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micro/immuno/virology review

micro/immuno/virology review

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enveloped DNA viruses: HPH:
Hepadnavirus (HBV)
Poxvirus (smallpox, vaccinia, molluscum contagiosum)
Herpesvirus (HSV, VZV, EBV, CMV, HHV-6, HHV-8)
naked DNA viruses: PAP:
Parvovirus (B19: slapped cheeks rash [5th disease], hydrops fetalis)
Adenovirus (pharyngitis, pneumonia, conjunctivitis)
Papovavirus (HPV, JC virus)
icosahedral RNA viruses: Picornavirus (polio, echo, rhino, coxsackie, HAV)
Calicivirus (HEV, norwalk)
Reovirus (colorodo tick fever and rotavirus)
Flavivirus (HCV, yellow fever, dengue, st. louis encephalitis, WNV)
Togavirus (rubella, EEE, WEE)
helical RNA viruses: Orthomyxovirus (influenza)
Paramyxovirus (parainfluenza, RSV, measles, mumps)
Rhabdovirus (rabies)
Filovirus (ebola, Marburg)
Coronavirus (common cold, SARS)
Arenavirus (LCV from mice)
Bunyavirus (sandfly and rift valley fever, crimean-congo, hantavirus)
Deltavirus (HDV)
live attenuated vaccines: MMR, sabin polio, VZV, yellow fever, smallpox, adenovirus
killed vaccines: rabies, flu, HAV, salk polio

(salK = Killed)

**egg based = flu, MMR, yellow fever**
segmented viruses: all are RNA viruses:
BOAR
bunya, orthomyxo*, arena, reo

*undergo reassortment=>pandemic
measles virus: -paramyxovirus
-Koplik spots on buccal mucosa
-SSPE as a late sequelae
-giant cell pneumo in immunocomp
3 Cs: cough, coryza, conjuntivitis (and Koplik)
influenza viruses: =enveloped ssRNA orthomyxo
-shift: reassortment of genome
..this causes pandemics
-drift: minor changes
-Tx: amant and ramantadine for flu A. zanamivir and oseltavir for both B and A (these are neuraminidase inhibitors)
-vaccine = killed
naked RNA viruses: all are icosahedral
picorna, calici, reo
rabiesvirus: =enveloped ssRNA rhabodvirus
-negri bodies pathognomonic
-bullet shaped capsid
-wks - 3 months incubation pd
-bat, raccoon, skunk in US
-migrates retrograde up to CNS
->fatal encephalitis
(seizures + hydrophobia)
arboviruses: =transmitted by arthropods
- flavi, toga, bunya
- ex: dengue and yellow fever
yellow fever: a flavivirus from Aedes mosquito
-> bites monkey or human
Sx: high fever, black vomit, jaundice, councilman bodies in liver
Tznack test: smear of an open skin vesicle
-detect giant cells
-assay for HSV 1, 2 or VZV

"Tzank heavens I dont have herpes"
hepatitis surface markers: -HAV IgM: active HAV
-HBsAg: continued presence indicates carrier state
-HBsAb: IMMUNITY to HBV
-HBcAb: + in window period, is an indicator of recent disease
-HBeAg: indicator of infectivity. "bE-ware!"
-HBeAb: indicates low infectivity.
HIV markers: diploid ssRNA genome
p24: nucleocapsid protein [gag]
reverse transcriptase [pol]
-synthesizes dsDNA from RNA
-dsDNA integrates into host
gp120: envelope protein [env]
gp41: envelope protein (inner)
p17: matrix protein
AIDS diagnosis: CD4 <200
HIV+ with AIDS disease (PCP...)
CD4/CD8 ratio <1.5
HIV mutations: CCR5 (deletion)
-homozygous: immune (1%)
-hetero: slower course (20%)
CXCR1
-rapid progression to AIDS
AIDS infections: -CNS: crypto, toxo, CMV, AIDS dementia, PML (JC virus)
-eyes: CMV retinitis
-mouth: thrush, HSV, CMV, EBV
[EBV = oral hairy leukoplakia]
-lungs: PCP, TB, histoplasma
-GI: cryptosporidium, MAC, CMV colitis, NHL (from EBV)
-skin: shingles, kaposi's
-genital herpes, warts, HPV
prions: -neither RNA nor DNA -> protein
-encoded by cellular genes
-ass'd with spongiform enceph
-normal prions have a-helix
-pathologic = B pleated sheet
what in S. pneumo is chemotactic for neutrophils?: teichoic acids and peptidoglycan. this causes pus formation
IgA protease allows attachment, and the polysaccharide capsule causes and antibody response.
most likely causes of cervitis and PID in young women: GC and CT
both induce endocytosis by epithelial cells of GU tract
GC contains B-lactamases
-Tx: ceftriaxone, azithromycin or quinolones
CT stains gram - but lacks peptidoglycan, so is also resistant to B-lactams.
-Tx: macrolides, quinolones and tetracyclines
antibiotic that causes serum-sickness reaction: Cefaclor: 2nd gen cephalosporin
-used to treat URIs, LRIs
->serum sickness = urticaria, pruritis, morbilliform rxn, eosinophilia, joint pain, swelling, fever
chloramphenicol adverse rxn in babies: 'grey baby syndrome'

