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Review Question - QID 106726

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QID 106726 (Type "106726" in App Search)
A 35-year-old HIV+ man presents to the ophthalmologist complaining of worsening vision for the past two weeks, and seeing new flashes and floaters in his right eye. He reports no pain in his right eye nor is there any redness. On ophthalmoscopic exam, the following is observed (Figure A). Which of the following best describes the virus responsible for these findings?
  • A

Linear (+)ssRNA, nonenveloped

6%

33/511

Linear (-)ssRNA, segmented, enveloped

7%

35/511

Partial circular, dsDNA virus, enveloped

7%

36/511

Linear dsDNA, enveloped

72%

366/511

Circular dsDNA, nonenveloped

5%

28/511

  • A

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This HIV+ male is experiencing CMV retinitis caused by the cytomegalovirus (CMV) which is a linear, dsDNA enveloped virus.

CMV, or human herpes virus type 5, is a linear, dsDNA, enveloped virus that is transmitted via the following routes: congenital, blood transfusion, sex, saliva, urine, and transplantation. Once CMV has established its initial infection, it establishes a latent infection within mononuclear cells. CMV causes mononucleosis in immunocompentent individuals. In infants, it causes cytomegalic inclusion disease resulting in neonatal jaundice, hepatosplenomegaly, thrombocytic purpura, hearing loss, and seizures. In the immunocompromised (e.g. individuals with AIDS or transplant patients taking immunosuppressive medications), it causes retinitis and pneumonia.

Figure A demonstrates cotton-wool spots on the retina in CMV retinitis, which appear as white patches on the retina and are caused by neuronal damage. Illustration A shows the classic CMV inclusion body which is intranuclear and is surrounded by a clear halo. Illustration B is another example of a CMV inclusion body that is demonstrating the "CMV owl's eye" appearance.

Incorrect Answers:
These viruses do not cause cotton-wool spots (Figure A).
Answer 1: Rhinovirus is a linear (+)ssRNA, nonenveloped virus.
Answer 2: Influenza virus is a linear (-)ssRNA, segmented enveloped virus.
Answer 3: Hepatitis B is a partial circular, dsDNA enveloped virus.
Answer 5: JC virus is a circular dsDNA, nonenveloped virus.

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