Term
| What is the frequency of generalized vaccinia from the small pox vaccine? Who does it generally affect? |
|
Definition
| 1:5000 cases of vaccine inoculation; healthcare workers and the children of vaccinated |
|
|
Term
|
Definition
| adenovirus, parvovirus, polyomavirus, papillomavirus, poxvirus, hepadnavirus, herpesvirus |
|
|
Term
| Describe the virion and genome of herpesvirus. |
|
Definition
| large linear dsDNA genome with enveloped icosahedral virion |
|
|
Term
| Name the alphaherpesvirnae. |
|
Definition
| herpes simplex 1, herpes simplex 2, varicella-zoster virus |
|
|
Term
| Name the gammaherpesvirnae. |
|
Definition
| epstein-barr and kaposi's sarcoma |
|
|
Term
| Name the betaherpesvirdae. |
|
Definition
| CMV, herpes lymhoptrophic (HSV6a, HSV6b), human herpes virus 7 |
|
|
Term
| How long ago did the herpesvirus subfamilies diverge? |
|
Definition
| over 300 million years ago |
|
|
Term
| What's the difference between alpha versus gamma and beta herpes viruses? |
|
Definition
| alpha viruses replicate well; gamma and beta have poor tc replication |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Where is Epstein-barr virus latent? |
|
Definition
|
|
Term
| here is kaposi's sarcoma latent? |
|
Definition
|
|
Term
| Where is cytomegalovirus latent? |
|
Definition
| hematopoietic progenitor cells/monocytes |
|
|
Term
| Where are herpes lymphotropic viruses latent? |
|
Definition
|
|
Term
| Where is human herpes virus 7 latent? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| kaposi's sarcoma associated herpesvirus |
|
|
Term
| How is HHV-1 transmitted, what is the primary infection site, and what disease does it cause? |
|
Definition
| close contact; mucoepithelial cells; oral (fever blisters), ocular lesions, encephalitis |
|
|
Term
| How is HHV-2 transmitted, what is the primary infection site, and what disease does it cause? |
|
Definition
| close contact/sexual contact; mucoepithelial cells; genital, anal lesions, severe neonatal infections, meningitis |
|
|
Term
| How is HHV-3 transmitted, what is the primary infection site, and what disease does it cause? |
|
Definition
respiratory route/inhalation/close contact
mucoepithelial cells
chickenpox, shingles |
|
|
Term
| How is HHV-4 transmitted, what is the primary infection site, and what disease does it cause? |
|
Definition
saliva/kissing
B cell
infectious mono; tumors (Burkitt's, immunoblastic lymphomas), nasopharyngeal carcinoma, some T cell tumors |
|
|
Term
| How is HHV-5 transmitted, what is the primary infection site, and what disease does it cause? |
|
Definition
close contact/sexual, congenital, blood to blood, transplant
lymphocytes, monocytes
mono, severe congenital infections, infections in immunocompromised (gastroenteritis, retinitis, and pneumonia) |
|
|
Term
| How is HHV-6 transmitted, what is the primary infection site, and what disease does it cause? |
|
Definition
close contact/respiratory
T lymphocytes
roseola in infants; infections in allograft recipients |
|
|
Term
| How is HHV-7 transmitted, what is the primary infection site, and what disease does it cause? |
|
Definition
saliva, close contact
T lymphocytes
some cases of roseola |
|
|
Term
| How is HHV-8 transmitted, what is the primary infection site, and what disease does it cause? |
|
Definition
sexual transmission
B lymphocytes, peripheral blood mononuclear cells
tumors including kaposi's sarcoma; some B cell lymphomas |
|
|
Term
| What is the tropism of alpha herpesvirus? |
|
Definition
| epithelial cells, multiple cell types, neurons |
|
|
Term
| What is the transmission for alpha herpesviruses? |
|
Definition
| contact, kissing, sexual, for VZV-aerogenically |
|
|
Term
| What is the pathogenesis of alpha herpesviruses? |
|
Definition
| HSV-vesicular exanthem (fever blisters, labialis, genitalis); VSV- primary chicken pox reactivates to shingles/zoster |
|
|
Term
| Alphaherpesvirus infections can be severe for which populations? |
|
Definition
| neonates and immunocompromised patients |
|
|
Term
| How do you diagnose alpha herpesvirus? |
|
Definition
| cultivation, serology (problematic), PCR |
|
|
Term
| How do you treat/vaccinate against herpes simplex virus? |
|
Definition
| no vaccine. tx with nucleoside analog prodrugs: acyclovir, valacyclovir (valtrex), trifuridine (ocular) |
