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MCPHS Inf Disease E1
MCPHS Infec Diseases Exam 1 P2s
| Question | Answer |
|---|---|
| West Nile Virus Causes? | Encephaitis, w/lower mortality than EEE |
| WNV (Encephalitis) Trans By? | Arthropod Born (Arboviral) Transmitted by Insects (Mosquito) Pool is Birds (people & animals = dead end b/c no significant viremia to contribute to trans cycle) |
| WNV inffects? | Found in Humans, Birds, Vertebrates (3-15% humans, higher in elderly) |
| WNV is Endemic in? | Africa, West Asia, Middle East, Europe, and now USA |
| WNV ID'd in USA in? | Aug 1999, Bronx Zoo, birds of NY, NJ, CT, genetic sequencing ID'd, Nov. 17, 1999 CDC reported 56 cases, 31 Confirmed, 25 Probable, 7 death |
| WNV Spread to? | By 2001 throughout Eastern Portion of USA, and now in almost all states |
| WNV Occurs | late Summer to Early Fall |
| WNV and Ticks? | Only in Africa & Asia, not considered a vector in the USA |
| Other vectors for WNV? | Transfusions, Transplants Mother-to-Child (small number of cases) |
| WNV (Etiologic Agent?) | Flavivirus genus, Single-Stranded RNA virus, 40-60 nm in diameter, Enveloped, Icosahedral Nucelocapsid |
| Cases in 1999, 2000, 01, 02, 03, 04, 05? | 1999 = 62, then: 21, 66, 4156, 9861, (04=?), by 2005 back down to 2819 cases WNV |
| WNV (Clinical Features)? | 3-15 days Sx dev., 80% no Sx (1/300 bitten get sick), 20% only mildly ill (West Nile Fever, HA, Body Aches, Nauea, vomiting, swollen Lymph Glands, Skin Rash on Chest/Stomach/Back, Sx last Days to Few Weeks |
| WNV (Severe: Meningitis)? | 1/150 WNV meningitis/poliomyelitis (muscle/stupor/coma/paralysis) Sx. can last weeks, or be permanent. |
| WNV (Diagnosis)? | Sx's & Lab Testing for IgM (8-14 d) Serum/CSF WBC & Protein Elevated w/Glucose Normal |
| WNV (Prevention)? | Avoid Mosquito Bites, DEET, Clear Standing H2O, Clothing, Dusk/Dawn stay inside, (No Vaccine Available) |
| Tx for WNV? | No Spec Tx Available, Supportve in Severe cases: Fluids, Respiratory Support, Prevent 2nd Infections, Control Fever |
| WNV Surveillance? | Notifiable to Nat'l Notifiable Disease Surveillance System |
| EEE causes? | Encephalitis w/High Rate of Fatality (though low numbers in USA each Year) |
| EEE is ? | Arboviral Encephalitis, Eastern USA, Birds/Mosquitoes (Sheep/Cow/Horse) |
| EEE and Horses? | Can Kill horses |
| EEE (Eiologic Agent?) | T. Alphavirus family/genus (closely related to Western & Venezuelan Equine Encephalitis Viruses 60-70 nm in Dia.) |
| EEE (T. Alphavirus) | Enveloped in Lipid Bilayer from Host Cell Plasma Membrane, has two viral glycoproteins (E1 & E2) |
| EEE (Incidence) | Ave 4 cases/year (0-14 per year) |
| EEE (incidence - where?) | Swamps and coastal wet lands (low numbers of people reside near these areas) |
| EEE (Risk Grp?) | Outdoor work, outdoor recreation, swamp dwellers, (more severe in 50 yr/old plus, or less then 15 yr/old) |
| EEE (Clinical Features - when)? | 4-10 days after bite Sx appear |
| EEE (Clinical SX?) | Mild Flu to Encephaitis/Coma/Death (Sudden Onset: Fever, HA, Vomitting, Stiff Neck, Ataxia) 35% who survive have mild to severe neurological deficits |
| EEE (Pathology)? | Virus Replicates in Peripheral Sites, viremia, followed by CNS invasion thru Olfactory tract, Intense Lymphocytic Infiltration to Brain causing Edema, Degeneration of Ganglion Cells, nerve Destruction |
| EEE (Diagnois)? | Sx. difficult to distinguish fibrile illness, ID virus in CSF/blood to confirm, (EEG is normal) |