(toxic drug!)
common virus other than flu that can undergo genetic shift: rotavirus (a reovirus. also has a segmented genome)
signs of bacterial endocarditis: Osler's nodes (fingers, toes)
Janeway lesions (painless plaques, small can be anywhere)
splinter hemorrhages
heart mumrurs in 90% of pts
->can be absent in R-sided
**S. aureus is usually the culprit
features of Kleb pneumo pneumonia: elderly, alcoholics, DM pts
currant-jelly sputum (clots)
lobar pneumonia
VRE mechanism of vancomycin resistance: vanc depends on ability to bind D-ala D-ala (synthesis of peptidoglycan bridges)
VRE use D-lactate in peptide bonds instead [=novel cell wall bridges!]
enzymatic deactivation = a mechanism of resistance to which antibiotics?: aminoglycosides
chloramphenicol
sulfonamides

acetylation, adenylation and phosphorylation are the most commmon methods
decreased ribosomal binding = a mechanism of resistance to which antibiotics?: macrolides and tetracycline, minocycline and doxycycline

(all of these inhibit protein synthesis)
manifestation of L.monocytogenes in infants (acquired in-utero): granulomas ["granulomatosis infantiseptica"]

can be fatal

mom may be asymptomatic or may present with febrile diarrhea
causes and treatment of traveller's diarrhea: ETEC, Shigella, Campy

Tx: fluoroquinolones [cipro, ofloxacin, norfloxacin]. TMP/SMX can be used in kids
aspects of maternal-child HIV transmission: all babies born to HIV + moms will have a positive ELISA and positive western blot

need PCR or viral culture on tissues to determine the infant's infection status
Bartonella henselae: 'cat scratch fever'

=regional lymphadenopathy w/or w/out low fever and headaches

produces self-limited granulomatous response in draining lymph nodes
Coxiella burnettii: Q fever

inhaling dust or cow's milk

Sx: mild, nonspecific or pneumonia. can progress to myocarditis or hepatitis
Rickettsia prowazekii: endemic typhus (body lice)

produces rash like rocky mtn spotted fever.
manifestations of in-utero infection with CMV: hepatosplenomegaly, periventricular brain calcifications, petichial hemorrhages, hydrops.
sensorineural deafness also occurs
**more severe infection if mom has a primary CMV infection during pregnancy (30% mortality)
E. histolytica: transmitted via fecal-oral route.
1st manifestation is intestinal colonization which may be asymptomatic
life threatening complication = HEPATIC amebiasis [abcess with necrotic debris. ameboae are located along edge]
nitrite test in UA is used to distinguish what?: most enterobacteriaciae are able to convert nitrate to nitrite

BUT Entercocci are NOT. so nitrite test is negative.
-> enterococcal UTIs are often nosocomial
diagnosis and treatment of Mycoplasma pneumoniae: cold hemagglutination
+ agglutination with S. salivarius strain MG

Tx: macrolides (erythromycin, clarithromycin, azithromycin)
Babesia: one week incubation pd, Eastern US, intra-RBC parasite (similar to Plasmodium)
transmitted by Ixodes tick
severe cases (rare): hemolysis-> hemoglobinuria and renal failure
reactive arthritis due to Yersinia enterocolitica: those with HLA-B27 are predisposed
VZV in AIDS pts: severe debilitating shingles

severe multifocal encephalitis that is often resistant to acyclovir
P. aeruginosa causes this usually benign disease: Otitis externa, or 'swimmer's ear'

