micro4 – Flashcard
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Most RNA viruses replicate
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in cytoplasm; flu uses nucleus extensively. poxvirus is in cytoplasm
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nucleocapsid
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R/Dna+structural proteins+NABP/enzymes= nucleocapsid
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enveloped virus
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nucleocapsid+GPs+memb=enveloped virus
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all picornaviruses
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plus sense. virion genome can be used as message. so is ~ to rna
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flu
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orthomyxoviridae=type A B C. genome is in pieces. mutates v fast=reassortment. is negative sense= meaningless to cell=need own RNA dep RNA polym.
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only virus with SSDNA
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parvovirus
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DNA vs RNA virus location
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DNA- nuc. RNA- cytoplasm
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for virus to make mRNA, needs
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polyA tail and cap
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EBV cell rec
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cd21
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herpes simplex cell rec
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nectin 1
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rhino cell rec
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ICAM1
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rabies cell rec
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ACh
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flu and paramyxovirus cell rec
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sialic acid
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polio cell rec
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IgG
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HIV cell rec
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CD4 + CXCR4 TCells and CCR5 mphage
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polio rec
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only in primates. rec in nasopharynx, gut, anterior horn cells
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measles tropism
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everywhere
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picorna virus
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translate- polyprotein- structural capside proteins, proteases. RNADRNAP.
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poliomyelitis
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inc. in upper classes and older ppl
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coxksacie A
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a picornavirus- forms vesicles of virus particles- herpangina
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EV71
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~ to cocksackie. ras. encephalitis. hand, foot, mouth disease
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toga virus
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RNA SS + enveloped. budding. mosquto vector
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toga and rubella
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same structure
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paramyxo and rhabdo virus
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neg sense RNA SS-> forms helical nuclear capsids with rna. enters cells via vesicles. nucles not involved. budding
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RSV
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paroxymyxovirus, SS, neg, enveloped. nuvleus not involved. have fusion protein. glycoproteins and budding.
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measles kopliks spots
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spots full of viruses. shows before rash does. very transmissible
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influenza
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rna SS neg, genome in pieces, enveloped. involves nucleus- rna need to be spliced. steals host cell caps on mrna
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bunyavirus
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rna ss +/- genome in pieces mosutios. #1 cause viral encehpalitis
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reovirus
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human rotavirus. non enveloped icosahedral segmented DS RNA. G.I.P.
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rotavirus
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DS ~ to reovirus replication strategy. nucleus not involved.
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parvovirus
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SSDNA only in cells mitotically active. has DS intermediate. proteins made in cytoplasm.
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herpes virs stages
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DS 1). envelope so do fusion of envelope w PM-> attachment and penetration. 2. targets nucleus-release DNA- IM/early stage. 3. replicate genome. virus polymerase and cell polymerase-> make more genome- early stage. 4. make structural proteins- late stage. 5. nuc memb modified by viral GPs, genome encapsidated, budding out from Nuc membrane. 2* membr-exocytosis. 6. can also lyse
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herpes 1* and 2* memb
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1* from nuclear memb. 2* for PM.
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poxviruses replicate
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all in cytoplasm, fast. DSDNA. lipid envelope, no budding out.
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retrovirus
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diploid, 2 SSRNAs, positive, but need DNA IM. needs a RT.
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viral protease
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clips up proteins, makes correct nuclear capsid particles.
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Hep B is
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has RNA to DNA step. exists outside cell as wild state. antivirals to retroviruses work on HepB too. envelopes, buds.
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Herpes
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DS DNA virus. icosahedral. lipid bilayer envelope
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Herpes and GPs
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use to bud thru membrane and attach to host cell rec
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alpha herpes
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type 1, type 2, varicellazoster 3
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alpha herpes treatm
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acyclovir
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herpes 1
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cold sore, some genital herpes
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herpes 2
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genital herpes
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herpes 3
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varicella- chickenpox. zoster-shingles
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beta herpes
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cmv 5, human herpes virus 6 roseola, human herpes virus 7 roseola (6+7 inc in AIDS)
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gamma herpes
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EBV 4, kaposi sarcoma 8
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all herpes have latent stage
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alpha- in neurons. beta- in mono/lymphocytes, gamma- in B cells. so if ur infected- infected for life, reactive if stress/infection.UV
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herpes envelope
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has envelope so enters via fusion
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early herpes life cycle
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make mRNA, go to cytoplasm, proteins MUST be made in cytoplasm w nuclear localization signals-> return to nucleus-> more more proteins and replicate genome
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herpes late stage life cycle
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actual viral capsids, make final virus, carbs via golgi, exit via budding/lyses/exocytosis.
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herpes latency
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replicate in sensory neuron, travels up neuron->ganglions, it is making LAT (latency associated transcript). virus moves along Microtubules
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LAT
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latency associated transcript from herpes
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herpes spread
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via saliva vesicle fluid/saliva/vagina
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herpes cell cell spread
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can avoid IS, need cell mediated immunity to resolve
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herpes and IFN
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herpes -/-IFN inhibition of viral synthesis
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TAP
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herpes has protein to plug transporter associated w AG processing channel (TAP) that inhibs delivery of peptides to ER
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herpes and cell recog
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herpes blocks association w MHCI, prevents CD8Tcell recog
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herpes infected cells express
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Fc rec and comp rec
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herpes shedding
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virus can ->asymp shedding. no
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herpes vaccine
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none but for chickenpox
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herpes type 1
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90% asym, 9% minor, 1% disease. 1* herpes- gingivostomatitis - v painful, latent cold sores. hepatic whitlow- digits.
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herpes type 2
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genital herpes. sex. 1 wk incub. long period malaise tender LNs. virus shed, not so bad...
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herpes 1* vs 2*
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1* prominent vesicles w virus. 2* smaller vesicles, less pain.
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neonatal herpes 2
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during birth canal passage. neonates dont have CMI.
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herpes type 2 progression neonates
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->CNS->v bad. prevent via Csection.
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V-Z spread
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via droplets, contact. respir tract-> other organs. viremia. ex if u see rash on skin
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VZ and CMI
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CMI needed for viral clear, can escape ABs.
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chickenpox
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less bad young. if YA, severe, pnuemonia.
