Viruses

Front 1

Genomic structure of Herpesviridae

Back 1

linear double stranded DNA; characteristic inverted repeat elements, several isomeric conformations

Front 2

Herpesviridae structure

Back 2

Capsid: icosahedral, 5 proteins;
Tegument: b/t capsid and envelop (protein);
Envelop: inner nuc. membrane, w/ glycoproteins

Front 3

Herpes Latency

Back 3

remains for life; latent have no protein expression/DNA replication; migrate to ganglion, WBCs,

Front 4

Effects of host immune response of Herpes latency

Back 4

has no effect on latent infection; CMI is only imp. in recovery from clinical disease; vaccine also don't prevent latency

Front 5

Herpes Transmission

Back 5

man only reservoir; direct contact (kissing, sex, wrestling); shed from asymtomatic carriers and visible lesions;

Front 6

Herpes Pathogenesis

Back 6

personal contact; entry mucous membranes-abrasions; replicates at primary site; systemic rare; initial site heals w/o scarring

Front 7

Herpes Primary Infection

Back 7

1+ clusters of blister-like lesions; painful, itch, contagious; switches to latent- rest of life (nerve ganglia)

Front 8

Herpes Recurrence

Back 8

at or near primary site; secondary milder/short duration; reactivation causes: trauma, stress, UV light, hormones, spices, immunosupp.

Front 9

Herpes 1' Orofacial Infections

Back 9

stomatitis, gingivostomatitis, cold sores; most subclinical; children, swollen gums, fetid breath, drool; ulcers buccal mucosa

Front 10

Herpes - recurrent "cold sores"

Back 10

stomatitis; largest reservoir; pain, itching, prodrome, very localized, thin-walled vesicles, burst, most infrequent 1/year

Front 11

Herpes- Ocular

Back 11

keratoconjuctivitis, autoinoculation, blepharitis, red/sore/painful, branching dendritic ulcers, progressive scarring, self-limiting; DON'T use opthalmic steroids

Front 12

Herpes- Gladiatorum

Back 12

HSV-1 dermatitis; contact sports, wrestlers/rugby; head and neck, constitutional symp., lymphadenopathy; Tx: education, routine exams

Front 13

Herpes- Genital Infections

Back 13

HSV-2; rare before puberty (sexual abuse); females: burning, labia/vagina, perfuse watery discharge, tender ulcers, severe pain, dysuria; males: painful ulcers on glans, shaft

Front 14

Herpetic Whitlow

Back 14

sores on the fingers

Front 15

Herpes- Eczema Herpeticum

Back 15

burn patients; pregnant, malnourished, immunosuppressed, generalized spread over body

Front 16

Herpes- simplex encephalitis

Back 16

acute necrotizing encephalitis, 70% mortality, neonatal-HSV-2; adults-HSV-1; common sporadic encephalitis; direct contact;

Front 17

Herpes- HSV1 encephalitis

Back 17

1 hemisphere; coalesce into cavitation; from trigeminal ganglion; orbitalfrontal/temporal; altered consciousness, delirium, seizures, coma

Front 18

Herpes- encephalitis; Dx and Tx

Back 18

Dx- CT, electroencephalograph, technetium scan, PCR detection of HSV DNA in CSF;
Tx- Ara-A, acyclovir

Front 19

Herpes- HSV-2 encephalitis

Back 19

neonates during birth, NO orbitalfrontal/temporal; most disseminated viremia; 65% mortality; sequelae: blindness, delays, mental retardation, seizures

Front 20

Herpes- Tx General

Back 20

self-limiting; usually no intervention; limit spread, reduce pain, prevent complications

Front 21

Herpes- Tx: Primary Infections

Back 21

oral- acyclovir; topical- %5 acyclovir; severe- IV therapy for disseminated; DO NOT use heterocyclic dyes (genital carcinomas)

Front 22

Herpes- Tx: Recurrent Infections

Back 22

oral acyclovir (during prodrome); daily suppressive therapy- for frequent recurr.; abstinence while symptomatic; all drugs- nucleoside base analogs

Front 23

Varicella- chicken pox; transmission

Back 23

inhalation of particles, direct contact; highest among household contacts; wait til crusted over to return to school

Front 24

Varicella- Symptoms

Back 24

prodrome, maculopapular lesions; trunk-> extremities; vesicular to scabs; severity- age dependent; adults more severe;

