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159 Cards in this Set
- Front
- Back
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How are Measles spread?
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by droplet contact
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What are the prodromal symptoms for Measles?
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fever, conjunctivitis, coryza, cough
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What is the pathognomonic for Measles?
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Koplic Spots
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What are Koplik Spots?
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salt deposits crystalized on the oral mucosa
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Where does the rash in Measles start and then spread?
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starts on face, and then to the trunk and extremities
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When does the characteristic red blotchy rash appear in measles?
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3-7th day
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How long does the generalized rash in measles last?
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4-7 days and sometimes becomes desquamated
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In developed countries, what populations get Measles?
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unimmunized and very young infants
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Why would immunized kids get Measles?
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they may fail to sero-convert
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What deficiency puts people at greatest risk for Measles?
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Vitamin A Deficiency
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Complications of Measles
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otitis media, pneumonia, croup, diarrhea, encephalitis
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What populations is Measles more severe in?
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adults and infants (more mild in children)
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What is the prognosis for Measles?
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mainly <5 y/o primarily from pneumonia and encephalitis; more severe in very young and malnourished
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How is diagnosis of Measles made?
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on clinical or epidemiological grounds
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What confirms the diagnosis for Measles?
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detection of measles specific IgM
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When is Measles communicable?
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just before prodromal period and until 4 days after the appearance of the rash
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Who is susceptible for Measles?
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not immunized, w/o history of prior disease
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Who is resistant to MEasles?
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those with acquired immunity after illness, maternal antibody, and those immunized at 15 mths
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How do you prevent Measles?
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immunization (given to all born after 1957)
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Who is given the immune globulin for Measles?
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people who have not been immunized can receive it 72 hrs after exposure, but within 6 days of exposure
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Rubella is described as a mild _____ viral disease.
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Febrile
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What illnesses can Rubella resemble?
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Scarlet fever, Coxsackie virus, and Mono Rash
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Describe the rash in Rubella
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diffuse punctate, maculo-papular rash
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What are the S/S of Rubella in kids?
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few or no constitutional symptoms
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How long can the prodromal period be for adults with Rubella?
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1-5 days
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What are the prodromal symptoms in adult with Rubella?
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low grade fever, mild coryza, HA, conjunctivitis, malaise
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Where is the lymphadenopathy in Rubella found?
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postauricular, occipital, and post cervical
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What is the most characteristic clinical feature in Rubella?
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lymphadenopathy
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How many days before the rash will patient get lymphadenopathy with Rubella?
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5-10 days
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What is the pathognomonic for Rubella?
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Forscheimer Spots
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Complications of Rubella
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arthralgia and less commonly arthritis esp. in young females, encephalitis rarely in kids and more in adults
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What will the labs in Rubella show?
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leukopenia and thrombocytopenia
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Why is identification of Rubella so imperative?
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b/c of risk of fetal abnormalities
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What does Rubella infection early in pregnancy cause?
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Congenital Rubella Syndrome
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What time of pregnancy carries the highest risk for CRS?
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the first 16 weeks
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What can early fetal infection with Rubella cause?
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early intrauterine death, spontaneous abortion, congenital malformation to incl. deafness, cataracts, microphthlamia, and glaucoma
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When are severe or moderate cases of CRS recognized?
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generally at birth
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Besides eyes and ears, what other congenital symptoms are seen in CRS?
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microcephaly, mental retardation, hepatosplenomegaly, bone disease, meningo-encephalitis, varied cardiac anomalies, icterus
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When are milder cases of CRS recognized?
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unrecognized for months to years
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What is a frequent late manifestation of CRS?
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Type 1 Diabetes
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What lab result indicates a recent Rubella infection?
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presence of rubella specific IgM on ELISA
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How is Rubella confirmed?
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4 fold rise in specific antibody titer, acute and conv serum
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When is the convalescent titer in Rubella collected?
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ideally 2-3 weeks
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How is Rubella confirmed in newborns?
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in CSF- single, specific IgM antibody
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Where is Rubella found worldwide?
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endemic worldwide in unimmunized populations
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What seasons is Rubella usually found?
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winter and spring
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Do adults or children get Rubella more?
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children
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How is Rubella transmitted?
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infected nasopharyngeal secretions, infants with CRs that shed large quantities and pass it in urine and secretion
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What is the communicable period for Rubella?
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from 1 week before onset to at least 4 days after onset of rash (highly communicable)
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What creates permanent active immunity in Rubella?
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active infection or immunization
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How do you prevent Rubella?
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immunization exp. pre-sexual and postpartum women
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Can you give the Rubella vaccine to pregnant women?
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No
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Infection with CMV is very common, but _____________ disease is rare.
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symptomatic
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In what population does the most severe form of CMV infect?