BUT can become malignant and lead to CN palsies (common in diabetics)
characteristics of VRDL: titer will fall late in disease, with or without drug therapy

FTA-ABS will remain high if untreated (won't further rise)
normal vaginal flora of pre-pubertal and post-menopausal women: colonic and skin organisms, including S. epidermidis

child bearing age: Lactobacilli, Candida, Streptococci
common cause of spontaneous abortion: Listeria monocytogenes
first line drug for S.pneumo pneumonia: penicillin

alternative therapies: vancomycin and erythromycin
common causes of impetigo: S. pyogenes, S. aureus

[distinguish with catalase]
safest tetracycline antibiotic for those with renal dysfxn: doxycycline (elimiated in feces)
appearance of H. capsulatum: 2-5 um yeast with a thin cell wall and no true capsule

TB like illness with formation of masses in the lungs.
often in Ohio-Mississippi river valleys
mechanism of septic shock via gram -s: lipid A of the LPS is the most toxic component. triggers release of IL-1 and TNF. also activates coag and complement cascades

(O antigen induces specific immunity)
causes of bacterial cholangitis: Ascaris lumbricoides
liver flukes
-Clonorchis sinensis
-Fascioloa hepatica

pruritis, jaundice, pale feces, dark urine
Pseudomonas aeruginosa toxin: exotoxin A
-ADP ribosylates [inhibits] eukaryotic EF-2 (G protein involved in translation)
neonatal manifestations of C. trachomatis: tachypnea, hypoxemia, crackles, wheezing and eosinophilia. Transmitted via mom's vaginal secretions. Conjunctivits precedes pneumonitis
most common bacterial gastroenteritis in the US: Campylobacter jejuni

-contaminated poultry products = 50% of infections
window period of hepatitis infection: when neither HBsAg or HBsAb can be detected

caused by ppt of Ag/Ab complexes in the zone of equivalence (so are removed from circulation).

eventually will become HBsAg negative, then will finally see presence of HBsAb
Rickettsia rickettsii: Rocky Mtn Spotted Fever

vasculitis affects skin and kidney. mortality rate can be up to 10%
Brucella abortis: brucellosis

=chronic disease manifested by fever, night sweats [undulating fever], and weight loss. no rash.
what are axial filaments?: the means of motility in spirochetes!
Opisthorchis sinensis: the Oriental liver fluke

causes pigmented gallstones (calcium bilirubinate)
Haemophilus ducreyi: pleiomorphic gram - rod in parallel short chains

causes chancroid-> tender ulcerative lesion + inguinal adenopathy.

remember, primary syphillis chancer is NON TENDER and hard
chlamydia structure: does not make ATP, so is obligate intracellular.

cell wall does not have muramic acid in the peptidoglycan.
unique feature of fungal cell membranes: ergosterol.

this is targeted by antifungals: Nystatin and imidazole
which part of growth curve does B-lactam antibiotics attack?: they inhibit cell wall synthesis, which occurs maximally during the LOG phase
post-infectious encephalomyelitis: can occur following measles, mumps, rubella, varicella, influenza, or chickenpox or rabies vaccine.

=perivenous microglial encephalitis with demylination

mortality of 15-40%, only supportive treatment
Bruton's agammaglobulinemia: (low B cells)
X-linked recessive
defect in tyrosine kinase gene = low levels of all classes of Igs

recurrent bacterial infections after 6 months (when mom's IgG levels decline)
DiGeorge's syndrome: =Thymic aplasia (low T cells)

thymus and parathyroids fail to develop (due to failure of 3rd and 4th pharyngeal pouches)
Tetany (low Ca), recurrent viral/fungal infections
22q11 deletion**
also congenital defects of heart and great vessels
SCID: B AND T cells

defect in early stem cell diff
recurrent viral, bacterial, fungal, protozoal infxns
has multiple causes
IL-12 receptor deficiency: low activation of T cells

presents with disseminated mycobacterial infections
hyper-IgM syndrome: defect in CD40L on T-helpers prevents class switching

presents early in life with severe pyogenimc infections
high IgM, very low IgG, A, E
Wiskott-Aldrich syndrome: X-linked defect in the ability to mount IgM response to bacterial capsules
elevated IgA, normal IgE, low IgM
symptoms = WIPE
Wiskott: recurrent Infections, thrombocytopenic Purpura, Eczema

