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Clin Med II Infectious Disease Lecture II—Viral Diseases, part 1/3.

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Presentation on theme: "Clin Med II Infectious Disease Lecture II—Viral Diseases, part 1/3."— Presentation transcript:

1 Clin Med II Infectious Disease Lecture II—Viral Diseases, part 1/3

2 Cytolomegalovirus

3 Cytomegalovirus  Usually asymptomatic  Seroprevalence 60-80% in Western countries  Transmission  sexual contact  breast feeding  blood products  transplantation  person-to-person  congenital

4 Congenital CMV  Most common congenital infection in developed countries—0.2%-2% of all live births  10% of infected newborns will be symptomatic with CMV inclusion disease

5 CMV in Immunocompetent  Most common cause of acute mononucleosis-like syndrome with negative heterophil antibodies  Critically ill—reactivated  Associated with multiple diseases but link is unclear  IBD  Atherosclerosis  Cognitive decline

6 CMV in Immunocompromised  Tissue and bone marrow transplant patients  CMV is immunosuppressive  Can contribute to transplanted organ dysfunction  HIV patients

7 Perinatal and CMV Inclusion  Jaundice and HSM  Thrombocytopenia and purpura  Microcephaly, periventricular CNS calcifications, mental retardation and motor disability  Hearing loss in > 50% symptomatic at birth  Most infected are asymptomatic but develop neurological deficits later on

8 CMV in Immunocompetent  Fever, malaise, myalgias, arthralgias, splenomegaly  Cutaneous rashes  Complications—mucosal GI damage, encephalitis, hepatitis, thrombocytopenia, Guillain-Barré, pericarditis, myocarditis

9 CMV in Immunocompromised  Distinguish between CMV infection and CMV disease  Patients at risk—HIV, organ transplant, stem cell transplant  CMV viral loads correlate with prognosis after transplantation

10 CMV in Immunocompromised  Retinitis—neovascular, proliferative lesions  GI/Hepatobiliary—odynophagia, gastritis, small bowel disease, colonic disease, liver transplant complications  Respiratory—pneumonitis  Neurologic—polyradiculopathy, transverse myelitis, ventriculoencephalitis, focal encephalitis

11 Cytomegalovirus  Mothers and Newborns—pregnant women tested for IgM CMV antibodies q 3 mo if positive assay in 1 st trimiester  PCR assays of dried blood samples from newborns and micro-ELISA on urine, saliva or blood specimens during 1 st 3 weeks of life to diagnose congenital CMV  Immunocompetent—initial leukopenia followed by absolute lymphocytosis with atypical lymphocytes  abnormal LFTs  CMV specific IgM or 4x increase in specific IgG  Immunocompromised—serology, cultures, PCR, pp65 antigen and viral load; rapid shell-viral cultures  CXR—consistent with interstitial pneumonia  Biopsy—especially useful in pneumonitis and GI disease


13 Cytomegalovirus  Retinitis—IV ganciclovir if sight-threatening; less severe disease, oral valganciclovir  Other infections—same antivirals; length of therapy depends on how immunosuppressed the pt is  CMV from transplant—ganciclovir (at same doses as retinis) for 2-3 weeks  Pregnancy—passive immunization with hyperimmune globulin  Prevention—no current vaccine; HAART prevents in HIV- infected patients

14 Cytomegalovirus  Refer  neonatal infections consistent with CMV inclusion disease  AIDS + retinitis, esophagitis, colitis, encephalitis  AIDS + hepatobiliary disease  Organ or hematopoietic stem cell transplants with suspected CMV reactivation  Admit  Risk of colonic perforation  Unexplained, advancing encephalopathy  Biopsy of tissues  Initiation of IV anti-CMV agents

15 Epstein-Barr Virus

16  Also known as human herpesvirus type 4  Infects >90% of population worldwide and persists for lifetime of host  Mainly transmitted by saliva but can also be recovered from genital secretions

17 Epstein-Barr Virus  Early—fever, sore throat, fatigue, malaise, anorexia, myalgia  Lymphadenopathy, splenomegaly, rash  Conjunctival hemorrhage, pharyngitis, tonsillitis, gingivitis, soft palate petechiae  Can see other organ system involvement as well

18 Epstein-Barr Virus  Labs—granulocytopenia followed within 1 week by a lymphocytic leukocytosis with atypical lymphocytes comprising over 10% of leukocyte count  May see hemolytic anemia or thrombocytopenia  Monospot test, IgM and IgG titers  PCR – useful for malignancies associated with EBV

19 Epstein-Barr Virus  Over 95% of patients with acute disease recover without specific antiretroviral therapy  Symptomatic—acetaminophen or NSAIDs, warm salt- water gargles TID-QID  Hepatitis, myocarditis, and encephalitis—symptomatic  Splenic rupture—splenectomy  Avoid contact sports for at least 4 weeks  Prognosis good in uncomplicated cases  fever resolves in 10 days  lymphadenopathy and splenomegaly resolve in 4 weeks  debility can linger for 2-3 months

20 Erythema Infectiosum

21 Erythrovirus Infections  Parvovirus B19  Widespread  Respiratory secretions, saliva, placenta, blood products  Incubation 4-14 days

22 Erythema Infectiosum  Children—exanthematous illness, erythema infectiosum  Fiery red cheeks  Circumoral pallor  Lacy maculopapular rash on extremities  Malaise, headache, and pruritis

23 Erythema Infectiosum

24 Erythrovirus Infections  Immunocompromised— transient aplastic crisis and pure red blood cell aplasia  Adults—limited nonerosive symmetric polyarthritis  Chloroquine— exacerbates erythrovirus-related anemia  Pregnancy—premature labor, hydrops fetalis, fetal loss

25 Erythrovirus Infections  Clinical diagnosis may be confirmed by elevated anti- erythrovirus IgM (serum) or with PCR (serum or marrow)  Complications—rare  Treatment is symptomatic in healthy patients  Immunosuppressed patients—IVIG  Intrauterine transfusion—severe fetal anemia  Prevention—screening donated blood, standard containment guidelines in nosocomial outbreaks  Prognosis—excellent in immunocompetent patients

26 Questions?

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