Virology: Skin And Eyes

Front 1

What are the three diseases dealing with vesicular or pustular rashes?

Back 1

1. chickenpox

2. herpes zoster

3. smallpox

Front 2

What is chicken pox?

Back 2

1. signs and symptoms: skin lesions, merciless and papule to itchy fluid-filled vesicles

2. Shingles-herpes zoster (reactivation of virus in ganglia)

3. causative agent: HHV , VZV, enveloped DNA virus

Front 3

What is the pathogenesis and treatment of chickenpox?

Back 3

HHV3 remains latent in ganglia and protects virus from attack by the immune system

**prevent by attenuated vaccine, Oka strain, Zaostavax prevents shingles in people 60 years or older

Front 4

What is the taxonomy of VZV?

Back 4

1. family: herpesviridae

2. species: HHV3 (VZV)

Front 5

What is the structure of VZV?

Back 5

1. genome: dsDNA

2. enveloped

3. no fomite transmission

**VZV smallest genome of herpes virus

Front 6

What does VZV cause/

Back 6

chicken pox primary infection and shingles (herpes zoster) second/latent infection

Front 7

How do i know i have VZV?

Back 7

maculopapular rash appears 14 days post infection and starts on trunk!...1st lesion is 204 mm red papule with irregular outline (rose petal)...thin walled clear vesicle (dew drop) develops on top of red area....."dew drops on a rose petal

**within 12 hours, vesicle becomes postural and crusts and then scapped. All three can be present and this is the hallmark.

Front 8

What is the transition of VZV in clinical manifestation?

Back 8

macules....papules...vesicles....pustules...dried crust (not infectious) 7-10 days later

Front 9

What is the 3 hallmark signs of VZV?

Back 9

1. rash more severe on trunk than extremities

2.lesions itch

3. primary infection more severe in adults than kids

Front 10

What is the pathogenesis for VZV?

Back 10

acquired through inhalation of infectious droplets....make their way to regional LN and spreads to T cells and carry it to skin.....

primary viremia occurs 5 days post infection and secondary viremia 11 days

*must engage in syncytial formation

Front 11

What is syncytial formation and what does it help VZV?

Back 11

fusion of virus infected host cell with neighbors regardless of being infection helps evade neutralizing antibodies.......this is its cytopathic effect

Front 12

Can VZV be dangerous?

Back 12

Yes...in adults much more severe....some get interstitial pneumonia, encephalitis, difficulty walking and seizures.

**infants, adolescents, adults, pregnant, immunocompromised

Front 13

What are the serious complications of chickenpox?

Back 13

dehydration, pneumonia, bleeding probles, infection/inflammation of brain, andbactertial infections of skin (GAS, blood stream infection, TSS< bone infections)

Front 14

How do i know if i have Herpes zoster?

Back 14

rash will appear only in single dermatomes (travel down nerve and reactivating in dermatome supplies by that nerve)

**lot of neuronal pain....should resolve in 7-10 days but completely in 4 weeks.

Front 15

What is the most common complication for hepres zoster?

Back 15

PHN (postherpectic neuralgia): chronic syndrome >90 days of pain lasting for years.

Front 16

What is zoster without rash called?

Back 16

zoster sine herpete

Front 17

How do diagnose herpes zoster?

Back 17

1. observe symptoms and look for "dewdrops on a rose petal" and examine the development

2. see GIANT CELLS when doing vesicle scrapings

3. CPE: intranuclear inclusions and syncytial formation

**lab confirmation of varicella is very important to confirm cause of outbreaks

Front 18

What is the most sensitive method for confirming varicella diagnosis?

Back 18

PCR !

Front 19

How can you infect other people if you have VZV?

Back 19

Both chicken pox and zoster are contagious illnesses...VZV highly communicable and people in same household can contract infection

Front 20

Patients are contagious from how many days before or after the rash appears until all lesions have dried?