|
|
Term
| What is the leading cause of infectious corneal blindness? |
|
Definition
|
|
Term
| Where can HSV-1 cause disease? |
|
Definition
| encephalitis, keratoconjunctivitis, oral (gingivostomatitis, tonsiliits, labialis), pharyngitis, esophagitis, tracheobronchitis, gladiatorum, genital Whitlow |
|
|
Term
| HSV infection on the hand is termed ______. |
|
Definition
|
|
Term
| Where can HSV-2 cause disease? |
|
Definition
| encephalitis, oral, pharygitis, genital, perianal, whitlow |
|
|
Term
| T/F IgM antibodies can be detected during the primary or lytic infection with HSV. |
|
Definition
| false, there is absence of detectable antibodies. |
|
|
Term
| Herpesviruses are latent in cells like nerve cells or B cells because they are _______. |
|
Definition
|
|
Term
| Recurrent infection is aka ________. |
|
Definition
|
|
Term
| What test do you use to diagnose a herpes simplex virus from a cold sore? |
|
Definition
| tzanck test--> histological determination of HSV-1 and HSV 2 infection (also works for VZV) |
|
|
Term
| How do you diagnose HSV encephalitis? |
|
Definition
| PCR on CSF (replaces brain biopsy) |
|
|
Term
| How do you determine whether a HSV infection is HSV-1 or HSV-2? |
|
Definition
| IFA/ELISA antibody type specific assays against glycoprotein G (gG) |
|
|
Term
| What percent of heterosexual women have HSV-2? |
|
Definition
1 partner= <10%
2-10 partners= 40%
11-50= 62%
>50= >80% |
|
|
Term
| What is the liklihood that a heterosexual man has HSV-2? |
|
Definition
1 partner= 0%
2-10= 20%
11-50= 35%
>50%= >80% |
|
|
Term
| How many people in the US have HSV-2? |
|
Definition
| 50 million (more common in women; approx 20% of women have HSV-2) |
|
|
Term
| How prevalent is neonatal herpes simplex and how do you prevent it? |
|
Definition
| 1:6000 births; C-section or antivirals late in pregnancy |
|
|
Term
| How/when do babies get HSV-1 and 2? |
|
Definition
in utero (5% of neonatal infections, HSV-2, ascending or transplacental)
intrapartum (75-80% of neonatal infections)
post-natal (HSV-1 mother/father kissing child) |
|
|
Term
| Name the neuronal herpesviruses. |
|
Definition
| alphaherpesviruses, herpes B/monkey B |
|
|
Term
| During the HSV latent period, the viral DNA exists as __________ within the neuron cell body. |
|
Definition
| in its genomic form as an episome |
|
|
Term
| What part of the HSV genome is expressed during latency? |
|
Definition
| only a stable intron called LAT transcript is expressed |
|
|
Term
| T/F No virus or virion proteins are produced during the HSV latent infection. |
|
Definition
| true (?) according to slide 37 |
|
|
Term
| What are common triggers that reactivate latent HSV? |
|
Definition
| sunburn, fever, "exam stress," "hormonal stress" |
|
|
Term
| Are the symptoms of HSV recurrent infection identical to the primary infection? |
|
Definition
| pretty much only symptoms of recurrent infection are usually a milder form of priamry infection |
|
|
Term
| What percent of americans are seropositive for HSV-1 infection? |
|
Definition
| 70% (175 million americans) (up to 90% positive by other means of detection) |
|
|
Term
| What percent of people positive for HSV-1 recurrent infections acquire it before the age of 6? |
|
Definition
|
|
Term
| What percent of seropositive individuals exhibit reccurrent HSV-1 infection? |
|
Definition
5% have 1/month
34% have 1/2-11 months
61% have recurrences of 1 or less per year |
|
|
Term
| What percent of HSV-1 infected people don't know they are infected? |
|
Definition
|
|
Term
| How does HSV cause enchephalitis? |
|
Definition
| virus transported from peripheral nerves to olfactory bulb and finally into brain. Classically HSV-1 affects the temporal lobe causing focal neurologic signs and cerebral edema |
|
|
Term
| Herpes simplex encephalitis can clinically resemble... |
|
Definition
| brain abscesses, tumors, intracerebral hemorrhage |
|
|
Term
| How do you treat herpes simplex encephalitis? |
|
Definition
|
|
Term
| What is the mortality of herpes simplex encephalitis? |
|
Definition
|
|
Term
| What percent of Americans adults ahve HSV-2? |
|
Definition
|
|
Term
| With what frequency does HSV-2 cause a recurrent infection? |
|
Definition
33%= >8-9/year
33%= 4-7
33%= 2-3 |
|
|
Term
