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Inflammation > Viral Infections > Flashcards

Viral Infections Flashcards

1
Q

What is the viral envelope

A

Lipid bilayer derived from host cell membrane
Not present in all viruses
Contains viral glycoproteins (spikes) that project from the membrane to attach to cells
Interaction between capsid and envelope is mediated by viral matrix protein

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2
Q

What does the viral envelope do

A

Determines the stability of virions outside the host and correlates with mode of transmission
Non-enveloped viruses are stable in the environment; may be transmitted by food or water (e.g. noroviruses)
Enveloped viruses often survive only transiently outside the host and infectious viruses do not persist in the environment (e.g. HIV)

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3
Q

What does IgM represejnt

A

acute or recent infection

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4
Q

What is viral hep

A

Inflammation of the liver

Wide spectrum of clinical diseases

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5
Q

What is type A viral hep

A

faecal oral transmission

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6
Q

What is type B viral hep

A

parenteral transmission

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7
Q

What heps cause chronic infection

A

Hep B +/- D and C can cause chronic infection
Associated with: persistent infection, chronic liver disease, chronic active or persistent hep, cirrhosis, hepatocellular carcinoma

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8
Q

What heps do not cause chronic infection

A

Hep A does not cause chronic infection
Hep E does not usually cause chronic infection but it can do in immunocompromised patients
Route of transmission, incubation similar

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9
Q

How is viral hep diagnosed

A

Liver function tests: aminotransferases (high 100s)
Serology: antigen, IgM, IgG, alpha fetoprotein (hepatocellular carcinoma)
Molecular qualitative, quantification, genotyping
Imaging: fibroscan and ultrasound (assess liver fibrosis, fatty deposits and general composition)
Histopathology: liver biopsy

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10
Q

What is hep A

A

ss RNA unenveloped Hepatovirus (more stable in GI tract)
Endemic worldwide Incubation period 3-5 weeks, median 4 weeks
Faeco-oral transmission
Rare parenteral transmission
Detect HAV IgM in blood samples

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11
Q

How can hep A be prevented

A 
Jaundice: considered infectious from 2 weeks before to 7 days after jaundice onset
Sanitary disposal of waste
Good hygiene
Active - hep A vaccine
Passive - human normal immunoglobulin
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12
Q

What is hep E

A

Ss RNA unenveloped virus
Foodborne zoonosis: undercooked meat products i.e. pork sausages
Evidence of transmission by blood transfusion
Sporadic and epidemic forms
Incubation 6 weeks

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13
Q

How is hep E in immunocompromised px treated

A

ribavirin (antiviral agent) or interferon (immunomodulator)

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14
Q

How is hep E detected

A

Detect HEV IgM in blood samples

HEV RNA detection and quantification

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15
Q

What is hep B

A

Partially ds DNA Hepadnavirus (has reverse transcriptase)
Narrow host range
E antigen is shed, which can be detected
6 weeks to 6 months, median 2.5 months
Sexual intercourse, blood and blood products injecting drug use, tattoos
When hep B surface antigen persists in circulation for over 6 months, classified as a carrier state

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16
Q

What are the two types of acute hep B infection

A

icteric (resolves just jaundiced) and anicteric (carrier state, causes cirrhosis and hepatocellular carcinoma)

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17
Q

What does HB core antibody contain

A

IgM and IgG.

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18
Q

What is HBsAg

A 
A protein on the surface
of hepatitis B virus; it can
be detected in high levels
in serum during acute or
chronic hepatitis B virus
infection. The presence of
HBsAg indicates that the
person is infectious
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19
Q

What is HB core antibody

A 
Appears at the onset
of symptoms in acute
hepatitis B and persists
for life. The presence of
anti-HBc indicates previous
or ongoing infection with
hepatitis B virus in an
undefined time frame.
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20
Q

What is HB core IgM

A

persists for 3 months after infection

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21
Q

What is anti-HBs

A 
The presence of anti-HBs
is generally interpreted as
indicating recovery and
immunity from hepatitis B
virus infection.
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22
Q

What is HB e antigen

A

is an indicator of active viral replication; this means the person infected with Hepatitis B can likely transmit the virus on to another person

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23
Q

What is delta hep

A

Ss RNa enveloped by HBsAg
Defective virus
Coinfection, acute delta infection is self-limiting as it cannot survive without HBsAg

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24
Q

What is hep C

A

ss RNA enveloped Flavivirus, with 6 genotypes

Incubation 6-12 weeks

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25
Q

How is hep B prevented

A

Passive immunisation: hepatitis B immunoglobulin use if mother is E antigen positive
Active: recombinant vaccine
Antiviral: Lamivudine, adefovir, tenofovir, entecavir, emtricitabine
Immunomodulators: interferon

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26
Q

How is hep c detected and cure

A

Serology: HCV abx. Molecular diagnostic tests: HCV RNA detection and quantification. HCV genotype. Antiviral resistance.
No vaccine
Antiviral: cure HCV infection to prevent liver cirrhosis and other complications. Aim is undetectable HCV RNA in blood by 12 weeks.

27
Q

What is VZV

A

Ds DNA, icosahedral, enveloped, 125 kbp
Only humans are susceptible (no animal reservoir)
Primary infections causes chickenpox
Latent in dorsal root or cranial nerve ganglia

28
Q

What does VZV reactivation cause

A

Reactivation causes shingles
During reactivation virus travels down sensory nerves and produce painful vesicles in the area of skin served by infected ganglion

29
Q

What happens in chickenpox

A

Prodome: fever, pharyngitis, malaise
Itch/painful lesions appear in crops
Macule (area of skin discolouration) -> papule (a small pimple) -> vesicle (small, fluid filled sac) -> pustule (small blister containing pus) -> crusts (liquid debris that has dried on the surface)

30
Q

What dermatome is most likely to see shingles

A

thoracic (50%) and cranial (20%). Ophthalmic singles can cause loss of sight.