Back 20

contagious from 1-2 days before rash appears until scab

Front 21

How can I transmit VZV?

Back 21

resp droplets and direct contact with lesions....zoster rash also contagious

**humans are only reservoir

Front 22

T or F: is VZV seasonal?

Back 22

false....worldwide all the time

Front 23

How can I protect my family if I have VZV?

Back 23

1. antiviral drugs + VZV immunoglobulin for immunocompromisd people and newborns

2. live vaccine for prevention of both

Front 24

What are FDA approved dugs for tx of adults with shingles and varicella?

Back 24

1. acyclovir

2. famciclovir

3. valcyclovir

**analgesics and topical anesthetics can provide releif

***VZig for immunocompromised people within 4 days after exposure

Front 25

What is the window for Varicella vaccine to be effective?

Back 25

must be used within 72 hours (3 days) and possibly u to 5 days after exposure

1.Varivax can prevent chicken pox in 70-90% of people

2, Zostavax is given to people above 60 to precent shingles (even if they've had it)...some 50 or above

Front 26

What is breakthrough varicella?

Back 26

MVLS "mild varicella like syndrome" is infection of those who have been vaccinated....use PCR to diagnose this!!!

Front 27

How is breakthrough varicella different from varicella infection in people who weren't vaccinated?

Back 27

mild in those who were vaccinated....breakthrough people have:

1. maculopapular rash instead of vesicular.

2. show less than 50 lesions and no fever

**breakthru can transmit varicella to others

Front 28

How can I test my immune status against virus?

Back 28

Whole infected cell ELISA to see if you have antibodies from previous infection

Front 29

What is general info about smallpox?

Back 29

1. signs and symptoms: fever, rash in mouth, mc pap vest and pus

2. causative agent: variola virus is an orthopoxvirus....enveloped brickshaped DNA virus

Front 30

What is the taxonomy of pox viruses (smallpox virus)?

Back 30

1. family: Poxviridae

2. species: Variola virus

Front 31

What is the structure of pox viruses (smallpox virus)?

Back 31

1. genome: dsDNA

2. enveloped

3. largest human viruses that code for their own polymerases in the cytoplasm (DNA dep. RNA polymerase)

4. most enveloped viruses don't give off fomites...but this one DOEs

Front 32

History of smallpox:

Back 32

jenner made the vaccinia virus (cowpox) to prevent it....ovoid to brick shaped viruses and sDNA with fused ends....replication happens in the cytoplasmic inclusion bodies (Guarnieri)....virus core assumes dumbbell shape (2 large lateral bodies)

Front 33

Why is smallpox still considered a threat?

Back 33

In the US and russia bc of bioterrorism.....smallpox is the first dz to be controlled by immunization and the first to be eradicated!

Front 34

How do I know if I have pox viruses (smallpox virus)?

Back 34

1. typical presentation: fever, malaise, myalgia, FOLLOWED by pus filled/vesicular rash which leaves disfiguring scars....usually after 3-17 day incubation period

2. rash emerges 1st. small red spots on tongue and mouth and develop into sores that break open in the mouth and throat (MOST CONTAGIOUS here)

3. rash appears on skin, start on face, work through the arms and legs, hands and feet...spreads everywhere in 24 hours. When rash appears, fever falls and feel better.....by the 3rd day of rash, it becomes raised bumps....by 4th day it fills with thick opaque fluid and often have a depression in center that looks like bellybutton - the most distinguishing characteristic ...fever will rise again and stay until scabs form. they will fall off after 3 weeks leaving pitted scars

Front 35

What are two clinical forms of smallpox?

Back 35

1. viral major (severe and most common form with more rash and higher fever)

2. variola minor

Front 36

What are the 4 types of viral major?

Back 36

1. ordinary (most common, 90%)

2. modified (mild and occur in people who were vaccinated)

3. flat (rare and severe)

4. hemorrhagic (rare and very severe)

Front 37

Can pox viruses (smallpox virus) be dangerous

Back 37

es...even with vaccination can cause serious effects in ppl w skin conditions, eczema, atopic dermatitis or weakened immune systems

Front 38

How can i transmit pox viruses (smallpox virus)?