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infants infected in the perinatal period following and intrauterine infection
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Infants with CMV exhibit generalized infections involving what two systems/organs?
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liver and CNS
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S/S of CMV in infants
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lethargy, convulsions, icterus, petechiae, purpura, hepatosplenomegaly, chorioretinitis, intracerebral calcifications, and pulmonary infiltrates
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What can survivors of CMV exhibit?
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mental retardation, microcephaly, motor disabilities, hearing loss, and evidence of chronic liver disease
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Besides newborns, what other patients may get CMV more easily?
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immunocompetent (HIV), disseminated infection with pneumonia, retinitis, GI tract disorders, hepatitis, post transplant infection
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What is the most common cause of CMV
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post transplant infection
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How is diagnosis of CMV made in newborns?
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by isolating virus from urine
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What is the mode for diagnosing CMV in adults?
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virus isolation, CMV antigen detection, CMV DNA detection (more difficult than in infants)
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What geographic location does CMV occur in?
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seen worldwide
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Mode of transmission for CMV
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excreted in urine, saliva, breast milk, semen, and cervical secretions; mucosal contact with infected tissues, intimate exposure
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In asymptomatic people, what can be the mode of transmission for CMV?
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viremia
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Reservoir for CMV
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humans only known reservoir
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For how long is CMV communicable?
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excreted for months and may persist for several years following the primary infection; longer after neonatal infection
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_________ secrete the CMV virus for shorter periods than infants.
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adults
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Who is most susceptible to CMV?
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universally susceptible, but the disease is more serious in immunocompromised
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Prevention of CMV
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proper hygiene and sanitation
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What is the prophylaxis used for organ transplants to prevent CMV?
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Ganciclovir
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Besides Ganciclovir, what other drug has been used in CMV?
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Foscarnet
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What is the salivary gland that usually swells with mumps?
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usually the parotid, but sometimes the sublingual and submaxillary
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S/S of mumps
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orchitis, oophoritis, encephalitis, pancreatitis, permanent nerve deafness, neurologic involvement
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Neurologic involvement and orchitis may occur without ________________ involvement.
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salivary gland
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Pancreatitis in Mumps may have a association with what?
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diabetes
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How often dies Mumps cause sterility?
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it is uncommon
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Is orchitis with mumps usually unilateral or bilateral?
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unilateral
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When is spontaneous abortion likely with mumps?
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during the 1st trimester
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Does Mumps cause congenital defects?
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no evidence to suggest that it does
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How is diagnosis of Mumps made?
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virus isolation or serology- ELISA IgM; skin tests unreliable
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What percentage of those exposed to mumps will have a subacute infection?
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30%
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What group generally gets subacute infections of Mumps
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those under 2
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What seasons do people get Mumps in?
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winter and spring
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Modes of Transmission of Mumps
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droplet spread, direct contact with saliva
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When does Mumps become communicable?
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6-7 days before overt parotitis
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How long does the CDC say to isolate mumps for?
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for 5 days after onset
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When is Mumps the most infectious?
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48 hrs before onset of illness
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How long will the urine be positive for Mumps?
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for as long as 14 days after the illness
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Who has immunity to Mumps?
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those who have had vaccine or subacute/clinical disease
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How do you prevent Mumps?
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virus vaccine (95% effective)
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What symptoms characterize mononucleosis?
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fever, sore throat, cervical lymphadenopathy, and splenomegaly
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S/S of mono
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fever that persist for 7-10 days, chills, malaise, fatigue, myalgia, severe sore throat, prolonged recovery; jaundice with normal LFTs, splenomegaly 1 to several weeks
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Duration of recovery in Mono
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several weeks to months
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What group is Mono milder and harder to recognize?
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young kids
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How long can splenomegaly last in Mono?
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one to several weeks
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Will LFTs be normal or abnormal in Mono?
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normal even with jaundice
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What group tends to have more severe Mono?
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elderly
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Mono is a causative agent in what conditions?
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several lymphoma, nasopharyngeal cancers, and some gastric cancers
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What will labs show in Mono?
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lymphocytosis greater than 50%, abnormal AST
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What is used for diagnosis of mono?
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Monospot test
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What is the infectious agent in Mononucleosis?
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EBV; human gamma herpesvirus 4
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What percentage of those infected with Mono will be asymptomatic?
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50%
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Reservoir for Mono
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humans are only known
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How is Mono transmitted?
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by oropharyngeal route
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Nickname for Mono
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The Kissing Disease
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Incubation period for Mono
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4-6 weeks on average
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Communicability of Mono
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prolonged for year or more after infection by pharyngeal virus excretion
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A person with Mono infection does not have immunity, but rather a high degree of what?
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resistance
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PRevention and Tx of Mono
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hygienic measures and adequate rest
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What antibiotic can you not use in Mono?
