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48 Cards in this Set

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What is an exanthem?
eruptive disease or fever
What is an enanthem?
eruption upon a mucous membrane
What are the childhood exanthems?
Measles, rubella, roseola, varicella, Fifth disease

*mumps has no exanthem
What are some other viral agents of exanthems?
HHV-6 (roseola)
enteroviruses (echo and coxsackie)
adenovirus
EBV
Dengue virus
Other hemorrhagic fever viruses
Measles and mumps are part of which virus family?
Paramyxoviridae

*Also includes parainfluenza and RSV
What is the morphology for mumps and measles viruses?
Paramyxo

negative ssRNA

Enveloped (all neg are env!)
Cell mem has key glycoproteins
What glycoprotiens are present in the envelope for mumps?
Hemagglutinin
Neuraminidase
Fusion protein
How is mumps transmitted?
Saliva/oral secretions
-communicable 7 days prior to illnes and 9 days after it develops
-highest frequency in ages 5-15
-peak season late winter-spring
How does mumps virus spread in the body?
Entry into respiratory tract where it has local replication
Viremia cause spread to target tissues
(salivary, CNS, kidneys, etc)
Where is mumps virus commonly found?
commonly found in urine

--> Viruria
What are the clinical manifestations of mumps?
fever
swelling of salivary glands (Esp. parotid)
earache or facial pain

Intraoral may reveal erythema or edema of Stensen's duct

Can be asymptomatic in up to 1/3
How is diagnosis of mumps made?
Clinical presentation and epidem

Lemon juice causes in increase in salivation and pain (does not occur with adenopathy)
What is treatment for mumps?
No specific treatment.

Live attenuated vaccine (MMR)
What are the glycoproteins in the measles virus envelope?
Hemaggluitinin
Fusion protein

(NO Neuraminidase!)
How is measles spread?
Transmision via saliva/oral secreations to respiratory tract or conjunctiva
When do measles epidemics occur?
Usually in winter-spring

Often in 1-3 year cycles
What is the pathogenesis in measles virus infection?
Entry into respiratory tract and replicated in resp epithelium
Spreads via blood & lymph to multiple sites including skin
In viremia, infects WBC
What are the clinical manifestations of measles?
1. initial = CCCF
2. enanthem 1-3 days later = Koplik spots (esp on buccal mucosa)
3. exanthem = maculopapular appears first at hairline, centrifugal spread to palms and soles
What are some complications from measles infection?
otitis media
pneumonia
bacterial superinfection
encephalitis

RARE = SSPE - rare progressive neuro disease begins 2-10 years p.i.
How is diagnosis of measles made?
Clinical presentation and epidem

Lab: viral culture, IF, serology
--> Warthin-Finkeldy cells = replicate in keratinocytes
What is treatment for measles?
Supportive

Vaccine = live attenuated (MMR)

Can also give ribavirin or vit A
What is the problem with immunization for measles?
15% of immunized fail to respond

35% are never immunized
What virus family is Roseola part of?
Herpes virus family

HHV-6
What is the morphology of HHV-6?
Large, enveloped - dsDNA - linear
When is HHV-6 most common?
Late fall and early spring
Who has been infected with HHV-6?
Nearly 100% of adult are sero+
**Most communicable herpesvirus

-->reactivation seen with immunocomp
What are the clinical manifestations of HHV-6?
1. Several days of high fever
2. Resolution of fever is onset of exanthem: irregular macules spread from trunk to face (lasts 2-48h)
3. Complications: febrile seizures
What is diagnosis for HHV-6?
Clinical presentation

Lab = serology, PCR
What is treatment for roseola?
No treatment

NO VACCINE
What is the STAR complex?
Sore Throat - Arthritis - Rash
Give examples of viruses that exhibit the STAR complex.
Rubella
5th disease (Parvo 19)
Hep B
Adenovirus
Echo and Cocksackie
EBV
What is Fifth disease?
5th exanthem found historically

Parvovirus 19

Also called "slap-cheek disease"
What is the morphology for parvovirus 19?
icosahedral capsid
ssDNA
naked
How is parvo 19 transmitted?
Probably respiratory route

30-60& of adults are sero+
What is the primary replication site for parvo 19?
Nucleus of immature erythrocyte in blood marrow
After replication = viremia

--> can cause problem in pregnant women
What are the clinical manifestations of 5th disease?
Mild illness: fever, headache, malaise
- may also have decrease in WBC adn RBC
- arthralgias/arthritis may develop
Confluent indurated rash on face
- lacy pink-red exanthem
What is Gloves and Socks Syndrome?
Papular-purpuric rash on palm of hands
- Differs from slapped cheek because immune responses against parvo 19 appear after onset of skin eruption
What are some complications seen with 5th disease?
Infection of fetus --> hydrops fetalis
Hemoglobinopathy --> anemia
Immunocomp --> persitent infection with persistent anemia
*implicated in Kawasaki disease
How do you diagnose 5th disease?
Clinical presentation

Confirm with serology, PCR
What is treatment for 5th disease?
No antiviral treatment
NO VACCINE
What is Rubella morphology?
Togavirus family

+ ssRNA - enveloped
How is rubella transmitted?
Oral secretions

*Highest frequency in school-aged children in unimmunized pop
Who is the major concern for rubella infection?
Fetus in pregnant women --> congenital infection
What is the pathogenesis in rubella infection?
Entry into respiratory tract, local replication with subsequent viremia
What are the clinical manifestations of rubella?
1 - Mild illnes = low grade fever, UR symptoms, lymphadenopathy
2 - Exanthem = maculopapular rash that (like measles) begins on face
3 - Enanthem = Forscheimer spots
What are the major complications in rubella infection?
Most common = arthralgia/arthritis in women
Major complication results from spread of virus to pregnant women and to their fetus
--> blue-berry muffin baby
How is rubella diagnosed?
Clinical presentation can be confused with other pathogens = need lab confirmation

Lab = viral culture, serology
What is treatment for rubella?
No specific treatment

Live attenuated vaccine ((MMR) -- essentially developed to prevent fetal infection