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103 Cards in this Set

  • Front
  • Back
what are the 4 host defense mech against skin infxns?
keratinized skin: tough, water resistant, continuous sloughing of outer layers
sebaceous and sweat gland secretions: high salt, acidic
Commensal flora
Resident Mac in dermis
Necrotizing fasciitis is a syndrome of what part of the skin?
subcutaneous tissues
cellulitis is the result of what type of entry?
endogenous entry
inlfammation in cutaneous area
term for severe itching?
term for redness of skin?
what is the term for release of purulent matter (Pus)?
was is crust?
dried residue of serum, pus, or blood on the skin
what is the hallmark of cellulitis presentation?
pt has discomfort above what appears legitmate
what does cellulitis look like?
diffuse erythema
no well demarcated edges
not raised
what are the 5 most likely org for maculopapular exanthems?
strep. pyogenes
rubeola virus
rubella vrus
Parvo B19
what are the 4 most likely org for vesicular exanthems?
coxsackie A
Pox viruses
HSV 1 and 2
what are the 2 most likely org for Toxigenic Rashes?
staph. aureus
strep. pyogenes
what are the 3 most likely org for abscesses?
actinomyces isreali
pasteurella multocida
staph. aureus
what are the 3 most likely org for folliculitis?
Candida albicans
Pseudomonas aeruginosa
staph. aureus
what are the 2 most likely org for impetigo?
staph auerus
strep pyogenes
what are the 4 most likely org for pustules?
Bartonella henselae
Candida albicans
Erysypelothrix spp
what are the 2 most likely org for Necrotizing fasciitis?
Clostridium perfringens
Strep pyo
what are the 5 most likely org for ulcers?
Francisella tularensis
leishmania spp
Mycobacterium spp
Sporothrix schenckii
Vibrio vulnificus
what are the 2 most likely org for Eschars?
orf virus
Bacillus anthracis
what are the 3 most likely org for Tinea-cutaneous mycoses?
Malassezia fufur
Microsporum, Trichophyton and Epidermophytn species
what are the 2 most likely org for warts?
Molluscum contagiosum
what is the most likely org for vescicular lesions?
HSV 1 and 2
what are the 11 most likely org for eye infxns?
Acanthamoeba castelanii
Bacillus cereus
Chlamydia trachomatis
H. flu
Pseudomonas aeruginosa
Staph. aureus
Strep. pyo
T. cruzi
Toxoplasma gondii
what is a exanthem?
eruptive disease (like measles) or its symptomatic eruption
widespread rash
all exanthems are caused by viruses with what exception?
strep pyogenes-Scarlet Fever
when can you call something a bullae?
when it is vesicular rash that is larger than 0.5 cm
waht is ecchymoses?
large purpora: when small petechia coalesce
what are the childhood rash syndromes: First, Second, Third, Fifth?
first disesae: Rubeola
second disease:Scarlet fever
third disease: Rubella (german)
fifth disease:Erythema infectiosum "slapped cheek"
Rubeola is waht ? Rubella?
Rubeola: measles
Rubella: German measles
Family, Genus and Species for Rubeola
Measles virus
Family, Genus and Species for Rubella
Rubella virus
Family, Genus and Species for Erythema Infectionsum (fifth disease)
Family, Genus and Species for Roseola (exanthem subitum)
Gamma virus
Family, Genus and Species for Varicella (Chickenpox)
Herpes virus
Alpha virus
Varicella Zoster Virus
Family, Genus and Species for Hand-Foot Mouth
Coxsackie A virus
characteristics of Rubeola?
ss-sense RNA (b/c paramyxo)
replicates in cytoplasm
transmitted respiratory
highly contagous
waht is the attack rate for Rubeola?
90% attack rate
highly contagous
who is at risk for Rubeola?
children 2-5
where does Rubeola bud from?
plasma membrane
what is on the surface of Rubeola? what does it bind to?
