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Questions and Answers

What are the common neurological manifestations associated with West Nile Virus?

  • Stroke, dementia, and seizures
  • Peripheral neuropathy and brain tumor
  • Meningitis, encephalitis, and meningoencephalitis (correct)
  • Cerebral aneurysm and spinal cord injury
  • Which demographic groups are at greater risk for severe forms of West Nile Virus?

  • Immunosuppressed individuals and older adults (correct)
  • Healthy adults in their 30s
  • Children and teenagers
  • Pregnant women and newborns
  • What is the main method used for diagnosing West Nile Virus?

  • Physical examination
  • Histological examination of tissues
  • Serology testing (correct)
  • Imaging techniques like CT or MRI
  • What family and genus does the West Nile Virus belong to?

    <p>Family Flaviviridae, Genus Flavivirus</p> Signup and view all the answers

    Besides serology, what are alternative methods for diagnosing West Nile Virus?

    <p>Viral culture and PCR</p> Signup and view all the answers

    What is one of the potential severe clinical manifestations of dengue?

    <p>Dengue hemorrhagic fever</p> Signup and view all the answers

    Which bodily fluid is capable of isolating dengue virus for several months?

    <p>Blood</p> Signup and view all the answers

    What is a complication associated with severe dengue infection?

    <p>Plasma leakage</p> Signup and view all the answers

    How many serotypes of dengue virus are known to exist?

    <p>Four</p> Signup and view all the answers

    Which symptom does NOT typically occur during dengue infection?

    <p>Excessive sleep</p> Signup and view all the answers

    What causes the expansion of the paracortical area in normal lymphoid tissue?

    <p>Activation of T cells</p> Signup and view all the answers

    What is a characteristic feature of hyperplastic lymphoid tissue?

    <p>Exuberant T cell proliferation</p> Signup and view all the answers

    What histological finding is associated with liver involvement in viral infections?

    <p>Necrosis in portal areas</p> Signup and view all the answers

    How do centrocytes differ from centroblasts?

    <p>Centrocytes possess a cleft nucleus</p> Signup and view all the answers

    What is the appearance of the nucleus in centroblasts compared to centrocytes?

    <p>Centroblasts contain an open chromatin structure</p> Signup and view all the answers

    What histological change is often noted in the spleen during viral infections?

    <p>Expansion of white pulp follicles</p> Signup and view all the answers

    The liver histology in viral infections may show atypical lymphocytes in which areas?

    <p>Portal areas and sinusoids</p> Signup and view all the answers

    Which feature best distinguishes centroblasts from other lymphoid cells?

    <p>Location of nucleus at the periphery</p> Signup and view all the answers

    What is a common complication of CMV mononucleosis?

    <p>Marked hepatic dysfunction</p> Signup and view all the answers

    Which of the following is NOT associated with congenital CMV infections?

    <p>Sore throat</p> Signup and view all the answers

    What age group is primarily affected by EBV, also known as 'Kissing Disease'?

    <p>Late adolescents or young adults</p> Signup and view all the answers

    Which symptom is commonly associated with infectious mononucleosis?

    <p>Fatigue</p> Signup and view all the answers

    How is CMV commonly transmitted?

    <p>Through birth canal or breast milk</p> Signup and view all the answers

    Which of the following best describes the typical course of symptoms in CMV mononucleosis?

    <p>Symptoms resolve within 4 to 6 weeks</p> Signup and view all the answers

    Which of the following is specifically a characteristic of congenital infections caused by CMV?

    <p>Interstitial pneumonitis</p> Signup and view all the answers

    Which symptom is NOT typical of infectious mononucleosis caused by EBV?

    <p>Diarrhea</p> Signup and view all the answers

    What population is primarily at risk for developing complications from EBV infection?

    <p>Immune-compromised individuals</p> Signup and view all the answers

    What is a characteristic appearance in the blood of individuals with infectious mononucleosis?

    <p>Mononucleosis cells (atypical activated T lymphocytes)</p> Signup and view all the answers

    What causes the progression of hemoconcentration in patients with severe dengue infection?

    <p>Leakage of plasma from blood vessels</p> Signup and view all the answers

    Which histological feature is characteristic of Diffuse Alveolar Damage (DAD) observed in dengue patients?

    <p>Alveolar collapse with hyaline membrane</p> Signup and view all the answers

    What is a potential consequence of excessive intravenous fluid therapy in dengue patients?

    <p>Pulmonary edema and respiratory failure</p> Signup and view all the answers

    What primarily alters the integrity of the blood vessel wall in severe dengue infection?

    <p>Reactive oxygen species and proinflammatory molecules</p> Signup and view all the answers

    Which of the following is NOT a complication associated with severe plasma leakage in dengue?

    <p>Cardiac arrest</p> Signup and view all the answers

    What monitoring is crucial for patients receiving isotonic intravenous fluids in dengue treatment?

    <p>Fluid intake, vital signs, and hematocrit levels</p> Signup and view all the answers

    What type of cells predominantly infiltrates the lung tissue during the inflammation observed in dengue?

    <p>Mononuclear cells</p> Signup and view all the answers

    What is the time frame in which patients may continue to experience leakage after proper resuscitation?

    <p>Up to 24-48 hours</p> Signup and view all the answers

    Which of the following correctly describes how the alveolar septa appear in a lung infected with dengue?

    <p>Thickened with blue-stained cells</p> Signup and view all the answers

    How much increase in hematocrit level indicates severe plasma leakage in dengue patients?

