163 - Exanthematous Viral Diseases Flashcards
1
Q
Prodrome of fever, cough, coryza and conjunctivitis
A
Measles
2
Q
_____ spots are pathognomonic of measles
A
Koplik
3
Q
Measles virus is a highly contagious, single-stranded, enveloped RNA virus that is a member of the _____ family
A
Paramyxoviridae
4
Q
Y/N: Humans are the only natural hosts of measles
A
Yes
5
Q
Koplik spots are tiny white lesions – “_____” – surrounded by an erythematous halo
A
Grains of sand
6
Q
Koplik spots are typically found on
A
Buccal mucosa near the second molars
7
Q
Koplik spots typically occur _____ and only last _____
A
48 hours prior to the onset of rash
12 to 72 hours
8
Q
Measles exanthem begins on the
A
Forehead and behind the ears
9
Q
Viral detection of measles via PCR is most successful when collection occurs within
A
3 days of the rash’s onset
10
Q
Measles IgM is typically positive on the first day of the rash and remains positive for at least _____ afterward
A
30 days
11
Q
Y/N: Within the first 72 hours of the rash, measles IgM assay may be falsely negative
A
Yes
12
Q
Measles is considered contagious
A
5 days prior to the onset of the rash until 4 days after the onset of the rash
13
Q
Most measles deaths are attributed to
A
Respiratory illness or
Encephalitis
14
Q
The WHO recommends that _____ should be administered to all children with measles regardless of their country of residence
A
Vitamin A
15
Q
Vitamin A dosage for measles
A
200,000 IU per day or
100,000 IU per day for infants
on 2 consecutive days
16
Q
Antiviral medication that has been used in children with severe measles disease or an immunocompromised state
A
Ribavirin
17
Q
Individuals at risk of severe illness and complications
A
Infants younger than 1 year of age
Pregnant women
Unimmunized
Immunocompromised
18
Q
Individuals at risk of severe illness and complications should be given measles immunoglobulin if presenting within _____ of exposure
A
6 days
19
Q
Measles immunoglobulin dosage
A
IM - 0.5 mL/kg; maximum dose: 15 mL
IV - 400 mg/kg
20
Q
In healthy individuals, the _____ should be given to boost immunity if it can be administered within 72h hours of measles exposure
A
Measles-mumps-rubella vaccine
21
Q
Measles vaccine administration
A
At 12 to 15 months
Prior to school entry, between 4 and 6 years old
22
Q
Enveloped positive-stranded RNA virus in the Togaviridae family
A
Rubella
23
Q
Rubella-infected individuals shed virus for
A
5 to 7 days before and up to 14 days after onset of rash
24
Q
Risk of transplacental infection is greatest to a fetus exposed to the virus in the
A
First trimester
25
Congenitally infected infants may shed the virus through urine, blood, and nasopharyngeal secretions for up to _____ after birth
12 months
26
Individuals at risk of severe illness and complications should be given measles immunoglobulin if presenting within _____ of exposure
6 days
27
Measles immunoglobulin dosage
IM - 0.5 mL/kg; maximum dose: 15 mL
| IV - 400 mg/kg
28
In healthy individuals, the _____ should be given to boost immunity if it can be administered within 72h hours of measles exposure
Measles-mumps-rubella vaccine
29
Measles vaccine administration
At 12 to 15 months
| Prior to school entry, between 4 and 6 years old
30
Enveloped positive-stranded RNA virus in the Togaviridae family
Rubella
31
Rubella-infected individuals shed virus for
5 to 7 days before and up to 14 days after onset of rash
32
Risk of transplacental infection with rubella is greatest to a fetus exposed to the virus in the
First trimester
33
Rubella-specific IgM antibody can be detected up to
8 weeks after infection
34
As the rubella prodrome resolves and the rash begins to appear, some patients develop an enanthem consisting of tiny red macules on the soft palate and uvula
Forchheimer spots
35
Y/N: Forchheimer spots is diagnostic for rubella
No - not diagnostic
36
The rash of rubella usually begins to disappear in
2 to 3 days
37
Lymphadenopathy in rubella is usually most severe in the