Back 38

1. respiratory route requiring close contact (transmission doesn't occur before rash)

2. fomites (bedding, clothing)

3. virus has immune escape mechanisms (cell mediated and humoral are needed to resolve)

**very young and very old can die

Front 39

How can I protect my family from pox viruses (smallpox virus)?

Back 39

1. Vaccinia virus vaccine provides complete protection for 5 years, waning for 10

2. can prevent/decrease severity when administered 3-6 days following exposure

3. put patients in negative pressure rooms with HEPA air filtration

Front 40

What are the two live vaccinia virus preps available?

Back 40

1. dryvax (made in calf lymph)

2. ACAM 2000 (african green monkey kidney cells (Vero cells))

**US has enough smallpox vaccine to vaccinate everyone in case of outbreak

Front 41

Is there a treatment?

Back 41

no. 1st disease to be eradicated by immunization

Front 42

What are the properties of smallpox that led to its eradication?

Back 42

1. exclusive human host range (no animal reservoirs)

2. single serotype

3. safe, live vaccines prepared from animal poxviruses

4. consistent dz presentation with visible pustules easy ID and quarantine

5. stable, inexpensive, easy vaccine....scar at injection site = success!

Front 43

How do you distinguish smallpox and chickenpox?

Back 43

1. all smallpox have same stage of development everywhere and develop slowly (chickenpox...rapid and different stages at same time)

2. smallpox lesions are big (5-10mm) and chicken pox 1-5 mm

3. BY DAY 7: smallpox scabs haven't formed yet (chicken pox most have scabs)

4. smallpox= arms and legs >trunk (opposite for chicken pox)

5. smallpox commonly on palms, soles

Front 44

Why can't we vaccinate pregnant woman against smallpox?

Back 44

danger to fetus

Front 45

What are the three reportable cases to US?

Back 45

1. smallpox

2. varicella

3. MMR

Front 46

What is general information about maculopapular rash diseases?

Back 46

(Measles-Rubeola)

1. signs/sx: Koplik's spots, maculopapular exanthemum, SSPE (subacute sclerosing panencepthalitis)

2. causitive agent: MORBILLIVIRUS (single stranded RNA enveloped virus)

3. pathogenesis/virulence factors: cause viremia, induce syncytia, disable human immune response

4. transmission: respiratory droplets

5. culture/diagnosis: clinical presentation, ELISA

6. prevention: MMR vaccine

Front 47

What is the taxonomy of Morbillivirus (measles)?

Back 47

1. family: paramyxoviridae

2. species: Measlesvirus

Front 48

What is the strucutre of Morbillivirus (measles)?

Back 48

1. genome: ssRNA, enveloped

Front 49

What does Morbillivirus (measles) cause?

Back 49

measles (rubeola) which is 1 of 5 classic childhood exanthema (rubella, roseola, fifth disease and chicken pox)...before 1960 most kids were affected by it..

confused with roseola and rubella

Front 50

How do I know if I have Morbillivirus (measles)?

Back 50

1. fever and three C's + P: cough, coryza (acute rhinitis), conjunctivitis and photophobia

2. after 2 days, Koplik's spots appear on mucous membrane on inside of cheek across from molars..."grains of salt surrounded by red halo."....Koplik spots precede measles rash and seen for 1st 2 days after rash

3. rash starts on head and takes 1-2 days to cover body....gradually coalesces into red patches which fade to brown.

Front 51

What happens with atypical measles?

Back 51

receive killed vaccine or unsuccessful immunication) spread from extremities inward and petechiae, vesicles, papules show up

Front 52

How do we diagnose Morbillivirus (measles) in the laboratory?

