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lecture 6 gill

alpha herpes family herpes simplex viruses 1 & 2 (HHV-1 & 2), varicella zoster and herpes simiae. infect mucoepithelial cells and exhibit latency in neurons
beta herpes family CMV (HHV-5) infects monocytes, T cells and some epithelial cells. latency in monocytes and lymphocytes
gamma herpes family EBV (HHV-4) and Kaposi sarcoma-related virus. infect lymphocytes and epithelial cells with latency in B cells
Herpes virus family DS DNA viruses that establish LIFE-LONG LATENT infections
EBV infection transmission through saliva, viruses uses CD21/MHC II as receptor for entry. replicates lytically in OP epithelial cells. infects B cells by viremia or direct spread. once latent EBV replicates as episome
EBV and B cells up to 20% of all B cells can be infected with EBV, become immortalized and activated to secrete lots of random Ig that incites NK and T cell response - this kills B cells and causes mono sx
pharmacologic tx of EBV most tx is ineffective b/c drugs target the lytic cycle of the virus which occurs while pt is asymptomatic. once sx start almost no virus is in lytic cycle but latent
Monospot test detects heterophile Ab secreted by EBV-infected B cells by mixing pt serum with horse RBCs to see agglutination. not as specific for kids < 5 y/o
EBV: early antigens encode viral polymerase and thymidine kinase (target for drugs), expressed early and in lytic phase of
EBV: viral capsid antigens late structural genes required for production of mature virion, produced in lytic phase // IgG will be expressed for life while presence of IgM indicates acute infection or reactivation
Epstein-Barr nuclear antigens required for maintenance of latency i.e. after resolution of acute infection
EBV: latent membrane proteins LMP1 is oncogenic, can stimulate B cells via CD40. LMP2 nonspecifically binds BCR to stimulate proliferation
clinical presentation of infective mononucleosis incubation period of 15-45 days. cause acute exudative tonsillitis and sore throat, fever from 38-40, malaise, diffuse myalgias, H/A, generalized lymphadenopathy and HSM. fatigue may persist for months
lab dx of infective mononuclosis WBC may be elevated, marked abs inc in lymphocytes (may be > 50% of all WBCs and atypical), heterophile Abs make Monospot (+). IgM EBV VCA (+)
complications of infective mononucleosis splenic rupture either spontaneous or from minor trauma, airway obstruction by tonsillitis, encephalitis, meningitis, myelitis, myocarditis and conduction abnormalities, blood cell abnormalities, Duncan syndrome
dz that can cause similar presentation to infective mononucleosis CMV mono, acute HIV retroviral syndrome, adenovirus or streptococcal pharyngitis, false Monospot (if young child)
other EBV associated dz endemic Burkitt's lymphoma (Africa), nasopharyngeal carcinoma (China, SE Asia), Hodgkin's lymphoma, non-Hodgkins in HIV pts, CNS lymphoma in AIDS, post-transplant lymphoproliferative disorders
EBV X-linked Lymphoproliferative Syndrome male pts with a very specific and exclusive immunodeficiency towards EBV, defect in T cell signaling, life-threatening condition with mortality rate of 66%
CMV infection lytic and productive infection in many cell types. latent in T cells and macrophages for life. acquired through any type of bodily fluid even resp droplets and saliva. doesn't immortalize cells, cleared by cell-mediate immunity
clinical presentation of CMV infection most always asymptomatic. if there are sx, appears just like infective mono, clinically indistinguishable except Monospot is (-) for CMV infections
complications of CMV infection congenital infection via placental transfer of CMV, CMV chorioretinitis in AIDS pts, GI ulcerative dz, esophageal ulcers, transplant organ failure, encephalitis, myelitis, meningitis and neuritis
congenital CMV infection causes microcephaly, deafness, sz disorders, MR, thrombocytopenia, HSM, hepatitis and jaundice or death. intracerebral calcifications are characteristic
dx of CMV infection may suspsect if viral syndrome but EBV IgM and Monospot (-), look for intranuclear/cytoplasmic inclusions in infected cells, CMV IgM (+), (+) blood culture/PCR
pharmacologic tx of CMV infection ganciclovir, valganciclovir, Foscarnet as 2nd line, cidofovir as 3rd line
paramyxovirus neg and SS RNA viruses. morbillivirus subgroup - measles; parainfluenza subgroup - mumps; pneumovirus subgroup - RSV
mumps paramyxovirus spread by resp droplets or saliva. infects parotid gland via viremia or direct contact. incubates 14-18d. replicates in epithelium of nose, NO LATENCY
clinical presentation of mumps pt asymptomatic contagious carrier up to 6d then H/A, malaise, low-grade fever the higher fever and large parotitis uni or bilaterally
complications of mumps meningitis most commonly with viral particles in CSF, encephalitis, sensorineural deafness, orchitis, oophoritis, pancreatitis
dx of mumps use clinical picture, mumps specific IgM acutely (cross-rxn with lupus pts)
Created by: sirprakes