Posterior cervical, suboccipital, and postauricular lymph nodes
38
Lymphadenopathy in rubella is noted up to _____ before the rash appears
7 days
39
Adults, particularly women (up to 70%), may develop _____ with rubella infection
Arthritis of small and large joints
40
Joint symptoms in rubella often first appear
As the rash fades
41
Rubella-specific IgM antibody can be detected up to
8 weeks after infection
42
Neonatal manifestations of congenital rubella infection
```
Growth retardation
Interstitial pneumonitis
Radiolucent bone disease
Hepatosplenomegaly
Thrombocytopenia
Dermal erythropoiesis ("blueberry muffin lesions")
```
43
Rubella IgM antibody can be detected from _____ to _____
Birth
| 1 month of age
44
The B19 virus belongs to the family Parvoviridae and the genus
Erythrovirus
45
Limited data indicate that _____ as postexposure prophylaxis for rubella-susceptible patients may decrease infection, viral shedding, and rate of viremia
IM immunoglobulin (0.55 mL/kg)
46
Contact isolation is recommended for infants with rubella until they are at least ____ old or repeated cultures are negative after _____ of age
12 months
| 3 months
47
It is imperative that individuals at risk for rubella infection are immunized, such as
Health care workers
Military recruits
College students
Recent immigrants
48
Receptor of parvovirus
Blood group P antigen (globoside)
49
Pruritic erythema, edema, and petechiae of the hands and feet, fever and oral erosions in adolescents
Papular purpuric gloves-and-socks syndrome
50
Persons with erythema infectiosum are infectious
Only before the onset of the rash
51
Causative agent of erythema infectiosum and papular purpuric gloves-and-socks syndrome
Parvovirus B19
52
Smallest single-stranded DNA-containing virus known to infect humans
Lacks an envelope and contains single-stranded DNA
Parvovirus B19
53
Y/N: Animal parvoviruses are thought to be transmissible to humans
No - not thought to be transmissible
54
The more serious manifestations of parvovirus infection relate to the fact that the virus infects and lyses
Erythroid progenitor cells
55
Receptor of parvovirus
Blood group P antigen (globoside)
56
Y/N: Most infections caused by B19 in children are asymptomatic and unrecognized
Yes
57
Most common clinical picture associated with parvovirus B19
Fifth disease
58
Fifth disease eruption typically lasts
5 to 9 days
59
Parvovirus B19 IgM can be detected within _____ and is present for up to _____ in many cases
A few days after onset of illness
| 6 months
60
Primary manifestation of B19 viral infection in adults
Acute arthropathy
61
Acute arthrophathy in adults occurs mainly in _____ and affects the _____
Women
| Knees and small joints of the hands
62
The constitutional symptoms of parvovirus B19 are usually (less/more) severe in adults than in children
More
63
Chronic anemia B19 usually resolves if treated with
IV gamma-globulin
64
Papular purpuric gloves-and-socks syndrome seems to affect
Teenagers and adults
65
May be necessary in transient aplastic crisis, and most patients recover in week
Red blood cell transfusion
66
Parvovirus B19 IgM can be detected within _____ and is present for up to _____ in many cases
A few days after onset of illness
| 6 months
67
Parvorirus B19 IgG can be identified by the _____ of illness and lasts for _____
Seventh day
| Years
68
Considered the test of choice in an immunocompromised patient, and to confirm fetal infection with parvovirus B19
PCR
69
Caveat to PCR testing in parvovirus B19 infection
DNA fragments may be present for more than a year after infection, however this does not always indicate that the viable virus is present
70
Also known as human herpesvirus 4
| Enveloped, double-stranded DNA virus
Epstein-Barr virus
71
Parvovirus B19 is the most common causes of _____ in patients with chronic hemolytic anemias
Transient aplastic crisis
72
Morbilliform exanthem after primary infection with infectious mononucleosis is most common after administration of