| Almost half of all HIV transmission can be contributed to _______. |
|
Definition
| HSV-2 infection; persistent inflammation targeted against subclinical recurrence of HSV-2 contributes to high levels of HIV infection |
|
|
Term
| What is the tropism of VZV? |
|
Definition
| epithelial cells, T cells, neurons |
|
|
Term
|
Definition
|
|
Term
| When are you most likely to transmit VZV? |
|
Definition
| just prior to rash onset (virus rarely isolated from crusted lesions) |
|
|
Term
| What is the pathogenesis of VZV? |
|
Definition
| URT to regional LNs to primary viremia; enters reticuloendothelial systems and initiates secondary viremia that infects T cells and skin |
|
|
Term
| Pain along the affected dermatome after a shingles infection is termed... |
|
Definition
|
|
Term
| What is the therapy for VZV? |
|
Definition
| live attenuated vaccine/ nucleoside analog. prodrugs for treatment (famiciclovir/Valacyclovir) |
|
|
Term
| T/F Herpes zoster/shingles is generally bilateral. |
|
Definition
|
|
Term
| What is the singles vaccine and for whom is it recommended? |
|
Definition
| zostavax= live attenuated (adults > 60 yrs old) |
|
|
Term
| What are the symptoms of chickenpox? |
|
Definition
| crops of vesicular lesion son neck and trunk, highly pruritic, high fever typical, progress to pustular; usually no scarring from virus |
|
|
Term
| What are the complications of VZV infections? |
|
Definition
| pneumonia, severe infection in immunocompromised, bacterial superinfection (e.g. group A strep) |
|
|
Term
| What is the pathogenesis of shingles/zoster? |
|
Definition
| virus travels down the sensory nerve fiber and infects epithelial cells innervated by the fiber: usually stays isolated to a single dermatome |
|
|
Term
| How long does post herpetic neuralgia last and how do you treat it? |
|
Definition
months after zoster resolves
doesn't respond to antiviral txs |
|
|
Term
| In what season is varicella prevalent? |
|
Definition
|
|
Term
| Highrisk patients like leukemics could be treated for varicella with... |
|
Definition
| passive immunization adminstered within 96 hours of exposure |
|
|
Term
| What is a relatively common side effect of the live attenuated varicella vaccine? |
|
Definition
| 5% of healthy children get a mild rash |
|
|
Term
| When do you give doses of varicella vaccine? |
|
Definition
1st= 12-15 months
2nd= 4-6 years |
|
|
Term
| When do you give doses of varicella vaccine? |
|
Definition
1st= 12-15 months
2nd= 4-6 years |
|
|
Term
| Do you give a person over 60 who has already had a case of shingles the zostavax vaccine? |
|
Definition
| yes; lessens probability of post-herpetic neuralgia |
|
|
Term
| When is the varicella vaccine or zostavax contraindicated? |
|
Definition
| immunosuppressed patients |
|
|
Term
| How do you treat herpes virus? |
|
Definition
| acyclovir related drugs (acyclovir, famcyclovir, valacyclovir, gancyclovir) |
|
|
Term
| How do acylcovir related antiviral drugs work? |
|
Definition
| virus encoded thymidine kinase phophorylates prodrug into active form- nucleotide triphosphate. This allows incorporatio of cyclovir-triphosphate into elongating viral DNA chain which terminates virus genome replicatoin |
|
|
Term
| Valacyclovir, acyclovir and famcyclovir are used against... |
|
Definition
|
|
Term
| Gancyclovir is used against... |
|
Definition
|
|
Term
| What is the natural host of monkey B virus? |
|
Definition
|
|
Term
| What is the tropism of monkey B? |
|
Definition
| epithelial cells, multiple cell types, neurongs, CNS |
|
|
Term
| How is monkey B transmitted? |
|
Definition
| needle stick; scratch; bite; spit in eyes |
|
|
Term
| What is the incubation of monkey B? |
|
Definition
|
|
Term
| What is the pathogenesis of monkey B? |
|
Definition
inital systemic: prodrone of "flu-like" symptoms
early neruological: paresthesias; disorientation; dysphagia
late neurological: rapidly progressive ascending paralysis; encephomyelitis; coma; death |
|
|
Term
| What is the fatality of monkey b? |
|
Definition
| 75-80% Severe residual neurological disorders for those who survive. |
|
|
Term
| T/F there is no evidence of subclinical infections of Monkey B virus in humnas. |
|
Definition
|
|
Term
| How do you diagnose monkey B virus? |
|
Definition
| cultivation; PCR; histology; testing of animal |
|
|