HN glycoprotein spike that binds to CD46
F fusion spike that facilitates uptake of virus by host cells*indcues cell-cell fusion to form multinucleated giant cells
avg. incubation pd for Rubeola?
10 days
describe the clinical presentation of Rubeola?
at the end of 10 day incubation: starts with fever 101, 3 C's, and photophobia
DX signs: Koplik spots on buccal mucosa and throat
maculopapular rash which starts on face and spreads to trunk and includes**palms and soles
waht is pathognomonic for Rubeola?
Koplik spots: bluish-white to grey spots that dissapear at the onset of rash
where is the maculopapular rash of Rubeola? why does it occur?
starts on face, spreads to trunk and includes palms and soles
T cells targeting infected endothelial cells in small blood vessels
approx 4 days after the Rubeola rash appears what is the state of the infxn?
pt is no longer infectous
see appearance of serum antibodies
what are the sequale of Rubeola?
postinfectious encephalitis
subactute sclerosing panencephalitis (SSPE)
no resoln of acute infxn due to defective cell mediated immunity
the rash of Rubeola is due to waht 2 things?
viral replication
immune response :T cells targeting infected endothelial cells
what vitamin has been found to reduce the severeity of Rubeola in malnourished populations?
Vit A
when is MMR given?
12-15 months and then at 5-6yrs
if you are immunocompromised, what should you receive for Rubeola infxn?
immune serum globulin: less than 1 yr old or with impaired cellular immunity
which rash would you describe as confluent in spots?
Rubeola measles
what are the 4 Sequelae of measles?
2ndary bacterial infxns
giant cell pneumonia
subacute sclerosing panencephalitis
when does SSPE develop?
1-10 years after initial measles infxn
progressive usually fatal CNS disease
waht are the signs of SSPE?
first signs: behavioral
loss of motor control and coordination: myoclonic seizures
speech ands swallowing impaired
risk factors for SSPE?
aquiring measles at an early age (under 2)
what sequalea is associted with defective forms of the measles virus in the brain
characteristics of Rubella virus
ss + sense linear RNA
transmitted resp with discharges from nose and throat of infected person as well as TRANSPLACENTAL
when is Rubella most contagous?
when rash is erupting but virus shed from 7 days before until 4 days after onset
who is at risk for Rubella?
unvaccinated populations
children 5-9
**unborn fetus
what must rubella and rubeola bring with them to replicate?
RNA dep RNA pol
Rubella: ss+sense RNA
Rubeola: ss-sense RNA
Rubella is inactivated by environmental factors unlike what other cause of childhood exanthems?
how are german measles different clinically from measles?
german: no photophobia, low fever
many cases are subclinical unlike in Rubeola wehre most infections result in clinical disease
clinal presentation of german measles?
LOW fever on first day
maculopapular rash (starts on face and moves to trunk)
cervial and occital lymphadenpathy
the rash of Rubella is associted with what?
immune complex formation when Ab titer is high which may result in polyarhralgia in the patient
what happens in congenital Rubella syndrome?
caused by transplacental transmission
virus acts as a teratogen during 1st trimester*** resulting in birth defects
*primary targets in fetus: heart, eyes, CNS
what organs are targeted in Congenital Rubella Syndrome and what is the result?
Heart: primary ductus arteriorsus
Eyes: cataracts, glaucoma, blindness
CNS: MR, deafness
is a baby born with Congenital Rubella Syndroma a health risk?
yes! the infant will shed the virus for months after birth so can act as a reservoir/source
what is the primary site of replication of Rubella?
pharyngeal tissues
person is infectous as long as the virus is produced in the pharynx
what is the best way to ID/Dx Rubella?
serology: IgM peak as measure of acute recent exposure
*same for Rubeola
what is the problem with a pruritic rash?
when it is itched it is now prone to 2ndary bacterial infxns
prevention for Rubella?
live attenuated MMR
life long immunity in MOST
what is differnt about the rash appearenc of Rubella than Rubeola?