Ampicillin or amoxicillin
73
Most common complication of intrauterine infection with B19
Nonimmune fetal hydrops
74
Approximately _____% of women of childbearing age are immune to parvovirus infection because of prior infection
50
75
Risk factors for early seropositivity with EBV
Lower household income
Parental education level
Uninsured status
Being Mexican American or Black (non-Hispanic)
76
Y/N: Patients with aplastic crisis or immunosuppression with chronic B19 anemia may have high-titer viremia and are particularly infectious
Yes
77
Also known as human herpesvirus 4
Epstein-Barr virus
78
Characterized by the triad of fever, lymphadenopathy, and pharyngitis
Caused by EBV
Infectious mononucleosis
79
Morbilliform exanthem after primary infection with EBV is most common after administration of
Ampicillin or amoxicillin
80
Malignancies associated with EBV
Oral hairy leukoplakia
Nasopharyngeal carcinoma
Kikuchi histiocytic necrotizing lymphadenitis
Certain types of cutaneous T-cell lymphoma
81
EBV is a worldwide pathogen with more than ____% of adults latently infected
90
82
Risk factors for early seropositivity with EBV
Lower household income
Parental education level
Uninsured status
Being Mexican American or Black (non-Hispanic)
83
Type of EBV which is found worldwide
EBV-1
84
Infectious mononucleosis is also referred to as the
"Kissing disease"
85
EBV is typically transmitted via
Saliva
86
After infectious mononucleosis, viral shedding continues for a median duration of
6 months
87
EBV infects B lymphocytes through the binding of the EBV glycoprotein _____ with _____ on the surface of B cells
gp350
| CD21
88
A clonal expansion of _____ allows recovery from primary and reactivation infection and is the source of the atypical lymphocytes associated with EBV infection
Cytotoxic T lymphocytes
89
Inherited immunodeficiencies particularly associated with impaired immune responses to EBV infection
X-linked lymphoproliferative disease
| GATA2 deficiency
90
Most common manifestation of EBV infection in adolescents and adults
Infectious mononucleosis
91
Lymphomatoid granulomatosis requires the initiation of
Chemotherapy
92
Suggestive features of primary EBV infection
Splenomegaly, posterior, as opposed to anterior
Cervical lymphadenopathy
Lymphocytosis with a predominance of atypical lymphocytes (defined as more than 10% of total lymphocytes)
93
Y/N: EBV infection during pregnancy is thought to be teratogenic
No - not thought to be teratogenic
94
Frequently occur in prepubertal or adolescent females and present as painful, multiple ulcers with red-purple ragged edges on the medial or outer surface of the labia minor
Caused by EBV infection
Lipschutz ulcers
95
Hallmarks: natural killer-cell phenotype (expression of CD2, CD56, and cytoplasmic CD3 but lack a surface of CD3), angioinvasion and necrosis
Strongly associated with EBV
Nasal-type extranodal natural killer/T cell lymphoma (ENK/T)
96
EBV-driven T-cell disorder
Development of vesicles, crusting, and varicellifom scarring
Distinguished by systemic symptoms, extensive facial edema, ulcerations and scarring, and lesions located in photoprotected sites
Histopathology reveals a monoclonal proliferation of T cells with a CD8 phenotype
Hydroa vacciniforme-like disease
97
Rare, angioinvasive proliferation of EBV-infected B cells and a reactive, polyclonal T-cell population
Pulmonary involvement is seen in almost all patients
Most often presents in the fourth to sixth decade
Lymphomatoid granulomatosis
98
Lymphomatoid granulomatosis requires the initiation of
Chemotherapy
99
Suggestive features of primary EBV infection
Splenomegaly, posterior, as opposed to anterior
Cervical lymphadenopathy
Lymphocytosis with a predominance of atypical lymphocytes (defined as more than 10% of total lymphocytes)
100
Heterophile antibody test frequently used to confirm infectious mononucleosis in adolescents and adults with classic symptoms because of its rapid turnaroud time and high specificity in the appropriate clinical setting
