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168 Cards in this Set
- Front
- Back
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What is determined by a bacterial serotype?
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virulence
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Where do endotoxins reside?
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in the cell walls of gram - bacteria
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When are endotoxins released?
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when the bacterial cell is destroyed
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What does an endotoxin do?
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1. activates the inflammatory process & causes fever
2. increases capillary permeability |
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What are general characteristics of a gram - endotoxin?
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1. very virulent/severe (can kill you in 1 hr)
2. less common 3. more fatal ex: meningocoxemia |
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What is an exotoxin?
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proteins released during bacterial growth
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Which types of bacteria typically produce exotoxins?
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Gram +, strep, staph
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What is the prototype clinical manifestation of an exotoxin?
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scarlet fever (red tongue, sandpaper rash, caused by group A strep infection of the throat)
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What feature of the 120 serotypes of strep determines a specific serotype's virulence?
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M protein
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What is a rheumatogenic side effect of an exotoxin?
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one that causes rheumatic fever
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What is a nephritic side effect of an exotoxin?
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one that causes glomerulonephritis
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How do you tx an disease that is caused by an exotoxin-producing bacterial infection?
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1. amoxicillin
2. penicillin *good in 48h |
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Can viruses produce endo/exotoxins?
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no
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What information should you inquire about to obtain a full hx for infectious disease?
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1. pattern of symptoms (order, timing)
2. epidemiology (regional contacts) 3. travel hx* 4. recent medical interventions (dental, GI, GU) 5. vaccinations, transfusions 6. unusual occurrences (loss of consciousness/trauma) 7. possible drug use 8. animal contact (toxo + cats) 9. unusual diet (raw milk, listeria, preg) 10. preexisting illness 11. congenital anomalies that increase likelihood of illness (down's) 12. med hx 13. hereditary dz 14. cultural practice |
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Which descriptive words are too vague for documentation in physical assessment.
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-A&O x 3
-NAD -lethargy |
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Which features do you want to document during the physical assessment?
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-fever
-respiratory distress -skin rashes (petechiae) -tachycardia, new onset of murmur -apnea/bradycardia (infants) -irratability, high-pitched cry, bulging fontanel, convulsions -state of child (quiet, active) -suck, anorexia -sweating -limitation of motion |
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What is an exanthem?
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a rash on the skin
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Describe the viral distribution of an exanthem in which the measles is prototype
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starts behind the ears-->face-->body
*fine in 3 days |
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Describe the viral distribuation of an exanthem in which varicella is prototype
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start trunk-->spread everywhere
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List the 6 classic exanthems of childhood
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1. measles (first disease)
2. scarlet fever (second disease) 3. rubella (third disease) 4. Filatov-Dukes disease--not a separate exanthem, but a variant of scarlet fever or toxin-producing staph infection (fourth disease) 5. erythema infectiosum (fifth disease) 6. exanthem subitum (HHV-6/roseola) (sixth disease) |
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What is an enanthem?
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a rash (abnormal rxn) on a mucus membrane
ex=ulcer |
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Describe the prodromal phase of measles (rubeola) & list the signs/symptoms.
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moderate-severe:
1. fever 2. malaise 3. dry cough 4. coryza 5. conjunctivitis *3 C's |
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What enanthem is associated with measles?
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Koplik's spots
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When does the measles exanthem appear?
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day 3 or 4
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How long is the incubation phase of measles?
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9 days
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Describe the contagion likelihood of measles in relation to the rash
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90% attack rate 4 days before and after the rash
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When is coryza and conjunctivitis prominent during the measles infection?
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during the stage at which the rash is exhibited
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Describe the measles exanthem
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rash is...
-blanching -erythmatous with... -some confluent macules on the trunk |
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What feature describes a morbilliform reaction?
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one that shows confluent, erythmatous macules
*such as that seen in measles |
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Where does a morbilliform reaction caused by a drug reaction take place?
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palmar area
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Describe the measles exanthem progression
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begins behind the ears, moves onto the face, spreads centrifugally.
when it appears on the lower trunk & extremities, it is frequently confluent on the face |
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Which enanthem is associated with measles?
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Koplik's spots
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What are Koplik's spots?
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whitish elevations on an erythematous background opposite the molars
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What are 2 ways to dx measles?
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1. clinical
2. serological (IgM, IgG) |
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How do you prevent measles in children?
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MMR
@1 yr + @ 4-6 OR 11-12 |
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3 treatments for measles?
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1. supportive care
2. vaccine if older 9 mo and within 3 days of exposure 3. gamma globulin |
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What is second disease?
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scarlet fever
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Describe the causative agent of scarlet fever
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group A beta-hemolytic strep
**rash is usually exotoxin-mediated **usually secondary to tonsilar/pharyngeal focus |
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route of transmission for scarlet fever?
