Term
| Viruses can only replicate __________ a host cell and cannot survive long-term ______ a host cell. |
|
Definition
|
|
Term
Viruses consist of a central __________ of either RNA or DNA and a protein ___________ shell, together forming the _______________.
Many viruses also have an outer _________, which is made of _________ and often has __________ ________. |
|
Definition
genome; capsid
nucleocapsid
envelope; lipoprotein
glycoprotein spikes |
|
|
Term
| Viral proteins are either _________ or __________. |
|
Definition
structural or non-structural
(usually enzymes) |
|
|
Term
| diagnostic virology methods |
|
Definition
-identification of viral proteins (antigens and enzymes)
-identification of viral nucleic acid
-microscopic identification (cytology, tissue biopsy)
-serology (IgM and IgG antibodies) |
|
|
Term
| What is the gold standard for virus isolation and identification? |
|
Definition
viral culture
(but specimen requirements are stringent) |
|
|
Term
| What should be done with a viral culture specimen that must be held for a few days before being processed in the lab? |
|
Definition
| place the specimen in a transport medium at a temperature that inhibits cellular degradation and microflora proliferation |
|
|
Term
| What cell morphologic changes can occur from a virus? |
|
Definition
giant-cell formation
cytopathic effects
inclusion bodies
malignant transformation |
|
|
Term
| What 3 things give a viral diagnosis with viral cytology? |
|
Definition
-visible cytopathic effect (CPE)
-cell morphology, syncytia
-inclusion bodies |
|
|
Term
| What is the characteristic viral cytology feature of HSV? |
|
Definition
| Cowdry type A intranuclear inclusions |
|
|
Term
| What is the characteristic viral cytology feature of measles? |
|
Definition
| multinucleated giant cells |
|
|
Term
| What is the characteristic viral cytology feature of CMV? |
|
Definition
| nuclear, "owl eyes" inclusions in large cells |
|
|
Term
| enlarged pneumocytes that contain large haloed, basophilic intranuclear inclusions and intracytoplasmic granular inclusions |
|
Definition
|
|
Term
| What bacterial infection is opportunistic and is a likely cause of respiratory symptoms in an immunosuppressed patient? |
|
Definition
| Mycobacterium avium-intracellulare (MAI) |
|
|
Term
| What viruses are opportunistic and are likely causes of respiratory symptoms in an immunosuppressed patient? |
|
Definition
|
|
Term
| What fungal infections are opportunistic and are likely causes of respiratory symptoms in an immunosuppressed patient? |
|
Definition
Candida albicans
Pneumocystis jiroveci |
|
|
Term
| All major transplantations (kidney, liver, heart, heart-lung, bone marrow) are associated with an increased risk of... |
|
Definition
|
|
Term
| After bone marrow and solid organ transplantation, the severe immunosuppressive regimens that are emplyed to prevent rejection of the transplant make the recipient prone to severe... |
|
Definition
|
|
Term
| The severity of the end-organ disease caused by CMV is related to... |
|
Definition
| the degree of immune suppression |
|
|
Term
| What type of transplant has the most sever immune suppression? |
|
Definition
|
|
Term
| What type of genome does herpesvirus have? |
|
Definition
|
|
Term
| Describe the life cycle of herpesvirus. |
|
Definition
1. acute infection
2. latent infection in which the virus persists in a non-infectious form with periodic reactivation and shedding of infectious virus |
|
|
Term
| the inability to recover infectious particles from cells that harbor the virus |
|
Definition
|
|
Term
| 3 subgroups of herpesviruses |
|
Definition
alpha-group
lymphotropic beta-group
gamma-group |
|
|
Term
| alpha-group herpesviruses |
|
Definition
|
|
Term
| What type of cells are most frequently infected by alpha-group herpesviruses? |
|
Definition
epithelial cells
latent infection in neurons |
|
|
Term
| lymphotropic beta-group herpesvirus |
|
Definition
|
|
Term
| What type of cells do lymphotropic beta-group herpesviruses most frequently infect? |
|
Definition
|
|
Term
| gamma-group herpesviruses |
|
Definition
|
|
Term
| What types of cells do gamma-group herpesviruses most frequently infect? |
|
Definition
|
|
Term
| What virus causes Kaposi sarcoma? |
