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Infectious Disease Final


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What is the viral agent for HAV?
Enterovirus 72 of the Picornoaviridae
What is the viral agent for HBV?
a DNA virus of the Hepadnaviridae
What is the viral agent for HCV?
NonAnonB (NANB) Enterovirus
What is the viral agent for HDV
aka, Delta agent, a defective RNA virus. Only member of Deltaviridae
What is the viral agent for HEV?
What is the viral agent for HFV?
it is a variant of HBV
What is the viral agent for HGV?
homologous to HCV, but does not cause symptoms
What does HAV cause?
Infectious Hepatitis
Describe the agent characteristics of HAV.
- Acid stable
- thermotolerant and cold tolerant
- unenveloped
How is HAV transmitted?
- Fecal/oral
- From contaminated food, shellfish, water
- venereal transmission via oro-anal practices
What is the pathogenesis of HAV?
- grows in intestinal epithelium
- spreads via blood to liver
- multiply in liver parenchymal (functional tissue) cells
What are the clinical manifestations of HAV?
In adults it causes jaundice (icterus).

In chilren it is typically anicteric.
In a patient with HAV, recovery from the virus confers life long immunity...true or false?
Patients with HAV are chronic carriers for life...true or false?
False. There is no chronic carrier state known
HAV is common among what people and groups?
American Indians, Alaskan natives, and institutionalized children in daycare centers.
HAV is prevented by what two methods?
1. Immune Serum Globulin immunization
2. Formalin vaccine
What does HBV cause?
Serum Hepatitis
What are the agent characteristics of HBV?
- It is associated with the Dane Particle, which is a complete virion.
- It has dsDNA
- It uses DNA polymerase and reverse transcriptase to catalyze its reproduction
What antigens are displayed on the surface of HBV?
HBcAg (c=core)
HBsAg (s=surface, Australia Agn)
HBeAg (if e is "present," risk of transmission is high, but if there is a high count of e, risk of transmission is actually low)
What is the pathogenesis of HBV?
1. Viral DNA replicates in nucleus of hepatocytes
2. Viral DNA integrates with the host DNA
3. Once viral DNA integrates, it stops replicating
4. When it stops replicating it begins causing liver damage
5. Hepatocellular carcinoma is the result (liver cancer)
There are three phases to HBV. What are they and describe each?
1. Preicteric phase - commences with malaise, lethargy, anorexia, nausea, vomiting, abdominal pain.
2. Icteric Phase (jaundice) - Causes bilirubinemia and bilirubinurea.
3. Convalescent phase - Malaise may last for months
How is HBV transmitted?
1. Blood transfusions
2. IV Drug abuse (needles)
3. tatooing and body piercing
4. venereal (sexually)
What six possible outcomes occur if you get HBV?
1. Transient subclinical infection
2. Acute Hepatitis
3. Fulminant Hepatitis (this is fatal)
4. Healthy Carrier - most patients remain asymptomatic
5. Persistent Infection - some people develop "polyarteritis nodosum" or "glomerulonephritis"
6. Chronic Active Hepatitis - Can progress to cirrhosis or Primary Hepatocellular Carcinoma (PHC)
What are the vaccines used for HBV?
Recombivax - For immunization in infancy

Hepatitis B Immunoglobulin (HBIG) - for newborns and anyone exposed.`
In the US, what group of people is more likely to contract HBV?
Asian Americans
What was HCV formerly known as?
What are the agent characteristics of HCV?
1. enveloped
2. ssRNA
How is HCV transmitted?
1. via blood borne routes
2. Most commonly transmitted when mother is HIV positive
3. blood transfusions
4. IV drug abuse
If someone has HCV, what are the clinical manifestations?
1. It is primarily an acute disease with a short preicteric phase and jaundice is mild or absent.
2. Frequently leads to chronic active hepatitis, cirrhosis, and hepatocellular carcinoma
3. episodes of elevated liver enzymes
How does someone develop immunity to HepC?
No vaccine. Immune response never completely eliminates HepC, so recurrent illness can occur.
What is the most frequent cause of liver transplants in the U.S.?
Hepatitis C Virus (HCV)
What is the leading infectious cause of liver disease in the U.S?
Hepatitis C Virus (HCV)
What are the agent characteristics of Hepatitis D Virus (HDV)?