12% chance of developing NHL*
Job's syndrome: failure of IFN-gamma [low macrophage activation] production by T-helpers. polys fail to respond to chemotaxis.

recurrent saph abcesses, eczema, coarse facies, retained primary teeth, high IgE levels
leukocyte adhesion deficiency syndrome: defect in LFA-1 adhesion proteins on phagocytes

presents early with severe pyogenic and fungal infections

also, delayed separation of umbilicus
Chediak-Higashi disease: AR defect in microtubule fxn and lysosomal emptying of phagocytes.

recurrent pyogenic infections w/staph and strep, partial albinism and peripheral neuropathy
CGD: defect in phagocytosis of polys due to lack of NADPH oxidase

presents w/susceptibility to opportunistic infxns, especially S. aureus, E.coli and Aspergillus.

Dx: negative nitroblue tetrazolium dye reduction test
chronic mucocutaneous candidiasis: T cell dysfunction specifically against C.albicans

presents w/skin and mucous membrane Candida infxns
selective immunoglobulin deficiency: defciency in B cells to switch to particular cass. selective IgA deficiency is most common-> presents w/sinus and lung infections + milk allergies and diarrhea
ataxia-telangiectasia: defect in DNA repair enzymes and associated IgA deficiency. presents w/cerebellar problems (ataxia) and spider angiomas (telangiectasia)
associated with HLA-B27: PAIR

psoriasis
ankylosing spondylitis
inflammatory bowel disease
Reiter's syndrome

(also had previous question that mentioned predisposition to Yersinia arthritis?!?)
acute transplant rejection: cell mediated due to CTLs
[hyperacute is due to preformed antibodies]

occurs weeks afterwards
Tx: cyclosporine
chronic rejection: antibody mediated vascular damage [fibrinoid necrosis] (type IV reaction)

occurs months to years later
IRREVERSIBLE
GVHD: immunoCOMPETANT T cells in the graft proliferate in host's irradiated immune system and reject the host's now 'foreign' cells.

Sx: maculopapular rash, jaundice, hepatosplenomegaly and diarrhea
type I hypersensitivity: anaphylactic and atopic:

antigen cross links IgE and triggers histamine release

rapid reaction after antigen exposure (preformed Ab)

ex: anaphylaxis, asthma, hives, local wheal and flare
type II hypersensitivity: antibody mediated

IgM and IgG bind to antigen on the foreign cell, leads to lysis by complement MAC/ phagocytosis

ex: hemolytic anemia, Rh disease, Goodpasture's, rheumatic fever, Graves', myasthenia gravis, ITP
type III hypersensitivity: immune complex, serum sickness

ex: PAN, SLE, RA

*most serum sickness caused by drugs (5-10 days after exposure)
type IV (delayed): sensitized T cells encounter antigen and release lymphokines that activates macs

ex: TB test, transplant rejections, contact dermatitis
anergy: self-reactive T cells become non-reactive (tolerant) w/out the co-stimulatory molecule
what HLA type is pernicious anemia associated with?: DR5

(DR5 is also associated with juvenile RA)
other HLA types and their associated diseases: DR2: Goodpasture's, allergy, MS, narcolepsy

DR3: celiac, type 1 DM, SLE

DR4: pemphigus vulgaris, RA, type 1 DM
caspofungin: inhibits synthesis of B (1,3) D-glucan in fungal cell walls

**for treatment of INVASIVE aspergillosis (when unresponsive to other Tx like ketoconazole and amphotericin B)
ketoconazole: inhibits steroidgenesis. so also works for Cushing's patients.

used to treat serious systemic mucocutaneous fungal infections
terbinafine: inhibits squalene epoxidase (which in turn inhibits ergosterol)

used to treat onychomycosis
anti-centromere antibody: in 90% of those with CREST syndrome [limited scleroderma]
auto-antibodies associated with Sjogrens: anti-Ro (also SS-A), anti-La (also SS-B), ANA, and RF

**these patients are at increased risk for developing malignant lymphoma (b/c of constant infiltration of glands)
resistant to sterilization (autoclaving): endotoxins [can only remove by scrubbing with detergents]

prions
most important mechanism for removing encapsulated organisms: IgG and/or C3b opsonization which takes them to the spleen

