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141 Cards in this Set
- Front
- Back
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List all the infections due to the herpes virus.
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-herpes simplex
-varicella zoster virus -EBV -CMV -roseola (HHV 6 > 7> Echo-16) -HHV- 6,7,8 |
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what is the general pathogenesis of VZV, CMV, and HSV?
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-primary infection
-latency -reactivation |
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List the primary infections of VZV, CMV, and HSV.
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VZV: varicella (chicken pox)
HSV: --oral mucocutaneous disease --genital ulcer disease --encephalitis CMV: --mononucleosis-like viral illness, other clinical ilness |
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list the reactivations of VZV, CMV, and HSV.
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-VZV: shingles
-HSV: REcurrent mucocutaenous lesions and recurrent genital ulcer disease -CMV: intermittent viral excretion, symptoms? |
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list the clinical manifestations of HSV in healthy individuals.
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-primary gingivostomatitis
-genital ulcer disease -neonatal herpres -encephalitis -eczema herpeticum -keratoconjunctivitis -herpes whitlow |
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ToF: HSV encephalitis will have skin lesions
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false!
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what is the most common cause of encephalitis in the US?
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HSV
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what can keratoconjunctivis lead to?
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blinding if the cornea is involved
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In primary gingivostomatitis, HSV 1 is responsible for __% of the cases and HSV 2 are responsible for __%
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90; 10
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what is the incubation period for primary gingivostomatitis?
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2 days to 2 weeks
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list the clinical symptoms of primary gingivostomatitis.
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-fever, irritability, ulcers/gingiva, mucosa: autoinoculation
-inability to eat -- pain, dehydration -adenopathy -virus shedding: high titier, 1-2 weeks, then intermittently |
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ToF: HSV can shedding only occurs when symptomatic
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false
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where do most lesions of primary gingivostomatitis occur?
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in front of mouth, lips and gingiva
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what can occur on the gums in gingivostomatitis?
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hypertrophy and erythema
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what will occur if a herpes whitlow lesion is cut and draines?>
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clear liquid will be drained and the lesion will not leave
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What is the most common form of encephalitis caused by HSV?
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necrotizing hemorrhagic encephalitis
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HSV encephalitis most common occurs in the ___ lobe, except in ___ where it is diffuse.
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temporal; neonates
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Which form of HSV is the most common cause of encephalitits? THis is not the case in which group?
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HSV1; not in neonates
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ToF: hsv encephalitis can be caused from primary or recurrent disease
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true
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what are the symptoms of HSV encephalitis?
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-acute onset of fever, altered state of consciousness
-personality changes, convulsions -focal neurological changes -coma or death if untreated |
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how many hours after rupture of membranes is the maximum before delivery in a mother with HSV?
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4 hours
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what is a symptom of type I HSV on the cervix?
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mother usually wouldn't know she is having an outbreak, but may complain of urinary retention
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Neonatal herpes is usually associated with primary maternal genital herpes (HSV ___)
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2
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there is a <___% risk of neonatal herpes with type I?
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5
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ToF: intrauterine infection of HSV is very common
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false: rare
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ToF: premature birth is often associated with neonatal herpes
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true
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when does neonatal herpes usually present?
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late in the 1st week or 2nd week of life up to 4-6 weeks age
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What are the types of neonatal herpes?
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-SEM
-central nervous system disease without involvement of other organ systems -generals disseminated disease and disseminated disease with CNS involvement |
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what is SEM?
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Skin, eyes, and mouth disease:
--vesicular lesions in areas of trauma (occuput, umbilicus, etc ) --eye: conjunctivitis, keratitis, chorioretinitis --up to 30% may disseminate |
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Tof: we usually don't treat SEM HSV with antiviral because the outbreak goes away on its own.
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false: we do treat because 30% become disseminated
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which form of HSV has high morbidity and mortality is untreated and often has recurrent skin and CNS reactivation?
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generalized disseminated disease and with CNS involvement
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what are the triggers for HSV 1 and 2?
