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Infectious Disease > Week 10 > Flashcards

Week 10 Flashcards

(51 cards)

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1
Q

Acute Viral Hepatitis

A

Asymptomatic > symptomatic > fulminant liver failure > death

Nausea, vomiting, abdominal pain, loss of appetite, fever, diarrhea, light colored stools, dark urine, jaundice

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2
Q

Hepatitis A:

  • Main features
  • transmission
A

Picornavirus, (+)ss linear RNA, icosahedral, nonenveloped

Main cause of acute hepatitis in US

Low morbidity and mortality, older people tend to be more symptomatic

NO chronic infection

Transmission: fecal-oral transmission

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3
Q

Hepatitis A

Prevention?

A

pre/post exposure immunization

KILLED vaccine (one serotype)

Can give passive vaccination with antibodies (not recommended)

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4
Q

Hepatitis A

Diagnosis?

A

IgM anti-HAV (recent infection), Anti-HAV IgG (past infection or vaccine, lifelong immunity

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5
Q

Hepatitis B

Main features

A

hepadnavirus, enveloped

Partially DS circular DNA

Neutralizing abs to surface antigen protective (anti-HBsAg)

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6
Q

Hepatitis B

Replication cycle

A

occurs in nucleus

Host DNA repair machinery “fixes” partially ssDNA genome → cccDNA

Host DdRP Pol II transcribes cccDNA → RNA transcript transported into cytoplasm → HBV pre-genome RNA packaged

HBV pre-genome reverse transcribed by HBV reverse transcriptase → cDNA → virus buds and egresses
**convert to cDNA on the WAY OUT instead of the way in

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7
Q

Hepatitis B

Transmission

A

parenteral transmission - blood/blood-derived body fluids
Can have mother to infant transmission → chronic infection of infant (prevent infection of infant with active and passive immunization immediately at birth)

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8
Q

Hepatitis B

Prevention

A

pre/post exposure immunization, vaccine

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9
Q

Hepatitis B

Disease

A

acute liver disease, chronic liver disease, cirrhosis, HCC

Long incubation period

Chronic infection more likely in kids (<5 yrs), but acute illness LESS likely in younger people (vice versa for > 5 yrs)

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10
Q

HBV surface Ag

A

HBV surface Ag = antigen on surface of HBV → indicates Hep B infection

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11
Q

Anti-HBsAG antibodies

A

Anti-HBsAG antibodies→ antibody to HBsAg, indicate immunity to HepB

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12
Q

Anti-HB-core antibodies

A

Anti-HB-core antibodies → IgM (acute) IgG (chronic or prior infection)

IgM is sole marker of infection during window period

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13
Q

HBeAg

A

HBeAg = sign of infectivity → Anti-HBeAb = sign of low infectivity

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14
Q

Treatment of HepB (4)

A

1) INF-a
2) Nucleoside/Nucleotide Analogs
3) Acute infection = SUPPORTIVE
4) Neonate of HBsAg+ mother –> vaccinate

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15
Q

IFN-a

Mechanism in Hep B and C

A

inhibition of transcription and translation of viral genes

inhibition of glycosylation and maturation of viral proteins

inhibition of liberation of newly synthesized viral particles

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16
Q

IFN-a

ADRs

A

flu-like syndrome,bone marrow suppression, increased susceptibility to bacterial infections, unmask autoimmune disease

NOT given in pregnancy

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17
Q

Entecavir

A

nucleoSIDE analog

Inhibits DNA polymerase priming, reverse transcription, and DNA-dependent DNA synthesis

Competes with cellular dGTP for viral DNA polymerase activity

Also used in HIV

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18
Q

Tenofovir

A

nucleoTIDE analog

Also used in HIV

Must be phosphorylated by cellular kinases to active triphosphate form

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19
Q

Hepatitis C

Main features:

A

Flavivirus, (+)ss linear RNA, icosahedral, enveloped

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20
Q

Hepatitis C

Disease

A

Acute infections are usually subclinical
Chronic infection possible - 80% go on to chronic infection
Cirrhosis, liver failure, HCC

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21
Q

Hepatitis C

Transmission

Study These Flashcards
A

parenteral - blood/blood-derived body fluids

22
Q

Hepatitis C

Treatment (5)

Study These Flashcards
A

1) Simeprevir
2) Ribavirin
3) Sofosbuvir
4) Ledipasvir
5) Pegylated IFN-a

23
Q

Simeprevir - mechanism? ADRs?