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chickenpox progression
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droplets-respir-lymphatics-retic system- viremia (fever malaise HA)- mucus memb and skin latency in neuron.
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VZ vesicle progression
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macule- papule- vesicle- pustule- crust
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chickenpox vs smallpox
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cpox- rash perfuse on trunk, sparse distal. smallpox- rash perfuse on face, sparse on trunk, profuse distally
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VZ vaccine
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live virus vaccine- monovalent, also quadravalent- MMRV.
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EBV
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mono- coated tongue. virus in saliva- kissing disease. get HSM. Bcell prolif. TCell response (lymphocytosis)-> infectious mono. see atypical lymphocytes
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EBV associated w
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HL, lymphomas if IS, african kids in malarial regions (burkitts), nasopharyngeal carcinoma
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EBV shed
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lifelong shed virus. kids asymp. no antiviral or vacine
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CMV
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blood tissue, secretions. semen is most. -/-epithel cells.
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CMV latent
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in T cells, mphages, others. need CMI, not much AB help.
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CMV is generally
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asymp. can ->"heterophile neg" infecitous mono can infect in utero. 4k/yr. opportunistc. anti virals exist but are toxic. no vaccine
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CMV and evade CMI
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imp. evade via prevent AG presentation by inhib MHC1. inhib w CK induced expression of MHC2 on APCs. inhib NKs. encodes IC-10 analogs that inhibit TH1.
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Herpes 6+7
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v infectious 100%. rapid onset, fever ,rash 1-4d. CMI. after 4 days, recovery w out complications.
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2 grps of papoviruses
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papillomavirus and polyomavirus. small, nonenveloped circular DSDNA.
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papillomavirus
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larger than polyomavirus. more complex genome. trophic for skin/muc membrane epithel cells. warts cervical cancer CVD
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papillomavirus early proteins
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E6+E7 are made in cancer tissues
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E6
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targets p53
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E7
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targets Rb
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HPV dx
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dna typing. dna, pcr, stain, papsmear
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HPV types
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100 types-> 16 grps based on DNA. are cutaneous or mucosal HPV.
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HPV early/late genes
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early: E1-E8. late: L1-L2
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HPV infects
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in sq. epithel of skin (wart) and muc. memb (genital, oral, conjunctival papilloma)
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HPV structure
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5 pt star shaped capsomere in icosadeltahedral structure.
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HPV type 16
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CCancer. see late L1,L2 (structural capside genes) and early E6,E7
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HPV and CCancer
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linked to ecro endocervical squamocolumnar junction. mostly types 16,18. integrate into genome
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epidermodysplasia verruci formis
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from HPV-> pruritic itchy pupules, erythematous. via HPV 5,8,17,20,36
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papsmear
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exfoliated cervicovag sq. epithel cells 2 perinuclear cytoplasmic vaculization- koilocytosis . see large sq cells w hyper chrom. nucleus
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koilocytosis
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The appearance of a cell in which the nucleus becomes large and swollen or contracted and wrinkled and is often surrounded by a "halo" of cytoplasmic clearing. PAP SMEAR hpv
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hpv infects via
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direct contact breaks in skin/mucus, sex, birth canal, chew wart
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hpv treatm
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surgery, electro, laser. Salicylic acid w LA, formaldehyde, bleomycin, imiquimod, IFN, cidofovir
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gardasil
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inhibs hpv 6,11 (genital warts), 16,18 (CCancer)
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polymavirus early late regions
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early- w large T(transforming) and small T AGs. late- 3 viral capside proteins
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polymavirus
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~ Viral infection capable of inducing tumor ~Viral agents of leukoencephalopathy (JC virus) and renal transplant complication (BK virus) ~Primary infections target cells producing giant swollen nucleus ~symptoms are asymptomatic or mild ~ transmission through urine and respiratory secretions ~treatment: interferon
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BK and JC viruses
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are types of polyomavirus esp in IC. both make T AGs ~ to SV40. new forms are Wu and Ki
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JC
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from brains of pats w progressive multifocal leukoencephalopathy.
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SV40
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DNA virus that pirates the DNA replication machinery from the host cell replicating its genome- rate determining factor is the helicase (only mechanism it uses it's own of). Large T AG and Small T Ag are made. also viral proteins VP1,2,3
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Merkel cell carcinoma
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Rare, aggressive and life-threatening neuroendocrine carcinoma of the skin located at head or neck of patient associated with sunlight and immunocompromised that's usually (>80%) caused by Merkel cell polyomavirus
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JC and BK viruses happen
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by 15 yo. spread via respir. latent reactive via IC, preg, tplant, AIDS. no treatm.
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adenovirus
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medium non envelped icosadeltahedral dna virus. 35 kb linear DSdna. has fiber projection from each of 12 vertices/bases. capsid -240 capsomeres of hexons and pentons. 11 viron proteins->serotyping
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adenovirus grouping
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grps A-F, 47 serotypes. in same grp have same fiber length, DNA homology, GC content, woldwide, tumor transforming, agglutinate RCs
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adenovirus reservoirs
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lung and brain via in situ hybrid+PCR. other reservoirs? lymph kid livr. can be reactivated in BMT
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adenovirus attachment
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to host cell via interaction penton w cell integrins-> uncoating in cytosol- cell nucleus as nucleoprotein complex
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adenovirus early events before viral dna syn
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induce cell->S phase for replciation and protect cell from host defense mechs. make viral proteins for viral DNA replic. make 20 E proteins- EIA- activate CCycle, EIB protec from apot, they interact w p105 Rb and p53
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adenovirus late events
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terminal protein primes viral dna syn. major late promoter "L". complex of EIB+E4-> support transport of viral transcripts. make capsomers in cytosol-> nucleus beocmes empty capsids-> load w dna- primed to maturity
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adenovirus inhib host defense via
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RNA blocks activation of PKinase R which inhibs PS by -/- eIF2. EIA inhibs IFN inducible genes. E3 inhibs MHC1 so cant do CTL lysis.
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adenovirus pathogensis
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1. entery @ eyes nose moth 2. conjunctivitis/pharyngitis/gastroenteritis 3 exit via eye mouth anal. also cause dis in liver lung cns/ur bladder/ nail bed/hep/cervix
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adenovirus can infect...