Term
| How do you treat monkey B infection? |
|
Definition
| no vaccine; post exposure: wound cleansing/disinfection;prophylactic acyclovir/gancyclovir; potential reactivation with cessation of treatment |
|
|
Term
| How big is the CMV genome? |
|
Definition
| 230 kb ds DNA: largest genome of human DNA viruses! |
|
|
Term
| What is the tropism of CMV? |
|
Definition
| endothelial cells, leukocytes, lymphocytes, monocytes |
|
|
Term
|
Definition
| contact, kissing, sexual, congenital, transplant, blood |
|
|
Term
| What are the associated disease of CMV? |
|
Definition
mono, severe congenital infections, transplant rejection
in immunocompromised: retinitis, gastroenteritis, pneumonia |
|
|
Term
|
Definition
| differentiation between CMV and EBV mono; CMV antigen; serology; PCR; histology |
|
|
Term
|
Definition
| no vaccine; nucleoside analog prodrugs: ganciclovir, valganciclovir, hyperimmunoglobulin; foscarnet |
|
|
Term
|
Definition
|
|
Term
| Upon reactivation, CMV infectious virions appear in the _______ and the ______. |
|
Definition
|
|
Term
| What is the prevalence of CMV in developed countries? developing countries? |
|
Definition
developed: 40% of adolescents; 70% of adults
developing: over 90% |
|
|
Term
| T/F CMV infection is often asymptomatic. |
|
Definition
|
|
Term
| What are the two periods during a persons lifetime when CMV infections increase: |
|
Definition
| perinatal period and reproductive years (when individual is sexually active) |
|
|
Term
| Congenital CMV infection may result in... |
|
Definition
| cytomegalic inclusion disease |
|
|
Term
| Perinatal CMV infection results in.. |
|
Definition
|
|
Term
| Post natal CMV infection is... |
|
Definition
| usually asymptomatic. infectious mononucleosis may develop which consists of fever, lymphadenopathy, and splenomegaly |
|
|
Term
| What is the course of CMV in immunocompromised patients (transplant recipients and AIDS patients)? |
|
Definition
| pneumonitis, ritinitis, colitis, encephalopathy |
|
|
Term
| T/F Reactivation or reinfection with CMV is usually asymptomatic. |
|
Definition
| true, except in immunocompromised patients |
|
|
Term
| How do you diagnose Cytomegalic inclusion disease? |
|
Definition
| isiolation of CMV from the saliva or urine within 3 weeks of birth |
|
|
Term
| What is the most common congenital viral infection? |
|
Definition
| CMV, affects .3-1% of all live births |
|
|
Term
| Which is responsible for more cases of congenital damage, rubella or CMV? |
|
Definition
|
|
Term
| What is the second most common cause of mental handicap after Down's syndrome? |
|
Definition
| CMV (cytomegalic inclusion disease) |
|
|
Term
| What is the percent chance of transmitting CMV to a fetus following a primary infection? |
|
Definition
|
|
Term
| T/F CMV can be transmitted to the fetus only during the first trimester. |
|
Definition
| FALSE, can be transmitted during all stages of pregnancy |
|
|
Term
| What are the CNS symptoms of congenital CMV infection? |
|
Definition
| microcephaly, MR, spasticity, epilepsy, periventricular calcification |
|
|
Term
| 5-10% of infants who are infected with CMV but without symptoms at birth will subsquently have... |
|
Definition
| varying degrees of hearing and mental or coordination problems |
|
|
Term
| What are the ocular symptoms of congenital CMV infection? |
|
Definition
| choroidretinitis and optic atrophy |
|
|
Term
| What are the otic symptoms of congenital CMV infection? |
|
Definition
|
|
Term
| What are the pulmonary symptoms of congenital CMV infection? |
|
Definition
|
|
Term
| What are the cardiac symptoms of congenital CMV infection? |
|
Definition
|
|
Term
| T/F Some children with microcephaly will be of normal intelligence and development, even though their heads will always be small for their age and sex. |
|
Definition
|
|
Term
| What are the complications of microcephaly? |
|
Definition
developmental delays (speech, movement)
difficulties with coordination and balance, dwarfism/short statures, facial distortion, hyperactivity, mental retardation, seizures |
|
|
Term
| Postnatal CMV infection mainly occurs through the ______. |
|
Definition
|
|
Term
| What type of sex is a risk factor for increased CMV transmission? |
|
Definition
|
|
Term