1. circular or linear ssRNA
2. capsid
3. It is a defective virus, dependent upon HBV for its replication
HDV causes what type of infection in HBV carriers?
An HDV superinfection
How is HDV transmitted?
Via IV drug users and transfusions (hemophiliacs have multiple transfusions, so HDV is not uncommon)
What are the agent characteristics of HEV?
- ssRNA
- nonenveloped
- a member of the Caliciviridae
How is HEV transmitted?
- fecal/oral (like HAV)
What is the pathogenesis of HEV?
- similar to HAV
- acute and sever, but no chronic sequelae
- has a high mortality among women
In general all Herpesviruses have what characteristics?
1. Are herpesviridae
2. All persist in host indefinitely
3. Infections are typically latent
4. Immunosupression causes recurrent symptoms
5. Almost everyone becomes infected with a herpesvirus, but most are not symtomatic
What are the agent characteristics of Herpesviruses?
1. enveloped
2. capsid
3. dsDNA
What is the pathogenesis of herpesviruses?
They multiply in the host nucleus and bud from the nuclear membrane.
Herpesviruses are not very responsive to chemotherapy...true or false?
False. Herpesviruses are the most responsive to chemotherapy.
What drugs offer symptomatic relief of the herpesviruses?
Acyclovir and Zovirax
What is the portal of entry for Herpes Simplex Viruses (HSV)?
It enters through skin and mucous membranes; saliva and transmission via direct contact.
What are the pathological manifestations of Herpes Simplex Virus I (HSV-I)?
1. Herpes Labialis (fever blisters, cold sores)
2. Gingivostomatitis (mostly in children)
3. AIDS patients get esophagitis and candidiasis
4. Keratoconjunctivitis
5. Encephalitis & Meningitis
Following recovery from HSV-I, what happens to the virus?
Virus is retained in the sensory nerve root ganglia of the trigeminal nerve.
HSV-I is associated with a pathological manifestation where the cornea and conjunctiva form dendritic ulcers. What is the name of this manifestation?
HSV-I has a pathological manifestation that is currently "the most common cause of corneal damage and blindness in the industrialized world." What is the name of this HSV-I manifestation?
What is the major cause of fatal sporadic encephalitis in the United States?
HSV-I and it's pathological manifestation of encephalitis and meningitis.
Is HSV-I typically above or below the waist?
Above the waist
Is HSV-II typically above or below the waist?
Below the waist
What are the pathological manifestations of Herpes Simplex II (HSV-II)?
1. Genital herpes
2. Herpes Neonatorum
3. aseptic meningitis
In HSV-II, what causes vesicopustular lesions which burst, forming painful ulcers?
Genital Herpes
What pathological manifestation of HSV-II causes viginal or urethral discharge, itching, and inguinal lymphadenopathy?
Genital Herpes
If someone has genital herpes, caused by HSV-II, what systemic manifestations are present?
Fever, malaise, myalgias, photophobia...and even meningitis in 4-8% of cases.
Following recovery from HSV-II related genital herpes what happens to the herpes virus?
It persists latently until stress triggers a lapse in CMI (Cell Mediated Immunity), and then it manifests again.
HSV-II recures more frequently than HSV-I...true or false?
What oncogenic (tumor producing) result in women is caused by HSV-II?
Cervical carcinoma
What pathological manifestation of HSV-II occurs as a intrapartum (during birth) infection?
Herpes Neonatorum
HSV-II recurres more frequently than HSV-I...true or false?
After delivery, a baby with Herpes Neonatorum manifests with what seven symptoms?
1. Irritability
2. Lethargy
3. Mucocutaneous vesicular eruptions
4. Jaundice
5. Respiratory distress
6. Seizure
7. Coma
What drug is helpful in babies that have been born with Herpes Neonatorum?
What is the other name for Human Herpes Virus 4 (HHV4)?
Epstein-Barr Virus
90-95% of the worlds population is seropositive for what Herpes family virus?
Epstein-Barr Virus
Epstein-Barr virus causes what infection typically associated with "Kissing?"
Infectious Mononucleosis (Mono)
Epstein-Barr virus causes what infection that is typically transmitted via oral contact (kissing)?
Infectious Mononucleosis
In Infectious Mononucleosis, where is the virus?
Within saliva and B-Cells
What is the other name for Infectious Mononucleosis?