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water supply- conjunctivitis
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adenovirus big 3 sx
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conjunctivitis, pharyngitis, gastroenteritis
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adenovirus eye/GI dis
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eye infections via grp B type 3,7. GI dis via grp F type 40-42.
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adenovirus 5
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hepatitis
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adenovirus 35
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cystitis/nephritis/colitis
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adenovirus time course
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21d
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adenovirus histo
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dark basophillic nuclear inclusion bodies w dna/proteins/capsids
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adenovirus DX
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long lasting immunity. DNA/elisa/serology
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adenovirus spread
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feco oral, swimming polls, infect w type 1 2 5 6 in first yr of life. chlorinate h20!
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adenovirus vector
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can use as vector for GT
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poxvirus
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largest virus. envelpe, oval/brick. linear DSDNA. inverted terminal repeats w hairpin loops. multiples of enzymes/transcription. 8 genera.
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poxvirus that afect ppl
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1. orthopox (cow monkey pox, vaccinia, variola- smallpox). 2. parapoxvirus- rare, localized lesions. 3. yatapoxvirus- rare, localized. tanapox inc. in skin infections in africa. 4. molluscipoxvirus- beign skin nodules via contact
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pseudocowpox
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orf lesion on finger
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molluscipoxvirus
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skin lesion and epidermis w molluscum bodies. BENIGN
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poxvirus replication
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unique among DNA virus- happens entirely in cytoplasm!!!!!. only animal virus uncoating step needs new virus encoded protein uncoatase. viral core released to cytoplasm- virons intitiate transcription. uncoatase releases DNA. DNA and protein-cores. virions bud thhru PM, released via lysis. 10k viral particles per cell
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poxvirus steps
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1. attach 2 entry 3 early mrna and early enzymes 4. uncoatase releases dna 5 replication 2-5hr 6. IM mrna and late TFs 7. late mrna 8. assembly 9. golgi for maturation 10. release via dissrupt/exocytosis
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poxvirus prodrome
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up to day 7 (see slide 16)
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poxvirus dx
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via serology, polypeptide map/
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poxvirus autoinnoculate
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via scratch vaccine area and rub eye- live virus. can have progressive vaccina (vaccina necrosum). rare SE- evzema vaccinatum
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vaccina
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a local infection induced in humans by innoculation with the virus causing cowpox in order to confer resistance to smallpox. levaes pitted scar
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vaccinia virus
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large DS DNA. can use for GT.
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parvovirus
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small non enveloped linear SSDNA. virus have 1 major, 1 or 2 minor coat proteins. human b19.
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b19 goes to
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trophic for erythroid cells based on distrib of rec for b19 (blood grp P (D?) pathogen)
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b19 lysis
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anemia, aplastic crisis.
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fifth disease
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a type of maculopapular rash disease of the skin; also known as Erythema infectiosum; caused by Parvovirus B19; caTACuses "slapped cheek" syndrome in children and very contagious. arthlagia. 4-14d incub. 1). viremia flu like, detect IgM parvovirus immune complex. 2). 2*phase after 17d-erythmous facial rash, lace like rash on limbs trunk fades 2-3d. 3). joint pain
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B19 TAC
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transient aplastic crisis-> loss of RCs cu of erythroid precursors, bad if u have SS, thal. fetal deatl 10%, 1* maternal infection.
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b19 timecourse
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1. initial lytic- flu like 7d incub, dec Hb, viremia, dec. reticulocyte. 2. non infectious stage immunologic stage- rash arth fifth disease. v hard to isolate virus. have specfiic IgG Ab.
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BK virus
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Cause of hematuria, hemorrhagic cystitis, or ureteric stenosis, or interstitial nephritis in a severly immunocompromised pat.Polyoma virus. dsDNA, naked, icosahedral renal disease in AIDS patients
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b19 dx
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dna, igm (2-3mo), igG (years)
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b19 widespread
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60% adults, 90% old have it
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b19 treatm
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no vacine for fith dis/TAC- treat symp.
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Slow disease
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viruses ex rabies. kuru and cjd
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prions
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Prp->dis. products of gene on 1 exon on Chrom 20. have long incub pds. w neuronal loss-> coordination loss.
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human/animal prion dis
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human- kuru, cjd, gss, fatal familial insom, cgdv. animal- chronic wasting dis, scrapie, bse
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slow diseases from viruses
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progressive multifocal leukoencephalopathy- jc virus. subacute sclerosing panencephalitis (SSPE)- measles 1-10 yrs later. progresive rubella panencephalitis- rubella. rabies
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prion disease
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only in CNS. 1-30 yr incub. show progressive ftal course. mad cow- vaculation of neurons. R to UV/Rad, proteases, disinfectant, digestion. rod like. kill via autoclave, no treatm
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prions and plaque
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cause amyloid plaque? form plaque-cerebellum- smaller plaques in granular and molecular layer.
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cjd vs vcjd
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older- cjd. younger- vcjd.
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PRP types
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PRPnormal- alpha helix. happy. protease sensit. PRPsc- mut- Bsheets- bad, protease R>
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prion transmit via
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infect, tplant, cannibal, food, cwd- infected deer
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prion time course
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1-30 yr incub, 3.5 month prodrome, 4 mo dementia/myoclonic stage- death
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prion dx
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no EM, AB or NA prob. no serology. DX w neuro symp
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viral gastroenteritis
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rota and norovirus
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reoviridae
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8 genera including rotavirus (#1 cause of severe diarrhea of kids under 5). 500k d/yr. 2d incub. vomit, watery diarrhea 3-8d
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rotavirus
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reovirus. fatal dehydratation. non enveloped, icosahedral, double capsid, wheel w spokes. DS RNA in 11 segments. separate via PAGE.
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rotavirus proteolysis->
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core particle and infectious subviral particle (ISVP)-> have v imp role in replication
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rotavirus stripping
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NEED stripping of envelope for virus to be infecious in gut
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rotavirus structural proteins
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outer VP7+VP4-> viral HA-spikes. inner core-VP1,2,3,6- AG determinant.
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rotavirus targets
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B adrenergic rec in host.
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rotavirus grps
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A-F via Ags. D,E,F not in ppl. A- mostly yung ppl in US. B- China. C- sporadic.