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airborne particles
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length of scarlet fever's incubation period?
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1-4 day
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Describe the onset of scarlet fever and the associated symptoms?
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abrupt:
-fever -sore throat -headache -N/V -abdominal pain |
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When does the scarlet fever exanthem appear?
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12-48 hr after the acute symptoms
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What time of year is it common to see scarlet fever?
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december + spring time
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Describe the facial appearance of a child with scarlet fever
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1. flushed face
2. perioral pallor |
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Describe the exanthem associated with scarlet fever
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rash is...
-diffuse -blanching -erythmatous feels like.. -sandpaper |
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What clinical manifestation occurs prior to the scarlet fever rash?
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Pastia lines
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What are pastia lines?
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pink or red lines formed of confluent petechiae are found in skin creases, particularly the crease in the antecubital fossa, the soft inside depression on the inside of the arm
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Which hallmark signs of scarlet fever do NOT blanch?
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1. purpura
2. petechiae (the smallest subset of purpura, characteristically do not blanch) |
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Describe a prominent oral symptom in a kid with scarlet fever
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strawberry tongue + foul smelling breath
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How do you tx strawberry tongue?
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1. brushing
2. mouthwash |
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What rash feature of scarlet fever occurs 7-10 days after it has been resolved?
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desquamation (peeling)
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Where does desquamation occur?
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1. axilla
2. groin 3. fingertips 3. toes |
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Which diagnostic tests do you order for scarlet fever? what do they test for?
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1. ASO test
2. DNAse B test *tests for strep |
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What is third disease?
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rubella
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When is rubella contagious in regards to the rash?
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a few days before and after the rash
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How long is the rubella incubation period?
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14-21 days
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Complications of rubella are rare, but which populations suffer most from complications?
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1. pregnant women
2. fetuses *can cause fetal death |
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Levels of what substance indicate if a mother (and subsequently her fetus) is protected from rubella?
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maternal IgG
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Another name for rubella?
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german measles
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Describe the prodromal phase of rubella.
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mild URI
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Describe the rubella exanthem.
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rash is...
-discrete -pink/red -fine maculopapular |
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What is the exanthem of rubella called in a baby?
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blueberry muffin rash
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In addition to an exanthem, what are the other 2 other general symptom clusters associated with rubella?
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1. Adenopathy
*occipital -posterior cervical -posterior auricular 2. vision/hearing loss |
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What symptoms of rubella manifest in adolescent females?
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arthritis/arthralgias
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How does the rubella exanthem spread?
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cephalocaudally, in which it becomes generalized
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How long does it take a rubella rash to fade and clear?
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72 hrs
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What enanthem manifests in rubella?
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Forchheimer spots
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What are Forchheimer spots?
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petechiae on the hard palate
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What is fifth's disease?
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erythmatous infectiosum
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Which agent causes fifth's disease?
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parvovirus B 19
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In which populations is fifth's disease particularly dangerous?
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people w/:
1. sickle cell disease 2. anemia **most kids with this disease are smiling, interactive, playful |
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How long is the incubation phase for fifth's disease?
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4-14 days
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During which season is fifth's disease common?
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spring (feb-->spring)
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How many phases are associated with fifth's disease?
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3
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What are the clinical manifestations of the 1st phase of fifth's disease?
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Prodrome:
1. malaise 2. myalgia 3. headache 4. low grade fever *time when contagious |
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What clinical manifestations are associated with the 2nd phase of fifth's disease?
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1. slapped cheek appearance
2. arthritis/arthralgia (adolescent) |
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What clinical manifestations are associated with the 3rd phase of fifth's disease?
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1. rash
-lacy -symmetric -maculopapular |
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How long does the fifth's disease exanthema last?
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waxes and wanes for 6 weeks
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What are clinical associations with parvovirus B19?
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1. asymptomatic
2. erythema infectiousum 3. arthropathy/arthritis 4. transient aplastic crisis (SCD) 5. chronic anemia (BMT) 6. hydrops fetalis*** 7. neuro dz 8. rheumatological dz 9. vasculitis |
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What cell line does the parvovirus infect?
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reticulocytes
causes aplasia .:. decreasing RBCs and causing anemia |
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What clinical manifestations occur due to starling's forces being messed up from anemia?
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1. tachycardia
2. HF |
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Describe the exanthem of fifth's disease.
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Slapped Cheeks!
rash is... -warm -erythematous (bright red cheeks) -nontender -circumscribed |
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Which serological test do you call for an acute infection of parvovirus?
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serum B19-specific IgM
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Which serological test do you call for if you want to see evidence of a past infection/immunity?
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serum B19-specific IgG
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Which other lab tests can be used for fifth's disease serological testing?