|
Definition
|
|
Term
| What virus typically causes genital herpes? |
|
Definition
|
|
Term
| Where does HSV spread to after the epithelium or mucous membranes? |
|
Definition
| sensory neurons that innervate the primary site of replication |
|
|
Term
| routine cytologic evaluation of HSV |
|
Definition
|
|
Term
| How is a Tzanck prep smear collected for HSV? |
|
Definition
| the base of the blister is scraped and smeared on the slide |
|
|
Term
| What test is used as an aid in the diagnosis of HSV and differentiates HSV-1 from HSV-2? |
|
Definition
|
|
Term
| When is the specimen best collected for HSV culture and typing? |
|
Definition
| best within the first 3 days after appearance of the lesion, but no more than 7 days |
|
|
Term
| What type of test for HSV gives you the quickest results? |
|
Definition
cytology (Tzanck smear) of cells scraped from the lesion (efficaciously detects herpes-induced inclusion bodies)
OR
direct fluorescent antibody with direct microscopic examination
(non-culture) |
|
|
Term
| positive Tzanck smear showing multinucleated giant cells, ground-glass chromatin, and intranuclear inclusions |
|
Definition
|
|
Term
| What is the gold standard for serologic diagnosis of HSV? |
|
Definition
Western blot test
99% sensitive, 99% specific for HSV antibodies |
|
|
Term
| What type of test is used to detect HSV type 1/2 IgM? |
|
Definition
|
|
Term
| transmission of chickenpox |
|
Definition
direct contact with infected person
coughed fluids
touching liquid from the blisters |
|
|
Term
| infectious time frame for chickenpox |
|
Definition
| 1-2 days before the rash starts until the last blister has dried |
|
|
Term
| What virus causes chickenpox? |
|
Definition
| varicella zoster virus (VZV) |
|
|
Term
| What cytopathic effect does varicella zoster virus have? |
|
Definition
| multinucleated syncytial cells with intranuclear inclusions |
|
|
Term
| 2 conditions caused by varicella zoster |
|
Definition
|
|
Term
| What type of infection with VZV causes chickenpox? |
|
Definition
|
|
Term
| What type of infection with VZV causes shingles? |
|
Definition
| reactivation of latent VZV |
|
|
Term
| another name for shingles |
|
Definition
|
|
Term
| How is varicella zoster similar to herpes simplex virus? |
|
Definition
-infects mucous membranes, skin, and neurons
-evades immune responses and establishes a latent infection in sensory ganglia |
|
|
Term
| How is VZV infection diagnosed? |
|
Definition
| viral culture or detection of viral antigens in cells scraped from superficial lesions |
|
|
Term
| What are common sites of herpes zoster infections? |
|
Definition
| thoracic dermatomes and those supplied by the trigeminal nerve |
|
|
Term
| CMV latently infects ___________ and their _____ _____ ______ and can be reactivated when cellular immunity is depressed. |
|
Definition
| monocytes; bone marrow progenitors |
|
|
Term
| What does CMV cause in healthy individuals? |
|
Definition
| asymptomatic or mononucleosis-like infection |
|
|
Term
| What does CMV cause in neonates and immunocompromised patients? |
|
Definition
| devastating systemic infections |
|
|
Term
| large inclusion surrounded by a clear halo within the nucleus |
|
Definition
|
|
Term
| transplacental transmission of CMV from a newly acquired or primary infection in a mother who does not have protective antibodies |
|
Definition
|
|
Term
| neonatal transmission of CMV through cervical or vaginal secretions at birth or later through breast milk from a mother who has active infection |
|
Definition
|
|
Term
| other routes of transmission for CMV |
|
Definition
-saliva (during preschool years)
-venereal route (dominant mode after about 15 years of age)
-respiratory secretions
-fecal-oral route
-iatrogenic transmission (organ transplants, blood transfusions) |
|
|
Term
|
Definition
toxoplasmosis
other (syphilis)
rubella
CMV
HSV |
|
|
Term
| infectious mononucleosis-like illness with fever, atypical lymphocytosis, LAD, hepatomegaly accompanied by abnormal LFTs (suggesting mild hepatitis) |
|
Definition
| cytomegalovirus mononucleosis |
|
|
Term
| What is the most common opportunistic viral pathogen in AIDS? |
|
Definition
|
|
Term