Back 52

1. clinical manifestations (Koplik's spots)

2. RT-PCR of throat/nasopharyngeal swabs/blood/urine

3. staining of respiratory cells from urine reveal syncytia

4. Ig detection when rash is present (IgM in serum within first few days) ....rapid, presumptive dx for recent infection

Front 53

Can Morbillivirus (measles) be dangerous?

Back 53

YES....30% cause: pneumonia, bacterial secondary infections(ear), diarrhea

1. 1/1000 children develop encephalitis causing deafness or retardation.

2. developing countries: malnutrition and vitamin A defiiciency can kill.....leading cause of blindness among African children

3. Worldwide, Measles used to kill 1 million children every year.

Front 54

What is the most serious complication for Morbillivirus (measles)

Back 54

subacute sclerosing panencephalitis (SSPE)

Front 55

Can I infect others if I have morbillivirus (measles)

Back 55

1. highly contagious, spread via respiratory droplets.

2. rash caused by immune T cells attacking infected endothelial cells

4. decrease in eosinophils/lymphocytes....host cell mediated immunity and hypersensitivity responses are DISABLED.....reason why predisposed to secondary bac. infections

Front 56

Whos is at feat of contracting this illness?

Back 56

all newborns, immunocompromised and non vaccinated people

Front 57

How can I protect my family?

Back 57

1. vaccinated with MMR vaccine...live attenuated virus given to kids 12-15 months with booster at 4-6 years old (mandated by state school entry requirements)

2. two ways to prevent infection when exposed: give a shot of measles vaccine within 72 hours of exposure and a shot of sIgs within 6 days of exposure

**you need MMR vaccine if u are going to college, work at health care facility, child baring age, or about to travel international

- no complications to vaccine...vaccine is grown in chick embryo tissue culture and given to people to egg allergies

Front 58

Why is MMR vaccine so successful in preventing measles?

Back 58

measles limited to humans and immunity is lifelong. only 1 type of serotype!

Front 59

How can measles (rubeola) be treated?

Back 59

no specific antiviral...supportive care with bed rest, fluids, control fever

Front 60

What is research on measles?

Back 60

inhalable form of dry powder vaccine triggered no adverse effect....why do we have to know this..?

Front 61

What is general information for Rubella?

Back 61

1. "3 day measles"..."little red" = rubella.."german measles"....one of the 5 classics

2. signs and sx: postnatal or congenital infection of the fetus.

3. causative agent: Rubivirus found in the family Togavirus: sRNA with loose lipid envelope

Front 62

What is the taxonomy for Rubivirus (rubella)?

Back 62

1. family: togaviridae

2. species: Rubella virus

Front 63

What is the structure of Rubivirus (rubella)??

Back 63

1. genome: +ssRNA, enveloped

Front 64

How do I know if I have Rubivirus (rubella)?

Back 64

1. normally benin in children.....multiplies in the respiratory epithelium, goes to LN and reaches blood....early sx: fever, malaise, lymphadenopathy

2. maculopapular rash 14-17 days AFTER exposure.....lasts 3 days and pruritic. initially on face and then goes to feet. more faint than measles

3. rash is more prominent when taking a hot shower/bath

4. older kids, young adults: can have arthralgia, arthritis, thrombocytopenic purport instead of rash...+ encephalitis

Front 65

How do we diagnose in the laboratory for Rubivirus (rubella)?

Back 65

1. RT-PCR of viral DNA (specimens: nasal, blood, throat, CSF)

2. detection of anti-rubella IgM (ELISA or latex agglutination)

3. clinical symptoms not specific bc easy to confuse with others

Front 66

What is the most commonly used method to isolate rubella virus?

Back 66

interference technique using African green monkey kidney (AGMK) cells and an enterovirus....inoculate cell onto primary AGMK monolayers....incubate for 9-12 days and then challenge with enterovirus.

**presence of Rubivirus (rubella) will interfere with enterovirus and prevent enterovirus CPE on the cells

Front 67

How can I diagnose congenital rubella?

