Habif Ch 14 Viral Exanthems

Front 1

Virus associated with Hand Foot and Mouth Disease

Back 1

Coxsackievirus A16 & Enterovirus 71

Front 2

Name for endemic, contagious disease produced by streptococcal, erythrogenic toxin?

Back 2

Scarlet Fever

Front 3

Another name for rubella?

Back 3

german measles, 3-day measles

Front 4

what trimester is more likely to have congenital rubella syndrome?

Back 4

first trimester

Front 5

Most common anomalies associated with congenital rubella syndrome?

Back 5

auditory -- sensorineural deafness
ophthalmic - cataracts, micro-ophthalmia, glaucoma, chorioretinitis
cardiac -- PDA, peripheral pulm art stenosis, ASD or VSD
neurologic -- microcephaly, meningoencephalitis, mental retardation
also, intrauterine and postnatal growth retardation

Front 6

How long after MMR should you wait to get pregnant?

Back 6

at least 2 months

Front 7

How do you distinguish a recent infection from a pre-existing rubella infection?

Back 7

Measurement of IgG avidity (avidity-ELISA). low is recent, high avidity usu pre-existing

Front 8

Which complication of rubella is more common in adults? children?

Back 8

adults 1:6000 get encephalitis/cns
children 1:3000 get thrombocytopenia

Front 9

Main target of Parovirus B19?

Back 9

red cell receptor globoside (blood group P antigen) of erythroid progenitor cells of the bone marrow

Front 10

B19 causes what diseases?

Back 10

- erythema infectiosum (immunocompetent)
- transient aplastic crisis in people with hemolytic disorders
- red cell aplasia and chronic anemia in immunosuppressed people
- in utero causes hydrops fetalis or congenital anemia

Front 11

Three stages of B19?

Back 11

Facial erythema ("slapped cheek") which spares nasolabial folds and circumoral region, Net pattern erythema, Recurrent phase (can be for 2-3 wks)

Front 12

What is papular-purpuric "gloves and socks" syndrome?

Back 12

seen in b19 infection; fever, pruritic edema followed by pain and petchial involvement of hands and feet with sharp demarcation at the wrists and ankles, and enanthem of petechiae and oral erosions

Front 13

Who is more susceptible to Polyarthropathy Syndrome and Pruritus?

Back 13

Women -- severe, symmetric polyarthritis which is similar to RA, may be migratory, RF factor can be positive. Can also mimic lupus clinically and serologically.

Front 14

How do you diagnose the Polyarthropathy is from B19?

Back 14

anti-parvovirus B19 IgM and IgG is diagnostic. IgM disappears in first few months, so test early. In general, IgM is most sensitive indicator of B19 disease -- appears 10-14 days after infection, and disappears up to 3 months later. IgG persists.

Front 15

What pattern of arthropathy is seen in children?

Back 15

equal male and female; two patterns: polyarticular (>5 joints) and pauciarticular (affecting 4 or fewer joints). knee is most common (82%), labs are normal, usu lasts <4 months

Front 16

what is fetal hydrops?

Back 16

severe anemia, CHF, & generalized edema in unborn fetus

Front 17

Eponyms for Roseola infantum

Back 17

exanthem subitum, "sudden rash," sixth disease, 3-day fever, rose rash of infants

Front 18

Percentage of population over age two with HHV6 Abs?

Back 18

over 90%, common cause of fever in infants.

Front 19

When does the rash of Roseola appear?

Back 19

rash begins as fever subsides

Front 20

Another name for Kawasaki Syndrome

Back 20

Mucocutaneous Lymph Node Syndrome

Front 21

What are the Diagnostic Features of Kawasaki's disease?

Back 21

"CRASH & BURN"
Fever >5days plus four of the following:
Bilateral conjunctivitis
Mucous membrane changes (Red fissured lips, red pharynx, strawberry tongue)
LE changes (Erythema of palms or soles, Edema of hands and feet, Desquamation)
Rash (erythematous exanthema)
Cervical Lymphadenopathy (1+ node greater than 1.5cm)

Front 22

Is there a sore throat with Kawasaki's?

Back 22

No

Front 23

Name two disease with 'strawberry tongue'

Back 23

Kawasaki's, Scarlet Fever

Front 24

First Disease?

Back 24

Measles

Front 25

Second Disease?

Back 25

Scarlet Fever

Front 26

Third Disease

Back 26

Rubella

Front 27

Fourth Disease

Back 27

Dukes' disease (probably coxsackievirus or echovirus)

Front 28

Fifth Disease

Back 28

Erythema Infectiousum

Front 29

Sixth Disease

Back 29

Roseola infantum

Front 30

What are some other clinical features of Kawasaki's besides the major diagnostic factors?

Back 30

Abdominal: hydrops of the bladder
Urethritis: sterile pyuria
Arthritis: polyarticular arthritis or arthralgia
Aseptic meningitis

Front 31

What infection is a major cause of acquired heart disease?

Back 31

Kawasaki's
Leading cause of morbidity & mortality for this disease
seen in 25% of untreated children

Front 32

Risk Factors for developing cardiac aneurysms in Kawasaki's?

Back 32

Fever for more than 10 days, recurrence of fever after 48 hour afebrile period, arrhythmias other than first degree heart block, male gender, less than 1 year old, cardiomegaly, and low platelet count/Hct/albumin at presentation, delayed treatment

Front 33

What lab is distinctive for Kawasaki's?

Back 33

Thrombocytosis

Front 34

Treatment of Kawasaki's?

Back 34

Acute Stage:
IVGG 2g/kg over 10-12 hours
ASA 80 to 100mg/kg/day every 6 hours
Chronic: Repeat Echo, CBC, ESR at 2-3 weeks and again at 6-8 weeks
Discontinue ASA if normal at 6-8 weeks, may have to continue low dose 3 to 5 mg/kg/day single dose indefinitely if aneurysm formation is seen.