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rotavirus serotypes
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15 total. 6=P type, ABs to VP7. 9=G type, ABs to VP4. Grp A- 4 serotypes. define w AG diffrences in VP6
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rotavirus epid
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500 k d/yr. 95% kids infected by 3-5 yr. fecooral route or fomites. max shedding 2-5d after diarrhea. communicable 2d before, 10 d after onset. most infants have AB by 3yo. most severe 3-24 mo old. 5-10% all cases of gastroent. <5yo.
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rotavirus clinical
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1-3 incub, fever, n/v/d. severe diarrhea no blood 3-9 d. neonates- hemorrhagic. dehydration, metab. acidosis, 2* malab of lactose, fats, chronic diarrhea
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rotavirus RFs
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daycare, hospital, caretakers, immune SCID, HIV, BMT
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rotavirus replicate
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. virion proteolysis-> ISVP or else wont infect
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rotavirus DX
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EIA, latext agglut, viral AG detect, ELISA, cultures, gel electrophoresis.
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rotavirus vaccine
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rotashellX. rotarix, rotateq
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other gastroent viruses
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small round RNA viruses. 1). structured- SRSV- norovirus, Astrovirus, calcivirus (astro and calci can culture). 2). unstructured: wollan and ditchling
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calcivirus
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non enveloped SS, pos sense, RNA, round, icosahedral, 1 capsid 32 cups-chalice. ~ to norov. 5AG types. worldwide, young kids, fecaloral, osters and shellfish. 1-4da incub, most asymp. d/v. anorexia, fever. 1/3 respir probs ~ flu. elisa, RIA
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norwalk
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bind carbs of A, B,O blood Ags. nonevelope, SS RNA. 1 capsid. 23 mil gastroent cases/yr in us. 24 hr incub, 3 d illness. nvd cramps, ha, fever, malaise. inc. in daycare, SHIPS. fecal oral. serology, EIA, RTPCR.
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astrovirus
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small ssrna, no envelope, 6 pt star. unbroken surface 7 serotypes. nvd, ha, fever. <7yo, fecaloral. food. EM useful- inc. shed in stool
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adenovirus and entero probs
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grp F 40-42-> gastroent. diarrhea <4yo, 5-12d. DNA VIRUS. fecaloral. respir tract infections. 8-10d incub. latex agglut, EM, elisa, PCR, probes
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other reoviruses
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are NOT gastroent. coltivirus and orbivurs
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coltivirus
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colorado tick fever- disphasic, HA, muscle pain, erthralgia. kids- hemorrhage, encephal.
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orbivirus
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animals, sheep, hourse, deer
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orbi and colti replic
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same as rotovirus, but takes place in arthropod and verteb host. need to remove shell- activate RNA dep. RNA Polym.
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Colorado tick fever
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coltivirus. dermacantor andersoni- ppl- BM cells, inhib Blood cell production -> thrombo cytopenia. can - CNS, encephal, CSF. 3-6d incub, fever, chill, HA, arthralg, photophobia, biphasic fever, conjunctivitis, LAD, rash
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flu reassort
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via segmented genomes.
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flu AG shift vs drift
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shift- introduce nu HA or NA-> pandemic. drift- accumulate muts in HA or NA->epidemic (seasonal flu). FLU A- SHIFT +DRIFT. B- just drift
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HA and NA
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HA-surface glycoprotein spike, also has lipid bilayer.
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flu vaccine and HA
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vaccine targets HA via neut ABs.
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antiviral flu target NA
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antivirals target NA (tamiflu, relenza), prevent cell spread of virus.
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M2 ion channel
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for Flu A-> amantadine and rimantadine.
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flu
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RNA SS negative sense, helical, enveloped, segmented genome-reassort- nu viruses
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flu proteins
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polymerase- made of PA, PB1, PB2. NSP: NS1 inhibs IFN, NS2 is nuc. export protein, M1 is matrix protein, M2 is ion channel, BP is nucleoprotein
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HA
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fuses w memb of endocytic vesicle
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flu replication
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most RNA virus in cytoplasm, but flu in nucleus. 6-8hr. has RDRP in 8 segments. nucleocapsids. enter via endocytic vesicle, fusion, release the 8 segments- nucleus- steal host message caps (7methyl G caps taken up by PB2
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how quantify flu
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HA titer- agglut of RCs. NA activity assay. plaque titration. cythopathic assay. elisa, trfia. rtcpr
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H3N2v
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SOIV- 2011 county fair flu- picked up 09 H1N1 pandemic gene
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virus and respir tract
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virus-> cilated mucosal cells of RT- denudes it->no protection- 2* bact infection
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flu acute adults
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fever, coryza, HA, malaise, myalgia, sore throat, non productive coff
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flu acute kids
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~ adults, but worse fever, GI probs, otitis media, myositis, croup
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flu complications
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myositis, cardiac, GBS, Reye's, encephal
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flu 2* bacterial
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spneu, mrsa, gas, hi
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flu vaccine
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takes 10 d, dead or alive (nose spray). -> AB and CMI. get viral infections, not disease. dont give for preg or IS
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MMR up/down
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measles, rubella dec, mumps inc
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paramyxovirus
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SS rna, nonseg, neg polarity, RDRP, helical neucleocapsid. little AG variation, M protein matrix, F gp spikes
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paramyxovirus fusion protein
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key to pathogenesis. class 1 fusion protein. ABs to FP neutaralize infection (if not, v bad)
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class 1 fusion proteins
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flu HA, HIV gp120, paramyxovirus FProtein, ebola
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RSV CPE (characteristic cytopathic effect)
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large multinucleate synctial cells.
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measles
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paramyxovirus. RNA, HA, one AG type, inhib by heat and lite. reservoir = ppl, airborne, inc. in winter/spring. spread 4d before/4d after rash. 8-12 d incub.
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measles clinical
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prodrome- fever, malaise, 4 Cs coff coryza, conjunctiv, Koplick spots on tongue. maculopapular erythamotous rash= morbilli form. otitis pneu, croup, diarr, encephal. lifelong immunity
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4 Cs of measles
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coff coryza conjunctiv koplick
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measles rec
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uses SLAM cd150 rec on mononuclear cells
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measles timecourse
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get 4 Cs day 10-13. febrile prodrome. after 13, viremia ends, rash starts. D0: mucus memb. D2: LNs D4: blood 1* viremia fever D6: liver/spleen. D10: 2* viremia. D12- rash, focal infection.