Monospot test
101
Sensitivity of rapid diagnosis heterophile antibody tests for EBV is approximately _____%
85
102
EBV _____ studies frequently used to monitor for posttransplantation lymphoproliferative disease as trending high viral loads serve as a marker for impending posttransplantation lymphoproliferative disease
Serum PCR
103
Often employed to confirm EBV infection in young children and when a suspicion for EBV infection remains high despite a negative heterophile antibody test
EBV-specific antibodies
104
Host IgM and IgG antibodies form against viral capsid antigen (VCA) and are positive during _____. IgM VCA wanes _____ after clinical illness and IgG VCA remains positive for life
Acute infection
| 3 months
105
EBV nuclear antigen (EBNA) is expressed when _____; consequently IgG to EBNA becomes positive usually _____ after symptoms develop
The virus establishes latency
| 6 to 12 weeks
106
A positive IgM BVA and negative IgG EBNA confirms
Acute infection
107
A positive _____ argues against an acute EBV infection
IgG EBNA
108
IgG to early antigen exists as 2 subsets, anti-D and anti-R. _____ antibodies occur during recent infection and resolve with recovery. The clinical significance of _____ antibodies is not clear
Anti-D
| Anti-R
109
EBV _____ studies frequently used to monitor for posttransplantation lymphoproliferative disease as trending high viral loads serve as a marker for impending posttransplantation lymphoproliferative disease
Serum PCR
110
Monomorphic dome-shaped or flat-topped papules symmetrically distributed on face and extensor extremities
Associated with multiple viral triggers and immunizations
Gianotti-Crosti syndrome
111
Gianotti-Crosti syndrome is also known as
Infantile papular acrodermatitis
| Papular acrodermatitis of childhood
112
Host risk factors associated with GCS
Young age
| History of atopic dermatitis
113
Cutaneous findings in the newborn with congenital HCMV infection
Petechial rash
Jaundice
Blueberry muffin lesions
114
GCS is historically associated with _____ infection, but now more often triggered by _____
Hepatitis B
| Epstein-Barr virus
115
Most common accompanying symptom of GCS
Pruritus
116
GCS usually fades over
10 to 60 days
Might last longer than most rashes associated with viruses
117
Also known as human herpesvirus 5
Human cytomegalovirus
118
Congenital infection with HCMV is a major cause of
Hearing loss
119
Most common congenital viral infection in humans
HCMV
120
Cutaneous findings in the newborn with congenital HCMV infection
Petechial rash
Jaundice
Blueberry muffin lesions
121
Perinatal infection with HCMV is very different from congenital HCMV infection, and is
Without diffuse visceral or CNS involvement
122
Cutaneous findings in perinatal HCMV infection
None
123
Approximately _____% of infectious mononucleosis cases are caused by HCMV`
10
124
Unlike EBV mononucleosis, HCMV-induced mononucleosis patients do not typically have
Pharyngitis and lymphadenopathy
125
HHV-6 primary infection often presents either as _____ or _____
```
Acute febrile illness
Exanthem subitum (roseola infantum, sixth disease)
```
126
Most common cutaneous manifestations of HCMV disease in immunocompromised patients
Perianal and rectal ulceration
127
Gold standard for diagnosis of HCMV infection
Viral culture from blood
128
Can be used to identify primary infection in children younger than 12 months of age as they shed HCMV for longer periods of time
PCR
129
In immunocompromised patients, _____ for CMV is the most widely used test for diagnosis, and monitoring response to treatment
Quantitative nucleic acid amplification testing
130
Characteristic histologic feature of CMV infection
Cytomegalic cells with nuclear inclusions
| Enlarged endothelial cells with large intranuclear inclusions and a clear halo (owl's eye cells)
131
Improves hearing and neurodevelopmental outcomes in patients with symptomatic congenital HCMV infection
Oral valganciclovir