Gladular Fever
What cell does Infectious Mononucleosis target?
What are the pathological manifestations of someone with Infectious Mononucleosis (Glandular Fever)?
1. Fever (as high as 104 F)
2. Sore throat with white/grey exudate covering tonsils
3. Enlarged lymph glands - lymphadenopathy
4. Hepatosplenomegaly
Most people who contract Gladular Fever (Infectious Mononucleosis) do not have life-long immunity to recurrence of the disease and can contract it if they kiss someone with the infection...true or false?
False. Someone who gets Glandular Fever has life-long immunity after recovery of the disease.
Epstein-Barr virus also manifests as what other four infections?
1. Infectious Mononucleosis (Glandular Fever)
2. Progressive Lymphoproliferative Disease
3. Burkitt's Lymphoma
4. Nasopharygeal Carcinoma
Progressive Lymphoproliferative Disease is associated with what impaired cell?
What is the name of the children's disease associated with Progressive Lymphoproliferative Disease?
SCID kids (Severe Combined Immunodeficiency)
Epstein-Barr virus manifests with an infection and cancer of the nodes of the jaw in children. What is it called?
Burkitts's Lymphoma
Epstein-Barr virus manifests with what cancer of adults in certain parts of China, in parts of Africa, and in Eskimos?
Nasopharyngeal Carcinoma
What virus is known as Human Herpes Virus 5 (HHV5)?
Cytomegalovirus (CMV)
What are the pathological manifestations of CMV?
1. Cytomegalic Inclusion Disease (CID)
2. CMV Mononucleosis
Cytomagalic Mononucleosis resembles what other pathology?
Erythroblastosis Foetalis
During pregnancy, what is now recognized to be the major viral cause of congenital abnormalities in newborns?
CMV infection
In a child with Cytomegalic Inclusion Disease (CID) what are the 5 classical presentations?
1. hepatosplenomegaly
2. Jaundice
3. Thrombocytopenia
4. Petechiae
5. pneumonitis
There are no CNS abnormalities in CMV, because the virus cannot cross the blood brain barrier...true or false?
False. CMV can cause microcephaly, encephalitis, chorioretinitis, epilepsy, impaired hearing and sight.
Cytomegalic Inclusions Disease (CID) causes what 6 CNS abnormalities?
1. Microcephaly
2. Encephalitis
3. Chorioretinitis
4. Epilepsy
5. Impaired hearing
6. Impaired sight
CMV Mononucleosis is seen primarily in children between the ages of 6-12...true or false?
False. It is seen in adults 25-34 YOA.
CMV Mononucleosis clinically resembles EBV, but with what 2 differences?
1. Pharyngitis
2. Lymphadenopathy
What are the 7 clinical manifestations of CMV Mononucleosis?
1. Pharyngitis
2. Lymphadenopathy
3. Interstitial cell pneumonia
4. Hepatitis
5. chorioretinitis ("pizza pie retinitis")
6. arthritis
7. carditis
Chorioretinitis, which is a manifestation of CMV Mononucleosis, is also known by what other name?
Pizza pie retinitis
How is CMV transmitted?
Via saliva, urine, semen, cervical secretions, breast milk, transplants
CMV can be spread from fomite contact...true or false?
True. From saliva, especially in daycare centers
CMV is not a venereal infection and cannot be spread during sexual contact...true or false?
False. It can be transmitted sexually, especially when multiple sex partners are involved.
CMV is the most frequent cause of what?
It is the most frequent cause of transfusion-acquired mononucleosis.
What are the agent characteristics of Human Papillomaviruses (HPV)?
1. nonenveloped
2. capsid
3. dsdna
4. Member of the Papovaviridae
What is the pathological manifestation of HPV?
It causes papillomas (warts)
What are the 7 different types of papillomas and conditions HPV causes?
1. Common warts
2. Flat warts
3. plantar warts
4. anogenital warts
5. laryngeal papillomatosis
6. squamous cell dysplasias
7. carcinomas of the genital tract
What is the pathogenesis of HPV?
Infection of basal cells in stratified squamous epithelium. Causes "koilocytosis."
What is the description of koilocytosis?
Enlarged, vacuolated cytoplasm, with shrunken nuclei
Koilocytosis is associated with what infection?