Front 25

Varicella- Tx

Back 25

no effective treament; symptom relief; DON'T give aspirin; Reyes Sx- projectile vomiting, encephalopathy; immunosupp- acyclovir

Front 26

Herpes Zoster- shingles

Back 26

reactivation of latent virus in ganglia; incidence increases w/ age;

Front 27

Herpes Zoster- symptoms

Back 27

chicken pox-like; less contagious, no respiratory; neuralgia (very painful); occur in 1 dermatome; erythema; prolonged pain (post-herpetic neuralgia); lymph adenopathy;

Front 28

Herpes Zoster- Tx

Back 28

mild- no Tx; 50+ acyclovir; reduce pain; post-herpetic neuralgia- analgesics, steroids

Front 29

Cytomegalovirus (general)

Back 29

very common; 40-100% in US; humans only reservoir; endemic; acquired in infancy and reproductive years; in all body fluids, usually asymptomatic; common cause viral birth defects

Front 30

CMV- at Risk

Back 30

fetus (intrauterine); seronegative pregnant; immunocomp.; organ transplants; AIDS; blood recipients; sexually active

Front 31

CMV - pregnant women

Back 31

mostly for seronegative pregnant; risk greatest in first 2 trimesters; stay away from day-care centers;

Front 32

CMV- Pathogenesis

Back 32

low pathogenicity, poor cell development in fetus; Owl's eye inclusion bodies; harbored in monocytes; clinically inapparent; heterphil-neg for EBV mono

Front 33

CMV- Infants

Back 33

retardation; low birth weight; hepatosplenomegaly; microcephaly, deafness; liver damage; cleft palate; seizures; ocular abnorm.

Front 34

CMV- Adult Symptoms

Back 34

hepatitis; pneumonia- transplant pts; interstitial lung infiltrates; chorioretinits-cotton wool spots(AIDS) - requires life-long Tx w/ ganciclovir or foscarnet; GI

Front 35

CMV- HIV patients

Back 35

progression of AIDS; infects lymphocytes; upregs HIV gene expression;

Front 36

CMV- Dx

Back 36

Owl's eye inclusions; seroconversion; mono-like symptoms w/ heterophil Ab negative; fever unknown origin

Front 37

CMV- Tx

Back 37

Ganciclovir- virostatic; suppresses replication; Foscarnet for chorioretinitis (adverse- nephrotoxic); CMV Ig; vaccine

Front 38

Epstein-Barr- Transmission

Back 38

through saliva; not highly contagious; kissing-adolescencents/adults; toys-children;

Front 39

Epstein-Barr- Pathology

Back 39

primary target- oropharnyx epithelium; parotid glands; no lysis if B-cells(become immortalized); infectected B's make heterophil Ab**; virus shed in saliva

Front 40

Epstein Barr- Symptoms

Back 40

asymptomatic- young children; prodrome; pharyngitis; B/L cervical lymphadenopathy; undulant fever; night sweats; FATIGUE; splenomegaly; rash w/ ampicillin

Front 41

Epstein Barr- Dx

Back 41

atypical lymphocytes (large, lot of cytoplasm); serology- heterophil Ab positive***;

Front 42

Epstein Barr- Complications

Back 42

Splenic rupture (physical activ.); anemia; meningitis; seizures; chronic form (these are higher risk in immunosupp. and transplant pts.)

Front 43

Epstein Barr- assoc. Burkitt's Lymphoma

Back 43

resticted to parts of Africa, N. Guinea; needs malaria as co-carcinogen; chromosome 8:14 abnorm.; uncontrolled prolif. B-cells; usually under 20yo

Front 44

Epstein Barr- other cancers

Back 44

Nasopharyngeal carcinoma- aggressive/ metastatic, males 20-50yo, S. China; Hodgkin's disease

Front 45

Epstein Barr- Tx

Back 45

no direct treatment; treat symptoms; NO ampicillin- RASH; acyclovir- prevents replication

Front 46

Picornavirus- General

Back 46

pos. ssRNA; small; icosahedral; canyons; no envelop; fecal-oral transmission

Front 47

Poliovirus- General

Back 47

notorious; very common, stable in environ.; fecal-oral; only human reservoir; children

Front 48

Poliovirus- Pathology

Back 48

oral route; replicates in intestinal mucosa; systemic spread- nerves,heart, liver; shed in feces