| EEE (Prevention)? | Vaccine for Equines Availble, People Avoid Mosquito Bites |
| Tx for EEE? | Antivirals (Acyclovir, foscarnet) NOT Effective, Spportive T Only, (anticonvulsants - phenytoin, anti-inflam - glucoCorticoids, Furosemide to reduce swelling, Sedatives, Asprin/Acetaminohen for HA & fever |
| EEE (Survillance)? | Reportable to Nat'l Note. Disease Surveillace System |
| prion disease (TSEs) | ransmissible Spongiform Encephalopathies |
| Prion Diseases are? | Uniformly fatal, ong incubaion, neuropathic: Loss of Neurons, Sponge-like texture, Astrogliosis from destruction of proximal neurons, No inflammation/No Immune Response |
| Prions (History) | Scrapie (Centuries in Europe), 1900's Reported in Ne Guinea in Fore People (50's) dubbed "KURU" meaning "Trembling w/Fear" |
| Creutzfeldt-Jakob Disease (CJD) ? | Classic CJD 1920' 1/1 million (10-15% Famiial Asso w/changes in Prion Gene - Remainder = Sporadic) Median age 68 yr/old |
| Iatrogenc Transmission of CJD ? | Corneal grafts in 1974, in 77' Neurological Equipment & EEG electrodes - 1980's hGH (3 pts.) Nat'l Hormone & Pitutary Program (NHPP), 26 pts by 2004 of 7700 pts rec'd |
| CJD is killed by? | NaOH (Strong Base) |
| BSE (Bovine Spongiform Encephalophathy)? | UK 1986 & Ireland 1989 (meat and bone meal contamination of scrapie infected sheep) |
| BSE UK by 2003? | 180K w/BSE in UK by 03', 750K slaughtered and potential consumed between 1980 - 96' |
| vCJD? | variant Creutzfelt-Jakob Disease (10 pts. UK 9 yrs after BSE Ident, Median Age: 28 yr/old, by 2005 177 cases world wide, w/156 UK, 12 France, 2 Ireland, 1 each in Can, Jap, ND, Prt, Saudi, USA |
| vCJD (Clinical)? | MRI = neuropathic lesions, early manifestations: Anxiety, depresion, withdrawl, myoclonus (shock contractions), dysthesia (loss of balance), Confirmed Dx w/immunodiagnotic tech (W. Blot) of Brain Tissue at Autopsy. |
| vCJD ???? | vCJD 28, 13-14 mos. ill, behavoiral early sx, delayed Neurologic S., EEG sharp waves (absent), Pulvinar Signs on MRI 75% cases, PrP-resd Accumulation on Brain Tissue, Agent in Lymphoid Tissue Readily Detected, Genotype at Codon 129of Prion Protein Met/met |
| Classic CJD ??? | Classic CJD effects older pts, 68 yr/old, ill for 4-5 months, Dementia/neurologic, Sharp EEG waves (present), Pulvinar Sings on MRI are ABSENT, Plaques Absent/rare, PrP-resd variable accum, Lymphoid agent = NOT Readily Detected, Codon 129 is Polymorphic |
| 2002 69 yr/old died of ? | vCJD after RBC transfussion (3 years to get vCJD, died 6.5 years later) |
| vCJD lymphocyte (blood phase) | "Prionemia" agent travels from gut to Brain via circulating lymph |
| 1966 Alper ? | Alper proposed scrapie could replicate w/out nucleic acids |
| 1982 Prusiner coined? | prusiner coined term Prion (Prion Protein Cellular = PrPc) Supporing normal neuronal synapic activity, copper binding, neuroprotection (PrPsc = patho prion changed alpha-helixes to Beta-sheet confirmation in Prion Protein) |
| Initially Scrapie was believed to be what kind of virus? | "Slow Virus" but, in 1966 Alper proposed agent replicated w/out ncleic acids. |
| TME? | Transmiissible ink Encephalopathy (1947) |
| CWD? | ChronicWasting Disease in . Am. Deer & Elk (can trans to humans) |
| PrPc ??? | disease of shape shifting prions via protein-flipping from normal prion to abnormal confirmations i lysosomes (until they burst to attack other cells) 43% PrPsc beta-sheet confirmation in Scrapies |
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