Back 67

VIRAL ISOLATION is preferred bc rubella serology is difficult to interpret....since IgG can cross the placenta it can confuse and also IgM may not be detectable.

**also can do a placental biopsy, rubella antigen detection via monoclonal antibody and PCR

**specimens for viral isolation: nasopharyngeal swab, urine, CSF, buffy coat of blood

Front 68

Can I infect others with Rubivirus (rubella)?

Back 68

Yes. via:

1. respiratory droplets

2. urine

Front 69

Who is at risk for Rubivirus (rubella)?

Back 69

newborns, immunocompromised peeps, non-vaccinated susceptible individuals

Front 70

What is the most serious outcome due to rubella?

Back 70

Congenital Rubella Syndrome

**fetus is at risk until 20th week of pregnancy....most common defect is deafness + abortion/stillbirth

Front 71

How can I protect my family from Rubivirus (rubella)?

Back 71

1. MMR vaccination (promotes humoral and cell mediated immunity) bc of increase in seropositve moms......dont get pregnant until after 3 months of getting the vaccine and don't get it at all during pregnancy.

Front 72

How can I be treated for Rubivirus (rubella)?

Back 72

no specific antiviral drug. Supportiv care only

Front 73

What is interesting about the potential for research in Rubivirus (rubella)?

Back 73

rubella viral capsid is an anti-apoptotic protein

Front 74

What is general information about fifth disease?

Back 74

1. erythema infectiosum

2. "slapped cheek" appearance

3. causative agent = parvovirus B19

4. bery contagious and can cause still birth

Front 75

What is the taxonomy for Parvovirus B19?

Back 75

1. family: Parvoviridae

2. species: Human B19 virus

Front 76

What is the structure for Parvovirus B19?

Back 76

1. genome = +ssDNA

2. no envelope

3. smallest human DNA virus

Front 77

What does Parvovirus B19 cause?

Back 77

fifth disease (erythema infectiosum)

Front 78

How do I know I have Parvovirus B19?

Back 78

1. low grade fever, malaise, "cold" for a few days before rash

2. bright redness of cheeks (slapped cheek), most intense under eyes and initial sign of sparing of eyelids, chin, premolar area

3. 2nd rash can go around later...

4. itchy on soles of feet

5. rash goes away in 7-10 days but can last many weeks

6. as it goes away, can look "lacy"

7. viremia occurs during initial phase of "cold symptoms" and is infectious then....rash with lacy pattern and pruritic in 50%

* adults= flulike symptoms +polyarthralgia and joint swelling

Front 79

How do I diagnose in the laboratory for Parvovirus B19?

Back 79

1. appearance of slapped cheek

2. ELISA of serum, test for IgM and IgG to B19 antigens

3. detection of vial DNA by PCR of blood specimen

Front 80

What causes the rash in Parvovirus B19?

Back 80

immune system recognizes as foreign...spits out antibodies...antibody-virus complex causes rash and can be exacerbated by warmth/sunlight

Front 81

Can fifth disease be dangerous?

Back 81

Yes....ppl with chronic anemia can fall into aplastic crisis and potentially die.

1. if seronegative for B19 pregnant woman infected: virus will affect fetus and cause anemia, CHF (hydrops fetalis)....infected fetuses have in utero transfusions and can live

Front 82

How can I give Parvovirus B19 to others?

Back 82

1. inhalation of respiratory droplets....found in saliva, sputum, nasal mucus before onset of rash

2. direct contact with secretions by sharing of cups, utensils

Front 83

Who is at risk for infection of Parvovirus B19?

Back 83

children (elementary schools), parents of kids with B19, pregnant women, chronic anemic patients, immunosuppresed

**animal parvovirus doesn't affect humans and human doesn't affect pet

Front 84

How can I be treated for Parvovirus B19?

Back 84

no treatment but Ig can be given to treat percents infections in immunocompromised......n active caccine .