Front 49

Poliovirus- Clinical Presentation

Back 49

mostly asymptomatic; systemic(5-10%)- headache, sore throat, fever, meningitis (if no progression- abortive); paralytic (0.1%) CNS, 23% mortality, spinal- neuropathy, muscle weakness, bulbar paralysis- diff. swallowing, breathing;

Front 50

Poliovirus- Post-polio Syndrome

Back 50

decades after infection; slow weakening of muscles; surviving motor neuron can't sustained increase demand; 60% of survivors

Front 51

Poliovirus- Tx

Back 51

no effective Tx, muscle strengthening for PPS; vaccination IPV 2-3 shots; prevents the paralytic disease

Front 52

Coxsackievirus/ Echovirus- Pathogenesis

Back 52

fecal oral; replicates in intestines; dissemination CNS, heart, lungs, skin;

Front 53

Coxsackie A/B Infections and (Echo)

Back 53

A- Herpangia, Hand/Foot/ Mouth diseas; B- myocarditis, pleurodynia; Echo give much of the same

Front 54

Coxsackievirus- Herpangia

Back 54

mostly from "A"; children, vesicles on soft palate and uvula; grayish color; ulcerate; fever, anorexia, sore throat; nurseries/schools

Front 55

Coxsackievirus- Hand, foot, and mouth

Back 55

"A and B"; A16**; children, sore throat;vesicles hard palate, buccal mucosa, hands and heel margins; last 1 week; 1-10yo

Front 56

Coxsackievirus- Aseptic meningitis

Back 56

school age kids; self-limiting; fever, headache, nausea, stiff neck; erythematous rash; caused by "A and B" and Echo

Front 57

Coxsackievirus- Pleurodynia

Back 57

devils grip; mostly "B"; abrupt fever; abdominal and chest pain;sudden onset; prodrome; recovery complete

Front 58

Coxsackievirus- Pericarditis and Myocarditis

Back 58

mostly "B"; older children and adults; fever precordial pain, arrythmias; severity pericarditis-> fatal heart failure; mimics MI; has neonatal form

Front 59

Coxsackievirus- Pathology (Cardiac)

Back 59

enters cardiomyocytes and macrphages; replication inside kills cells; viral proteases- cause contractility prob. and fibrosis; causes autoimmune response;

Front 60

Coxsackievirus- Tx and Prevention

Back 60

fecal-oral-> hand washing; sanitation; supportive care; no specific Tx; analgesics for myocarditis;

Front 61

Rhinovirus- General

Back 61

mild self-limiting; "common cold"; 115 diff. serotypes; vary by geographic locale; acid labile; NOT in GI tract; cooler upper respiratory tract; non-enveloped; very stable to environment

Front 62

Rhinovirus- Transmission

Back 62

early fall/ late spring; return to school; respiratory droplets; fomites; high in household contacts

Front 63

Rhinovirus- Pathogenesis

Back 63

targets ciliated epithelium; replication in nose; runny nose-virus shedding; interferon helps recovery; can spread secondarily to get otitis media and sinusitis

Front 64

Rhinovirus- Symptoms

Back 64

mild self-limiting; clear watery nasal discharge; cough/sneezing; sore throat; peaks 2-3 days; recovery: 1-2 weeks; hard to distinguish b/t other cold viruses

Front 65

Rhinovirus- Tx

Back 65

good infection control; hand washing; no anti-virals used; vit C/herbals not beneficial

Front 66

Paramyxovirus- General

Back 66

non-segmented negative ssRNA; helical capsid; envelop- lipid (host plasma mem.), 2 peplomers: F prot.- allows fusion b/t infected and its neighboring cells; HN prot- hemagglutinating and neurominidase

Front 67

Morbillivirus- Transmission

Back 67

humans only host; winter/ spring; temperate climate; children; 2-3yr cycles; highly** contagious; coughing during prodrome; respiratory droplets

Front 68

Morbillivirus "measles"- Pathogenesis

Back 68

replicated in mucosal epithelium; goes to lymph nodes; get 1' viremia; disseminates; lymphoid hyperplasia- giant cells; rash; syncytium- b/t infected and adjacent