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1. ELISA
2. radioimmunoassay tests |
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Is the parvovirus difficult to grow?
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yes
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What is sixth's disease?
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roseola
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Which viruses cause roseola?
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Herpes 6 & 7
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Which age group is most susceptible to roseola?
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6 mo - 3 yrs
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Describe the initial course of roseola.
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a high fever (101-105) for 2-5 days
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What condition is the child with roseola in?
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generally looks happy, might be irritable or anorexic
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what is the source of the roseola fever?
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none
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What is the #1 reason for febrile seizures in 6 mo - 3 y/os?
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roseola
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What is the hallmark clinical course for roseola?
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as the fever ends, the exanthem begins
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Describe the roseola rash
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rash is...
-erythematous -maculopapular |
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How long does the roseola rash last?
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fades in 1-3 days
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Describe the pattern of progression of the roseola rash
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Begins on trunk-->spreads to neck, face, arms, legs
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What time of year is enterovirus particularly dangerous?
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summer: may-oct
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What viruses does the enterovirus family include?
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1. coxsackie
2. echovirus 3. poliovirus |
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Describe the illness severity in one w/ enterovirus
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milk illness w/ complete recovery in most cases
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What are the most common clinical presentations of enterovirus? What is the typical causative agent?
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coxsackie A:
1. hemorrhagic conjunctivitis 2. pharyngitis 3. pleurodynia (pain fm pleural inflammation) 4. herpangina 5. hand-foot-and-mouth disease |
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What are the typical clinical manifestations that are associated with coxsackie B?
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coxsakie B:
1. paralysis 2. hepatitis 3. myocarditis (may cause need for transplant) 4. pericarditis 5. encephalitis 6. aseptic meningitis 7. neonates at risk for disseminated infection |
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What is the causative agent for hand-foot-and-mouth disease?
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coxsakie A16
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Describe the prodromal phase for hand-foot-and-mouth disease.
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Prodrome:
1. fever 2. malaise 3. sore mouth 4. anorexia |
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At which time in the hand-foot-and-mouth disease course does the exanthem appear?
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within 2 days
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How long does the exanthem last?
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stays on the surface for 2 weeks...does not need to be in all 3 spots
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Describe the oral lesions caused by coxsackie
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oral lesions are...
1. shallow 2. yellow ulcers 3. surrounded by red halos |
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Where are coxsackie oral lesions located?
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1. buccal mucosa
2. gingiva 3. tongue 4. soft palate 5. uvula 6. tonsils 7. back of throat |
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Describe the skin lesions (exanthem) caused by coxsackie.
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Skin lesions are...
-thick walled -gray vesicles -on an erythematous base |
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Where does the coxsackie exanthem commonly manifest?
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1. buttocks*
2. palmar/plantar aspects |
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Which enterovirus is commonly responsible for causing trunchal exanthema?
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echovirus
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Is coxsackie contagious?
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highly
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What is the incubation period for coxsackie?
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2-6 days
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What is the peak season for coxsackie?
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summer
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How long do coxsackie symptoms last?
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2-6 days
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Describe the tx for coxsackie.
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1. supportive care
2. analgesia (ibuprofen) 3. magic mouthwash (benedryl, maalox, viscous lidocaine) |
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Is it necessary to give magic mouthwash to a child with coxsackie?
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no, the virus is usually self-limiting so advil will suffice
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What is a major adverse side effect of magic mouthwash (from the lidocaine)?
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OD can cause status epilepticus
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List 8 viruses that are a part of the herpes viral family.
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1. EBV
2. CMV 3. VZ 4. HSV I 5. HSV II 6. HHV 6 7. HHV 7 8. HHV 8 |
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Which cells do EBV infect?
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B cells
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How do most people get HHV 6? What does it cause?
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from kissing mothers-->roseola
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How do HHV 7 & 8 clinically manifest? What provokes their manifestation?
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1. fever blisters
2. herpes sun, stress |
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What characteristic is VZ known for?
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viral latency: lies int he dorsal root ganglion somewhere along the spinal cord
infected person develops shingles later in life |
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Where are shingles commonly distributed?
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1. trigeminal nerve
2. 1 side of the trunk |
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What does HSV-1 cause in babies?
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SEM disease (skin, eye, mucus membrane disease)
from mother to baby causes HSV sepsis and CNS disease |
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What clinical forms of HSV-1 primary infection manifest?
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1. herpetic gingivostomatitis
2. herpetic whitlow 3. isolated skin lesions 4. herpes gladiatorum 5. herpes of the eye (emergency!) |
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What is the hallmark feature of the herpes exanthema?
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vesicles in small groups
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What drug is effective in tx herpes?
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acyclovir, an antiviral
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How does acyclovir work?