| What assays are used for antigen detection for CMV in a specimen such as a throat swab or washing from the lower respiratory tract? |
|
Definition
-indirect fluorescence
-ELISA
-Western blot |
|
|
Term
| What is a rapid method to amplify a specific fragment of DNA and can be used in detection of CMV? |
|
Definition
| polymerase chain reaction (PCR) |
|
|
Term
| What test is used to quantitatively detect CMV DNA in plasma specimens and aids to diagnosis and management of CMV infections? |
|
Definition
| CMV quantitative plasma PCR |
|
|
Term
| localization of antigens or proteins in tissue sections by the use of labeled antibodies as specific reagents through antigen-antibody interactions that are visualized by a marker such as fluorescent dye, enzyme, or colloidal gold |
|
Definition
|
|
Term
| characteristic triad of fever, pharyngitis, and lymphadenopathy lasting for 1-4 weeks |
|
Definition
|
|
Term
| What does a work-up of infectious mononucleosis show? |
|
Definition
-moderately elevated WBC count
-increased total number of lymphocytes
-greater than 10% atypical lymphocytes |
|
|
Term
| What does a positive reaction to a mono spot test indicate? |
|
Definition
|
|
Term
| In patients with symptoms compatible with infectious mononucleosis, what test result is diagnostic? |
|
Definition
| positive heterophile antibody test |
|
|
Term
| What virus causes infectious mononucleosis? |
|
Definition
|
|
Term
| Epstein-Barr virus is a _________ virus that infects _________. |
|
Definition
| herpes-type virus; B lymphocytes |
|
|
Term
| What does a characteristic blood smear of infectious mononucleosis have? |
|
Definition
|
|
Term
| When are EBV heterophile antibody titers the highest? |
|
Definition
| during the first 4 weeks of disease |
|
|
Term
| What test is used only as a screening test for infectious mononucleosis? |
|
Definition
|
|
Term
| What test is used to differentiate an acute from chronic or reactivated infection with Epstein-Barr virus? |
|
Definition
| EBV acute infection antibodies profile |
|
|
Term
| Serological testing for EBV antibodies involves the use of... |
|
Definition
| EIA (enzyme linked immunoassay) |
|
|
Term
| incubation period for hepatitis A |
|
Definition
|
|
Term
| incubation period for hepatitis B |
|
Definition
|
|
Term
| incubation period for hepatitis C |
|
Definition
|
|
Term
| progression of hepatitis A |
|
Definition
|
|
Term
| another name for hepatitis A |
|
Definition
|
|
Term
| What hepatitis has no other chronic disease associated with it and has no cancer association? |
|
Definition
|
|
Term
| transmission of hepatitis A |
|
Definition
fecal-oral route
contaminated water and foods (especially shellfish) |
|
|
Term
| IgG antibodies to hepatitis A |
|
Definition
|
|
Term
| How do you determine if the patient has acute hepatitis A? |
|
Definition
| look for IgM antibodies on serology |
|
|
Term
| serology findings of acute hepatitis A |
|
Definition
+ IgM anti-HAV
- IgG anti-HAV |
|
|
Term
| serology findings for prior hepatitis A |
|
Definition
- IgM anti-HAV
+ IgG anti-HAV |
|
|
Term
| When does IgM anti-HAV peak? |
|
Definition
| about 1-2 weeks after development of jaundice |
|
|
Term
| Can hepatitis A be chronic? |
|
Definition
|
|
Term
| transmission of hepatitis B |
|
Definition
parenteral or sexual
transplacental |
|
|
Term
| What risks are associated with hepatitis B? |
|
Definition
|
|
Term
| Hepatitis B virus (HBV) is composed of an inner _________ _____ and an outer _________ _________. |
|
Definition
| protein core; protein capsule |
|
|
Term
| What does the outer capsule of the HBV contain? |
|
Definition
|
|
Term
| What does the inner core of the HBV contain? |
|
Definition
core antigen (HBcAg)
e-antigen (HBeAg) |
|
|
Term
| What is the first marker of infection in HBV? |
|
Definition
|
|
Term
| If HBsAg sticks around for more than 6 months, it is labeled... |
|
Definition
| chronic hepatitis B infection |
|
|
Term
|
Definition
|
|
Term
| The hepatitis B surface antibody indicates _________ or __________. |
|
Definition
|
|
Term
| What antibodies would be present in a person who received a hepatitis B vaccination? |
|
Definition
| antibody to surface antigen ONLY |
|
|
Term
| After infection with HBV, the early serologic markers to become detectable are ______ and _______. |