Front 69

Morbillivirus- Symptoms

Back 69

Measles; prodrome; cough/ coryza; conjunctivitis; fever; Koplik's Spots**- red spots with bluish-white specks on buccal mucosa; macular/ blotchy rash- neck to chest, trunk, and limbs

Front 70

Morbillivirus- Complications

Back 70

tracheobronchitis; encephalitis- confusion, seizures, and coma; subacute sclerosing panencephalitis**- (myoclonus, personality changes, focal neurologic defic., memory loss) years to decades after infection

Front 71

Morbillivirus- Dx

Back 71

reportable disease; physical and history; cough, rash, conjuctivitis

Front 72

Morbillivirus- Tx

Back 72

no specific Tx; manage symptoms, post-exposure passive immunity; vaccine (MMR); no assoc. with autism

Front 73

Parainfluenza- Transmission

Back 73

direct contact; respiratory droplets;

Front 74

Parainfluenza- Pathogenesis

Back 74

infect respiratory epithelium; nose and pharnyx; Type 1,2 - croup (larynx, upper trachea); Type 3 severe illness- bronchopneumo; no persistent immunity;

Front 75

Parainfluenza- Symptoms

Back 75

children; rhinitis, pharyngitis, bronchitis; croup- barking nonproductive cough; bronchiolitis or pneumo- fever, productive cough; infants- wheezing, dyspnea, hypoxia

Front 76

Parainfluenza- Tx

Back 76

supportive care; maintain airway; cool mist therapy; some intubation;

Front 77

Pneumovirus (RSV)- General

Back 77

human respiratory syncytial v. (RSV); no H/N factor; bronchiolitis/pneumo in infants <6mo; temperate climates; household contacts; nosocomial; sometimes need hospitalization;

Front 78

RSV - Pathogenesis

Back 78

generally localized; ciliated mucosal cells; nose, eyes, mouth; shed in respiratory secretions;

Front 79

RSV- Symptoms

Back 79

Bronchiolitis- lower resp. tract, severe necrotic lesions, plugging small airways; Pneumonia- infants, necrosis, inflammation, mucous; atelectasis; asthma; sensitization;

Front 80

RSV- Dx

Back 80

suspected in infants w/ lower resp. disease; viral antigen detection on bronchial secretions

Front 81

RSV- Tx

Back 81

supportive care; 02; cool list; Ribavirin reduces severity/duration; no vaccine

Front 82

Rubulasvirus- General

Back 82

childhood diease; 2-3 yr epidemics; man only host; 5-14 yo; close contact; salivary gland secretions

Front 83

Mumps- Pathogenesis

Back 83

systemic infection; spread by viremia; glandular and nervous involved; upper resp.-> lymph nodes-> blood; target organs: parotid, testes, ovaries, brain, pancreas

Front 84

Mumps- Symptoms

Back 84

edematous, painful, enlargement, bilateral parotids; self-limiting;

Front 85

Mumps- Complications

Back 85

orchitis-unilateral, testicular atrophy; meningitis- WBCs in CSF; pancreatitis- diabetic symptoms; oophoritis

Front 86

Mumps- Dx

Back 86

clinical grounds; parotid swelling; orchitis; aseptic meningitis; lacking proper immunizations; serologic/ELIZA

Front 87

Mumps- Tx

Back 87

supportive care; vaccine**;

Front 88

All mammalian adenoviruses

Back 88

Mastadenovirus

Front 89

Adenovirus
Ad1-Ad52
Low #'s generally cause what?
High #'s generally cause what?

Back 89

Lower=respiratory and ocular disease
Higher=GI disease

Front 90

Adenovirus
Non-enveloped so can be spread by?

Back 90

Fecal/Oral

also respiratory aerosol

Front 91

Adenovirus:
Endemic Respiratory Disease
Ad1, Ad2, Ad5

Back 91

common children < 2
fever, sore throat, coryza
self-limiting

Front 92

Adenovirus:
Pharyngoconjuctival Fever
Ad3 and Ad7

Back 92

Swimmer's Eye
Classic Pink Eye

Front 93

Conjuctivitis with sore throat think what?

Back 93

Adenovirus

Front 94

Adenovirus:
Acute Respiratory Disease (ARD)

Back 94

Seen in close quarter living
Military
3-4 days fever, malaise.

Front 95

Adenovirus vaccine serotypes?

