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Questions and Answers
What is the duration of treatment for a patient with HIV+ who is prescribed acyclovir for herpes infection?
What is the duration of treatment for a patient with HIV+ who is prescribed acyclovir for herpes infection?
- 10-14 days
- 5-10 days (correct)
- 3-7 days
- 7-14 days
For daily suppressive therapy in HIV+ patients, which of the following dosages is NOT appropriate for acyclovir?
For daily suppressive therapy in HIV+ patients, which of the following dosages is NOT appropriate for acyclovir?
- 600 mg po tid (correct)
- 800 mg po bid
- 400 mg po bid
- 400 mg po tid
In the treatment of neonatal herpes with disseminated/CNS infection, which of the following dosing regimens is correct?
In the treatment of neonatal herpes with disseminated/CNS infection, which of the following dosing regimens is correct?
- 30 mg/kg IV q12h for 14 days
- 10 mg/kg IV q8h for 14 days
- 15 mg/kg IV q6h for 21 days
- 20-60 mg/kg IV q8h for 21 days (correct)
What is the recommended treatment for suspected acyclovir resistance in herpes infections?
What is the recommended treatment for suspected acyclovir resistance in herpes infections?
Which statement about herpes encephalitis caused by HSV is accurate?
Which statement about herpes encephalitis caused by HSV is accurate?
What is a common complication of chickenpox that requires attention?
What is a common complication of chickenpox that requires attention?
What is the recommended dose for children aged 12 months to 12 years receiving the Varicella vaccine?
What is the recommended dose for children aged 12 months to 12 years receiving the Varicella vaccine?
What occurs as a result of the reactivation of the Varicella Zoster Virus (VZV)?
What occurs as a result of the reactivation of the Varicella Zoster Virus (VZV)?
Which medication is proven effective for treating localized and disseminated VZV?
Which medication is proven effective for treating localized and disseminated VZV?
Which of the following is NOT FDA-approved for treating post-herpetic neuralgia (PHN)?
Which of the following is NOT FDA-approved for treating post-herpetic neuralgia (PHN)?
What vaccine is currently recommended in the U.S. as the preferred shingles vaccine?
What vaccine is currently recommended in the U.S. as the preferred shingles vaccine?
What is the dose of Acyclovir for treating disseminated VZV?
What is the dose of Acyclovir for treating disseminated VZV?
What role does Varizig® play in the management of Varicella Zoster Virus exposure?
What role does Varizig® play in the management of Varicella Zoster Virus exposure?
Which virus is included in the egg-based flu vaccine recommendations for the year 2021?
Which virus is included in the egg-based flu vaccine recommendations for the year 2021?
What is the primary mode of transmission for hantavirus infection based on the content provided?
What is the primary mode of transmission for hantavirus infection based on the content provided?
Which of the following is a characteristic symptom of Hantavirus Pulmonary Syndrome (HPS)?
Which of the following is a characteristic symptom of Hantavirus Pulmonary Syndrome (HPS)?
What is the current treatment approach for Hantavirus infections mentioned in the content?
What is the current treatment approach for Hantavirus infections mentioned in the content?
Which virus is identified as a vector-borne disease transmitted by mosquitoes?
Which virus is identified as a vector-borne disease transmitted by mosquitoes?
What is the recommended supportive treatment for West Nile Virus according to the content?
What is the recommended supportive treatment for West Nile Virus according to the content?
What symptom is commonly associated with severe cases of West Nile Virus?
What symptom is commonly associated with severe cases of West Nile Virus?
Which of the following viruses has no approved protocols for treatment according to the provided content?
Which of the following viruses has no approved protocols for treatment according to the provided content?
What is the primary mode of COVID-19 transmission?
What is the primary mode of COVID-19 transmission?
Which vaccine is primarily used against mpox during the current outbreak in the United States?
Which vaccine is primarily used against mpox during the current outbreak in the United States?
What is a common characteristic of the spread of COVID-19?
What is a common characteristic of the spread of COVID-19?
Which treatment is NOT listed for managing mpox disease?
Which treatment is NOT listed for managing mpox disease?
What additional route of COVID-19 transmission is indicated aside from person-to-person spread?
What additional route of COVID-19 transmission is indicated aside from person-to-person spread?
Which of the following vaccines is used under an Expanded Access Investigational New Drug protocol for mpox?
Which of the following vaccines is used under an Expanded Access Investigational New Drug protocol for mpox?
What type of droplets are responsible for the spread of COVID-19?
What type of droplets are responsible for the spread of COVID-19?
Which of the following statements about the COVID-19 pandemic is true?
Which of the following statements about the COVID-19 pandemic is true?
What is the primary mechanism by which ganciclovir and valganciclovir exert their effect?
What is the primary mechanism by which ganciclovir and valganciclovir exert their effect?
Which adverse effect is common with the use of foscarnet?
Which adverse effect is common with the use of foscarnet?
What percentage of Americans over the age of 35 are CMV positive?
What percentage of Americans over the age of 35 are CMV positive?
Which treatment is specifically indicated for the prevention of CMV infection in allogeneic stem cell transplant patients?
Which treatment is specifically indicated for the prevention of CMV infection in allogeneic stem cell transplant patients?
What is the likely onset of symptoms for influenza compared to a common cold?
What is the likely onset of symptoms for influenza compared to a common cold?
What differentiates Type A influenza from Type B regarding the evolution of the virus?
What differentiates Type A influenza from Type B regarding the evolution of the virus?
Which gastrointestinal condition is commonly associated with CMV in immunocompromised patients?
Which gastrointestinal condition is commonly associated with CMV in immunocompromised patients?