132
HHV-6 primary infection often presents either as _____ or _____
```
Acute febrile illness
Exanthem subitum (roseola infantum, sixth disease)
```
133
HHV-6 is a common viral infection with up to _____% of the population acquiring the infection by 2 years of age
80
134
Primary infection with HHV-6 typically occurs between the ages of
6 months and 2 years when maternal passive immunity wanes
135
HHV-6 primary infection exhibits seasonal variation with the highest incidence in
Spring
136
HHV-(6a/6b) causes ES and reactivates in immunocompromised hosts. It is unclear what diseases, if any, are caused by HHV-(6a/6b)
6b
| 6a
137
HHV-6 preferentially infects
Activated CD4+ T lymphocytes
138
Cellular receptor for HHV-6 infection
Immune regulatory protein CD46
139
HHV-6 transmission occurs via
Shared saliva
140
Hallmark of exanthem subitum
"Rose"-colored macules and papules surrounded by a white halo
141
Exanthem subitum lasts for
3 to 5 days
142
A unique feature of ES is that it presents
1 day before to 1 o 2 days after the fever resolves
As opposed to most viral exanthems where eruptions occur at the onset of the illness
143
Children with ES may also have palpebral edema resulting in a "sleepy" appearance and erythematous papules on the soft palate (_____) that may precede the viral exanthem
Nagayama spots
144
Other diseases associated with HHV-6
Pityriasis rosea
Rosai-Dorfman disease
Drug-induced hypersensitivity syndrome
145
Diagnosis of HHV-7 active infection can only be made from
Acellular material such as CSF, serum, or plasma
Because the virus is latent in peripheral blood mononuclear cells and tissue
146
_____% of ES are caused by HHV-7
10
147
Primary infection with HHV-7 occurs during childhood, but (earlier/later) than, and at a (slower/faster) rate than, infection with HHV-6
Later
| Slower
148
HHV-7 is a member of the _____ family
Beta-Herpesviridae
149
HHV-7 establishes persistent infection in the _____, and transmission is likely through _____
Salivary glands
| Saliva
150
Reactivation of HHV-7 occurs (less/more) often than reactivation of HHV-6
More
151
The rash associated with HHV-7 is (lighter/darker) in color and occurs later in the course of the disease than HHV-6 associated ES
Lighter
152
Diagnosis of HHV-7 active infection can only be made from
Acellular material such as CSF, serum, or plasma
Because the virus is latent in peripheral blood mononuclear cells and tissue
153
Enteroviruses are small, single-stranded RNA picornaviruses and include
Echovirus
Coxsackieviruses A and B
Poliovirus
154
Most common cause of aseptic (viral) meningitis
Nonpolio enteroviruses
155
Viral exanthem seen most commonly in children in summer and fall
Erosions in the mouth and papulovesicles on the palms and soles
Hand-foot-mouth disease
156
HFMD is caused by
Coxsackievirus A16
| Enterovirus 71
157
HFMD transmission
Fecal-oral route
| Less commonly, respiratory inhalation
158
HMFD vesicles quickly erode and form yellow to gray, oval or "_____-shaped" erosions surrounded by an erythematous halo
Football
159
Most common serious complication associated with HFMD
Aseptic meningitis
160
(Coxsackievirus A16/Enterovirus 71), an important cause of HFMD outbreaks in Asia, is associated with severe illness
Enterovirus 71
Severe neurologic disease
161
Oral ulcerations, a defining feature in classic HFMD, found in nearly 100% of patients, are seen less frequently in _____ infection
Coxsackievirus A6
162
2 most common complications for CVA6
Desquamation of the hands and feet
| Onychomadesis
163
Enteroviruses which cause eruptive pseudoangiomatosis
Echovirus 25
| Echovirus 32
164
Pink papules that start in a large flexural region, become bilateral, but remain asymmetric
Unilateral laterothoracic exanthem
165
Unilateral laterothoracic exanthem is also called
Asymmetric periflexural exanthem of childhood
166
Unilateral laterothoracic exanthem has a seasonal variation and occurs most frequently in
Late winter and early spring
