses

Question 1

Seroprevalence of CMV in adults of western developed countries is

Answer 1

60-80%

Question 2

T or F: Congenital CMV infection is the most common congenital infection in developed countries

Answer 2

True, seen in about 0.6% of live births . Higher rate of transmission from mothers with primary disease than those with reactivation (40% vs .2-1.8%)

Question 3

In immunoCOMPETANT patients, CMV usually causes

Answer 3

Mononucleosis-like syndrome with negative heterophil antibodies

Question 4

Which immunoCOMPROMISED are most at risk for CMV infections

Answer 4

• Organ transplant and HIV patients

Question 5

CMV inclusion disease in infected newborns presents clinically as:

Answer 5

Baby with jaundice, hepatosplenomegaly, thrombocytopenia, purpura, microcephalic, periventricular CNS calcifications, mental retardation, and motor disability
- hearing loss develops in >50% of infants symptomatic at birth

Question 6

How are CMV mononucleosis-like syndrome and EBV mono differentiated clinically?

Answer 6

Cervical lymphadenopathy is not common in CMV (but the rash following amoxicillin Administration IS seen in both)

Question 7

CMV retinitis is often described as __________ on fundoscopic exam

Answer 7

“Pizza pie” retinopathy. Infants with CMV retinitis have macular > peripheral involvement

Question 8

Other CMV presentations in immunocompromised patients

Answer 8

1. Gastrointestinal and hepatobiliary CMV : esophagitis, gastritis, IBD
2. Respiratory CMV: pneumonitis -> often occurs in lung/bone marrow transplant recipients with a mortality rate of 60-80%
3. Neuro CMV: encephalitis, more common in HIV population

Question 9

Diagnosis of CMV in immunocompetent patients

Answer 9

+ CMV DNA, abnormal LFTs, lymphocytosis are all supportive of an acute infection

Question 10

Diagnosis of CMV infections of the CNS in AIDS patients

Answer 10

PCR analysis -> cultures are not specific for disease

Question 11

Diagnosis of CMV with gastrointestinal / hepatobiliary involvement

Answer 11

Biopsy -> intranuclear “owls eye” appearance

Question 12

Treatment of CMV

Answer 12

Ganciclovir!

• foscarnet, cidofovir, and fomiversen can be used for resistant strains but they have potential toxicity so don’t use them first line

Question 13

What percentage of adults have been infected by EBV (HHV 4)

Answer 13

> 95%

Question 14

Classic symptoms of EBV mono

Answer 14

Fever, malaise, posterior cervical lymphadenopathy, myalgias, upper lid edema

• splenomegaly (50%) of patients,
• maculopapular/petechiae rash (15% of pts unless given amoxicillin than 90%)
• soft palatial petechiae

Question 15

What is Hoagland sign?

Answer 15

Transient upper lid edema seen in EBV monocnucleolus

Question 16

Lab findings in acute EBV

Answer 16

Rise and fall of IgM to EB virus capsid antigen (VCA)

And rise in IgG to VCA and EBV nuclear antigen which persists for life

Question 17

Treatment of mono

Answer 17

• supportive. If impending airway obstruction, hemolytic anemia or thrombocytopenia give corticosteroids

Question 18

If an EBV patients has a secondary bacterial pharyngitis with beta hemolytic strep, what is the treatment of choice

Answer 18

Penicillin or azithromycin -> AVOID AMPICILLIN AND AMOXICILLIN DUE TO RASH

Question 19

EBV can cause ____ in HIV patients

Answer 19

Primary CNS lymphoma

Question 20

T or F: HSV 2 increases the risk of HIV

Answer 20

True! HIV replication is increased by interaction with HSW proteins

Question 21

T or F: HSV-2 is associated with cervical cancer

Answer 21

False

Question 22

HSV meningitis presents how

Answer 22

Flu-like prodrome, HA, fever, behavioral and speech disturbances, seizures

TEMPORAL lobe often involved

Question 23

_________ of the people who develop herpes labialis will have recurrence

Answer 23

1/3

Question 24

Recurrences of HSV infections are often milder with a shorter course. What can provoke recurrence?

