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DNA VIRUSES: CYTOMEGALOVIRUS and EPSTEIN BARR VIRUS DR.

JOHN ANTHONY DOMANTAY CYTOMEGALOVIRUS DISEASE The most common cause of congenital anomalies in the US Causes Cytomegalic inclusion body disease (CID) in infants Causes Mononucleosis in transfusion recipients Fever, fatigue, sore throat, swollen cervical lymph nodes Differential diagnosis: TB Causes the following in immunocompromised patients 1. Pneumonia 2. Hepatitis 3. Retinitis (AIDS patients) 4. Enteritis (AIDS patients) TRANSMISSION The virus is found in human body fluids a. Blood b. Saliva c. Semen d. Cervical mucus e. Breast milk* (breastfeeding) f. Urine These fluids can be transmitted: a. Across the placenta (congenital anomalies) b. By organ transplantation PATHOGENESIS Initial infection in the oropharynx Fetus: many organs like CNS and kidneys Adults: WBC particularly lymphocytes are affected Latent stage( occurs on the leukocytes) Reactivation ***triggers are similar with the triggers of HSV and VZV Disseminated infection of immunocompromised patients result from: a. Primary infection b. Reactivation of latent infection

DIAGNOSIS 1. Cell culture Gold standard CPE (+) 2. Fluorescent antibody test Done on the cells of the cell culture Result is Specific for CMV 3. Owls eye nuclear inclusions are seen:cytomegalic inclusion body disease (CID)

4. Serologic test A fourfold or greater rise in the antibody titer in the convalescent phase serum is diagnostic E.g : Microwell Elisa(cytomegalovirus IgG) TREATMENT Ganciclovir is beneficial in treating pneumonia and retinitis CMV is largely resistant to Acyclovir thus the drug is effective PREVENTION No vaccine is available Ganciclovir: supresses progressive retinitis in AIDS patients Do not transfuse CMV antibody (+) blood into newborns or immunocompromised patients Abroad: CMV screening is a part of routine donor screening due to its higher prevalence in the US EPSTEIN-BARR VIRUS DISEASE 1. Infectious Mononucleosis Symptoms: same presentation with TB (Fatigue,Malaise, cough, Lymphadenopathy, Splenomegaly, Hepatomegaly) 2. Burkitts lymphoma in East African Children TRANSMISSION Transmitted primarily by exchange of SALIVA kissing disease The virus is found in the human oropharynx And B lymphocytes Blood transmission is very rare

PATHOGENESIS Pharyngeal epitheliumcervical lymph nodes via blood to liver and spleen (hepatomegaly and splenomegaly) latency in B lymphocytes Differential diagnosis: Typhoid fever or Malaria DIAGNOSIS The virus is rarely isolated. Lymphocytosis, including atypical lymphocytes(T), occurs

Patients with deficient cell-mediated immunity should receive passive-active immunization against EBV

35-year old man - With grand mal seizure this morning - MRI: revealed a lesion in the temporal lobe - Brain biopsy: multinucleated giant cell with intranuclear inclusion bodies - Which is the most likely cause? Herpes Simplex virus Type 1 - What is the best choice of drug? Acyclovir 22-year old woman - With episodes of bloody diarrhea - With CD4 count of 50 - HIV antibody positive - Stool culture for Shigella, Salmonella, Campylobacter are negative - Assay for Clostridium difficile is negative - Colonoscopy revealed ulcerated lesions - What virus? CMV - Drug? Gancyclovir

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Atypical lymphocytes: larger cells, look like monocytes or blastsmight be mistaken for leukemia Serologic test: Heterophil antibody test (Monospot test) is typically positive If test is negative: CMV is the etiologic factor Principle: heterophil antibody agglutinates sheep or horse red blood cells Heterophil: refers to antibodies that are detected by tests using antigens different from the antigens that induced them A significant rise in EBV- specific antibody to viral capsid antigen(VCA) is diagnostic More sensitive or more specific than Monospot test TREATMENT No effective drug is available for treatment Viral: infection will just run its course PREVENTION There is no drug or vaccine for prevention Regarding EBV and IM, which one of the following is most accurate? - EBV enters the latent state primarily in CD4 positive helper T cells - Approximately 10% of people in the US have been exposed to EBV - People with IM produce antibody that agglutinate sheep blood cells - The atypical lymphs in the blood of people with IM are EBV infected T helper cells

VI. HUMAN HERPES VIRUS 8 (HHV 8) A. Disease - Causes Kaposis sarcoma in AIDS patients o Lesions are purple in color due to collection of RBC - Diagnosis is made by pathologic examination of lesion Molluscum contagiosum virus - Causes molluscum contagiosum - Lesions are pinkish and popular with umbilicated center - Lesions usually occur on the face, especially around the eyes - Transmitted by direct contact - Diagnosis is made clinically rather than by laboratory means - No established antiviral therapy and no vaccine - For extensive lesions and immunocompromised patients, Cidofovir may be useful

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