Microbiology: Viral Encephalitis, Rabies & Prions, And Hiv: Block Ii

Front 1

This form of meningitis is more common but is less severe and non life threatening.

Back 1

Viral meningitis

Front 2

This is the major cause of viral meningitis: When does it peak?

Back 2

Non-polio enteroviruses which peak in the summer and fall. Prior to the MMR vaccine, mumps was the pirmary cause in the winter/spring.

Front 3

Viral ________ is severe and life threatening.

Back 3

Encephalitis

Front 4

This is the major cause of sporadic necrotizing encephalitis:

Back 4

HSV 1 & 2

Front 5

This is the major cause of encephalitis in the summer and fall:

Back 5

Encephalitic arboviruses

Front 6

Inflammation of the meninges covering the brain and spinal cord, lead to symptoms of fever, headache, stiff neck, vomiting, and photophobia.

Back 6

Meningitis

Front 7

Inflammation of the brain and spinal cord, leads to symptoms of meningitis with mental confusion, seizures, and coma.

Back 7

Encephalitis

Front 8

Inflammation of the spinal cord caused by polio.

Back 8

Myelitis

Front 9

Caused by encephalitic arbovirus transmitted to humans through mosquito

Back 9

Acute encephalitis

Front 10

Occurs years after an acute infection (like measels and SSP)

Back 10

Subacute encephalitis

Front 11

Autoimmune reaction one week after an infection (measels or post vaccination from smallpox vaccine)

Back 11

Post Infectious encephalitis

Front 12

While most viruses causing meningitis or encephalitis reach the spinal cord or brain via the bloodstream, HSV and rabies are exceptions because transmission occurs via __________.

Back 12

Retrograde neuronal transport

Front 13

Which viruses travel via retrograde neuronal transport?

Back 13

Rabies and Herpes Simplex virus

Front 14

Type of encephalitis caused by HSV 1 and 2

Back 14

Necrotizing encephalitis - M&M reduced by acyclovir

Front 15

What is the major cause of aseptic meningitis?

Back 15

Non polio enterovirus

Front 16

This type of meningitis spreads via the fecal/oral route and has its peak incidence in the summer and fall.

Back 16

Aseptic Meningitis

Front 17

Causes sporadic necrotizing encephalitis occuring throughout the year. There can be primary infection or reinfection of latent virus in sensory ganglia.

Back 17

HSV I and II

Front 18

This encephalitis is mainly caused by HSV II and is associated with genital infection in the mother.

Back 18

Neonatal herpes encephalitis

Front 19

This is the only treatable cause of encephalitis:

Back 19

Herpes

Front 20

Major cause of encephalitis in the summer and early fall with mosquito borne west nile virus being the major agent

Back 20

Arbovirus

Front 21

The major non-arboviral zoonotic agent of encephalitis globally.

Back 21

Rabies

Front 22

The animal with the highest reported incidence of rabies in the US. Spreads from southeast to the north and west.

Back 22

Racoons

Front 23

Animal associated with almost all of the rare human cases of rabies when expoure occured in the US

Back 23

bats

Front 24

Where does initial replication of the rabies virus occur? How does it spread?

Back 24

Initial replication in the striated muscle near the site of the bite or the mucosal exposure - it then spreads to infect the nerve endings, and travels via the neurons to the spinal cord and brain.

Front 25

What is the post-exposure prophylaxis for rabies virus?

Back 25

1. Active immunization with an inactivated virus vaccine
2. Passive immunization with with high-titer human IgG (RIG)

Front 26

What is the pre-exposure treatment for ppl likely to be exposed to rabies?

Back 26

A 3 dose primary vaccine and boosters every year

Front 27

What health programs are in place to prevent rabies?

Back 27

Yearly rabies vaccination for dogs and cats and limited vaccination of wildlife.

Front 28

Are responsible for slow-developing but fatal neurological syndromes known as subacute spongiform encephalopathies:

Back 28

prions

Front 29

Prion has abnormal conformational changes from the normal protein with increased ___________ and less _________.

Back 29

Increased Beta sheet and less alpha helical structure.