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Ampicillin
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How is acute poliomyelitis most often recognized?
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acute onset of flaccid paralysis
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S/S of acute polio
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infection in GI tract that spreads to regional nodes and rarely to the nervous system
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What percentage of polio infections are subacute ?
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90%
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OIn the minority of polio cases with nervous system involvement what occurs?
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flaccid paralysis
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Most commonly these symptoms are seen when polio presents as a minor illness
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fever, malaise, HA, N/V
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What are the S/S of acute polio that s major case?
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severe muscle pain, neck/back stiffness with or without flaccid paralysis
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Describe the paralysis of polio
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normally asymmetric, fever present at onset, acute flaccid paralysis without sensory loss
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What are the three categories of polio?
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abortive polio, non paralytic polio, paralytic
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How does abortive poliomyelitis present?
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mild illness
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How does non-paralytic poliomyelitis present?
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meningeal irritation and muscle spasm
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What is the most affected body part with paralytic polio?
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legs more than arms
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When does paralysis in polio become life threatening?
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when respiratory or swallowing muscles are affected
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Difference between Guillan Barre syndrome and Polio
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GB usually symmetric will have high protein low cells counts in the CSF, and fever, HA, and N/V are absent
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What makes a presumptive diagnosis of acute polio?
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fourfold or greater rise in antibody levels
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In what fluids do you isolate the polio virus?
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stool, CSF, oral pharyngeal secretions
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Is polio more prevalent in adults or kids?
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in infants and children
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Mode of transmission for polio
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primarily person to person--> oral fecal route and pharyngeal spread
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When is communicable period of Polio?
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not well defined-- possibly as long as virus is excreted
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who is immune to polio?
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those receiving vaccine and following an infection immunity is lifelong
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What is OPV?
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live trivalent vaccine
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What is IPV?
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inactivated vaccine (has higher levels of GI excretion)
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Described as acute generalized viral disease with sudden onset low grade fever, mild constitutional symptoms, and skin eruptions that quickly evolve.
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chicken pox
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Describe the progression of the skin eruptions in varicella.
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start as maculo-papular for a few hours, then vesicular for 3-4 days, followed by granular scabs
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Do the monocular vesicles in chickenpox collapse when punctured?
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yes
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Varicella lesions generally occur in what?
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crops
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Are chickenpox synchronous or asynchronous?
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asynchronous
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Where are chickenpox more abundant on the body?
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on covered skin surfaces and in diaper area and axilla
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Besides the diaper area and axilla, what are other locations of lesions in varicella that are common?
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scalp, high in the axial, mucous membrane of the mouth, upper resp tract, and conjunctiva
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Severe fever and constitutional symptoms occur with chickenpox in what age group more typically?
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adults--> can be fatal esp. if involving upper resp system
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What is usually cause of death in chickenpox in adults?
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viral pneumonia
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What is usually cause of death of children with chickenpox?
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septic complications or encephalitis
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What can infection in early pregnancy with chickenpox cause>
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congenital malformations in 2%
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This condition is described as localized reactivation of latent varicella that was hiding in the dorsal root ganglion
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Herpes Zoster or Shingles
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Describe the vesicles in Shingles
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vesicles over an erythematous base restricted to a single dermatome
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The lesions in Shingles will appear as _______crops, deeper seated, and more closely _________ than in varicella.
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irregular; aggregated
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Common complication of Shingles
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severe pain and paraesthesia known as post-herpetic neuralgia
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The incidence of Shingles increases with what?
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age
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In what population would you see an atypical presentation of Herpes Zoster outside of dermatome?
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immunocompromised esp. HIV/AIDS
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Varicella infection while intrauterine or under age 2 is associated with what?
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zoster at a younger age
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How is diagnosis of chickenpox and Zoster made?
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viral DNA by PCR, visualization by EM, viral antigen in smears using FA, or viral isolation in cell culture
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What is the infectious agent in Varicella and Herpes Zoster?
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human alpha herpesvirus 3
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What seasons are Zoster and chickenpox more common in?
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Winter and early spring
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Mode of transmission for Zoster and chickenpox
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person to person by direct contact; droplet or airborne spread of vesicle fluid, respiratory secretion
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During what period is Herpes Zoster and chickenpox communicable
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1-2 days before onset of rash and 5 days after the first crops of vesicles
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Are the scabbed over lesion sin chickenpox and Varicella considered infectious?
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no
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Who is susceptible to Varicella and Zoster?
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anyone not previously infected
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What does infection with Zoster or Varicella concur?
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lifelong immunity
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Prevention of Varicella and Herpes Zoster
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for high risk individuals, consider VZIG within 92 hours, Virus vaccination
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Tx for Herpes Zoster
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Acyclovir
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