Back 95

Ad4, Ad7, Ad21

Front 96

Adenovirus:
Keratoconjuctivitis:
Sporadic Acute Follicular Conjuctivitis

Back 96

Most common eye infection with Adeno
Similar to Pharyngoconjunctival fever (PCF) but WITHOUT sore throat

Front 97

Adenovirus:
Keratoconjuctivitis:
Epidemic Keratoconjuctivitis (EKC)

Back 97

Rare in US
HIGHLY contagious
Pseudomembrane formation
Children in SOUTHEAST ASIA

Front 98

Adenovirus' vaccine is LIVE capsule given of what serotypes?

Back 98

Ad 4, Ad7, Ad21

Front 99

What virus is the smalled of DNA viruses?

Back 99

Parvovirus

Front 100

Parvovirus:
Erythrovirus B19

Back 100

Erythema Infectiosum (5th's Disease)
"Slapped Cheek"
Virus sheds before symptoms appear.
Acute Arthritis
Hydrops fetalis-edema in fetus

Front 101

2 genera of Papovaviridae?

Back 101

1. Papillomavirus-warts
2. Polyomavirus-JC and BK-PML (neuro)

Front 102

What layer of skin does HPV infect?

Back 102

Stratum Germinatrium-basal layer.

Front 103

Papilloma virus is heat stable so must be sterilized by?

Back 103

Steam Sterilized

Front 104

HPV associated with?

Back 104

Cervical Cancer

Sexually transmitted

Front 105

What types of HPV are associated with cervical cancer?

Back 105

HPV 16 and HPV 18!

Front 106

HPV vaccine contains what HPV types?

Back 106

HPV 16, 18, 6, and 11

Front 107

Polyomavirus:
JC and BK associated with what?

Back 107

Progressive Multifocal Leukoencephalopathy (PML)

Front 108

3 Genera for Orthomyxoviridae:

Back 108

Influenzavirus A
Influenzavirus B
Influenzavirus C

Front 109

Orthomyxoviridae
Type A viruses infect?

Back 109

Infects PEOPLE and some ANIMALS

Front 110

Orthomyxoviridae
Type B and C infect?

Back 110

Only People
Type C is not important

Front 111

Orthomyxoviridae
What important protein decreases the pH inside the virion?

Back 111

M2 protein!

Front 112

Orthomyxoviridae
Hemagglutinin (HA) responsible for what?

Back 112

entry of virus into the cell.

Front 113

Orthomyxoviridae
Neuraminidase (NA) responsible for what?

Back 113

Liquifies mucous in the respiratory tract
allowing the virus easy access to the epithelial cells

Front 114

Orthomyxoviridae
Various subtypes are distinguished primarily by what?

Back 114

their differences in HA molecules
This is responsible for Antigenic Shift

Front 115

The HA in Orthomyxoviridae binds to what?

Back 115

Binds to Sialic Acid and causes membrane fusion.

Front 116

Orthomyxoviridae
TYPE A
What 3 combinations of HA and NA have been found to circulate in humans?

Back 116

H1N1, H2N2, H3N2

Front 117

What HA are asscociated with human disease?

Back 117

H1, H2, H3

Front 118

When is Antigenic Drift occuring with the Flu Virus?

Back 118

Constantly!
This is why we have flu outbreaks each year

Front 119

SEASONAL FLU
Influenza virus A

Back 119

In individuals who live in close proximity to domesticated animals.
Usualy begins in Southeast Asia and China

Front 120

Who is at greatest risk for Seasonal Flu?

Back 120

Elderly

BUT, children are most likely to develop the virus

Front 121

Seasonal Flu
How does it spread?

Back 121

Through inhalation of respiratory droplets.

Infects ciliated columnar epithelial cells.

Front 122

What symptom is Seasonal Flu characterized by?

Back 122

Abrupt onset of fever.
Headache, Sore throat, Non productive cough, tired
BUT NO Runny Nose (Coryza)

Front 123

What is someone who has flu more succeptible to?

Back 123

Bacterial Pneumonia (Strep Pneu, or Staph Aureus)

Front 124

Don't give children this if they have Influenza A, and mostly B?

Back 124

Aspirin!

Reye's Syndrome

Front 125

Give this Neurominidase inhibitor if the patient is over 12 and has been symptomatic for < 2 days?

Back 125

Zanamivir (Relenza)
Inhalant!