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measles pathology
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GC formation, vasculitis, lymphocytic infiltrate
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mumps
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paramyxovirus. rubulavin family. RNA. one AG type, bilateral. spread 1-2d before, 5d after swelling. 16 d swelling
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mumps tropism
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salivary gland stensons duct
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mumps clinical
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prodrome fever, HA, malasie, myalgia. 20% asym. parotitis. 50% cns pleiocytosis. 10% cns. LRT, illness. renal 60%. abn ekg 10%. oophoritis, orchitis
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parainfluenza
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laryngotracheobronchitis. croup, barking honking coff. DEX clears airways.
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croup
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STEEPLE sign on XR- upper airway narrowing. croup coff- STRIDOR, retractions, use accessory muscles to breathe. give cold moist air. self limited, lasts 72H.
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RSV bronchiolitis
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acute viral infection. LRT young kids. obstruction, wheeze, rales, hypoxemia, hear on inspiration.
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RSV
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respir/fomites. communicable whole time u have it. bronchiolitis
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RSV pathogenesis - bronchiolitis
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replicate in URT, spreads to LRT. infalmm bronch and epithel. narrow airway, mucus plugs. R to flow, abn ventil perfusion, hyperreactive airways, IgE hypersensit
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RSV and bronchiolitis
answer
50% have asthma
question
types of parainflu
answer
1- croup. 3- bronchiolitis. 4- benign.
question
croup vs broncholitis
answer
broncholitis hear on EXPIR (LRT???) Croup hear on INSPIR (URT??)
question
ribavarin
answer
aerosol treatm of RSV. treats HCV. teratogenic
question
synagis
answer
for RSV for preemis and babies w chronic lung dis and CHD- palivizumab ab for FP.
question
human meta pneumovirus
answer
~ RSV. cytopathic effect. GCs fuse.
question
infants cant coff
answer
-> vomit- post tussive emesis
question
TORCH
answer
vertical. toxo, other (syph, b19, varicella), rub, cmv, herpes/hiv/hep.
question
TORCH RFs
answer
intimate relation of mom and fetus, organ systems are in early develop, inc. susceptible of placenta to microbes, pass thru birth canal, IS is immature.
question
type 1 vertical transmission
answer
transplacental/early 1* trimester- toxo, syph, rub, cmv, varicella. major impact on growth organ develop, MR>
question
type 2 vert transmission
answer
perinatal/late- via passage of birth canal or in labor- hep B, chlam, gonhorrea, HSV, HIV, GBS. effect in neonate pd or later in life.
question
1st trimester infecions result in
answer
deaf, HD, cns, neonatal purpura (blueberry), cataract, glaucoma.
question
sources of maternal infection
answer
STD, Pets, food, blood IUDA
question
TORCH infections w NO prevention
answer
cmv, hepC, B19, enterovirus
question
TORCH can result in
answer
IUGD, rash, vasculitis, petechiae, thrombocytopenia, HSM, CNS
question
rubella
answer
togavirus. SS + RNA. icosahedral, HA. fever, LAD, conjunct, maculopap rash. 3 d rash exanthem, encephal, arth, arthralg. life long immunity.2-3wk incub. respir spread.
question
rubella vs measles
answer
rub rash not as extensive, discrete, maculopapular erymathous rash. rub=LAD and malaise, no fever til day 4-5, fever <101, no coff.
question
rubella replicates in
answer
nasopharynx, regional LNs viremia after 5-7d-> placenta and fetus.
question
rubella timecourse
answer
Igm at d 10, igg@ d14 when fever start. virus shed d8-22. lad d8-28.
question
congenital rubella
answer
85% infections first 4 weeks of gestation. dec. % later on. transmit @ viremic stage. can inhib via immuniz
question
mom baby rubella ABs
answer
mom w rub-> IgG-> infant gets maternal igg, makes igm and g and a
question
congenital rub syndrome
answer
deaf, cataracts, heart, microcephaly, MR, bone alter. HSM, preemie, IUGR rash PDA. bony lucencies- celaray stalk
question
congenital rub syndrome eye probs
answer
cataracts, glaucoma, strabismus, nystagmus, micropthalmia, iris dysplasia.
question
mom -/+ abs in rubella
answer
mom -- G+M is susceptible if gets rub. Mom M-,G+- is protected. mom M+G+/- ->autoinfection - manage the baby.
question
congen rubella baby AGs
answer
if baby G+ abs are from mom or baby. if M or A +, from infant- infected.
question
congenital CMV
answer
10% symp @ birth, 15% later. most common congenital infection in US- hearing loss, MR, palsy, viz, leading cause of hearing loss and brain damage.
question
cmv
answer
ds dna envelope B herpes family icosahedral. inclusions. surrounding tegument outer memb GPs. inc. liver fnctions, hyperbili, tcp, inc. csf protein- seeding ing meninges w cmv
question
congen cmv leads to
answer
petechiae, purpura jaundice HSM. microcephaly, IUGR, calcif intracranial, choriorentitis
question
cmv long term
answer
hearing loss, mr, neuro probs w inc. igm
question
congen toxo
answer
hydrocephaly, intracranial calcif, bony abnormal. cateracts, microopthalmia. hemat spread of tackys to fetus. 1*trimester TORCH 2/3* silent.
question
congen syphillis
answer
bony probs, rash is not blueberry, weepy, mucus, periostitis, hsm, penum, desquam
question
chronic hep progression
answer
normal- chronic inflamm- fibrosis- bridging/septal fibrosis- HCC
question
hepA
answer
30d incub, inc. jaundice w age, fulminant encephal, cholestatic, relapsing hep. AI disease.
question
hepA clinical
answer
inc ALT, jaundice, fecal shedding, IgM anti HAV. inc. in young kids (contact, food, blood).