Front 35

Name some pyrogenic toxin superantigens

Back 35

toxic shock syndrome toxin-1, exfoliating toxin, staphylocccal enterotoxins A through E, and streptococcal pyrogenic exotoxins A through C, and streptococcal M protein

Front 36

What are superantigens?

Back 36

proteins with special structure made by bacteria or viruses that are NOT PROCESSED by the antigen presenting cells, and instead bind directly to the MHCII causing nonspecific stimulation of T-cells

Front 37

Superantigens activate what % of T-cell population?

Back 37

5-30% (versus 0.01% conventional antigens)

Front 38

Superantigen Massive cytokine production includes what cytokines?

Back 38

TNFa, IL-1, IL6

Front 39

Causes of TSS?

Back 39

Mainly TSST-1 & enterotoxin B & C (TNFa & IL-1)

Front 40

Causes of STSS?

Back 40

Erythrogenic toxins (aka pyrogenic exotoxins) A, B, and C produced by group A B-hemolytic streptococci (S. pyogenes)

Front 41

How are TSS and STSS different?

Back 41

STSS has focus of infection in skin and many patients have bacteremia

Front 42

CDC Definition of TSS?

Back 42

1. Fever >102
2. Rash
3. Desquamation (1-2 weeks after illness)
4. Hypotension
Plus 3 or more of the following systems involved:
GI, Musculoskeletal, Renal, Hepatic, Hematologic (platelets<100,000), CNS

Laboratory criteria: negative blood, throat, and CSF cultures; negative titers for Rocky mtn spotted fever, leptospirosis, or measles

Front 43

CDC Definition of STSS

Back 43

Similar to TSS except isolation of group A strep is found

Front 44

Derm findings of TSS

Back 44

Erythroderma, desquamation (palms, soles, tips of fingers and toes w/o scarring), edema (hands and feet), petechiae (extremities), conjunctival injection, oropharyngeal hyperemia, vaginal hyperemia, loss of hair and nails (appx 2 months after onset)

Front 45

Treatment of TSS

Back 45

Supportive
Anti-Staph PCN or 1st generation cephalosporin (or Vancomycin or Erythromycin)
For STSS, PCN + Clindamycin (erythromycin or ceftriaxone for Pen allergic)
IVIG 2gm/kg for 2 days decreases mortality

Front 46

What test can help verify an anaphylactic event due to allergen or drug?

Back 46

Serum Tryptase -- biochemical marker of mast-cell granule release. Excreted exclusively by mast cells.

Front 47

Ampicillin rash associated with what infection?

Back 47

50-80% of patients with mono who take ampicillin get this

Front 48

Describe Amoxicilin Rash

Back 48

starts on trunk, is pruritic, maculopapular. spares palms, soles, and mucous membranes.

Front 49

Common drugs that cause morbiliform eruptions

Back 49

Ampicillin, Amoxicillin, allopurinol, and TMP-SMX (in AIDS pts)

Front 50

Most common cause of Urticarial drug reaction?

Back 50

ASA, PCN, and blood products

Front 51

Radiocontrast Media Reaction Rate?

Back 51

4-12%; If previous reaction, 20-30% with re-exposure. Can prophylax with Doxepin.

Front 52

Name different mediators of itching

Back 52

Histamine, Kinins, Leukotrienes, prostaglandins, serotonin

Front 53

What is AGEP?

Back 53

Acute Generalized Exanthematous Pustulosis = nonfollicular sterile pustules on an erythematous background in folds and/or face, elevated blood neutrophils,

Front 54

Most common causes of AGEP?

Back 54

calcium channel blockers, NSAIDS, anticonvulsants, antimicrobials (macrolides and beta lactams)

Front 55

Baboon Syndrome

Back 55

Distinctive form of systemic contact dermatitis with symmetric erythema in flexural areas including the elbows, axilla, eyelids, and sides of the neck accompanied by bright red anogenital lesions

Front 56

Most common site of fixed drug eruptions?

Back 56

Glans of penis

Front 57

Is there a refractory period with fixed drug reactions?

Back 57

Yes -- can be weeks to months

Front 58

Most common cause of Lichenoid Drug Eruption?

Back 58

Gold & Antimalarials; mean age it 60 years (vs. 50 yrs old for lichen planus)

Front 59

Most common cause of Lupus like drug eruption?

Back 59

Procainamide & Hydralazine

Front 60

Is LE-like drug eruptions dose dependent?

Back 60

Yes

Front 61

Describe common phenotype of people who have LE-like drug eruptions

Back 61

Slow acetylation phenotype

Front 62

Other risks factors for LE-like drug eruptions

Back 62

Female (4:1), HLA-DRW4, slow acetylator, hydralazine (greater than 200mg/day)

Front 63

Most common cause of chemotherapy induced Acral Erythema?

Back 63

Cytosine arabinoside, fluorouracil, doxorubicin

Front 64

What is Anticonvulsant hypersensitivity syndrome?

Back 64

Spectrum of: fever, rash, LAD, and hepatitis, leukocytosis and eosinophilia. Outcome depends on amount of hepatic injury

Front 65

Most common causes of anticonvulsant hypersensitivity syndrome?

Back 65

phenytoin (19% of pts), phenobarbital, and carbamazepine

Front 66

Where does a measles rash begin?

Back 66

Behind the ears and neck

Front 67

Where does scarlet fever rash begin?

Back 67

neck, chest, axilla

Front 68

What type of virus is rubeola?

Back 68

paramyxovirus

Front 69

type of virus is rubella?

Back 69

Togaviridae, RNA virus

Front 70

#1 cause of serum sickness

Back 70

Cefaclor