(resistant to phagocytosis but NOT opsonization!)
HIV western blot considered positive when...: at least two of three of these are present:
gp120, gp41, p24

if not, considered indeterminate, and must get a PCR to confirm
Ixodes tick transmits these microbes: Borellia burgdorferi
Babesia microti
Erlichia phagocytophila
->presents similar to RMSF but does not have a rash. also see characteristic 'berry like' clusters of organisms inside granulocytes
response to polysaccharide antigen stimulation: (in a vaccine). even without T cells, will still make a IgM response.

the T cells (often elicted by a toxoid coupled to the polysaccharide Ag) cause class switching, DTH, etc.
presentation of T. gondii in AIDS patients: 15-25% of cases will present with seizures
multiple ring-enhancing lesions also seen
tuberculoid vs lepromatous leprosy: tuberculoid: indolent course, affects cooler parts of body, and hard to isolate AFB from the affected areas

lepromatous: progressive and invasive. can isolate large #s of AFB from lesions [non-granulomatous..
histiocytic!]
double stranded DNA viruses: poxviruses, herpesviruses, adenoviruses
pathognomonic histo feature for measles (or measles vaccine [live attenuated MMR]): WF giant cell
-multinucleated with eosinophilic cytoplasm and nuclear inclusion bodies

*created by fusion of lymphs
mixed connective tissue disease: joint pain, myalgias, pleurisy, esoph dismotility, skin probs

anti-RNP (high titer), low titer RF, low titer anti-ssDNA
unusual attribute of Cryptococcus neoformans: urease positive!

(preferred test is actually not the India Ink stain, but latex agglutination for capsular antigen)
Rickettsia typhi: endemic typhus

spread by feces of the rat flea, and the reservoir is the rat
PML: caused by JC virus (a papovavirus)

EEG = diffuse slowing over both cerebral hemispheres.
Bx= disease limited to WHITE MATTER. also abnormal giant oligodendrocytes, some w/eosinophilic inclusions
viral causes of neonatal encephalitis: HSV I (95% of cases)
HSV II
CMV

*HSV I usually involves temporal lobes
HLA type associated with Lyme disease arthritis (if untreated): HLA-DR4

often occurs in large joints (knees) and in intermittent attacks
catalase positive organisms: staph, pseudomonas, candida, aspergillus, enterobacteriaceae

**allows longer survival of bacteria intracellularly
Nystatin mechanism: (drug of choice for C. albicans)

complexes with ergosterol and punches holes in yeast membrane
[amphotericin B has similar mechanism]
griseofulvin mechanism: interferes with mitotic spindle function

used topically to treat dermatophytes (b/c concentrates in stratum corneum)
flucytosine: interferes with thymidylate synthetase
used for cryptococcosis

**contraindicated in HIV pts b/c causes BM suppression
common variable immune deficiency: complex of ACQUIRED diseases, usually in 20s or 30s

number of B cells is NORMAL (distinguish from X-linked agammaglobulinemia)
some have intact cellular immunity, but some have severe T cell defects
can also see autoimmunity (Addisons, RA, thyroiditis)
also bronchiectasis, carcinoma, lymphoma
low levels of all Ab classes
Histoplasma capsulatum: systemic DIMORPHIC infection acquired through inhalation of soil dust

tiny yeast forms intracellularly (so is NOT spread person-person)
often found in RES cells
malarial hypnozoite: only in P. vivax and P. ovale

causes relapse of disease b/c of dormant forms in the liver

**cured by PRIMAQUINE
immune mechanism used to fight filarial infection: antibody dependant cell mediated cytotoxicity

coats w/thin layer of IgE and triggers eos-mediated cytotoxicity [type II] and release of substances from basophils/mast cells [type I: local anaphylaxis]
C3 deficiency: susceptible to recurrent infections w/encapsulated bacteria
(C3 is an opsonin)
usually not detected til later in life
fluroquinolone use in kids <18: arthropathy, myalgias, leg cramps
appearence of Tinea pedis [dermatophyte]: colorless, branching hyphae with cross-walls and arthroconidia
maximum spore formation of B. anthracis occurs during what phase of growth curve?: stationary phase
(cell growth ceases b/c of a lack of nutrients or build up of toxins)
Leptospirosis: caused by a spirochete shaped like a "shephard's crook"

fatal form: Wal's disease-> jaundice, bleeding, renal failure, skeletal muscle necrosis

spread via contact w/blood or urine of infected animals (often rats)
tabes dorsalis: manifestation of tertiary syphillis

