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121 Cards in this Set

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how long do viruses take to replicate?
Viruses:
1-3 wks to replicate
what is the most common way to spread viral infection? how to stop it?
Most common route of viral transmission = contact => washing hands decrease transmission
Tropism
=> viruses have receptors for certain cells, enter via endocytosis
Genetic drift
spontaneous mutation (Ex: Influenza B)
Genetic shift
gene reassortment (Ex: Influenza A, Rotavirus)
5 steps of Viral Entry Into The Cell:
1) Invasion
2) Adhesion to their receptors
3) Penetration
4) Uncoat
5) Replication
6) Assembly
7) Lysogeny
Adhesion
what happens
presentation
to their receptors (viremic, asymptomatic)
Invasion:
what happens
presentation
invasion inhibitor
virus enters body (viremic, asymptomatic)
Inhibitor: y-Globulins
Penetration:
what happens
what virus is an exception to this?
via receptor-mediated endocytosis - except HIV
Uncoat
take capsule off to expose RNA or DNA (Eclipse)
tx Influenza A
uncoating Inhibitors:
• Amantidine
• Rimantidine
• Selegeline
Amantidine
Anticholinergic/DA release
Rimantidine
quick resistance
Selegeline
MAOI
Replication
(Eclipse): inserts his DNA/RNA into your genome
what are the viral replication inhibitors?
Inhibitors:
Guanine Analog
Adenosine Analog
•Thymidine Analogs
what are the guanine analogs (6)
Acyclovir
Pencyclovir
Demcyclovir
Valcyclovir
Gancyclovir
famcyclovir
Acyclovir
MOA
given how many times?
guanine analog
take 3-5 times per day
Pencyclovir
MOA
how many times a day?
guanine analog
take 3x/ day
Demcyclovir
how many times its given
take 3x/ day
Valcyclovir
MOA
how many times is it given?
guanine analog
take 1x/day, better compliance (not a cure)
Gancyclovir
MOA
tx
guanine analog
tx CMV retinitis
famcyclovir
MOA
tx
guanine analog
tx shingles
Adenosine Analog:
Vidarabine
Thymidine Analogs
Idoxuridin, Trifluridine
Assembly:
describe
presentation
package the virus
(viremic, symptomatic)
Lysogeny:
what happens in RNA/DNA viruses?
pt. presentation
how do we get autoimmune diseases?
virus explodes out of the cell (viremic, symptomatic)
• RNA ⇨ destroys cell membrane
• DNA ⇨ destroys nuclear membrane
• Wrap themselves with cell membrane=> autoimmune diseases
Viral Associated Cancers: EBV
Nasopharyngeal CA, Burkitt's lymphoma
Viral Associated Cancers: HPV 16,18,31,45:
Cervical CA
Viral Associated Cancers: Hep B
Liver CA
Viral Associated Cancers: HIV
Kaposi's sarcoma, CNS/testicular lymphoma's
Viral Associated Cancers: HTLV-1
T cell leukemia
Encephalitis: Sx and name 2 bugs
Headache, ataxia
• Arbovirus
• HSV-1
Arbovirus:
vector
presentation
loves what part of the brain
equine mosquitos =>headache, ataxia (frontal lobe)
"more e's~> more lethal''
HSV-1
disease it causes
presentation
EEG
what part of the brain affected?
hemorrhagic encephalitis
seizures
EEG slow wave complexes
(temporal lobe)
Meningitis:
presentation
positive for what test?
headache, photophobia, stiff neck (infection of pia and arachnoid)
positive for these test
• Brudzinski's sign
• Kernig's sign
Brudzinski's sign
bend neck => knee flexion
Kernig's sign
flex knee => pain, resistance
most common cause of Viral Meningitis: kids and adults, tx
Kids: Arbovirus
Adults: HSV -2
(Tx: Acyclovir)
Bacterial Meningitis Tx:
Vancomycin + Ceftriaxone
bacterial meningitis prophylaxis
Rifampin or Ciprofloxacin
most common pathogen of bacterial meningitis
Strep pneumo
0-2 mo: most common pathogen of bacterial meningitis
Group B Strep/E. coli/Listeria can cause deafness "Baby BEL"
10-21 y/o: most common cause of bacterial meninngitis
N. meningitides
Meningitis CSF: PMNs
⇨ bacteria
Meningitis CSF: T cells/MP
⇨ non-bacterial
Meningitis CSF: Normal glucose
Dx and what is the name of the pathogen?