| ___% of blood taken from CMV seropositive donors leads to infection of seronegative recipients. |
|
Definition
|
|
Term
| What type of organ transplant increases your risk of CMV transmission? |
|
Definition
| renal (usually 5% chance of transmission, renal is 70-80% chance of transmission) |
|
|
Term
| CMV mononucleosis is aka_____ and normally infections individuals ages ___. |
|
Definition
kissing disease
ages 14-25 |
|
|
Term
| How long does CMV mono last? |
|
Definition
|
|
Term
| What are the symptoms of CMV mono? |
|
Definition
| chronic fatigue, sore throat/swollen tonsils, chills/fever, loss of appetite, nausea/vomiting occasionally |
|
|
Term
| T/F Infectious mononucleosis can cause photophobia. |
|
Definition
|
|
Term
| What do you tonsils look like if you have mono? |
|
Definition
| swollen with a whitish-yellow (exudate) covering |
|
|
Term
| T/F You can get a swollen spleen and sometimes jaundice from CMV mononucleosis. |
|
Definition
|
|
Term
| What is the fatality rate of mono? |
|
Definition
|
|
Term
| What is the most common cause of death from mono? |
|
Definition
| ruptured spleen: recommend avoiding contact sports during and two weeks after infection symptoms subside |
|
|
Term
| EBV mono is characterized by.. |
|
Definition
| production of heterophile antibodies |
|
|
Term
| What test do you use for EBV mono? |
|
Definition
| monospot test (heterophil antibody test) |
|
|
Term
| WHen during the course of infection can you use the monospot test? |
|
Definition
| 2-9 weeks after a person is infected. Generally not used to diagnose mono that started more than 6 months earlier |
|
|
Term
|
Definition
| its histological appearnce: enlarged cytomegaly. Infected cells have pronuclear inclusions that appear as "owl-eyes" on histology |
|
|
Term
| What treatment used on AIDS patients will increase their risk of developing active CMV infection? |
|
Definition
|
|
Term
| In cases of CMV infecting immunocompromised patients, what percent of cases involve the eye? what are the symptoms? |
|
Definition
| 30% blurred vision, eye pain, photophobia, redness, and blindnes |
|
|
Term
| What is cytomegalovirus retinitis? |
|
Definition
| aka CMV retinitis; inflammation of the eye's retina that can lead to blindness |
|
|
Term
| What are the two major causes of serious morbidity and mortality after blood and marrow transplantation? |
|
Definition
| CMV and graft versus host disease account for 2/3rds of all deaths after transplanation |
|
|
Term
| What is the most common presentation of CMV in post transplant patients? What percent die from it? |
|
Definition
| pneumonitis; 85% die within 2 to 3 weeks |
|
|
Term
| What are strategies to control CMV infection post transplant? |
|
Definition
| get a CMV seronegative graft donor (immunoprophylaxis, blood product filters) or use ganciclovir treatment |
|
|
Term
| How big are the roseolaviruses (HHV-6 adn 7)? |
|
Definition
|
|
Term
| What is the tropism of HHV 6 and 7? |
|
Definition
| T and B lymphocytes, neurons |
|
|
Term
| How is HHV6 and 7 transmitted? |
|
Definition
| saliva; blood; HHV7 breast milk |
|
|
Term
| What are the associated disease of HHV6 and 7? |
|
Definition
| ubiquitous childhood disease (roseola infantum: 6th disease) rarely encephalitis; possibly links with MS and also with myocarditis |
|
|
Term
| What are the associated disease of HHV6 and 7? |
|
Definition
| ubiquitous childhood disease (roseola infantum: 6th disease) rarely encephalitis; possibly links with MS and also with myocarditis |
|
|
Term
| What is the vaccine/therapy for HHV6 and 7? |
|
Definition
| no vaccine; not FDA approved but clinicians utilize nucleoside analog prodrugs; ganciclovir; valganciclovir. Also, foscarnet and cidofivir |
|
|
Term
| What is exanthema subitum? |
|
Definition
| "sudden rash" aka roseola infantum (rose rase of infants) aka sixth disease. Disease of children generally under 2 years old that presents with 3 days of fever followed by a transient rash |
|
|
Term
| Which viruses cause roseola infantum/exanthema subitum? |
|
Definition
|
|
Term
| What percent of the population has been infected by roseolavirus? |
|
Definition
| 90% by age 2. 100% by adulthood |
|
|
Term
| T/F Roseolavirus cause a pruritic rash that occurs after a three day high fever. |
|
Definition
| False, the rash isn't itchy |
|
|