Front 30

_______ have extreme resistance to physical and chemical treatments.

Back 30

Prions

Front 31

What association do prions have with genetics?

Back 31

There are genetic alterations that are associated with familial/genetic disease rather than sporadic cases.

Front 32

Name one sporadic prion disease:

Back 32

CJD

Front 33

Name two exogenous prion diseases:

Back 33

Kuru (cannibalis) and vCJD (variant)

Front 34

Name one familial or genetic prion disease:

Back 34

Gerstmann-straussler Scheinker syndrome - fatal familial insomnia

Front 35

Scrapie is a prion disease of what animal?

Back 35

Sheep

Front 36

This prion disease is seen in cattle and it is suspected that they got it from eating feed with scrapie infected sheep brains:

Back 36

Bovine Spongiform Encephalopathy

Front 37

This disease was common in New Guinea due to cannibalistic practices. Involves staggering, dementia, etc.

Back 37

Kuru

Front 38

This disease involved progressive deterioration of mental function, dementia, muscle twitching, and staggering. It ususally affects people in their 50's and 60's.

Back 38

Creutzfeldt-Jacob Disease

Front 39

This is a newer prion disease that usually affects younger patients and has all the symptoms of CJD.

Back 39

Variant CJD

Front 40

This prion disease affects primarily the thalamus, which controls sleep.

Back 40

Fatal Familial Insomnia

Front 41

This prion disease causes muscle incoordination followed by slow deterioration of mental function. It usually progresses more slowly than CJD and runs in families. The cause of death is usually pneumonia due to impairment of muscles that control breathing and coughing.

Back 41

Gerstmann-Streassler-Scheinker Disease

Front 42

This is lipid enveloped icosahedral virus with ssRNA+ genome and structural RNA dependent DNA polymerase (reverse transcriptase)

Back 42

HIV

Front 43

What is the primary attachment site on the cell for HIV?

Back 43

CD4 on T lymphocytes- HIV 1 binds via viral gp-120 envelope glycoproteins

Front 44

This is an essential co-receptor for HIV that when deficient will confer resistance to HIV

Back 44

CCR5

Front 45

These are important non-structural proteins of HIV involved in RNA synthesis and transport to cytoplasm. They help upregulate viral gene expression:

Back 45

Tat and Rev

Front 46

This protein of HIV is important for in vivo pathogenicity, and when deleted HIV is attenuated:

Back 46

Nef

Front 47

This HIV protein down regulates CD4 and enhances HIV replication at an early state. Without this protein, HIV is attenuated.

Back 47

Nef

Front 48

This is the test for initial screen of HIV. It is not specific for IgM and mainly detects IgG so it cannot tell if the infection is recent or v. old.

Back 48

Antibody capture ELISA

Front 49

This test is used to confirm ELISA resuts for HIV b/c ELISA has false positives

Back 49

Western Blot

Front 50

Why aren't ELISA and western blot tests useful for infants with an affected mother?

Back 50

Because they would detect IgG from the HIV infected mother - all newborns would have anti HIV IgGs from the mother

Front 51

How is an infant of an HIV infected mother screened for the disease?

Back 51

Do PCR to detect proviral DNA in peripheral blood or RT-PCR to detect viron RNA in serum or plasma

Front 52

When is an HIV infected person likely to test negative?

Back 52

Immediately following exposure - becasue anti HIV antibody is not detectable until 2-14 weeks after infection.

Front 53

What test is used to measure the amount of virus in the blood (viral load) and used to monitor the efficacy of therapy and current status of infection? What are the drawbacks?

Back 53

RT-PCR or bDNA - it does not measure infectious vius and is not always a good predictor of immune decline or CD4 T cells

Front 54

Body fluids that are important in the transmission of HIV contain high amounts of what two things?

Back 54

WBC's and infected monocytes

Front 55

This drug is used to prevent mother to fetus transmission of HIV and is also used as PEP for healthcare workers and other non-occupational exposures.