question
hepA vacc
answer
esp if traveler, gay, drugs, chronic liver dis, Nat Ams
question
Hep A post exposure
answer
give Ig in 14d
question
HepB replication
answer
in nuc. no cure. has covalently closed circular DNA- is reservoir to make new virons
question
HepB
answer
no cytopathic- dont kill liver cells- immune response is what does. younger pat- higher risk of chronicity. can -> cirrhosis and cancer
question
hepB and babies vs adults
answer
babies- weak IS, dec. symptomatic infection, inc. chronicity. adults- strong IS, so inc. symptomatic infection, inc jaundice, dec chronicity
question
IgM anti HBC
answer
marker of acute infection. IgG/total anti HBC= past marker of remote infection
question
how tell someone vaccinated to HepB
answer
if not have AB to core, but have HBs+
question
4 phaes chronic hep B
answer
1. immune tolerance phase: HBeAg+, high HBV-DNA, normal ALT. 2). immune clearence phase: + HBeAg, high HBV-DNA, high ALT. 3). non replication: --, low, normal. 4). HBeAg-/chronic hepatitis: --, high high (active inflamm)
question
HepB variants
answer
HBeAg+= WT. inc. viral load, inc infectivity. HBeAg- is mutation @ core promoter, poor respons to therapy
question
hepb drugs
answer
1* tenofovir and entecavir inhib replication, dec. R. first drug was Lamivudine, high R.
question
HepD
answer
needs HbsAg to survive. only get if 1). coinfect with HepB acute not chronic, or 2). in a chronic hep B superinfection carrier
question
HepC
answer
replicates competely in cytoplasm, is curable. 6-7 wk incub. dec. fatal. 75% chronic. 10% cirrhosis.
question
hep C markers
answer
anti HCV=marker of infection, not protective. can have reinfection. anti HCV and normal ALT and --HCV-> acute hepC, recovered, and is good
question
chronic HepC RFs
answer
>50, duration, Male, steatosis, alcohol, coinfect w hbv/hiv, ivdu, immigrate, tfusion. low risk are perinatal, piercing, hemodialysls, work, coke factors that are NOT RFs: HCV viral load, HCV genotype, ALT****. baby boomers high rates of hepc
question
hepc treatm
answer
IFNa (high SEs). 1. direct anti viral affect via 2'5' oligoadentylate synthetase. 2). immunomodulation. so big 2 drugs are PEG IFNa, Ribavarin. IFN- stage 1 decline rapid, inhibit viral replciation. stage 2 decline determines response- clearance of infected hepatocytes. good PEG IFN response if genotype 2,3, dec fibrosis, thin, white, non insulin R, il28b genotype
question
IL28b genotype
answer
wiht HepC- a snp- inc. clearence, inc. response, milder course.
question
Hep C types of ppl
answer
good if ur C/C, bad if T/C or T/T
question
Hep E
answer
fecal oral. 40d incub. fatal if preg. illness inc w age. inc. in TPlants
question
Hep types
answer
fecal oral- A,E. percutaneous- B,C,D. chronic B C D E. Acute A. Vaccine B E/
question
Hep drugs
answer
A- supportive/globulin/prophylaxis. B- PEG IFN, nucleoside inhibs. C- protease inhib. D- treat HepB. E- ribavarin
question
Hep A A's
answer
Acute, asymp, alone (no carriers.
question
Hep B B's
answer
Blood borne
question
Hep C C's
answer
chronic, cirrhosis, carcinoma, carriers.
question
Hep D D's
answer
defective, depend on HBV.
question
Hep E E's
answer
enteric, expectant moms, epidemics
question
viral v alcoholic hep
answer
viral- ALT> AST. alcoholic: AST> ALT
question
see bottom of last page hep lecture...
answer
...
question
OM
answer
via spneu, HI, MCAT. give multiple ABs. chronic fluid collection in middle ear- conductive hearing loss-> get tympanostomy tube- clear out fluid. keep ear dry. can -> rupture, meningitis, mastoiditis, abscess, sigmoid sinus thrombus, facial nerve paralysis
question
otitis externa
answer
outer ear swollen, swimmers ear, pseudomonas. malig in diabetes- osteomyelitis of temporal bone
question
sinusitis
answer
blocked sinus w pus- spneu, HI, MCAT, mucor (if IC, get diab ketoacidosis, leuk, BMT) in frontal sinus: meningtis, brain abscess. in ethmoid sinus: orbital cellulitis. in sphenoid sinus: cavernous sinus thrombosis
question
foreign body kid
answer
kid w unilateral foul smelling pusy rhinorhrea
question
SAureus
answer
TSS. nasal packing like tampon-> exotoxin binds MHC2-PIL1+ IL2.
question
pharyngitis
answer
GAS, viruses, white on tonsils, abscess. viral- ebv mono +monospot test.
question
GAS
answer
RF, glomeruloneph, scarlet fever w strawberry tongue, rash.
question
ludwig angina
answer
disease of dental cavity, infection- cellulitis, inflamm of floor of mouth, submandiv space. polymicrobial w stap/strep/bacteroides- compress airway, pushes tongue up
question
epiglottitis
answer
HFlu type B, spneu, saureus, virus. hard to swallow, inc. on XR.
question
ramsey hunt syndrome
answer
herpes zooster orticus. 7,8* CN. facial palsy, auriciular vesicles, hearing loss, tinnitus, vertigo
question
HPV and head
answer
tonsil cancer type 16, recurrent respir papillomatosis- blocks airways.
question
HIV and head
answer
cervical LAD, cystic growths in parotid, thrush, kaposis, acute mono like HIV sero conversion syndrome.
question
neck mass
answer
suppuratve LAD- pus inside a LN. SA and GAS.
question
retropharyngeal abscess
answer
direct spread from tonsil/dental carries or TV/Potts disease. sore throat, fever, sneck, stridor, obstruct, mediastinitis, aspiration pneu, epidural abscess, jugular ven thromb, necrotiz fascitis, sepsis, carotid Art erosion.
question
bartonella neck mass
answer
not painful. IC, pleomorphic, G-, bacillus, wartin starry silver stain.
question
neck mass via mycobacteria
answer
MAC, kansasii, TB scrofula painless, firm, no pulm probs.
question
parotitis
answer
staph/mumps(also orchitis, pancreatitis, CNS)/HIV
question
J-H rxn
answer
syphillis- FTA-ABs is best for syph, VDRL not as good test
question
retrovirus GPs
answer
gp120 surface protein, gp41 transmemb gp- attach virus to cell. 41- fusion rec. 120-cd4rec.