Front 126

Give this Neurominidase inhibitor if the patient is over 18 and has been symptomatic < 2 days?

Back 126

Oseltamivir (Tamiflu)
Give Orally!

Front 127

Antiviral treatment for Seasonal Flu?
What are they used to treat?

Back 127

Amantadine and rimantadine

TYPE A, don't work against Type B.

Front 128

Two genera of Togaviridae

Back 128

Alphavirus - arboviruses (transmitted by insects)

Rubivirus - Rubella virus is only member of this species. "German Measles"

Front 129

Togaviridae Structural characteristics

Back 129

positive single stranded RNA (10-12 kb)

Icosahedral capsid made of only one protein

Surrounded by tight lipid envelop (E1 and E2) - Attachment and fusion

Front 130

Rubella virus - epidemiology

Back 130

Less contagious/low risk of spread

Appears as mild measles - acute febrile illness with rash and lymphadenopathy

Man is natural host

Congenital Rubella Syndrome - leads to defects

Front 131

Rubella virus - pathogenesis

Back 131

Respiratory Aerosol

16 day incubation

Day 7 -viremia occurs until antibody forms

Prodrome - anorexia, conjunctivitis, HA, low fever, malaise and mild respiratory symptoms

Prominent lymphadenopathy in auricular, posterior cervical, and suboccipital nodes

Pink maculopapular rash - "Runs out the feet"

Front 132

Rubella virus - complications

Back 132

Poly arthralgia/ polyarthritis - adult females, up to 2 weeks, self limiting

Thrombocytopenia Purpura - transient, mild asymtomatic depression of platelets. Self limiting

Encephalitis - 2 forms - Post-infection - 1-7 days post rash. HA, fever, stiff neck. Most recover w/no sequalae

Progressive Rubella Panencephalitis (PRPE) - Very rare, years later. Neurologic decline to death. Most likely seen with CRS

Front 133

Why doesn't the Antiviral for Seasonal Flu work against Type B?

Back 133

Because the drugs block the M2 ion channel. Type B doesn't have M2 protein.

Front 134

Do not give Antivirals for Seasonal Flu to whom?

Back 134

PREGNANT WOMEN

Front 135

TIV-Trivalent Inactivated Vaccine conatains what viruses?

Back 135

H3N2 and H1N1 and one Type B strain
For anyone who is at high risk for flu
give IM
Can't get flu from this!

Front 136

LAIV-Live attenuated strains

Back 136

only replicates in cooler regiosn of resp. tract.
Intranasal Spray
May cause MILD SYMPTOMS
2-49

Front 137

What strain was the Avian Bird flu?

Back 137

H5N1-very rare! But really BAD if happens

Front 138

NOVEL H1N1-Swine Flu
Who is at most risk?

Back 138

5-24 years old

Front 139

Rhabdovirus- General

Back 139

bullet shaped; ss (-) RNA; helical capsid; enveloped- peplomers, glycoprotein G

Front 140

Rabies- Transmission

Back 140

warm-blooded animals; bite or scratch of rabid animal; in saliva; always fatal untreated; rural areas; common host: skunks, raccoon, bats; diverse reservoir

Front 141

Rabies- Pathogenesis

Back 141

replication in muscle at site; long incubation 14-90; neurotropic- peripheral to CNS quickly; spreads back 2' salivary glands;

Front 142

Rabies- Symptoms

Back 142

encephalitis; aggressive behavior; Negri bodies; prodrome; mood changes; paresthesia- at bite site

Front 143

Rabies- 2 Clinical forms; (Furious vs. Dumb)

Back 143

Furious (fulminant)- hydrophobia, seizures, hallucinations, mood swings, inc. heart rate, coma, cardiac arrest;
Dumb(paralytic)- less common; flaccid paralysis; resp. paralysis;

Front 144

Rubella virus - Dx and Tx

Back 144

ID of Antibodies to Rubella virus in serum

No Tx. Tx symptoms and comfort pt.

Vaccine!! 95% effective. Don't give to pregnant women!

Front 145

Congenital Rubella Syndrome (CRS) - Prebirth signs

Back 145

Occurs during pregnancy. Varying outcomes based on contraction time. Blueberry Muffin Babies. 20% mortality prebirth.