=ataxia, wide based/slapping gait, degeneration of dorsal spinal columns and dorsal roots
erythromycin facts: macrolide used in treatment of URIs and skin infection

inhibits CYP450, so potentiates effects of theophylline
pair of molecules that causes phagocytes to enter area of infection: LFA-1 (integrin) + ICAM-1 (member of Ig superfamily)

causes strong adhesion to promote diapedsis of polys, T lymphs, macs, dendritic cells
which part of the brain does infective endocarditis affect?: emboli cause multiple small PARIETAL LOBE abscesses

(can present with stroke like symptoms)
distinguishing feature of H.flu that causes epiglottitis and/or meningitis: polyribitol phosphate CAPSULE (HIB)

H. flu causing otitis media does not possess this capsule
species that undergo natural transformation: (take up free DNA)
Haemophilus, Streptococci, Neisseria gonorrhoeae, H.pylori
Th1 cells produce which cytokines?: IFN-gamma and TNF-B

(these stimulate macrophage microbicidal activity)
TNF-alpha: product of macrophages and NK cells

cytotoxic for TUMOR cells, induces cytokine production, causes chronic inflammation
mechanism of sulfonamides: competitive inhibition of PABA
->inhibits folic acid synthesis required for bacterial growth
mechanism of quinolones: inhibit DNA gyrase (which is nescessary for DNA replication and repair)
cytokine that induces class switch to IgA: IL-5
immune status of patients with full blown AIDS: make lots of IgM to gp120, gp41 (envelope proteins) b/c don't need T cells to make IgM
but can't make IgG to viral structural proteins
**are ELISA seronegative (ELISA looks for IgG to p24)
but paradoxically have high total Ig levels (b/c of high IgM levels from B cells)
rat bite fever (2 forms): -> Streptobacillus moniliformis
-short incubation pd
-more common in US
-> Spirillium minus
-1-4 wk incubation pd
-more common in Japan

*both manifested in children, with a rash (most obvious on palms and soles)
immunoglobulin allotypes: *can be used in paternity cases

ex: Kappa light chains, IgG1, IgG2, IgG3 heavy chains
anti-histone autoAb: drug induced SLE
anti-ribonucleoprotein (SS-A, SS-B): mixed connective tissue disease
important reservoir cells of HIV: follicular dendritic cells in germinal cells of lymph nodes
retroviruses means of replication: produce a dsDNA intermediate that transcribes mRNA
-ssRNA means of replication: produces a (+) sense ssRNA intermediate that produces mRNA

(uses RNA-dependant RNA polymerase)
which is the most common type of mycobacteria in AIDS patients?: TB!

although MAC is common, TB is still more prevalent (except when CD4 falls below 60)
cytokine that mediates isotype switch to IgE: IL-4 (produced by Th2 cells)
anti-mitochondrial autoAbs: associated with primary biliary cirrhosis
->increase in alk phos more than AST/ALT
-> ass'd with Sjogrens, scleorderma, RA, thyroiditis, celiac, glomerulonephritis
anti-smooth muscle autoAbs: seen in autoimmune hepatitis
PCP is seen in AIDS patients and also in..?: preemies (2nd most common group to be infected)

3rd: probably BM transplants
ascaris method of infection: ingestion of human feces containing eggs (contamination)

no intermediate host!
hives (urticaria) are what type of hypersensitivity?: type I
screening test for CGD: nitroblue tetrazolium (negative)
IL-10: produced by Th2 cells to inhibit Th1 (which effectively decreases likelihood of a DTH rxn)
ofloxacin + antacids: = dramatic increase in bioavailability of the fluoroquinolone (the two will bind in the GI tract)
cromolyn sodium: stabilizes mast cell membranes (inhibits degranulation)
theophylline: inhibits phosphodiesterase, which increases cAMP and makes degranulation less likely
most powerful neutrophil chemotactic factors: C5a and IL-8
parasitic stage of T. gondii that crosses the placenta: tachyzoite [rapidly dividing forms that spread via blood]
associated with HLA-DR2 and DR3: SLE

(type 1 DM is DR3 and DR4)
most common outcome of HBV infection: subclinical disease and recovery (60-65%)
which complement component removes immune complexes from the serum?: C3b
acyclovir mechanism of action: inhibits viral DNA polymerase

[must be phosphorylated by a viral kinase to work]

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