1. Kingdome of Saudia Arabia Al-Majmaah University Applied of Medical Science Clinical Virology CLINICAL VIROLOGY MDL 325 Presented by : Mohammad Al- Turaqi & Mohanad Al-Mulheim. Supervisor : Dr. Gomaah Abd- Ulrahim Abd-Aleem

2. case  A 28-year-old man presents to the physician’s office for evaluation of a rash on his chest.  He has subsequently developed multiple new lesions and suffer fro weight loss.  The lesion don’t hurt, itch, or bleed, but he continues to get new ones.  He has never had anything like this before like allergies not exposure to any new medications, foods, lotions,or soaps.

3.  His vital signs are normal.  Examination of his pharynx shows thick white plaques on the posterior pharynx and soft palate & multiple oval-shaped purple or brown macules on his chest.  - In 5 days you get the pathology report with the diagnosis of Kaposi sarcoma

4. Q1: With what virus is this patient likely infected? Q2 :What specific cell types are most commonly infected with this virus? What cell surface receptor is the binding site of this virus? Q3 : What serologic testing is most frequently performed to make this diagnosis? Questions

5. Discussions From clinical finding : A 29-year-old man has weight loss, white plaques on the pharynx,and purple lesions on the abdomen, which on biopsy reveals Kaposi sarcoma. 1- Virus with which this patient is most likely infected: Human immunodeficiency virus (HIV). 2- Specific cells infected by and binding site of HIV: CD4 surface receptor protein on macrophages and T lymphocytes. 3- Serologic testing to confirm diagnosis: HIV enzyme-linked immunosorbent assay (ELISA) and Western-blot analysis, or PCR.

6. Diagnosis HIV infection can be diagnosed by :  virus isolation  detection of antiviral antibodies by Western blot tests.  measurement of viral nucleic acid or antigens.  Most individuals are seropositive within 6–12 weeks after infection.  enzyme-linked immunoassays (EIA, ELISA) are routinely used as screening test.  Amplification assays (RT-PCR, DNA PCR. or bDNA tests) are used to detect viral RNA in clinical specimen.

7. Treatment and prevention 1- Treatment of HIV infection uses classes of drugs that inhibit the virally-coded reverse transcriptase and inhibitors of the viral protease enzymes. 2- Therapy with combinations of antiretroviral drugs is called highly active antiretroviral therapy (HAART).

8. Comprehension Question (1) :During a medical check-up for a new insurance policy, a 60-year-old grandmother is found to be positive in the ELISA screening test for antibodies against HIV-1. She has no known risk factors for exposure to the virus. Which of the following is the most appropriate next step? A. Immediately begin therapy with azidothymidine. B. Perform the screening test a second time. C. Request that a blood culture be done by the laboratory. D. Tell the patient that she is likely to develop AIDS. E. Test the patient for Pneumocysti carinii infection. (2) : In a person with HIV-1 infection, which of the following is the most predictive of the patient’s prognosis? A. CD4+ cell count B. CD4:CD8 cell ratio C. Degree of lymphadenopathy D. Level of HIV-1 RNA in plasma E. Rate of decline in anti-HIV antibody

9. (3) : Highly active antiretroviral therapy against HIV infection includes one or more nucleoside analogue reverse transcriptase inhibitors in combination with representatives of which class of antiretroviral agents? A. Inhibitors of viral binding B. Inhibitors of viral protein processing C. Inhibitors of viral release D. Inhibitors of viral uncoating E. Nonnucleoside antiretroviral agents (4) : Which of the following is the pathogen responsible for blindness in advanced HIV infections? A. Cytomegalovirus B. Epstein-Barr virus C. Fungus D. Toxoplasma