|
Definition
|
|
Term
| When do the markers first appear in hepatitis B serology? |
|
Definition
| within 1-2 months after infection and are present when initial symptoms appear |
|
|
Term
| What serologic marker is diagnostic for acute HBV infection? |
|
Definition
|
|
Term
| What marker cannot be detected in hepatitis B serology? |
|
Definition
|
|
Term
| What does the presence of HBeAg reflect? |
|
Definition
| viral replication and increased infectivity |
|
|
Term
|
Definition
period of time when the only marker detectable through serology is the IgM anti-HBc
There is a time frame where HBsAg has dropped off and anti-HBs has not picked up yet. |
|
|
Term
| What happens during resolution of a hepatitis B infection? |
|
Definition
| IgM anti-HBc is replaced by IgG anti-HBc and anti-HBs develops |
|
|
Term
| Anti-HBs is a _________, _________ antibody. |
|
Definition
|
|
Term
| What does the presence of anti-HBs indicate? |
|
Definition
| recovery from acute infection and immunity from re-infection |
|
|
Term
| the period during which all HBsAg has been neutralized by anti-HBs and neither HBsAg nor anti-HBs is detectable |
|
Definition
|
|
Term
| What replaces HBeAg during resolution? |
|
Definition
|
|
Term
| What marker usually remains detectable throughout life in people with resolved HBV infection? |
|
Definition
|
|
Term
| What marker may become undetectable in remote HBV infection? |
|
Definition
|
|
Term
| In chronic hepatitis B infection, _______ persists for over 6 months and _______ does not develop. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What patients may give false positive tests for antibody to hepatitis B surface antigen? |
|
Definition
transfused individuals
hemophiliacs receiving plasma components |
|
|
Term
|
Definition
| persistence of circulating HBsAg for 6 months or longer after initial detection without clinically apparent disease |
|
|
Term
|
Definition
| persistence of HBsAg, HBeAg, and HBV-DNA indicates viral replication |
|
|
Term
| What HBV marker can be detected 1-7 weeks before liver enzyme elevation or the appearance of clinical symptoms? |
|
Definition
|
|
Term
| best available markers for HBV infectivity |
|
Definition
|
|
Term
| The presence of anti-HBs is frequently associated with __________. |
|
Definition
|
|
Term
| another name for hepatitis C |
|
Definition
| post-transfusion hepatitis |
|
|
Term
| transmission of hepatitis C |
|
Definition
parenteral or sexual
transplacental |
|
|
Term
| Hepatitis C has a high rate of __________. |
|
Definition
|
|
Term
| What conditions are associated with hepatitis C? |
|
Definition
|
|
Term
| In HCV, serum antibody to HCV (anti-HCV) almost always implies... |
|
Definition
| active infection (it is not protective) |
|
|
Term
| When does anti-HCV usually appear? |
|
Definition
| within 2 weeks of acute infection (but is sometimes delayed) |
|
|
Term
| What marker is always present in active HCV infection? |
|
Definition
|
|
Term
| vertical transmission of hepatitis B |
|
Definition
90% if mother is HBeAg+
10% if mother is HBeAg- |
|
|
Term
| vertical transmission of hepatitis C |
|
Definition
|
|
Term
| transmission period for hepatitis A |
|
Definition
2-3 weeks before and 1 week after onset of jaundice if symptomatic
1-2 weeks after exposure if asymptomatic |
|
|
Term
| What does the presence of anti-HBeAg indicate? |
|
Definition
resolution of acute infection
waning or resolving chronic disease |
|
|
Term
| What virus causes squamous cell carcinoma of the cervix? |
|
Definition
| human papillomavirus (HPV) |
|
|
Term
|
Definition
|
|
Term
| What causes the progression of untreated HPV lesions to micro-invasive and invasive cancer? |
|
Definition
| integration of the HPV genome into the host chromosomes |
|
|
Term
| What type of cells does HPV infect? |
|
Definition
|
|
Term
|
Definition
6,11,42,43,44
non-oncogenic strains |
|
|
Term
| What strains of HPV are most associated with warts? |
|
Definition
|
|
Term
| specific morphology of HPV |
|
Definition
| clear halos around nuclei |
|
|
Term
| What type of cells does HPV induce? |
|
Definition
| koilocytic cells (enlarged nucleus and intracytoplasmic halo) |
|
|
Term
|
Definition
16,18,31,45
oncogenic strains |
|
|
