HSV-1 / HSV-2
VZV
CMV/EBV
JC Virus
HTLV-1
100
All members of the herpesviridae family are [single stranded?/double stranded?] [DNA?/RNA?] viruses.
Large, double stranded, DNA viruses
100
What is the capsid shape for all herpesviridae members?
Icosahedral (composed of 162 different capsomeres/proteins).
100
CMV and EBV are Herpes Virus # and # respectively (HHV#)
CMV = HHV5
EBV = HHV4
100
The most feared complication of JC virus reactivation is this neurologic condition.
Progressive Multifocal Leukoencephalopathy (PML)
100
What piece of medical history is associated with HTLV-1?
It was the first human retrovirus ever discovered (1979).
200
A newborn presents with encephalitis and has had multiple seizures in the three weeks after vaginal delivery. What virus is most likely responsible?
HSV-2
The virus can pass from an infected mother to the neonate most commonly during vaginal birth.
Prophylactic antiretroviral therapy is recommended for women with HSV-2 starting at 36 weeks. If lesions are present at time of labor a c-section may be recommended.
200
An elderly patient who had chickenpox as a child presents with a painful rash on his trunk limited to a single dermatone that does not cross midline. You correctly diagnose the patient with shingles (VZV reactivation). Where was the virus laying dormant?
In a dorsal root ganglion.
200
A minimum CD4+ count of _____ is needed to reduce the risk of CMV infections in patients that are HIV+
100 cells/mm3
Interestingly unlike some other opportunistic infections the 100 cells mark is not a queue to start prophylactic treatment. In general "primary antiviral prophylaxis against CMV is not recommended for adults/adolescents with HIV regardless of CD4 count."
Guidelines state that treatment goals/ART should be used to maintain a CD4 count > 100 cells/mm3 to prevent CMV related end organ damage.
200
In the CNS of an immunocompromised individual, JC virus most productively infects this type of glial cells and leads to lysis and cell death.
Oligodendrocytes
200
Genetic characteristics of HTLV-1
Positive sense, single-stranded RNA virus that utilizes reverse-transcription (retrovirus) to generate double-stranded viral DNA upon infecting host CD4+ T-cells.
300
This is the most sensitive and specific test to detect and distinguish HSV-1 from HSV-2.
Nucleic acid amplification testing or Polymerase chain reaction(NAAT/PCR)
300
A child receives a chickenpox vaccine that is meant to generate long-term cellular immunity. What type of vaccine is most commonly used to prevent primary VZV infection in immunocompetent children?
Live attenuated vaccine.
300
What histologic finding can support a diagnosis of CMV infection?
Owl Eye nucleus.
300
What are the characteristics of JC virus?
Circular
Double-stranded DNA
Icosahedral capsid
Non-enveloped
300
What are the three most common transmission routes for HTLV-1
Breastfeeding
Sexual Contact
Exposure to Blood/Transfusion
400
A patient develops recurrent painful vesicles on the vermilion border after several days of intense sun exposure. In which sensory ganglion does the causative virus most commonly remain latent?
Trigeminal Ganglion
400
Which two cranial nerves are most commonly effected by VZV?
Trigeminal/Cranial Nerve V
Facial/Cranial Nerve VII
Important to note that VZV can infect any CN.
400
An immunocompromised patient presents with blurred vision, retinal hemorrhages, and "fluffy white" lesions surrounding the blood vessels of the eye. What is this symptom called?
CMV Retinitis
400
Before starting treatment with this drug all patients should be tested for latent JC virus infection.
Natalizumab
Anti–α4-integrin monoclonal antibody that blocks lymphocytes from crossing the blood–brain barrier.
This is actually what makes natalizumab beneficial in treatment of MS (blocks autoreactive Tcells from entering the brain). But in this case natalizumab blocks JC virus specific CD8+ cytotoxic T cells from entering the brain resulting in JC virus reactivation and PML.
400
What malignancy is associated with longterm HTLV-1 infection.
Adult T-Cell Leukemia/Lymphoma (ATLL)
ATLL develops after a prolonged latency of ~30–50 years, and arises almost exclusively in those infected early in life through breastfeeding
500
Acyclovir is commonly used to treat HHV infections but is ingested in an inactive form. It relies on what viral enzyme to be activated (this is also a common route of resistance).
Thymidine Kinase
TK is encoded by HSV-1, HSV-2, and VZV. It adds a single phosphate to acyclovir forming acyclovir monophosphate. This is then recognized by normal cellular machinery and further phosphorylated to form acyclovir triphosphate, the active form of the drug.
500
This rare inflammatory condition of the CNS can present with fever, headache, confusion, extreme tiredness, seizures, and neurological deficits like muscle weakness or vision loss 1-3 weeks after administration of the VZV vaccine. Name the condition.
Acute Disseminated Encephalomyelitis (ADEM)
More frequently associated with bacterial/viral infections but can present following certain vaccines.
500
This B-cell lymphoma classically associated with equatorial African children is EBV-associated.
Burkitt Lymphoma
500
Characteristics of the brain lesions visualized on MRI of an immunocompromised individual with reactivated JC virus. (Basically whats the buzzword)
Non-enhancing white matter lesions.
vs.
Ring-enhancing white matter lesions = Toxoplasmosis
500
HTLV-1 is associated with what progressive neuroinflammatory disease?
HTLV-1 Associated Myelopathy(HAM)
AKA
Tropical Spastic Paraparesis
Slow and progressive disease of the spinal cord. It causes leg weakness, stiff muscles, painful spasms, and trouble with bladder control.