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stress, UV light, menses
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what does the prodrome stage of HSV 1 and 2 often feel like
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tingling
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where do the less extensive lesions of HSV often occur?
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oral lesions only on the vermilion border
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when is viral shedding for HSV at its highest?
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in 1st 24 hours, low titer for <5 days
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what are the forms of HSV in immunocompromised patients?
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-gingivostomatitis
-genital herpes -keratoconjunctivitis -cutaneous herpes -esophagitis -pneumonitis -hepatitis -disseminated disease |
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If a person has varicella lesions for > 7 days, what is this a sign of?
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immunocompromised state
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what is the incubation period for chicken pox in health children?
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12-21 days
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what are the prodromal symptoms of the chicken pox?
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prodromal fever, irritability
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what is the sequence of progression of the lesions of varicella?
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papules --> vesicles --> pustules --> crusting
all states occuring at the same time |
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how long do the lesions of varicella tend to last? how long does crusting last?
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lesions: 3-7 days
crusting: 1-2 weeks |
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what is the mean number of lesions in varicella?
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300
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ToF: scarring always occurs with varicella?
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false: only with secondary infection
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what are the severe complications of varicella?
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-cerebral ataxia, encephalitis
-arthritis, hepatitis -hemorrhagic varicella -invasive group a strep infections -reye's syndrome (aspirin) |
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how many hospitalizatins and deaths from varicella occured before vaccination?
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Hosp> 10,000
death: 50-100 |
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how many cases of cerebellar ataxia and encephalitis occur each year due to chicken pox?
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CA: 1/4000
Encep: 1/50,000 |
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if an immunocompromised patient gets shingles, what might be seen?
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diffuse vesicles along with the dermatone region
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which groups often get severe chicken pox?
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-HIV
-leukemia, other malignancies -transplant -immunocompromised -systemic steroids |
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which group has been seen to get recurrent chicken pox?
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HIV
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which groups have been found to have increased frequency and severity of zoster?
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-hodgekins disease, malignancies, transplant (especially BM)
-radiation and chemo -HIV (especially CD4 < 15% at time of chicken pox) |
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what lung complication can occur from varicella in immunocompromised patients?
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viral pneumonia
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what often occurs with EBV in africa?
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leads to Burkitts lymphoma
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what is an assessment consistent with diphtheria?
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grey/necrotic looking tonsils
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what is the incubation period for EBV?
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30-50 days
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what are some of the symptoms of EBV?
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fever, non-specific illness in infants ad young children,
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Tof: there are specific treatments and vaccines available for EBV
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false to both
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what are the complications of EBV?
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-rash with amp
-splenic rupture -aplastic anemia -severe headache/encephalitis/ aseptic meningitis -X-lined lymphoproliferative disorder -PTLD -burkitt's lymphona -undifferentiated CNS B cell lymphomas/ AIDS -nasopharyngeal carcinoma |
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what type of lymphoma is PTLD? can it be prevented?
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B cell lymphoma, acyclovir given prophylactically
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what is exanthum subitum?
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roseola; sixth disease
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what are the symptoms of roseola?
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high fever for 3-5 days follow by lacy rash
-rash occurs on trunk, neck, face and proximal extremitis, fades in 1-3 days |
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what organism is most responsible for roseola? what are the other ones?
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HHV-6
others HHV-7 and Echovirus 16 |
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__% of the cases of roseola occur before age 2
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80
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what are some of the complications of roseola?
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-febrile seizures
-encephalitis? |
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what are some of the thought of symptoms of reactivation of roseola?
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-fever, hepatitis, bone marrow suppression, pneumonia, encephalitis
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what type of virus causes measles?
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RNA virus (paramyxovirus family)
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ToF: measles is highly contagious?
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true
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what is the incubation period for measles?
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8-12 days
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list the clinical symptoms of the measles.
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-coryza
-conjunctivitis -cough -koplik spots -rash that starts on the face and goes down |
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what treatment may be effective for the measles?
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riboviran
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list the complications of the measles.