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it inactivates thimidine kinase .:. preventing HSV DNA from being synthesized
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Describe the enanthem in herpetic gingivostomatitis
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mucosal ulceration shows...
1. gingival erythema 2. edema 3. friability |
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Besides the mucosal ulcer, what other symptoms are associated with herpetic gingivostomatits?
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1. fever
2. dysphagia 3. adenopathy |
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What factors provoke herpetic gingivostomatitis?
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sunlights & stress
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Describe a child with herpetic gingivostomatitis
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NOT happy because the lesions are PAINFUL
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How long is one infected with HSV-I symptomatic?
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5-14 days
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How long is the HSV-I virus shed?
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weeks
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How do you treat HSV-1 infections?
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1. supportive
2. analgesic 3. magic mouthwash 4. hydration 5. acyclovir |
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Describe a herpetic whitlow.
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thick walled, painful, vesicular or pustular lesions on the finger
*on an erythematous base |
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Which clinical manifestations accompany a herpetic whitlow? (4)
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1. fever
2. lymphadenitis 3. axillary lymphadenopathy (epitrochlear indicates leukemia) |
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Is a herpetic whitlow primary or secondary?
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secondary to a direct inoculation
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What are the causative agents of mono?
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1. EBV (90%)
2. CMV 3. adenovirus |
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Which virus is the #1 cause of congenital infection in the US?
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CMV:
1% of babies are infected, causes a mono-like illness |
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What effects can CMV have on an infant?
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In many, the infection may be benign, but it can result in sensorineuronal hearling loss, deafness, blindness
causes a mono-like illness |
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By 5 years old, what percentage of children in poor urban settings or developing countries are seropositive for EBV?
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70-90%
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What are the EBV symptoms generally shown in poor/developing settings?
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asymptomatic or subclinical
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In more affluent societies, what age do symptomatic cases of IM manifest?
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adolescence & young adulthood
1 in 2500 students |
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What are the 2 main modes of transmission for IM?
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1. close personal contact (ie kissing)
2. contaminated fomites |
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What is the main source of transmission?
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pharyngeal secretions
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What percentage of healthy, infected individuals shed virus at one time?
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15-20%
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What percentage of infected patients on immunosuppressive therapy (including steroids) shed virus at a time?
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up to 50%
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What is the incubation period for the infectious mono virus?
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2-6 weeks (ave 20-30 days)
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Describe the period of communicability for IM.
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difficult to assess
period of incubation thought to be 2-6 wks |
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Where does the IM virus reside in a clinically ill infected person and for how long?
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saliva and blood
many months |
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What tissue does IM primarily effect?
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1. primary lymphoid tissue
2. peripheral blood |
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How long do symptoms last in IM?
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variable, can last up to 2-3 weeks
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What are the clinical manifestations for IM?
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1. enlargement of lymphoid tissue (regional lymph nodes, tonsils, spleen, liver)
2. almost all body organs involved (esp. lungs, heart, kidney, adrenals, CNS, skin) |
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In a patient with IM, what does a CBC reveal?
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atypical lymphocytes
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What are 8 key signs of IM?
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1. fever
2. sore throat 3. lymphadenopathy 4. splenomegaly 5. hepatomegaly 6. skin rash 7. periorbital edema 8. rare s&s |
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Describe a fever in IM.
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greater than or equal to 103 F
lasts for 1-3 days |
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When does a sore throat in IM occur?
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a few days after the fever
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Describe the sore throat in IM.
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1. painful
2. tonsillar enlargement 3. grayish-colored exudate 4. ulceration & pseudomembrane formation 5. palatal petechiae 6. tonsils 4+ w/ exudate |
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Describe the lymphadenopathy associated with IM.
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1. occurs in anterior, but especially posterior cervical nodes
2. neck nodes do NOT obscure jaw 3. firm, nontender, discrete |
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In what percentage of cases of IM can splenomegaly be found?
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50-75%
*rupture is rare |
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Hepatomegaly is also common in IM. How is it typically detected?
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abnormal liver function tests
5-25% have clinical hepatitis |
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What percentage of IM cases manifest in a skin rash?
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20%
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Describe the types of IM exanthema that can manifest.
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1. maculopapular
2. urticarial 3. scariatiniform 4. hemorrhagic OR 5. nodular |
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What is the association of developing a rash during IM?
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Ampicillin
Probably represents a form of arteritis or vasculitis |
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What percentage of cases report periobital edema?
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25%
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List of rarer S&S associated w/ IM
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-myalgia
-arthralgia -chest pain -ocular pain -photophobia -conjunctivitis (bloody) -gingivitis -ab pain -D -cough -pneumonia -rhinitis -epistaxis -bradycardia -aseptic meningitis -Guillain-Barre syndrome -bell palsy -reye syndrome -acute cerebellar ataxia |