⇨ viral (usually Enteroviruses)
Meningitis CSF: Low glucose
⇨ fungus, TB
Meningitis CSF: Protein
⇨ TB
Meningitis CSF: ( +) Quelling
Pneumococcus
Meningitis CSF: Geimsa stain:
Trypanosomes
Meningitis CSF: India ink
cryptococcus
Meningitis CSF: Gram stain
Bacteria
Meningitis CSF: Wet mount
N. Fowlerii
Meningitis CSF: PCR
HSV
Meningitis CSF: AFB
TB, Nocardia
Coxsackie A:
Hand-Foot-Mouth dz
Coxsackie B:
diseases it cause
• Endocarditis
• DM type1
Common Cold Viruses in spring
Coronavirus
"drink a Corona beer on spring break"
summer Common Cold Viruses
Rhinovirus => runny nose
Common Cold Viruses in the fall:
pathogen
presentation
Adenovirus => red eyes, necrotizing bronchiolitis,

"swimming pool conjuctivitis"
Common Cold Viruses in the winter? what bacteria follows it?
Influenza virus=> Staph aureus follows it
=> pneumonia (an orthomyxovirus)
influenza proteins function
tx
H protein: penetrate cells
• N protein: explodes out of your cells
• Tx: Amantadine, Ramantadine
• Tx: Oseltamivir "Tamiflu", Zanamivir'- neuraminidase inhibitors
which protein is used as a influenza vaccine
H protein: vaccine
Parainfluenza:
most common cold Virus
common cold viruses
Herpesvirus:
pt presentation
what should not be given to the patient?
painful ulcers of gums, keratitis
cornea will be destroyed by steroid tx!
CMV: eye clue, who is at risk, tx
vision loss w/ "floaters" (neonates, AIDS pts)
Tx: Ganciclovir or Foscarnet
Coxsackie B:
• ST Depression=>
• ST Elevation=>
Coxsackie B:
• ST Depression=> myocarditis
• ST Elevation=> pericarditis
EBV Mononucleosis: presentation
teenager w/ sore throat, fatigue, splenomegaly
EBV Mononucleosis: test and Ab
Monospot test: may be negative for first week
(+) Heterophile Ab.
EBV Mononucleosis: presentation and recommendations and Tx
• Posterior cervical lymphadenopathy
Avoid contact sports (can rupture -spleen)
Tx: NSAIDs
CI for EBV Mononucleosis:
No Ampicillin => skin rash if have EBV due to circulating PCN Ab
HSV-1:
presentation
• Gingival stomatitis (gum ulcers)
• Herpetic keratitis=> dendritic spine cornea
"shattered window'' on fluorescein stain
HSV-1:
test and CI
• + Tzanck prep
• no steroids
Rabies: sx
hydrophobia, laryngospasm
Rabies tx: Bat exposure
(aerosolized bat poop)
Tx: Rabies vaccine "toxoid" x 5 doses+ Ig
Rabies: Dog/ cat/wild animal bites (raccoon/ skunk/ fox). tx
Tx:
1) tetanus toxoid x 3 doses (if > 5 yrs)
2) Tetanus Ig (if dirty wound)
3) Amoxicillin/ Clavulanate
Rabies from Rodent bites (mice/ rats/squirrels/rabbits) tx
no rabies
how does the rabies attack the body
Virus ⇨ unmyelinated nerves ⇨
CNS (hippocampus) ⇨
peripheral nerves, Negri bodies.
Meningitis:
0-2mo:
>2mo:
10-21y/o:
0-2mo: "baby BEL"
• Group B Strep
• E: coli
• Listeria.
>2mo: Strep pneumo
10-21y/o: N. meningitidis
Human Herpes Viruses: name all
1: HSV1
2: HSV2 (genital)
3: Varicella "chickenpox:"
4: Epstein-Barr virus
5: CMV
6: Sixth Disease
7: Pityriasis Rosea
8: Kaposi's Sarcoma
HSV 1, type HHV, what diseses can it cause?
HHV 1: (oral) => fever blisters, corneal blindness, herpetic whitlow (dentist finger pustules)
HSV II: HHV, what diseses can it cause?
(genital) = > genital ulcers, neonatal herpes (via birth canal)
Varicella "chickenpox:"
HHV
what diseses can it cause?
HSV 3
Zoster "shingles"=> encephalitis in AIDS pts
Epstein-Barr virus
HHV #
diseases (3)
HSV 4: => mononucleosis, Burkitt's lymphoma, oral hairy leukoplakia (AIDS pt)
CMV
HHV
what diseses can it cause?
