M2-C3-L89 --> Congenital Infections

Front 1

What are three ways damage can occur for congenital diseases?

Back 1

1. Cytopathic effect (CPE)
- direct infection of cells interfere with normal development (e.g. - Rubella)

2. Inflammatory reaction
(e.g.-CMV, toxoplasmosis)

3. Placental infection resulting in placental insufficiencies.

Front 2

What does TORCHS stand for?

Back 2

Toxoplasmosis gondii

Other (HIV, HepB, VZV, entero..)

Rubella virus

CMV

Herpes Simplex virus

Syphillis (Treponema pallidum)

Front 3

CMV:

- family
- major cause of?
- symptoms? x2

Back 3

Herpesviridae

Congenital defects

90% asymptomatic at birth,
but 20% develop signs later

10% of infected newborns have CMV-related symptoms at birth
(4000/yr)

Front 4

CMV -> Common defects x8

Back 4

Jaundice
Mental Retardation
Deafness
Microencephaly
Anemia
Thrombocytopenia
Chorio-retinitis
Hepatosplenomegaly

Front 5

CMV:

- Diagnose x2

Back 5

PCR

Grow virus in cell culture
(combined with immunofluorescence for early antigens in 2 days)
(4-6 weeks for CPE to develop)

Front 6

HSV:

- Usually what type for congenital infections?

- prevalence for congenital infection?

- prevalence for natal/neonatal infection

- Transmission?

Back 6

HSV-2

1 in 200,000

>1 in 5,000

Transplacental or ascending

Front 7

Congenital diseases associated with HSV-2. x4

Back 7

Undeveloped cellular immune response

Skin, eye, mouth infection

Encephalitis
(50% dies)

Disseminated infection
(multi-organ disease)
(80% have vesicular rash)
(80% die if untreated)

Front 8

HSV-2:

- Diagnosis x3

Back 8

Detect DNA in TISSUE sample
(PCR, Hybridization)

Isolate virus

Detect viral antigen
(immunofluorescence, immnuohistochemistry)

Front 9

HIV:

- transmission x2
- type of infection?
- symptoms x3

Back 9

In utero
Mother milk

Chronic

Encephalopathy
Lymphadenopathy
Failure to thrive

Front 10

What are the outcomes to Parvovirus B19? x5

Back 10

Erythema infectiosum - fifth's dz
(RASH - slapped cheek appearance)

Arthropathy
(in females, hands and wrists)

Aplastic crisis
(due to block in erythropoiesis)

Fetal loss
(due to infection of pregnant women)

No birth defects

Front 11

Parvovirus B19:

- transmission:

Back 11

Respiratory

Front 12

Parvovirus B19:

- how does it spread?
- starting from when?
- spread in what?

Back 12

Viremia

Day 7

Erythroid precursors

Front 13

Parvovirus B19:

- What happens 2wks post infection in children?

- What happens 2wks post infection in women?

- What happens to mothers that become infected?

Back 13

Rash to face, then to trunk, then to limbs

Arthropathy to hands / wrists

In 4-6 weeks, fetal loss (fetal hydrops), with no defects.

Front 14

Toxoplasmosis:

- organism name?
- organism type?
- host?
- symptoms?

Back 14

Toxoplasma gondii

Obligate intracellular sporozoan

CAT

Asymptomatic in immunocompetent patients.

Front 15

Toxoplasmosis:

- transmission x3

Back 15

Oocysts via CAT fecal/oral

Cysts via poorly cooked meat

Asexual tachyzoite in congenital from acutely infected mother.

Front 16

How can you reduce the congenital infection of toxoplasmosis by 60%?

Back 16

Treat mother

Front 17

What would you see clinically in severe cases of Toxoplasmosis gondii? x5

Back 17

Hydorcephaly
Encephalitis

Pneumonitis
Psychomotor retardation

Chorioretinitis

Front 18

Lab Dx for toxoplasmosis gondii. x4

Back 18

PCR
IgM
EIA - 4x rise in IgG
Wright or Giemsa stain lymph tissue shows trophozoite

Front 19

Toxoplasmosis treatment? x2

Back 19

Pyrimethamine + Sulfadiazine

Front 20

Herpes and VSV have what common rash associated with them?

What families do they belong to?

Back 20

Vesicular Exanthema

Both Alphaherpesvirinae

Front 21

Acantholysis:

- define:
- caused by:

Back 21

Disruption of
intracellular j(x)
btw
epidermal keratinocytes

Lysis of cellular cement substance, leading to degeneration.

Front 22

T/F - You can notice acantholysis in Mid stage of HSV-1 only.

Back 22

False. You can see acantholysis in mid and full stage of HSV-1.

Front 23

What is the general manifestion of HSV skin infections called?

- in patients with associated condition?

- describe lesions

Back 23

Eczema herpeticum

with underlying atopic dermatitis

can be localized or disseminated.

Front 24

What is herpetic whitlow?

- responsible virus?
- symptoms x3
- location
- duration with symptoms
- prognosis?

Back 24

HSV infection of the digits

HIV-1 (sometime HIV-2)

Pain, itching, then deep vesicle

Usually at terminus of 1 digit

10 day process with constant pain

After 10 days, lesion dries up, pain subsides.

Front 25

VZV vesicular exanthems

- type/progression of lesions

- Herpes zoster distribution is mostly where?

Back 25

Umbilicated, eliptical early lesion

Mulitiple stages or "crops" of lesions appear simultaneously

Thoracic distribution

Front 26

Genital HSV infections display what type of skin lesion?

Back 26

Ulcers

Front 27

HSV-2 infections usually occur after what major life event?

Back 27

Sexual maturity

Front 28

HSV-2:

- probability of transmission with # of sexual partner
- # of cases per year
- What is the significant source of transmission?
- When does the virus shed?
- What is the largest reservoir of HSV-2?

Back 28

1P -> 10%
2-10P -> 40%
>10P -> 62%

40-60M

Asymptomatic shedding

During primary & recurrent infections, with or without symptoms

Recurrent genital infections

Front 29

Bulla(e) is associated with:

- what disease
- what virus
- lesions initially where
- lesion progression?
- associated symptoms x2
- prognosis

Back 29

Hand-foot-mouth disease

Coxsackievirus A16

In the mouth

In one day, will move to hand palms and foot soles.

Painful lesions
Mildly febrile

Subsides in a few days.

Front 30

Petechia(e) is what kind of lesion?

- Name three viruses that cause this.

Back 30

Hemorrhagic lesion

Rickettsia Rickettsii
(Rocky Mountain spotted fever)

Ebola virus

Dengue virus

Front 31

During Meningococcal sepsis, what skin lesions would you expect to see?

Back 31

Ecchymoses

Front 32

Poxviridae is associated with what type of skin lesion?

Back 32

Nodules

Front 33

Poxviridae:

- List two skin lesion diseases
- Compare the two in terms of symptoms, durations, and prognosis

Back 33

PSEUDOCOWPOX (Milker's nodule)

Papular lesions on hand & fingers
Increase in size over 1-2 weeks
Painless with NO vesiculation
Heals without scars

MOLLUSCUM CONTAGIOSUM

Painless, but may be itchy
Appears alone or in groups,
anywhere on body
Regress within 6 to 12 months