Back 55

NNRTI - was nevirapine and it had to be used within 72 hours of infection for 28 days but side effects discontinued its use

Front 56

This is the HIV target of NRTI (like AZT) and NNRTIs like Nevirapine:

Back 56

Reverse transcriptase

Front 57

This is the target of HIV drug class PI

Back 57

Viral Protease

Front 58

This is the target of HIV drugs like Isentress which is used for people with drug resistance

Back 58

Vrial Integrase (Integrase inhibitors)

Front 59

This is the HIV target of CCR5 antagonists like Maraviroc

Back 59

gp 120 binding

Front 60

This envelope glycoprotein on HIV is the target for fusion inhibiting drugs

Back 60

gp 41

Front 61

This disease is associated with encephalopathy, wasting, malignancies and opportunistic infections

Back 61

AIDS

Front 62

How is AIDS defined?

Back 62

As HIV infection with less than 200 CD4 T cells

Front 63

This disease is characterized by a CD4 count of less than 200 with an unknown cause

Back 63

Idiopathic CD4 T lymphocytopenia

Front 64

The incubation period of HIV to AIDS is ____ years without specific therapy.

Back 64

10

Front 65

This syndrome occurs within months of infection with HIV and is often the first sign.

Back 65

Acute retroviral syndrome

Front 66

These people have protective HLA alleles against HIV such as HLA-B57 and strong anti-HIV CTL response but the infection remains.

Back 66

Long term non-progressors (elite controllers)

Front 67

This bacteria seen in HIV patients causes PCP and is the most important cause of M&M, it represents 1/3 of initial AIDS diagnosis and is treated with TMP-SMZ

Back 67

Pneumocystis jiroveci

Front 68

This oppotunistic fungal infection is seen in AIDS patients and it generally not life threatening

Back 68

Esophageal Candidiasis

Front 69

This opportunistic infection is the 2nd most common diagnosed in males and is associated with HHV-8 and treated with IFN alpha:

Back 69

Kaposi's sarcoma

Front 70

This opportunistic infection is seen in AIDS patients and with EBV (herpes virus) and is an early indicator of progression to AIDS

Back 70

Oral Hairy Leukoplakia

Front 71

This herpes virus is the most important opportunistic virus in immunodeficient and immunocompromised ppl. It causes retinitis, pneumonia, hepatitis, and esophagitis and is treated with ganciclovir.

Back 71

CMV

Front 72

This opportunistic infection is the most important occupational hazard to healthcare workers:

Back 72

Active respiratory infection with TB

Front 73

What does highly active anti-retroviral therapy (HAART) consist of?

Back 73

A protease inhibitor and two reverse transcriptase inhibitors

Front 74

Didanosine, Stavudine, Zalcitabine, and zidovudine/AZT are all examples of what?

Back 74

NRTI

Front 75

Nevirapine and Delavirdine are examples of what?

Back 75

NNRTI

Front 76

When is HAART treatment started in HIV infected patients?

Back 76

With AIDS or less than 350 CD4 T cells with symptoms and greater than 20,000 viral load

Front 77

Initially this treatment may consist of two NRTIs and one NNRTI while saving the PI and fusion inhibitors for later

Back 77

HAART

Front 78

This is a once daily tablet combination therapy of 2 NRTIs and 1 NNRTI

Back 78

ATRIPLA

Front 79

This is a way of testing for drug resistance in HIV patients that involves DNA sequencing of Pol genes to elucidate changes in reverse transcriptase or protease:

Back 79

GART - Genotype Antiretroviral Resistance Testing

Front 80

This opportunistic virus causes progressive multifocal lekoencephalopathy (PML)

Back 80

JC papovirus

Front 81

This opportunistic virus caues pneumonia or retinitis and is treated with ganciclovir or cidofovir

Back 81

Cytomegalo virus (CMV)

Front 82

This opportunistic infection causes small wart-like bumps

Back 82

Molluscum Contagiosum (poxvirus)

Front 83

This opportunistic virus causes oral hairy leukoplakia and B cell malignancies

Back 83

Epstein Barr Virus

Front 84

This bacteria casues pneumocystic pneumonia and is a major cause of morbidity and mortality in AIDS patients

Back 84

Pneumocystis Jirovechi

Front 85

Disappointing HIV treatment that involves stopping the anti-retroviral drugs for a number of weeks to months then restarting it when the viral load increases

Back 85

Structured interrupted therapy