What is a common lab diagnostic method to identify CMV infection?
What is a common lab diagnostic method to identify CMV infection?
Which antiviral agent needs to be administered with caution due to its potential for renal toxicity?
Which antiviral agent needs to be administered with caution due to its potential for renal toxicity?
How is cytomegalovirus typically transmitted?
How is cytomegalovirus typically transmitted?
In terms of drug interactions, what is a major consideration when using cidofovir?
In terms of drug interactions, what is a major consideration when using cidofovir?
Which of the following adverse effects is less commonly associated with ganciclovir treatment?
Which of the following adverse effects is less commonly associated with ganciclovir treatment?
In patients with AIDS, which condition is the most common manifestation of CMV?
In patients with AIDS, which condition is the most common manifestation of CMV?
What should be done if a patient's CD4 count exceeds 100 for three to six months regarding secondary prophylaxis for CMV?
What should be done if a patient's CD4 count exceeds 100 for three to six months regarding secondary prophylaxis for CMV?
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Study Notes
Herpes Treatment in HIV+ Patients
- Acyclovir dosing for infections: 400 mg PO tid for 5-10 days, or 200 mg PO five times daily, or Famciclovir 500 mg PO bid, or Valacyclovir 1 g PO bid for the same duration.
- Daily suppressive therapy options include Acyclovir 400-800 mg PO bid-tid, Famciclovir 500 mg PO bid, or Valacyclovir 500 mg PO bid.
- If resistance is suspected, options include Foscarnet 40 mg/kg IV every 8 hours until clinical resolution or topical Cidofovir 1% gel daily for 5 days.
Herpes Encephalitis
- Associated with both HSV-1 (in adults) and HSV-2 (in newborns).
- Diagnosis via cultures for HSV-2 in CSF, PCR preferred for rapid results.
- Mortality ranges from 50-85%; early diagnosis is crucial.
- Empirical treatment: Acyclovir 5-10 mg/kg every 8 hours for 2-3 weeks; Foscarnet indicated for resistant cases.
Neonatal Herpes
- Transmission occurs during pregnancy, leading to significant morbidity and mortality.
- Acyclovir 20-60 mg/kg IV every 8 hours for 21 days for disseminated/CNS infections, or 14 days for limited skin/mucous membrane infections.
Oral-Facial Herpes
- Treatment varies based on immune status; common complication post-chickenpox is bacterial infection of blisters.
Chicken Pox Management
- Supportive care: cool baths, calamine lotion, topical antipruritic; aspirin is contraindicated.
Varicella Zoster Virus (VZV)
- Reactivation of latent virus causes Herpes-Zoster; affects ~67% of individuals over 40.
- Symptoms include erythematous macules and grouped vesicles; resolves in 2-4 weeks.
- Common treatment includes Acyclovir, Famciclovir, and Valacyclovir; corticosteroids use is controversial.
Drug Dosing for Herpes-Zoster
- Acyclovir: 800 mg PO five times daily for 7-10 days.
- Famciclovir: 500 mg PO three times daily for 7 days.
- Valacyclovir: 1 g PO three times daily for 7 days.
Post-Herpetic Neuralgia (PHN)
- Lasts over 30 days post-rash onset; FDA-approved treatments include topical capsaicin, lidocaine patches, gabapentin, and pregabalin.
- Recombinant zoster vaccine (Shingrix) recommended for shingles prevention.
Cytomegalovirus (CMV) Infections
- High prevalence: 53% in 18-25 age group, 81% in >35, with >90% in MSM.
- Transmitted through congenital routes, sexual contact, and blood products; often remains asymptomatic until immunosuppression.
- Common manifestations include chorioretinitis, GI infections, pneumonia, CNS infections, and retinitis.
Treatment for CMV
- Primary agents: Ganciclovir, Valganciclovir, Foscarnet, Cidofovir.
- Ganciclovir: Induction with 900 mg BID for 14-21 days, maintenance with 900 mg daily.
- Foscarnet: Reserved for resistant strains; can cause renal impairment.
Prophylaxis for CMV
- Secondary prophylaxis recommended; may discontinue if CD4 count >100 for 3-6 months. Primary prophylaxis is not recommended.
Influenza Overview
- Seasonal virus (peak in winter); mortality highest in individuals over 65, particularly those with comorbidities.
- Transmission primarily via respiratory droplets; incubation averages 2 days.
Types of Influenza
- Type A: Defined by hemagglutinin/neuraminidase variations (e.g., H1N1, H3N2); pandemics result from antigenic shifts.
- Type B: Prone to mutations; epidemics occur every 5 years.
Influenza Treatment
- Antivirals (Amantadine, Rimantadine) not recommended according to current guidelines.
- Vaccination key; includes egg-based and cell-based composition tailored to circulating strains.
Hantavirus Infections
- Primarily rodent-borne; manifests as Hemorrhagic Fever, Nephropathia Epidemica, or Hantavirus Pulmonary Syndrome (HPS).
- Supportive treatment; no FDA-approved drugs; IV ribavirin under study.
West Nile Virus
- Transmitted by mosquitoes; symptoms range from mild febrile illness to severe encephalitis.
- Treatment is largely supportive; no effective antivirals available.
COVID-19 Transmission and Prevention
- Primarily person-to-person via respiratory droplets; also possible via contaminated surfaces.
- Vaccines available: Moderna, Pfizer, J&J, Novavax, contributing to preventive strategies against the disease.
Monkey Pox Virus
- Outbreak caused by Clade IIb; treatment options include Tecovirimat, Brincidofovir, and Vaccinia Immune Globulin.
- JYNNEOS vaccine is commonly used for prevention during outbreaks.
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