HSV/VZV and CMV Trivia

Epidemio-logy

100

Herpes simplex virus is categorized in 2 types: HSV-_ and HSV-_

1 and 2

200

Without prophylaxis, HSV/VZV/CMV often occurs in THIS time period as a result of reactivation of latent virus

1-6 months

300

CMV is also known as human herpesvirus-_

5

Clinical Disease

100

The most common manifestation of HSV disease after transplant is in this region

mucocutaneous disease (orofacial) in 85-90% of cases

200

Name an INDIRECT effect of CMV infection

allograft rejection, secondary fungal/bacterial/viral infections, increased PTLD, etc

300

CMV infection among immunocompromised patients is generally split into either CMV ______ or tissue-invasive CMV disease

syndrome (fever, malaise, arthralgia, leukopenia, flu-like symptoms)

400

Disseminated HSV can result in encephalitis, meningitis, keratitis, pneumonitis, esophagitis, and less commonly...

Hepatitis (or other acceptable answer)

Diagnosis

100

The most common and most sensitive diagnostic test for HSV and CMV is...

Nucleic acid testing (NAT) by PCR

200

______ testing can be used to prove tissue-invasive disease with CMV or HSV

Histopathology

300

Characteristic histologic finding on histopathology for CMV is the ___-eye inclusions

Owl

400

CSF findings in the setting of HSV meningitis would most likely include normal/low protein, normal glucose, and mildly elevated WBC with ____ predominance

lymphocyte

500

Mutations within UL__ have been shown to confer resistance to Letermovir (bonus points for mentioning other UL mutations and their resistance)

56 for letermovir

97 for ganci, 54 for fos/cido/ganci

Prevention

100

AST guidelines recommend duration of HSV prevention for patients without CMV prophylaxis for at least ____

1 month

200

T/F - transplantation should ideally be delayed ~4 weeks after administration of the Varivax vaccine

True (live vaccine)

300

This prophylactic drug for CMV does not have dual coverage for HSV and should be paired with acyclovir

Letermovir

400

Valacyclovir and Valganciclovir are ___ ester prodrugs of acyclovir and ganciclovir respectively

L-valyl. This change increases intestinal permeation and oral bioavailability

500

Osmotic nephrosis, resulting in acute kidney injury, can occur due to this component of Cytogam infusions

Stabilizers such as sucrose, maltose, sorbitol, etc.

Treatment

100

T/F - Letermovir is emerging as a new monotherapy treatment option for CMV with high burden of DNAemia

False

200

Name at least 2 important monitoring parameters for foscarnet therapy

renal function, calcium, magnesium, phosphorus, potassium

300

Duration of IV therapy for disseminated HSV disease recommended by AST guidelines is at least...

14 days (or 21 for CNS infection)

400

This drug is an oral bioavailable form of cidofovir currently in development

Brincidofovir

500

Although HSV resistance is uncommon, the most common mechanism of resistance is due to thymidine kinase mutation by the ___ gene

UL23