31
Q

What happens in VZV reactivation

A

Pain at site may precede eruption of painful vesicles. Unilateral, 1-2 dermatomes involved. Ophthalmic division of trigeminal nerve -> involvement of eye in 50%. Post-herpetic neuralgia especially in the elderly. Incidence increases with age and in the immunocompromised host.

32
Q

What is horizontal transmission of VZV

A

respiratory (varicella) commencing 48h before onset of rash. Skin lesions of varicella and zoster are infectious until crusted over

33
Q

What is vertical transmission of VZV

A

congenital infection of foetus in utero (maternal varicella in the first 20 weeks of gestation results in foetal defects in <2% of cases) . Perinatal infection causing neonatal varicella (requires urgent treatment) - maternal varicella occurring within 7 days before and 7 days after delivery is associated with a high mortality in the newborn infant.

34
Q

What is post exposure VZV prophylaxis

A

Aciclovir
Varivax vaccine (live) - may be contraindicated and administer within 72 hours
VZIG - prevents or ameliorates chicken pox, administer within 7 days of significant contact. Use for pregnant, immunosuppressed, neonate of seronegative mother.

35
Q

What is Oka varicella vaccine

A

Live attenuated vaccine
2 does schedule
Recommended in UK for susceptible healthcare workers and susceptible household contacts of IC patients

36
Q

What is zoster vaccine

A

Prevent Zoster and post herpetic neuralgia
High does Oka vaccine (14* potent c/w varicella vaccine)
Augments VZV specific T cell immunity

Offer to 70 & 79 year olds

37
Q

What are DNA viruses

A

poxvirus, herpesvirus, adenovirus, warts virus, parvoirus

38
Q

What are RNA viruses

A

influenza virus, mumps, rotavirus, eastern equine encephalitis, HIV, corona virus, LCM virus, rabies

39
Q

Why do RNA viruses mutate quickly

A

RNA dependent polymerases lack proofreading ability
+RNA is essentially equivalent to mRNA and can be immediately translated to protein. Viral polymerase synthesis is the first step.

40
Q

What cancers does HPV cause

A

cervical carcinoma, anogential & vulvo-perineal tumour

41
Q

What cancers does HHV cause

A

Kaposi’s sarcoma

42
Q

What cancers does EBV cause

A

Burkitt’s lymphoma, Nasopharyngeal carcinoma, Hodgkin’s lymphoma, Lymphoproliferative disease

43
Q

What cancers does hep cause

A

Hepatocellular carcinoma

44
Q

What type of cells is in the resp epithelium

A

ciliated pseudostratified columnar epithelium

45
Q

What type of cells is in the oral mucosa

A

stratified squamous epithelium

46
Q

What are upper resp infections

A

common cold (nasal obstruction, nasal discharge, sneezing), pharyngitis 9sore throat, inflammation with/out exudates), Laryngitis (hoarseness)

47
Q

What are airway infections

A

croup (hoarseness, barking cough), tracheobronchilitis (cough, substernal pain), bronchiolitis (cough, dyspnoea, wheezing - may need surgical intervention)

48
Q

What causes bronchiolitis

A

RSV

49
Q

What causes common cold

A

Rhinovirus and coronavirus

50
Q

What causes croup

A

parainfluenza virus

51
Q

What causes pneumonia

A

influenza, RSV, adenoviruses

52
Q

What is influenza

A

an envelope virus. 8 cartridges of RNA> Two major proteins: hemagglutinin (binds to sialic acid receptor, determines where in respiratory tract) and neuro-aminidase (catalyses cleavage of glyosidic linkages to sialic acid bonds facilitating exit of new progeny viruses from the cell, major target for current anti-influenza therapies).

53
Q

What is H1N1

A

Swine flu

54
Q

When does influenza A occur

A

Start of season

55
Q

When does influenza B occur

A

End of season

56
Q

What is antigenic drift

A

Virus encodes RNA dependent RNA polymerase
Lacks proof reading ability
RNA replication error accumulation
Need for annual influenza immunisation

57
Q

What is antigenic shift

A

genetic segment reassortment (influenza A only)
New virus emerges into the population - primed immune response ineffective
Hence origin of influenza A pandemic. New virus must have the capacity for spread directly from human to human

58
Q

What flu vaccine is given to children

A

live attenuated intranasal flu vaccine. Increased efficacy compared with inactivated against antigenically drifted influenza. Intranasal route has high acceptability.

59
Q

What flu vaccine is given to adults

A

3-4 influenza components
H1n1, H3N2, B components 1-2
Inactivated

60
Q

What is ebola

A

single stand enveloped RNA virus, filovirus
Day 1-3: fever, fatigue, myalgia, relative bradycardia
Day 3-10: rash, vomiting, abdominal pain
Day 7-12: shock, oliguria, reduces GCS

61
Q

What are the lab findings of ebola

A

hrombocytopenia, coagulopathy, transaminitis AST>ALT, electrolyte abnormalities

62
Q

What are the symptoms of Zika

A 
Symptoms 2-13 days in infection
Viremia very transient
Only 25% are symptomatic
Fever
Maculopapular pruritic rash
63
Q

How is Zika transmitted

A

Aedes aegypti

mosquitos, extrinsic incubation period of 10 days. Mother to child. Sexually - detection in semen in 18 days

Inflammation (12 decks)

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