Rubella, Viral Exanthema, And Congenital Infections

Front 1

classification and spread of rubella?

Back 1

togaviridae in genus rubivirus, only one in the family not spread by mosquito, human is the only natural host

Front 2

tissues infected?

Back 2

all kinds - pantropic

Front 3

describe postnatal rubella

Back 3

sx begin with lymphadenopathy, then prodrome of flu like with sore throat and coryza, then faint maculopapular exanthem on face or trunk, lasts 3 days and note it may not appear at all. complications are polyarthritis and arthralgia, rare encephalitis by 7 days, pt is infectious before prodrome until 14 days after rash (2 weeks before and 2 weeks after). IgM is diagnostic, immunity is permanent. infection may be asymptomatic, symptomatic Rx, very low mortality, reinfection produces no viremia thus no hazard to fetus if mom gets reinfected.

Front 4

how often do rubella outbreaks appear, who do they infect and what time of year do they usually outbreak?

Back 4

6 to 8 year intervals, usually in spring, in children 5 to college age.

Front 5

describe the rubella vaccine and when it is given.

Back 5

live-attenuated vaccine, MMR! given at 15 months and then a booster bw 4 and 6

Front 6

incubation period of rubella?

Back 6

16 to 25 days

Front 7

what causes the rash in rubella?

Back 7

it is immune mediated

Front 8

describe rubella infection in adults.

Back 8

usually more severe, arthralgia and arthritis, rare thrombocytopenia, postinfectious encephalopathy (rare)

Front 9

how many serotypes of rubella exist?

Back 9

1

Front 10

what is the preffered assay for rubella detection?

Back 10

hemagglutination inhibition assay (if 1/8 of titer will inhibit then the person is immune)

Front 11

should pregnant women get MMR?

Back 11

nope, this is still live virus and potentially dangerous to the fetus

Front 12

what are the cytological effects in congenital rubella?

Back 12

not lysis but affects growth, mitosis, chromosomal structure

Front 13

severity of outcomes of congenital rubella infection as well as times during pregnancy compared to severity of thess outcomes.

Back 13

congenital rubella syndrome with severe defects or stillbirth. 1st month over 80% pathology and all fetuses infected, 1st trimester 70 to 85% pathology, 2nd trimester 25 to 35% infected, last ten weeks, few will have severe defects

Front 14

describe the transient manifestations of congenital rubella syndrome (note these may disapear).

Back 14

LBW, thrombocytopenia purpura (blueberry muffin), hepatosplenomegaly, meningoencephalitis and large anterior fontanelle, bone lesions. uncommon manifestations: adenopathy, hepatitis, cloudy cornea, hemolytic anemia, pneumonia, myocarditis.

Front 15

describe the permanent manifestations of CRS.

Back 15

uni or bilateral deafness due to screw up with organ of corti, congenital heart disease, central language defects, MR, cataracts and microphthalmia, glaucoma, permanent retinopathy

Front 16

describe the late manifestations of CRS.

Back 16

usually due to CNS infection, behavior DOs, MR, IDDM, autoimmune disease in some HLA types. Very rare: progressive rubella panencephalitis (can appear 20 yrs after birth), behavior changes (ataxia and intellectual decline), spasticity (fatal within 8 yrs, lose white matter and then demyelinate), perivascular cuffing

Front 17

how do you diagnose an infant with rubella?

Back 17

IgM in cord blood or serum

Front 18

describe all the agents that can cause congenital infections.

Back 18

TORCHS. toxoplasma gondii, other (HIV, Hep B, VZV, enterovirus, etc.), rubella, CMV, HSV, syphilis

Front 19

congenital CMV stats

Back 19

0.5 to 2.5% of newborns excrete CMV at birth, 90% normal at birth but 20 % develop sx later, 10% of infected newborns have CMV related sxs at birth

Front 20

common defects in congenital CMV?

Back 20

microenceph, anemia, deafness, jaundice, MR, chorioretinits, thrombocytopenia, hepatosplenomegaly... hard to tell dif bw CMV and rubella

Front 21

diagnosis of CMV?

Back 21

culture virus and look for CPE, combine with IF for early antigens after 2 days, PCR

Front 22

how do newborns get HSV2?

Back 22

natally usually, some neonatal

Front 23

diseases of HSV seen in newborns?

Back 23

skine, eye and mouth. disseminated infection ( most common killer if not treated), encephalitis (half die, survivors can have neurological impact)

Front 24

HSV diagnosis?

Back 24

DNA detection via PCR, etc. detection of viral antigen

Front 25

describe newborn HIV transmission and results of it.

Back 25

in utero or mom's milk, chronic infection that leads to lymphadenopathy, failure to thrive, encephalopathy.

Front 26

describe toxoplasma infections in neonates including transmission and treatment.

Back 26

obligate intracellular sporozoan, usually asympto in immuno compentent. transmission is oocysts via cat fecal oral, environment. congenital infection is from the asexual tachyzoite infecting the fetus. treating mom reduces congenital infection by 60%, severe cases can have encephalitis, pneumonitis, chorioretinitis, hydrpencephaly, psychomotor retardation. diagnosis is by PCR, IgM, EIA 4 fold rise in IgG titer, write or giemsa stain lymph tissue to show trophozoites. Treat with pyrimethamine and sulfadiazine

Front 27

define macule, papule, vesicle, bullae, ulcer, petechiae, nodule, and wart.

Back 27

red spot on skin that is not elevated. circumscribed elevated area that is less than 1 cm. circumscribed elevated area on skin containing clear fluid. large vesicles over 5mm containing serous or seropurulent fluid. excavation of tissue (sloughing of inflammatory necrotic tissue). pinpoint non raised, round, purplish red spot caused by intradermal or submucous hemorrhage. small node that is round and defined by touch. lobulated hyperplastic epidermal lesion with a horny surface and several morphological types

Front 28

viruses that cause a maculopapular exanthem?

Back 28

measles, rubella, HHV6, EBV, HIV1, enteroviruses, CMV, hep B, dengue, chikungunya

Front 29

viruses that cause vesicular exanthema.

Back 29

VZV, HSV, enterovirus

Front 30

viruses that cause hemorrhagic exanthema?

Back 30

dengue, yellow fever

Front 31

viruses that cause a pustular exanthema?

Back 31

vaccinia, monkeypox, cowpox.

Front 32

viruses that cause a nodular exanthema?

Back 32

papilloma, molluscum contagiosum, pseudocowpox

Front 33

describe hand, foot, and mouth disease

Back 33

bullae caused by coxsackievirus A16, lesions initially in oral cavity, move to hand palms, and foot soles. mildly febrile, subsides in a few days, painful lesions

Front 34

what causes a milkers nodule?

Back 34

pseudocowpox

Front 35

whats an ecchymosis?

Back 35

hemorrhagic rash that looks like massive bruises