HSV 5: fetal blindness, pneumonia (transplant pts)
Sixth Disease
HHV
presentation
HSV 6: => roseola in kids (fever ⇨ rash)
Pityriasis Rosea
HHV
presentation
HSV 7: herald patch ⇨ then follows skin lines "C-mass tree appearance"
Kaposi's Sarcoma
HHV
who is at risk
presentation
HSV 8: (AIDS pts)- purple, pink, brown nodules all over body·
Herpes Virus Tx: name all (6)
• Ganciclovir (G)
• Idoxuridine (T)
• Vidarabine (A)
• foscarnet (phosphonate)
• Acyclovir (G)
• Valacyclovir
Ganciclovir
(G) analog
tx CMV
Acyclovir
MOA
SE
(G) analogue
kills renal tubules
Valacyclovir cotraindications
don't use w / cimetidine ( increase CNS toxicity)
Core Ag
gone before pt has symptoms (2 mo)
Core Ab
past infection (stays positive for life, "natural-immunity")
Surface Ag
current infection (or recent immunization if surface Ag only)
Surface Ab
vaccination
E Ag
transmissibility/infectivity
E Ab
low transmissibility
Window period
core Ab only (no Ag) "equivalence zone"
Hepatitis etilogy
virus, EtOH, Acetaminophen, Aflatoxin
hepatitis:
how long does the surface antigen last?
how long does the elevated enzymes last?
what does it mean when a patient is jaundiced?
Surface Ag >6 mo
Elevated enzymes >6 mo
Icteric jaundice phase of hepatitis => bile plugs in canaliculi
Chronic persistent hepatitis
nothing wrong with liver
Chronic active hepatitis
will have fibrosis and can lead to cirrhosis, cancer
hepatitis tx
Tx: Interferon or Amantidine/Rimantidine
Hep A: infection
IgG =>
IgM =>
Hep A:
IgG => past
IgM => current
Autoimmune Hepatitis:Type 1:
anti-SM Ab (young women)
Autoimmune Hepatitis:Type II:
anti-LKM Ab (kids)
HepA/E
Incubation:
Transmission:
Chronic active:
Cancer:
Tx:
HepA/E
incubation period: 2-6 wks
Transmission: Fecal-oral
"Vowels from the bowels"
Chronic active: no
Cancer: No
Tx: none
Hep E and Hep A
who is at risk?
most common cause of Hep A?
• attacks pregnant women/ Asians
• Shellfish = >Hep A
HepB
Incubation:
Transmission: top 4
Chronic active:
Cancer:
Tx:
(DNA virus) rvs transcriptase
Incubation: 2-6 months
Transmission:
1. IV 2. Blood 3. Sex
4. Vertical (mom-baby)
Chronic active: 10% risk
Cancer: highest risk
Tx: INF + Lamivudine
Hep C
Incubation:
Transmission:
Chronic active:
Cancer:
Tx:
Incubation: 20-30 years
Transmission: 1. Blood, 2. Transfusion 3. IV 4.Sex (not vertical)
Chronic active: 70% risk
Cancer: Less than B
Tx: INF+ Ribavirin
Hep D
Incubation:
Transmission:
Chronic active:
Cancer:
Tx:
Hep D "defective"
Incubation: none
Transmission: Post-Hep B
⇧AST,ALT
Chronic active: none
Cancer: none
Tx: none
hep B
kind of particle and when should the vaccination be recieved?
• Dane particle= DNA
• Baby must get vaccine
and IgG at birth
Envelope: RNA/DNA
DNA virus: Naked (except herpes, pox, hepadenovirus)
RNA virus: Enveloped (except "CPR" calcivirus, reovirus, piconovirus)
Strands: RNA/DNA
RNA virus: single stranded
Except:
• Reovirus ( ds)
• Rotavirus '(segmented ds)
DNA virus: Double stranded
Except:
• Parvovirus (ss)
• Hepadenovirus (segmented)
Replication: RNA/DNA virus exceptions
RNA: Cytoplasm (except retrovirus)
DNA: Nucleus (except poxvirus)
Polymerase: RNA/DNA viruses
RNA viruses (2)
RNA polymerase (RNA dep: retrovirus)
DNA polymerase (rvs transcriptase)

DNA viruses
RNA polymerase (DNA dep: poxvirus)
Assembly of : RNA/DNA viruses
RNA: cell membrane
DNA: nuclear membrane
why does it take longer for a ( - ) strand to replicate than ( + ) strand.
(-)strand ⇨ (+) mRNA before it is Assembled on cell membrane
( +) strand: illness takes < 1 wk (Ebola)
(-) strand: illness takes 1-3 wks
why do DNA viruses can cause cancer?
"intranuclear" inclusions
DNA viruses cause cancer b/c they replicate in the nucleus