Prior to 8 weeks - Heart and Eyes

Up to 18 weeks - Brain and Ear

After 18 weeks - Less Frequent abnormalities

Front 146

Congenital Rubella Syndrome - Post Birth signs and symptoms

Back 146

Deafness, cataracts, cardiac abnormalities, Thrombocytopenic purpura.

50 fold increase risk for diabetes

Risk of Progressive Rubella Panencephalitis

Front 147

Rabies- Dx

Back 147

clinical findings; skin biopsy; RT-PCR; quarantine animal; post-mortem brain analysis

Front 148

Rabies- Tx

Back 148

clean wound; irrigate w/ HRIG; give remaining HRIG IM injection; vaccination series of inactivated vaccine- away from site of injury; prophylactic tx of at risk groups;

Front 149

Congenital Rubella Syndrome (CRS) - Common Transient Manifestations

Back 149

Thrombocytopenia purpura (Blueberry muffin appearance)
Hepatospenomegaly, meningoencephalitis, bone lesions, large anterior fontanelles, Intrauterine growth retardation

Front 150

Congenital Rubella Syndrome (CRS)- Common Permanent Manifestations

Back 150

Bilateral or unilateral sensorineural deafness - VERY COMMON

Congential heart disease - Patent ductus arteriosus, pulmonary artery stenosis, aortic valvular stenosis, pulmonary valvular stenosis
Central language defects, mental retardation, cataracts, microphtalmia, permanent retinopathy

Front 151

Congenital Rubella Syndrome (CRS) - Developmental and Late Developing Manifestations

Back 151

Behavior disorders

Mental Retardation

Insulin dependent diabetes mellitus

Front 152

Congenital Rubella Syndrome (CRS) - Dx

Back 152

Pregnant women with contact of rubella should be checked for rising titer

Baby born from suspecting mother should be checked for virus and serum IgM antibodies and symptoms

Front 153

Congenital Rubella Syndrome (CRS) - Tx

Back 153

Definite diagnosis prior to 10 weeks of pregnancy - "Therapeutic Termination"

No Treatment, treat symptoms.

Vaccine!! Live attenuated rubella vaccine. Not recommended for women during pregnancy.

Front 154

Alphavirus - epidemiology

Back 154

Typically transmitted by mosquitos.

Temperate climates - summertime only

Three varieties - EEE (eastern), WEE (western), VEE (south)

Well known variety - West Nile Virus

Front 155

Alphavirus - pathogenesis and disease

Back 155

Female mosquito injects saliva containing virus. 3-7 day incubation.

Replicates locally in macrophages; then viremia ensues. Febrile response.

Leads to myositis, arthritis, rash, encephalitis

Front 156

EEE

Back 156

Eastern US, Canada, Central and South America and in Carribbean.

Loves capillary endothelial cells in the brain

80% severe case fatality rate.

Most deadly mosquito disease in the USA.

Front 157

WEE and VEE

Back 157

WEE - parkinsonism possible with tremor

Both have 10-20% fatility with severe cases.

Front 158

Alphavirus - Dx and Tx

Back 158

Immunoassay for IgM - good in first 2 weeks

Look for Antibodies

Care is supportive and relieve symptoms

No vaccines. Avoid mosquitos and kill their habitats

Front 159

Coronaviridae - general structure, etc

Back 159

Only mild infections in humans

Club shaped peplomers

Sun surrounded by solar corona

Nasal epithelial and do not spread to blood

positive single stranded RNA (mRNA), Helical capsid, Enveloped

Front 160

Coronaviridae - epidemiology

Back 160

25% of common cold associated

Respiratory aerosolized or hands infect eyes or nose

Immunity is strain specific and short lived. Cyclic.

All ages affected

Front 161

Coronaviridae - pathogenesis

Back 161

Mild URI

Replicates locally in cilliated epithelium. Release of inflammatory mediators cause symptoms.

Some strains come out in feces and could cause diarrhea and gastroenteritis

Front 162

Coronaviridae - disease

Back 162

Acute URI - second to Rhinovirus in common cold

Incubate 3 days, then nasal discharge. Gone in 1 week.

Front 163

Coronaviridae - Dx and Tx

Back 163

No differential is required. Disease mild. No Tx. Just supportive care.

Front 164

Coraviridae - asides..

Back 164

Found in brain tissue of MS patients - No relationship known yet.

SARS - 2002
Started in Hong Kong. Went worldwide and disappeared.