Rubella lesions are less intensily red and rarely if ever coalesce**
circulating Ab can block the transfer of Rubella from where?
block spread from 2ndary infxn sites: lymph nodes, liver, spllen
block primary and secondary viremia
block transfer to skin or placenta
what should you do in a woman that wants to get pregnant and thinks she was exposed to Rubella?
check Ab titer
if greater than 1:64 use birth control for 3 months
get vaccinated
primary viremia of Rubella causes?
rash to develop due to I-C formation
if mother is sero neg for Rubella, what can occur?
congenital rubella syndrome
viruse goes through typical progression then spreads via 2ndary viremia to fetus
characteristics of parvovirus B19
ssDNA (-or+ sense)
where does B19 virus replicate?
nucleus bc ssDNA
must make dsDNA replicative form to do so
what childhood exanthems are transmitted transplacental?
B19 virus
who is at risk for B19?
elementary age
parents of children with B19
unborn fetus*
replication of B19 virus requires what of the host cell?
that the host be undergoing DNA replication; they cannot initiate DNA synthesis so these viruses are restricted to the dividing cells of the body such as erythopoitic and immune systems
in which cells does B19 virus infect?
only dividing cells like erythroid precursors and immune systems bc requires that the host cell be undergoing DNA replication
what does the B19virus bind on host ?
erythroid precursor receptor GLOBOSIDE ~ P Ag
this is presnet on endothelial cells and causes vasculitis
what is the disesase that B19 virus causes? how does it prseent?
Fifth disease or Erythema Infectiousum
non specific prodromal illness
2-5 days later: slapped cheek rash
rash followed by lacy, reticulate maculopapular body rash on trunk and limbs
what are the clinical disease names for B19virus?
erythema infectiousm
fifth disease
slapped cheek syndrome
what disease is associated with circumoral pallor?
circumeral pallor = bilateral inflammation of the cheeks
Slapped Cheek syndrome/ Erythema Infectiosum/Fifth disease
in which childhood exanthem do we see a drop in hemoatocrit and pancytopenia that is transient?
Erythema Infectiosum
Aplastic crisis can occcur as a result of what disease in what population?
B19 Virus-Erythema Infectiosum
pts with underlying anemias: sickle cell anemia
Tx: transfusion
what are the 3 huge clinical expression hallmarks of B19virus?
1. Erythema Infectiosum with slapped cheek syndrome
2. Aplastic anemia
3. Hydrops fetalis
why is impt to diagnose B19 in pregancy?
b/c of spontaneous abortion and need to differentiate from Rubella which is more likley to lead to congenital anomalies
prevention from B19 virus?
no vaccine
infection provides long lasting immunity
what does it mean when a pts serology for parvovirus shows IgG + and IgM-?
past infxn
pt probably immune
what does it mean when a pts serology for parvovirus shows IgG+ and IgM+?
ongoing or recent infxn
fetus may be at risk if prgenent
lacy reticulate maculopapular body rash
parvovirus B19
characteristics of HHV6?
risk factors/high risk ppl for HHV6?
children 6mo-12mos
what is considered the most common childhood exanthem?
where does HHV6 bud from?
nucleus then moves cell to cell via fusion
leaves with only 1 membrane derived from inner nuclear membrane
appearence of HHV 6 infected cells?
larger than normal
inclusions in both cytoplasm and nuclus**
clinial disease of HHV6?
Exanthem subitum (Roseola)
3-5day high fever
fever ends then rose-colored macular rash on face and trunk
what is the Roseola rash due to ?
I-C formation
seen on trunk and face
the childhood exanthems can be Dx how?
serology (Ab titers) and PCR
what the 3 impt descriptions of Scarlet Fever rash apperance?
1. circumoral pallor (bilateral inflammation on cheeks)
2. Pastia's lines
3. Positive blanching