Human Papillomavirus
In women, where do most lesions of HPV occur?
In cervix, in zone where it merges with uterine tissue
Anogenital warts are a manifestation of what infection?
Human Papillomavirus
What is the other name for Anogenital Warts?
Condyloma Acuminatum
In HPV, where is condyloma acuminata found?
It is found on the penis, vulva, vaginal wall, cervix, and perianal regions
The typical form of anogenital warts is described with what features?
soft, raised, fleshy, lesions
The typical form of anogenital warts is caused by what HPV numeric types?
HPV 6, 10, 11, 40-45

HPV 6 & 11 are most implicated
The atypical form of anogenital warts is caused by what HPV numeric type?
HPV 16, 18, and 31
HPV Type 16 is implicated in what?
Half the cases of cancer cases in the U.S. and Europe
If someone were going to get treatment for anogenital warts, what procedures would be done to remove them?
1. Caustics
2. Cauterization
3. Surgical excision
What is the most prevelent sexually transmitted infection in the U.S.?
Human Papilloma Virus
What disease is the leading cause of death in Africa, and 4th leading cause of death worldwide?
What are the three ways HIV is transmitted?
1. Venereally
2. Blood-borne
3. In Utero and Perinatal
In the U.S, who is at highest risk for HIV?
Homosexual/bisexual males with multiple partners
In the world, 75% of HIV infections are aquired by who?
How does one acquire HIV via a blood borne route?
1. Via IV Drug Use
2. Transfusions

(The same as HBV)
Virtually all HIV transmission in childhood cases are caused by what?
In utero/perinatal transmission
All infants of HIV infected women do not have HIV antibodies, and therefor do not have HIV or AIDs...true or false?
False. All children born to HIV infected monthers have HIV antibodies at birth
The HIV virus cannot be spread via breast milk...true or false?
False. It can be shed via breast milk, but it's less infectious and not plentiful.
You cannot contract HIV from casual contact, air-borne transmission, and arthropods (bugs)...true or false?
True. All of those vectors have been investigated and eliminated.
What types of cells does HIV target for infection?
Cells with CD4 receptors (T4 Helper Lymphocytes, some macrophages, monocytes, and Langerhans cells)
HIV enters its target cell by what process?
Receptor mediated endocytosis or fusion

For instance: the receptor is the CD4 receptor on Macrophages, T4 lymphocytes, and it uses these to get into the cell)
HIV kills what cells?
T4 cells
HIV does not kill what cells it infects?
Macrophages and Monocytes, because they do not have enough CD4 receptors.
Early on, HIV infects what cells more than others?
Macrophages and Monocytes
What is the term used for HIV's targeting of Macrophages and Monocytes?
What cells does HIV use to transport the virus to the lymph nodes?
Macrophages and Monocytes
Why can HIV infect the brain?
Because it can infect monocytes and macrophages, which can cross the blood brain barrier.
HIV can infect alveolar macrophages, causing what problem in AIDs patients?
Pneumocystis Pneumonia
Slim disease is associated with what infection?
HIV infection
HIV infection persists for life in most people...true or false?
What is the primary reservoir (location within the body) of the HIV virus?
The lymph nodes
Infected macrophages and monocytes are resistant to cytolysis. What does this mean to a person who is infected with HIV?
Since HIV infects macrophages and monocytes, HIV can remain within these cells, which results in persistence of the infection.
HIV gradually changes from M-Tropic to ____-tropic?
T-tropic. later attacks T-cells.
What are the three phases of HIV?
1. Early - Acute Phase
2. Middle - Chronic/latent phase
3. Final - Crisis phase
In the Early - Acute Phase of HIV, what are the symptoms?
Flu-like: sore throat, fever, myalgias, fatigue, rash, diarrhea, vomiting
In the Middle - Chronic/Latent phase of HIV infection what are the symptoms?
Viral replicates in lymphoid tissue where it remains for 7-10 years without treatment. Minor infections occur, and some are asymptomatic.
In the Final - Crisis phase of HIV, what are the symptoms?
Collapse of immune defense.
Prolonged fever
weight loss
In the Final - Crisis Phase of HIV, what happens to the CD4 cells count?
It dramatically drops to a cell count below <500
If the CD4 cell count is less than <200 in a patient with HIV, what are they considered to have?