**ppl with aplastic crisis need transfusion

Front 85

What are the biggest complication caused by Parvovirus B19?

Back 85

B19 targets erythroid precursor cells and lyses them in the bone marrow

Front 86

What is general information about Roseola?

Back 86

1. maculopapular rash

2. HHV-6 and HHV-7

3. 1st isolated from blood of AIDS patients.....virus is lymphotropic and ubiquitous....kids are 45% seropositive for 6 and adults are 90% seropositive for both

Front 87

What is the taxonomy for Human Herpesvirus 6 and Human Herpesvirus 7?

Back 87

1. family: Herpesviridae

2. species: Human Herpesvirus 6/7

Front 88

What is the structure for Human Herpesvirus 6 and Human Herpesvirus 7?

Back 88

1. genome: dsDNA

2. enveloped

3. no fomite transmission

Front 89

Primary infection for HHV-6 happens in:

Back 89

first year of life

Front 90

Primary infection for HHV-7 happens:

Back 90

first 2-3 years of life

Front 91

Two forms of HHV 6 have been identified....what are they?

Back 91

Variant A and B.....B is major cause of roseola, while A is unknown

Front 92

What is Roseola?

Back 92

1.aka exanthema subitum....rapid onset of high fever for up to 3 days

2. possible seizures

3. on the 4th day, fever gone but faint maculopapular rosh over neck, trunk, butt and lasts 24-48 hrs

Front 93

How can I give Human Herpesvirus 6 and Human Herpesvirus 7 to others?

Back 93

1. transmission of 6B primarily via saliva and vertical transmission

2. sexual transmission

3. 6A detected more on skin....direct contact

4. HHV7 shed throughout life in saliva

Front 94

How can I be treated for Human Herpesvirus 6 and Human Herpesvirus 7?

Back 94

1. self-limited dz and requires supportive care

2. no formal treatment

3, acyclovir, foscarnet, cidofovir, ganciclovir IN VITRO helps. not in vivo

Front 95

What are the wart like eruption diseases?

Back 95

1. viruses cause all warts

2. warts (papillomas) are benign, squamous epithelial growth.

**HPV

can become malignant when caused by a particular HPV

Front 96

What is the taxonomy for HPV?

Back 96

1. family: papovaviridae

2.species: Human papilloma virus

Front 97

What is the structure for HPV?

Back 97

1. genome: dsDNA

2. no envelope

3. fomite transmission

Front 98

HPV is the most prevalent viral cause of:

Back 98

STD s in the US (over 100 types and 40 can infect the genital area)

Front 99

What does HPV cause?

Back 99

1. warts (papillomas)....can be painless like on finer (HPV 2,4,27,29) or painful warts can be on sole of feet (plantar warts) and caused by HPV 1

**flat warts: smooth, skin colored on face, trunk, elbows, knees (HPV 3,10,28,49)

Front 100

What is genital warts?

Back 100

found in genital/anal of both men and women....17-33 y/o commonly.

**HPV 6 and 11 (sexual contact)

Front 101

How do I know I have HPV?

Back 101

1. external warts

2. immunohistochemical detection of HPV structural proteins

3.Southern blot (more sensitive/specific technique and can tell u what HPV type)

4. PCR

Front 102

Can HPV be dangerous?

Back 102

almost all nongenital warts are harmless

Front 103

Can I infect others with HPV?

Back 103

YES. via direct contact....auto inoculation.

**viruses are stable and transmit via fomites (counters, showers, medical equipment) and inadequately chlorinated swimming pools

Front 104

How can I be treated for HPV?

Back 104

1. remove with salicylate acid preps, cryotherapy, electrocautery, laser, surgical excision, chemical

2. inject IFN and stimulate immune response

3. imiquimod applied topically to activate immune response

4. podophilox causes tissue necrosis and destroys warts via antimitotic activity

5. topical cidofovir inhibits viral DNA synthesis (immunodeficient people)

Front 105

How do I prevent HPV?