question
GAG ENV POL
answer
gag- internal proteins. env- envelope glycoprotein. POL- RT polym, integrase, protease.
question
transecting proteins
answer
TAT for HIV for replication, TAX for HTLV.
question
HIV LTR
answer
-> TAR element. API. growth promoting, NFA, NFKB.
question
course outline M75 pg6
answer
see
question
ccr5, cxcr4...
answer
.........
question
HIV immunological changes
answer
dec CD4, dec IL2, inc CD8: cd4 ratio, inc CD8, inc. CD8 activation markers cd25and 38
question
hiv replication
answer
need primer trna- bind primer binding site, DNA hypbridze to RNA, neg strand made first, then + strand-> DS DNA w LTR, LTR has CA at both ends
question
HIV + ...
answer
+ECs-> kaposi. +Bcell->lymphoma. +Epithel cell-> carcinoma.
question
AZT
answer
~ T base- chain terminate . pyrimidine analog. inc. absorb- CNS oral toxic BM. dec viral loading by a log. good in combo therapy w RTIs and Protease inhibs is (P) in host compete w thymidine in DNA synthesis catalyzed by RT -> chain termination- use prophylaxis in babies. has a azido grp . inc. cd4 cells. nevirapine
question
HTLV
answer
TALL, myelopathy, inhib CD4 AND 8. TAX proteins- inc. IL2, IL2R, Tcell GFs. causes tropical spastic paraparesis in brain, TALL, leuk/lymphoma. give AZT, ifna.
question
toxoid vaccine used for
answer
dipth and tetanus
question
passive v active immun
answer
passive- immun serum globin, specific IG, monoclonal AB. active- inactivated (subunit/toxoid/peptide/plolysac/killed unit) or live (attenuated/hybrid/low virulent)
question
passive immun adv/disadv
answer
adv- inc amount of AB. dis- dec lifespan of ABs, hypersensit rxns, inc cost.
question
VZ IG
answer
igg to vz abs. prophylaxis for Tplant of kidney lung liver pancreas heart.
question
vaccina IG
answer
for smallpox w live virions. need to inhib infection if IC.
question
humanized monoclonal ABs
answer
for RSV, CMN, hep B
question
ribavarin
answer
for RSV. guanosine analogue.
question
mexlmusane c
answer
company- makes ig treatm for RSV. respigam, synagis (ABs to F protein) and numex no vaccine.
question
vaccines not to give in preg
answer
VZ/MMR- are alive, can pass to baby
question
non replicative vaccines
answer
no risk of infection. use w bact/virus. cant be attenuated, can -> recurrent ifnection, or are oncogenic.
question
adjuvants
answer
include alum and sqalene (HPV),
question
inactivated viral vaccines
answer
flu pollio hep A rabies
question
live vaccines
answer
polio MMRV adenovirus, yellow fever. orgs w limited ability to cause disease- avirulent and attentuated, get humoral and CMI. long lived immunity. are temp sensative can be hybrid. but dont give if pregnant, or can get interference.
question
vacine via recomb dna
answer
hepb, hpv.
question
PS vaccines to
answer
HI, spneu, n mening, only give if over 2. TCell indep, so no memory response which is via B cells, no anamnestic response either.
question
Dipth
answer
#1 choice to link to
question
mening vaccine
answer
has A C Y W 135 forms, no B form - xreact w self. but B is 50% of cases
question
polio vaccine sabin
answer
live oral not used in US local gut infection + inc. SIGA that inhib incoming WT polio. can infect if IS.
question
polio vaccine salk
answer
parenteral inactive dead. only inc. igG not IgA. if there was WT polio it could be amplified in gut and spread.
question
sabin vs salk
answer
sabin inhibs polio @ GI epithel via SIGA. salk inhib @ blood via igg.
question
flu mist
answer
dont use if IS or preg or under 2.
question
rotovirus vaccine
answer
live, intussception, has many serotypes
question
hpv vaccine
answer
L1 protein of HPV- marker. virus like particles + neutralizing epitopes. target hpv16,18. gardasil target hpv 6,11- genital warts.
question
structural analog AVs
answer
acyclovir, didanosine, ribavarin, ganciclovir.
question
acyclovir
answer
hsv 1,2. purine analog, requires viral coded posphokinase (Thymidine Kinase) to convert acyclovir mono(P). host converts to tri(P)-> is potent inhib of HSV DNA polym. and chain term.
question
gancyclovir
answer
cmv retinitis in AIDS. phosphorylated to active form by viral encoded PKinase. cmv dont encode TKinase. toxic.
question
ribavarin
answer
purine analog. RSV. measles mumps flu paraflu hepC, lassa. combo therapy w IFNa for hepC. Phosphoro to tri(P) via cell enzymes, inhibs GMP snythesis- inhibs R/DNA synthesis and mrna capping. is broad spectrum. looks like atp or gtp. also inc. toxicity! has lots of SEs.
question
nevirapine
answer
non nucleoside inhib of HIV RT. discovered by random binds to RT. inhibs catalytic site. no (P) needed. inc R.
question
protease inhibs
answer
end in AVIR. dec HIB burden. combo w AVs target RTs inhib cleavage of HIV proteins to produce mature HIV
question
ritonavir
answer
boosts other protease inhibs by inhib CYP3a3.
question
enfurvirtide
answer
fusion inhib- targets GP41
question
ccr5 antags
answer
marviroc and vicriviroc
question
raltegravir
answer
integrase inhibs
question
cidofivir
answer
nucleotide (Cytidine) analog attached P grp. in cells long time- inc. potent. for cmv Herpes poxvirus . inhib viral DNA polym, inhib growing dna chain
question
foscaret
answer
hiv, cmv. use w phosphonoacetic acid
question
arlidone
answer
fo picornavirus uncoating.
question
amantidine
answer
inhib uncoating and M2 ion channel- flu. inhib flu A not B. inc R best for prophylaxis. inhib disso c of M1 from nucleocapsid uncoating. inhb HA also
question
zanamivir
answer
inhaled- NA inhibs inhib release from host cell
question
oseltamivir
answer
oral- na inhibs inhib release from host cell
question
rifampin
answer
TB. also for poxovirus assembly
question
AV toxcity
answer
can be nonspecific, high toxic like ribavarin or v specific and low toxic like acyclovir.