What are the 14 clinical manifestations when someone has AIDS? There are the all.
- Kaposi's sarcoma - skin cancer (immediate cause of death in early cases)
- B cell Lymphomas - may be from EBV
- Cervical Cancer - associated with HPV. 10X more common in women with HIV infection
- Pneumocystis jiroveci (nee carinii) pneumonia (PCP)
- Toxoplasmosis - systemic infection of many organs
- Cryptosporidiosis - chronic diarrhea
- Candidiasis - most common fungal infection in AIDs patients
- Cryptococcosis - an infection acquired by inhalation of soil contaminated with the encapsulated yeast (fungus)
- Histoplasmosis - a disease caused by the fungus Histoplasma capsulatum.
- Coccidiodomycosis - (also known as Valley fever and California valley fever) is a fungal disease
- Mycobacteriosis (tuberculosis)
- AIDs encephalopathy or dimentia
What infection is the leading cause of death among HIV+ persons in the world?
Mycobacterium Tuberculosis
In a patient with AIDs, what are the available treatments?
- Chemotherapy
- Protease inhibitors
What are the side effects of chemotherapy and AZT cocktail for AIDs patients?
Diabetes and heart disease
What two countries have the most cases of HIV+ persons?
1. Africa is #1
2. India is #2
What is the agent causing Gonorrhea?
Neisseria Gonorrhoeae
On tissue, what does Gonorrhea attach to and in what parts of the body?
Neisseria Gonorrhoeae attaches to the microvilli in the urethra, uterine cervix, anal canal, throat, and conjunctiva
To what types of tissue does gonorrhea attach?
mucosal surfaces lined by transitional or columnar epithelium
When Gonorrhea attaches to the microvilli of its target tissues, what does it evoke?
It multiplies and evokes a chronic purulent (pus) inflammatory response
What is considered diagnostic when a gram-stain smear is done on Gonorrhea?
Finding neutrophils and lots of phagocytosed Gonorrhea diplococci
When a Gonorrhea infection heals, what is the result?
extensive scar formation and fibrosis
There is no protective immunity against Gonorrhea...true or false?
In males, to what areas of the body does untreated Gonorrhea spread?
1. posterior urethra
2. major glands of genital tract (prostate, seminal vesicles, epididymis)
In males, to what areas of the body does untreated Gonorrhea NOT spread?
The testes
In males, destruction and fibrosis from Gonorrhea may cause what?
1. sterility
2. gonococcemia
3. arthritis
Why is Gonorrhea in females often undetected?
Because the urethral pathology is less conspicuous
If a woman is infected with Gonorrhea what areas of the body are affected?
1. vulvar glands
2. cervix (cervicitis)
3. fallopian tubes (sapingitis)
In Gonorrhea of women, if there is a back up of tubal discharge in the Fallopian Tubes, what resulting pathology can occur?
What areas of the pelvic region in women are not affected by Gonorrhea?
1. The uterus
2. The ovaries
What pathology, as a result of Gonorrhea, develops when the Fallopian Tubes are blocked by discharge?
Pelvic Inflammatory Disease (PID)
Pelvic Inflammatory Disease, in women with Gonorrhea can result in what problems?
1. Ectopic pregnancy
2. bacteremia
3. endocarditis
4. arthritis
5. infertility
6. sterility
Gonorrhea causes what problem in newborn babies?
Conjunctival infection (aka, opthalmia neonatorum)
If a baby has contracted Gonorrhea, and gets a conjunctival infection, what might be the resultant problem?
To reduce the incidence of newborn babies being blinded by conjunctival infection (from Gonorrhea), what was implemented?
Chemoprophylactic eyedrops
What is the 2nd most common STD in the U.S.?
What has led to further spread of Gonorrhea?
Complacent (improper) us of Penicillin
When people infected with Gonorrhea did not use penicillin properly, what was the result?
Strains of Gonorrhea started to become Penicillin resistent.
What is the name of the strain of Gonorrhea that become absolutely resistent, because of the poor use of penicillin?
Penicillinase Producing Neiserria Gonorrhea (PPNG)
In women, what contributes to creating a salutary (beneficial) environment for the Gonorrhea organism?
Birth control pills
What are the four infections caused by Chlamydia Trachomatis?