Back 105

avoid contact with infected people and wear slippers in communal showers

Front 106

What is the taxonomy for Molluscum contagiosum?

Back 106

1. family: Poxviridae

2. species: Molluscuscum contagiosum virus

Front 107

What is the structure of Molluscum contagiosum?

Back 107

1. capsid: brick shaped

2. genome dsDNA

3. enveloped

Front 108

How do I know I have Molluscum contagiosum?

Back 108

1. papules to pearly unbilicated nodules in different size

2. central caseous plug

3. common on trunk, genitalia, proximal extremities

4. clusters of 5-20 and painless

5. children: face, neck, armpits, hands and arms (ABOVE WAIST) and adults: can come from STD so genitals, lower abdomen, inner upper thigh and buttox (BELOW WAIST)

6. lesions disappear within 6-18 months without treatment and without scar

Front 109

How do I diagnose in the laboratory for Molluscum contagiosum?

Back 109

1. case study and confirm histologically by large eosinophilic cytoplasmic inclusions

2. PCR

Front 110

When can I get Molluscum contagiosum?

Back 110

worldwide and genital is a marker for sexual activity

Front 111

How can I give Molluscum contagiosum to others?

Back 111

1. poor hygiene

2. climatic factors

3. direct contact (including sexual)

4. fomite transmission via towels or clothing....also swimming pools and sharing baths.

*if infected with molluscum bumps:

1. cover lesion w bandaid

2. dispose of used bandage at home

3. don't share anything!

****sexual transmission most common in adults

Front 112

How can I be treated for Molluscum contagiosum?

Back 112

1. IV cidofovir (antiviral) which blocks DNA replication

2. crettage: most efficacious tx with low rate of side effects

3. cantharidin topically

4. imiquimod (induce IFNs)...more effective than #3 but more expensive

+ salicylic acid and laser therapy......lesions should disappear in 6-18 most without tx or scars

Front 113

What are the viral infections of the eye?

Back 113

1. viral conjunctivitis by adenovirus

2. viral keratitis by HSV

Front 114

What is the taxonomy for adenovirus?

Back 114

1. family: adenoviridae

2. species: human adenovirus

Front 115

What is the structure for adenovirus?

Back 115

1. genome: dsDNA

2. no envelope

3. can spread by fomite

Front 116

What is general information about adenovirus?

Back 116

1. about 100 serotype an 51 infect humans.....unlikely for universal vaccine

2. most important defense against is CELL MEDIATED IMMUNITY....

3. shows latent infection of lymphoid tissues

Front 117

What does adenovirus cause?

Back 117

1. URT infections

2. conjnctivits

3. hemorrhagic cystitis

4. gastrotenteriris.

5. EKC (conjunctivitis and epidemic keratoconjunctivitis): causes mucosa of palpebral conjunctiva to be nodular and both palpebral and bulbar to be inflamed...blame the swim,ming pools and 8,19,37 serotypes

Front 118

What is the most common cause of viral conjunctivitis in people of all ages?

Back 118

adenovirus

Front 119

What is the most problematic cause of conjunctivitis?

Back 119

herpes simplex conjunctivitis

Front 120

How do I know if I have adenovirus? Lab diagnosis?

Back 120

1. clinical presentation and history

2. epidemiologic studies use lab dx

3. immuno assays, PCS, DNA probe to detect

Front 121

Can adenovirus be dangerous?

Back 121

lytic DNA viruses that can disseminate in immunocompromised or neonates.....significant morbidity and mortality

Front 122

How can I transmit adenovirus?

Back 122

1. spread by fomites

2. resistant to drying, detergent, GI tract secretion and mild chlorine

3. spread to eye by fingers or contaminated water

4. direct contact with ocular secretion, fomites contact, food borne route, inhalation of infectious aerosols

Front 123

How do adenovirus evade immune system?