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-AOM
-bronchopneumonia/larygnotracheobronchitis -diarrhea -encephalitis with brain damage -death due to encephalitis or resp complications -subactue sclerosing panencephalitis |
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what are the situations in which the mortality and morbidity of the measles is at its highest?
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in malnutrition, Vit A deficiency and immunocompromised
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What is the rash of the measles? does it get worse or less noticeable with immunocompromised patients?
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-rash occurs as an immune response to the infection, therefore in immunocompromised patients, the rash may not appear at all
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what occurs on the skin during the recovery phase of the measles?
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desquamations
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as the rash of the measles moves down the body, how does the rash higher up appear?
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as a confluent rash
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What happens to the lesions of varicella in an immunecompromised patient? ie do they get more or less obvious?
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MORE!!!
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Describe the rash of rubella.
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it starts on the face and moves down the body, but unlike measles, as it moves down the rash above will begin to clear
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what disease other than measles has rash and conjunctivitis?
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rubella
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what is a tale-tell sign of rubella?
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posterior auricular lymph nodes
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when is the risk of congenital rubella at its highest?
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1st and 2nd trimester
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what are the SxS of congenital rubella?
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-congenital heart disease
-deafness and mental retardation -cataracts, glaucoma, microphthalmia, chorioretinitis -low birth weight -purpura -BLUEBERRY MUFFIN RASH! |
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what is the biggest concern with a mumps infeciton?
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aseptic meningitis
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what family of viruses does the mumps come from?
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paramyxovirus family
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how is the mumps contracted?
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direct contact with respiratory secretion
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the incubation period of the mumps is __ to __ days
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16-18
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what are the symptoms of the mumps?
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parotitis, orchitis, aseptic meningitis
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what areas is polio still an issue?
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afganistan, nigeria, and pakistan
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what virus family does polio come from?
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enterovirus
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Most polio infections are > ___% asymptomatic
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95
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what is the most common symptom of polio
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gastrointestinal symptoms
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ToF; paralysis is a common occurance in polio infections?
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false! only 0.1-2% and 1/250 have residual paralysis
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4-8% of polio cases have which symptoms?
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non-specific illness with fever and sore throat
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why does paralysis occur in polio?
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infection of the anterior horn cell and muscle fibers causing loss of innervation.
and then loss of residual muscle fibers with age |
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what are the non-polio enteroviruses?
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-group A coxsackie
-group B coxsackie -echoviruses -4 enteroviruses 1-4 |
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how many types of Group A coxsackie are there?
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23: labeled 1-24 but skipping number 23
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ToF: paralysis can occur with non-polio enterviruses?
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true
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what are the respiratory infections caused by non-polio enteroviral infections?
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-herpangina
-coryza -pharyngitis -LTB/bronchitis -pleurodynia |
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what are the gastrointestinal symptoms of non-polio entero?
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-vomiting/diarrhea
-hepatits, pancreatitis -necrotizing enterocolitis |
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What is the most common disease related need for heart transplant?
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myo or pericarditis caused from non-polio enteroviral family ie Cox B 1-5
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what is the common virus causing hand foot and mouth disease?
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Cox A16; enterovirus 71
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what non-polio enterovirus is the cause of actue hemorrhagic conjunctivitis?
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Cox A24v: enterovirus 70
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what is erythema infectuosum?
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fifth disease; parvovirus
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What type of virus is parvovirus?
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DNA virus
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what are the symptoms of parvovirus?
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fever followed by rash in children; arthritis and arthralgia in adults with a characteristic slapped cheek appearance
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what can occur with a fetal infection/during the 1st half of pregnancy of parvovirus?
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hydrops fetalis in 2-6%
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what group of individual, if they get parvovirus are at high risk?
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pregnancy --> neonate
and sickle cell: aplastic anemia crisis |
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what is the rash of scarlet fever?
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sandpaper: occurs from the hypertophy of the hair folliclces and actually feels like sandpaper
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what are the symptoms of scarlet fevers?
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-sandpaper rash
-strawberry tongue -fever -sore throat -pastia's lines -beau's lines: on the nails that occurs several weeks post scarlet fever |
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what is the treatment for scarlet fever?