1. Trachoma
2. Chlamydial Urethritis or Cervicitis
3. Inclusion Conjunctivitis
4. Lymphogranuloma Venereum
What are the three types of Trachoma infections caused by Chlamydia Trachomatis?
A, B, and C types
What is the worlds leading cause of treatable blindness?
Trachoma, caused by Chlamydia Trachomatis
What is the treatment for Trachoma?
Antibiotic eyedrops
"Filth Flies" act as mechanical vectors for what infection?
Trachoma, caused by Chlamydia Trachomatis
Trachoma cannot be contracted by direct contact or fomites...true or false?
False. Trachoma CAN be contracted from fomites and direct contact.
Chlamydial urethritis or cervicitis is the most common bacterial STI in the world...true or false?
True. Remember, the most common BACTERIA!
What is the most frequent form of Chlamydial infection seen in the U.S.?
Chlamydial Urethritis or Cervicitis
Reiter's syndrome is associated with what infection?
Chlamydial Urethritis or Cervicitis
What are the pathological manifestations of Reiter's syndrome?
Genital infection, polyarthritis, conjunctivitis
Inclusion Conjunctivitis is caused by what infection?
Infection by Chlamydia Trachomatis
Inclusion Conjunctivitis occurs in what age range?
How does a newborn contract Inclusion conjunctivitis?
It is contracted during passage through the birth canal of a mother with Chlamydial Cervicitis
How does an adult contract Inclusion Conjunctivitis?
It is acquired via contamination with genital secretions, or in unchlorinated swimming pools.
Lymphogranuloma Venereum (LGV) is a pathology of what infection?
Chlamydia Trachomatis
Bubos is caused by what pathology and what infection?
Pathology is Lymphogranuloma Venereum, from an infection of Chlamydia Trachomatis
Chlamydia Trachomatis is a parasite of what cells within the body?
columnar epithelial cells
There are two morpholigical forms of Chlamydia Trachomatis, what are they?
1. An "elementary body," which is the infectious form
2. A "reticulate form" which is the dividing form.
What is the aka for Syphilis?
"The great imposter"
What is the agent that causes Syphilis?
Treponema Pallidum
Treponema Pallidum is easily killed with what ordinary things?
Soap and water, antiseptics, heat, cold, light
Transmission of Syphilis is almost always from sexual intercourse...true or false? kidding...TRUE!
Syphilis causes damage to what areas of the body?
It causes inflammation of the blood vessel endothelium, blocking the arteriol lumen, causing obliterative endarteritis.
What are the clinical manifestations of Syphilis and its three phases?
1. Primary Phase - Chancre is the primary lesion.
2. Secondary Phase - Macular skin rashes on palms and soles, white patchy lesions on oral membranes, condylomata lata (flat reddish/brown elevations) in moist areas (anus and vagina)
3. Latent Phase - Most infections dont progress beyond latent phase
In Syphilis, if the infection progresses beyond the latent phase and into the Tertiary phase, what are the manifestations?
1. Aortic aneurism caused by mesaortitis
2. Neurosyphilis (causing meningitis, brain atrophy)
3. Syphilitic Gumma (lesions of liver, bone, testis, skin, with a characteristic rubbery center)
Syphilis can also be transmitted to the fetus and cause what things?
A Congenital condition and marasmic (undernourished) infant. May result in still birth
Syphilis also causes what other pathology?
Non-syphilitic treponematoses
Non-syphilitic treponemotoses presents with what signs?
1. Yaws - Strawberry lesion
2. Pinta - lesions on hands, feet, scalp
3. Bejel - lesions in oral cavity
4. Chancroid (soft chancre)
The Chancroid (soft chancre) is caused by what agent?
Haemophilus ducreyi
Chancroid causes what problems?
painful, unilateral, inguinal lymphadenitis (bubo) that drains to the outside
What is the protozoan sexually transmitted infection?
What is the causitive agent of Trichomoniasis?
Trichomonas vaginalis
Trichomonas vaginalis is a trophozoite....true or false?
Trichomoniases causes small blisters in the genital tract. What are they called?
Strawberry Mucosa
Trichomoniasis causes what in females?
Vaginitis - with heavy, greenish, thick, foul smelling, foamy discharge, severe itching, painful intercourse and urination
Trichomoniasis causes what in males?
mostly asymptomatic
Loss of normal vaginal acidity predisposes women to what infection?

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