Study These Flashcards
A

NS3/4A HCV protease inhibitor, prevents viral replication

ADRs: photosensitivity reactions, rashes

Used in conjunction with peginterferon and oral ribavirin or sofosbuvir

24
Q

Ribavirin

Study These Flashcards
A

purine nucleoside analog

ADRs: hemolytic anemia, NOT given in pregnancy

25
Sofosbuvir
inhibits HCV RNA-dependent RNA polymerase (NS5B) → chain termination Used in combination with Ledipasvir ADRs: fatigue, headache, nausea
26
Ledipasvir
inhibits NS5A HCV protein essential for HCV assembly, replication, secretion Used in combination with Sofosbuvir
27
Hepatitis D Main features
Delta virus, ss (-) circular RNA virus, enveloped
28
Hepatitis D Disease
requires concurrent Hep B infection (particles packaged with HBVsAg) Increases severity of hepatitis HDV becomes chronic and persists along with HBV
29
Hepatitis D Transmission
percutaneous, permucosal, blood/blood-derived body fluids | HBV vaccine also prevents HDV
30
Hepatitis E Main features:
Hepevirus - naked, icosahedral (+) ssRNA
31
Hepatitis E Transmission
fecal-oral transmission | ****reservoir in pigs/swine = zoonotic
32
Hepatitis E: Disease?
fulminant hepatitis in pregnant women** (20% mortality) | In other people is acute, self-limiting hepatitis
33
Hepatitis E Diagnosis
IgM anti HEV or RT-PCR
34
Hepatitis E Prevention
no FDA approved vaccine (vaccine used in China)
35
Meningitis in newborns (0-6 months) (3)
1) Group B strep 2) E. Coli 3) Listeria
36
Meningitis in Children (6 months - 6 years) (4)
1) Strep pneumoniae 2) Neisseria meningitidis 3) Haemophilus influenzae type B 4) Enteroviruses
37
Meningitis in Adults (6-60 years) (4)
1) N. Meningitidis 2) Enteroviruses 3) S. Pneumoniae 4) HSV
38
Meningitis in Older Adults (60+ years) (3)
1) S. Pneumoniae 2) Gram negative rods 3) Listeria
39
HAV vaccine vs. HBV vaccine
HAV vaccine: passive human Ig and active (KILLED vaccine) HBV vaccine: passive (HBIG) and recombinant SUBUNIT (HBsAg) vaccine
40
Droplet precautions
Isolation of patients infected with organisms that can be transmitted via droplets than can be generated by patient during coughing, sneezing, talking, or during procedures Private room + mask + hand hygiene Influenza, RSV, Neisseria meningitidis
41
Airborne precautions
Isolation of patients with organisms spread via airborne droplet nuclei Private room + negative pressure + > 6-12 air changes per hour N-95 mask worn by all persons entering the room Used for M. TB, measles, primary infection for VZV
42
Contact precautions
Private room Use of hand hygiene Gloves and gowns prior to entry into patient room Used to prevent spread of MDR organisms (VRE, MRSA, MDR acinetobacter, C. diff)
43
Dysbiosis
abnormal composition of a microbiome EX) IBS, antibiotic associated diarrhea, obesity, bacterial vaginosis, “non-bacterial” prostatitis, pouchitis, T1DM, Mother-to-child HIV transmission, MRSA colonization and infection - Bacterial vaginosis - caused by loss of protective species (lactobacilli) and gain of anaerobes (prevotella, gardnerella) - Crohn’s Disease: diminished levels of Clostridium and bacteroides species in the gut
44
Environmental factors that influence patterns of colonization in infants
1) Mode of delivery (C-section vs. Vaginal) | 2) Feeding (breast milk vs. formula)
45
Infant microbiome
Infants born sterile but are quickly colonized by diverse microorganisms Within weeks, baby has bacterial load of typical adult Development of immune system occurs in parallel → likely influenced by microbiome
46
Gut microbiome in human nutrition
Evidence for obesity-predisposing microbiome Metabolic function of microbiome = - Ferment non-digestible polysaccharides and mucus - Synthesize vitamins (B3, B5, B6, B12, K, Biotin, Folate) - Sequester metals
47
Pathogen exclusion
commensals compete with pathogens → limit infectivity Nutrient, receptor competition Antimicrobial products of commensals (lactic acid, H2O2, pH, bacteriocins) EX) C. Diff infection after antibiotic use
48
Immune homeostasis
balance between hyper-reactive / unresponsive immune system
49
Commensal vs. Parasite vs. Mutualist
Commensal: interaction between two species in which one benefits and one is unaffected Mutualist: interaction between two species in which both species benefit Parasite: interaction between two species in which one benefits and one is harmed
50
Gnotobiotic
growth in a germ-free environment
51
Microbiome
community of microorganisms inhabiting a particular niche Aka “commensals' Neutral or beneficial functions Found on all exposed surfaces 10 microbes per human cell (10^14 microbes colonize a person), collective microbial genome is 100x human genomes

Infectious Disease (9 decks)

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