    <p>20% or more compared to baseline</p> Signup and view all the answers

    Study Notes

    West Nile Virus

    • An acute systemic viral infection
      • It can cause mild, self-limited infections or neuroinvasive disease
      • The neuroinvasive disease is associated with long-term neurological sequelae
    • The virus belongs to the Flaviviridae family, Genus Flavivirus
    • It has a broad geographic distribution, including:
      • The Old World
      • Africa
      • The Middle East
      • Europe
    • Diagnosis is mainly done through serology
    • Other diagnostic methods include:
      • Viral culture
      • PCR

    Epstein-Barr Virus

    • Causes infectious mononucleosis
    • It's a usually benign, self-limiting lymphoproliferative disorder
    • Associated with various human tumors, including:
      • Lymphomas
      • Nasopharyngeal carcinoma
    • Characterized by:
    • Fever
    • Sore throat
    • Generalized lymphadenopathy
    • Splenomegaly
    • Appearance of mononucleosis cells in the blood
    • Atypical activated T lymphocytes in the peripheral blood
    • Certain individuals may also develop:
    • Hepatitis
    • Meningoencephalitis
    • Pneumonitis
    • Transmitted through close human contact
    • Often spreads through saliva, especially during kissing, earning it the nickname "Kissing Disease"
    • Usually occurs in late adolescents or young adults
    • More common among upper socioeconomic classes in developed nations

    Cytomegalovirus

    • Commonly infects healthy young children and adults
    • Usually asymptomatic
    • About 50-100% of adults have CMV antibodies globally, indicating prior exposure
    • The most common clinical manifestation:
    • Infectious mononucleosis-like illness
      • Fever
      • Atypical lymphocytosis
      • Lymphadenopathy
      • Hepatitis
      • Marked hepatomegaly
      • Abnormal liver function tests
    • CMV Mononucleosis:
    • Affects children and adults
    • Almost always symptom-free
    • Infants with CMV or transplacental CMV infection:
    • Might experience permanent deficits, such as:
      • Intellectual disability
      • Hearing loss
      • Neurologic impairments
    • May develop congenital infections, including:
      • Interstitial pneumonitis
      • Hepatitis
      • Neurologic disorders
    • Perinatal Infections:
      • Transmitted through the birth canal or breast milk
      • Usually asymptomatic due to protective maternal antibodies
      • Many individuals secrete CMV in urine and saliva for months or years
    • Less common complications:
    • Interstitial pneumonitis
    • Failure to thrive
    • Rash
    • Hepatitis

    Dengue Virus

    • Transmitted by Aedes aegypti mosquitos
    • Clinical manifestations range from mild to severe:
      • Fever with headache
      • Macular rash
      • Severe myalgias (breakbone fever)
      • Severe dengue (Dengue hemorrhagic fever):
      • Bleeding
      • Liver failure
      • Reduced consciousness
      • Organ failure
      • Plasma leakage
    • Severe dengue leads to shock and respiratory distress
    • Widespread hemorrhages throughout the body with:
      • Hepatic necrosis
      • Mononuclear infiltrates
      • Septal thickening
      • Hyaline membrane formation in the lung
    • The immune response to dengue virus dictates the severity of infection
    • Dengue virus has four serotypes:
    • Each serotype infection provides protective immunity to that specific serotype
    • Mechanism of increasing vascular permeability in severe dengue:
    • Not fully understood
    • Evidence suggests reactive oxygen species, enzymes, and proinflammatory molecules breakdown the glycocalyx layer
    • Allows plasma to reach intercellular junctions and leak out into the tissues
    • The blood vessel wall integrity is altered

    Histologic Analysis of Lung Tissue in Dengue

    • Diffuse Alveolar Damage (DAD) is observed:
      • Previously known as acute respiratory distress (ARDS)
      • Characterized by alveolar collapse
      • Some alveoli are collapsed, while others are distended
      • Lined by a hyaline membrane
      • Dense, thick, pink bands of proteinaceous material
      • Accompanied by inflammation
      • Inflammatory infiltrates consist mainly of mononuclear cells, similar to dengue (macrophages and lymphocytes)

    Pathology of Viral Infections

    • Comparison of lymphoid tissues
    • Normal lymphoid tissues:
    • Paracortical area (dark purple area surrounding the germinal center)
    • Expansion is due to T cell activation (immunoblasts)
    • Hyperplastic lymphoid tissues:
    • Shows an expansion of white pulp follicles (paracortical area) and red pulp sinusoids
    • Vulnerable to rupture
    • T cell proliferation may be exuberant
    • Makes it difficult to differentiate nodal morphology
    • Follicles (B cell area) might exhibit mild hyperplasia

    Liver Pathology

    • The liver is usually involved to some extent
    • Moderate hepatomegaly
    • Histology:
      • Atypical lymphocytes in portal areas and sinusoids
      • Scattered isolated cells or foci of parenchymal necrosis

    Spleen Pathology

    • Enlarged spleen
    • The organ often shows:
      • Expansion of white pulp follicles
      • Expansion of red pulp sinusoids
      • Vulnerable to rupture

    Centrocytes vs. Other Cells

    • Centrocytes:
      • Small, cleaved cells with a cleft nucleus
      • Nucleus is centrally located
    • Centroblasts:
      • Larger cells with a nucleus located at the periphery
      • Open chromatin
      • Several nucleoli
      • Modest amount of cytoplasm

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