Answer 24

Sun exposure, fever, surgery, viral infection, chemotherapy, stress

Question 25

HSV ___ can cause bell palsy

Answer 25

HSV- 1

Question 26

What is the leading cause of erythema multiforme minor

Answer 26

HSV

Question 27

HSV diagnosis

Answer 27

1. HSV ocular disease: dendritic ulcers that stain with flourescein 2. Esophagitis: endoscopic biopsy with PCR and cultures 3. Proctitis: Rectal swab + PCR and cultures

Question 28

Treatment for HSV keratitis

Answer 28

Trifluridine and vidarabine

Question 29

Treatment for HSV encephalitis and CNS meningitis

Answer 29

IV acyclovir

Question 30

Treatment for first episode of orolabial herpes

Answer 30

Valacyclovir 1gm BID x7-10 days, acyclovir

Question 31

Treatment for recurrent HSV episodes

Answer 31

Most are mild and do not require treatment. Can give valacyclovir x5 days. - suppressive therapy for frequent outbreaks = valacyclovir x1 year

Question 32

Influenza A and B have similar symptoms including

Answer 32

Fever, malaise, chills, substernal soreness, HA, nasal stuffiness, nausea coryza nonproductive cough, and sore throat

Question 33

Which influenza is highly associated with schools and military camps?

Answer 33

Influenza B

Question 34

The elderly may present atypically when infected with influenza. Atypical sx include

Answer 34

Confusion and malaise

Question 35

The flu can cause ______ in pregnant patients

Answer 35

Sepsis, PTX, spontaneous abortion, preterm labor

Question 36

Detection of influenza via nasal or throat swabs has what sensitivity

Answer 36

60-80%

Question 37

Treament of influenza within 48 hours of symptoms

Answer 37

Oseltamivir and zanamivir. These reduce the duration of symptoms but do NOT decrease the rate of hospitalization or mortality

Question 38

What is Reye syndrome

Answer 38

Complication of influenza type B + varicella + ASA. (1) hypoglycemia (2) increased aminotransferases (3) increase ammonia (4) AMS

Question 39

Complications of influenza

Answer 39

Epithelial necrosis - acute sinusitis, otitis media, purulent bronchitis, PNA

Question 40

Incubation period for rabies (Rhabdovirus)

Answer 40

About 3-7 weeks after animal bite

Question 41

Pathophysiology of rabies

Answer 41

Virus travels to nerves of the brain, multiplies, then migrates along efferent nerves to salivary glands

Question 42

Symptoms of rabies

Answer 42

Prodrome of fever, malaise, HA Skin sensitive to temperature changes (aerophobia), pain paresthesia at bite site (ganglionueuritis)

Question 43

When do CNS changes occur in rabies?

Answer 43

About 10 days after the prodrome

Question 44

CNS changes in rabies can be ________ or ___________

Answer 44

1. Encephalitis aka “furious” (80%): restless, muscle spasms, bizarre behavior, delirium, hydrophobia, thick saliva, seizures, coma 2. Paralytic aka “dumb” (20%): acute ascending paralysis resembling GBS

Question 45

When should postexposure immunization be given for rabies?

Answer 45

Depends on the behavior and type of animal that bit. Any contact or suspected contact with bat, skunk or raccoon qualifies for prophylaxis

Question 46

What is the rabies postexposure treatment for NON immunized people?

Answer 46

HRIG administered once- as much as possible around the wound with any remaining injected in a distant IM site + (4) human diploid cell vaccines IM on day 0, 3, 7, and 14

Question 47

What is the rabies post exposure prophylaxis for immunized people (such as vet techs etc.)?

Answer 47

(4) human diploid cell vaccines IM on day 0, 3, 7, and 14 | No HRIG