question
IFN
answer
gp CKs from virus infected cells- metab response in uninfected cells which inhib viral infections in new cells. first line of defense. gives flu like symptoms while ur on it.
question
IFN inducers
answer
viruses, dsrna, rna analogues ( ssrna or ds dna or ssdna are NOT inducers), bacteria, endotoxin, mitogens.
question
IFN types
answer
alpha- made in leukocytes, 15 subtypes. beta- in fblasts. 1 subtype. ~ w alpha type. gamma- made in T cells response to mitogen=mphage activation factor. 1 subtype. inhib by acid, alpha and beta are stable.
question
IFN rec
answer
doest nee to enter cell, interacts w IFN rec on cell-> induces anti viral state.
question
iFN induces...
answer
2 enzymex are activated via DSRNA. 1. oligoadenylate synthase -> 2,5oligoA up to 10 residues from ATP, it activates endoribonuclease- egrade viral mrna. 2). PKinase-(P) and incatvates eukaryote eIF2.
question
gamma IFN
answer
inc. activity of NKs, cytotoxic T cells mphage phagocytic activity.
question
IFNs and MHC
answer
IFN inc MHC2 (gamma), MHC1 (alpha, beta, gamma). also transiet suppression of CMI.
question
alpha IFN does
answer
rhinovirus colds in nasal spray, laryngeal warts, hairy cell leuk, chronic hep B combi w lamivudine, chronic hep C combo w ribavarin, herpes keratitis, papilloma, hemorrhagic fever, rabies
question
IFNb does
answer
treat relapsing MSclerosis.
question
IFNg does
answer
CGD
question
IFN disadv
answer
need injection, SEs: fever, malaise, n, leukopenia, confusion, dep, hypoten, expensive
question
2 kinds STDs
answer
ulcerative (syph chancroid LVG, GI HSV), mucopurulent (Gon Chlam HSV)
question
neuro syph
answer
treatm ceftriaxone. meningovascular, parenchymous (paresis, argyll rob puil, optic atrophy), tabes dorsalis (ataxia, impotence, bladder, rombergs sign, CN2-7). gumma
question
ducreyi
answer
give azithromycin also cefriaxon, cipro, erythmomycin
question
LGV
answer
Buboe. small fleeting lesion, painless. LAD has groove sign painful . mostly unilateral. 2* stage systemic- fever chills HA mening, hepatitis, erythema nodosa, arthritis. give doxy erythromycin, drain.
question
GI
answer
donavonosis. deep erosive lesion dont go away by self, get worse. bloody, painful, NO LAD. dx w wrights/giemsa stain- blue rods w polar granules w pink capsules in epithel cells (donovon bodies). doxy
question
tzanck
answer
herpes- multinucleate GCs.
question
gon/chlam
answer
puruent discharge, 4-14d after sex. ch less discharge than gon, more clear than yellow
question
gonhorr
answer
disseminates- tinosynovitis, ~ reiter syndrome in chlam. jt pain and swelling, opthalmitis. gam stain more specific in men. oral sex- gonococcal pharyngitis . chocolate agar
question
treat G+C
answer
azithro
question
chlamydia
answer
cervicitis, urethritis. treatm Doxy, not if preg, GI probs, also azithr.
question
other drip STDs
answer
itchy, cheesy- candida. white discarge, strawberry- trichomonas. mucopurulent- G+C. Clue cells- vaginosis
question
vaginitis
answer
mobi/uncus.
question
treatm for PID
answer
1). parenteral- cefoxitin/cefotetan and doxy. clinda and genta. amp and doxy. 2). oral- ceftriaxone, doxy, cefoxitin, metron, levofloxin
question
HPV treatm
answer
warts- give cryotherapy, imiquimid, polofilex
question
sensit/specific
answer
sensit: tp/tp+FN. specific: TN/TN+FP
question
aldehyde fuchsin dye for
answer
HBsAg
question
#1 cause liver tplant
answer
hepc
question
wnv
answer
flaviviridiae- enveloped SSRNA. mosquito bite- 3-14d. 1 wk sx. 80% mild (HA, n/v). <1% meningoencephal. see perivascular cuffing of inflam cells
question
cjd types
answer
sporadic, inherited, iatrogenic, variant- meat, tfuson
question
picornaviruses
answer
rhinoviruses and enteroviruses. naked small icosahedral capsid with SS + RNA
question
picornaviruses replication
answer
in cytoplasm, are cytolytic.
question
rhinovirus
answer
common cold. 100 serotypes. attach to ICAM-1. start in nose- sneezing, rhinorrhea sore throat HA malaise. peak 3 days, lasts 7 d. nasal SIGA transient, IgG lasts longer.
question
enterovirus
answer
R to environtal conditions, often asymp, via fecal oral, ingestion, fomites, inhale.
question
enterovirus grps
answer
poliovirus- 3 serotypes, 1+3 mostly. coxsackA. coxsackB. echovirus. enterovirus
question
poliovirus
answer
replicates in pharynx and lymphoid in SI. spread to blood and CNS. retrograde along nerves too. motor neurones ant. horn cells of SC. neuron death- paralysis. if brain stem, respir. paralysis (bulbar poliomyelitis)
question
typs of poliomyelitis
answer
90% asymp. 1). abortive- mild, febrile illness HA ST nv. 2. nonparalytic- aseptic, fever, HA, stuff neck, spont. resolution 3). paralytic- flacccid paralysis, brain stem, respir. possible
question
coxsack A
answer
herpangina w fever ST vesicles in oropharynx. H/F/Mouth dis
question
coxsack B
answer
pleurodynia- feer and pleuritic chest pain, myocarditis and pericarditis, pancreas probs
question
coxsack A+B cause
answer
aseptic mening, mild paresis, partial paralysism transient parlaysis. URT, minor febrile illness, rash
question
echoviris
answer
enteric cytopathic human orphan. -> aseptic mening, URT, febrile illness, rash, infant diarr, hemorrhagic conjunct. H/F/Mouth dis
question
Enterovirus 72
answer
IS HEPA.