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penicillin
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ToF: epidemics of scarlet fever have been found to decrease the rate of rhuematic fever cases
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false increase it
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what has been found to decrease the prevalence of rhuematic fever secondary to GAS?
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McDonald's effect: developed countries that eat more meat have less prevalence of rheumatic fever post GAS
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what are the post streptococcal suppurative complications of GAS?
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-rheumatic fever: after pharyngitis, type 5 M-protein strains
-post-strep glomerulonephritis --after impetigo or pharyngitis --nephritogenic strains |
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ToF: MRSA is more virilant than MSSA
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false
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what did MRSA occur?
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introduction of mecA genes (I-V) into MSSA
it altered the penicillin binding proteins (PBP-2a or -20) became resistant to methicillin and all other b-lactam antibiotics |
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what is the definition of CA-MRSA?
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-cultured from outpatients or hospitalized patients within 72 hours of admission
-no exposure to healthcare facility in the last year -resistant to 2 or fewer classes of antibiotics -SCCmec type or pulsed-field gel electrophoresis type |
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ToF: infants with pertussis have the characteristic whoop?
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false; they do not have the muscle strength to whoop
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what is the organism to cause pertussis?
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Bordetalla pertussis
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what are the 3 stages of pertussis?
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-catarrhal
-paroxysmal: whoop comes in -convalescent |
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what are the complications of pertussis?
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-FTT
-secondary pneumonia -AOM -cerebral hemorrhage -convulsions -transient hemiplegia -encephalopathy -death |
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what is the early treatment for pertussis?
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erythromycin: only decreases the contagiability
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what is an antigenic drift?
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due to frequent point mutations during replication in a subtype
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what is an appearance of a "new" subtype after genetic reassortment of a disease?
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antigenic shift
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what are the two types of influenza B?
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Yamagata and victoria lineages
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what are the SxS of influenza?
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abrupt onset of non-productive cough, fever, maylgia, headache, sore throat and runny nose for 3-7days
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what are the symptoms of influenza that are often seen in children?
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AOM; N/V
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influenza virus sheds in respiratory secretions: __ to __ days prior to symptoms to __ days after
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1-2; 10
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what are the complications of influenza?
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pneumonia with secondary bacterial infection; febrile seizure, encephalitis; transverse myelitis; myocarditis
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what are the antivirals that can be used for influenza A?
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-amantidine and rimantidine
-oseltamavir and zanamivir |
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what are the antivirals that can tx influenza B?
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-oseltamavir and zanamivir
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which influenza strains tend to switch in the middle of the season?
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B strains
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which virus has been known to cause explosive diarrhea in children?
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rotavirus
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what is the transmission of CMV?
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-contact with infected salivary, urine, cervical secretions, semen
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what are the situations when cmv is transmitted in health individuals?
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-daycare centers
-infusion and transplant recipients -reactivation/latent virus in seropsitive immunocompromised patients |
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ToF: the incubation period for CMV in healthy individuals is 2 months
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false: it is unknown
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when do the clinical symptoms of CMV occur in healthy individuals?
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usually 3-12 weeks after blood transfusion and 4 weeks to 4 months after organ transplant
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what are the clinical manifestations of CMV in healthy individuals?
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-mono-like syndrome
-fever, malaise -adenopathy, splenomegaly, pharyngitis -mild hepatitis, heterophile negative, atypical lymphocytosis |
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what are the rare complications of cmv?
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guillain-barre, granulomatous hepatitis, meningeoencephalitis, myocarditis
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ToF: the primary infection of CMV is more severe than the reactivation in persons infected after the onset of immunosuppression
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false! PRIOR TO THE ONSET
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what transplants have the highes morbidity and mortality when CMV occurs?
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BM, liver, heart, heart-lung vs renal.
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what is correspond to the mucocutaneous lesions of HSV?
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neurons of sensory ganglia
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what population has the highest rate of shingles?
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15-30% of population by 80 years old
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what are the clinical manifestations of CMV in AIDS patients?
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-chorioretinitis
-colitis -menngoencephalitis -pneumonitis |