Back 123

1. able to interfere with operation of CTLs by blocking function of MHC I

2. virus producs protein that provides resistant to tumor necrosis factor (TNF)...TNF released by monocytes that are exposed to viruses and lyses the virally infected cells

3. interfere with the supervise action of interferon by making 2 small RNA molecules (VC RNAs) that mimic darns and bind to proteins that shut down protein synthesis

Front 124

How can I protect my family from adenovirus?

Back 124

1. strict hand washing

2. isolation apparel in hospital

Front 125

How can I be treated?

Back 125

1. no known treatment ....run its course

2. live oral vaccine for type 4 and 7 is for MILITARY ONLY ages 17-50 (1st 4 then 7)

3. eyedrops for comfort.

4. steroids for swelling

Front 126

What is the taxonomy for HSV I and II?

Back 126

1. Family: Herpesviridae

2. species: HSVI, HSVII

Front 127

What is the structure for HSV I and II?

Back 127

1. genome: dsDNA

2. enveloped

Front 128

What is general information about HSV I and II?

Back 128

1. don't survive well on environmental surfeit and requires direct inoculation in mucus membranes, genitals, anus

2. can be lyric or latent (latent advantage that it can avoid immune system)

3. after primary infection virus establishes latency in neurons...reactivation results in lesions of lips, eyes, fingers, genitals...most are asymptomatic.

**50-80% seropositvie for HSVI....20-40% seropositive for HSV2

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What does HSV I and II cause?

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1. herpes keratitis: usually caused by reactivation by HSV1....travels down ophthalmic branch instead of mandibular of trigeminal nerve.

2. herpetic whitlow: inflammed nlister (HSVI or II) enters a cut in skin of finger

3. Herpes gladiatorum and eczema herpeticum

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How do I know if I have herpes keratitis?

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gritty feeling in eye, conjunctivitis, sharp pain, photophobia....recurrent and interfere with vision

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How do I know if I have herpes gladiatorum?

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skin infection with wrestlers/athletes engaged in contact sports. (treat with aciclovir)

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How do I know if I have eczema herpeticum/ Kaposi's varicellum eruption?

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preexisting skin disorder or immunocompromised....abrupt clusters of dimpled blisters emerge 7-10 days and spread widely...untreated and fatal. can heal in 2-6 wks

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How can I diagnose HSV I and II?

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1. case study

2. viral culture/isolation (grab from the vesicles)

3. PCR for HSV DNA

4. Tzanck smear: look for multinucleate and eosinophilic intranuclear leasions

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Can HSV I and II be dangerous?

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Yes, neonates and immunocompromised

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What is the leading infectious cause of blindness in the US

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herpes

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How can I transmit HSV I and II to others?

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usually via asymptomatic source of infection...HSV1 usually orally and HSV2 sexually or placement of hands into eyes/breaks of skin....asymptomatic shedding helps with its transmission. LIFELONG infection

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Latent HSV infections

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1. advantage : virus can avoid immune system and activate later...

2. reactivation causes virus to replicate on lips, eyes, fingers, genitals.

3. limted # of viral genes are transcribed (LATS)

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Lytic HSV infection

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DNA replication starts as soon as cell allows synthesis of viral DNA polymerase....show local spreadd and progression of lesions. rarely systemic except in the immunocompromised and neonates

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How can I protect my family from HSVI and II?

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wear gloves, wash hands, keep away from risky people.

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How can I develop protective immunity from HSV 1 and 2?

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1. humoral and cell mediated immunity can help

2. during primary infection, interferon production and NK cells limit the disease....HSV rarely causes viremia

3. production of ABs help limit virus

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How can I be treated for HSV 1 and 2?

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1. Trifluridine: herpes keratitis treatment; use of artificial tears for conceal healing (Virdarabine if allergic)

2. cidofovir (CMV retinitis and HSV infections)

3. acyclovir/valacyclovir for herpes gladiator and eczema herpeticum)