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Fitz 9th > 163 - Exanthematous Viral Diseases > Flashcards

163 - Exanthematous Viral Diseases Flashcards

1
Q

Prodrome of fever, cough, coryza and conjunctivitis

A

Measles

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2
Q

_____ spots are pathognomonic of measles

A

Koplik

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3
Q

Measles virus is a highly contagious, single-stranded, enveloped RNA virus that is a member of the _____ family

A

Paramyxoviridae

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4
Q

Y/N: Humans are the only natural hosts of measles

A

Yes

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5
Q

Koplik spots are tiny white lesions – “_____” – surrounded by an erythematous halo

A

Grains of sand

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6
Q

Koplik spots are typically found on

A

Buccal mucosa near the second molars

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7
Q

Koplik spots typically occur _____ and only last _____

A

48 hours prior to the onset of rash

12 to 72 hours

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8
Q

Measles exanthem begins on the

A

Forehead and behind the ears

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9
Q

Viral detection of measles via PCR is most successful when collection occurs within

A

3 days of the rash’s onset

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10
Q

Measles IgM is typically positive on the first day of the rash and remains positive for at least _____ afterward

A

30 days

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11
Q

Y/N: Within the first 72 hours of the rash, measles IgM assay may be falsely negative

A

Yes

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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

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13
Q

Most measles deaths are attributed to

A

Respiratory illness or

Encephalitis

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14
Q

The WHO recommends that _____ should be administered to all children with measles regardless of their country of residence

A

Vitamin A

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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

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16
Q

Antiviral medication that has been used in children with severe measles disease or an immunocompromised state

A

Ribavirin

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17
Q

Individuals at risk of severe illness and complications

A

Infants younger than 1 year of age
Pregnant women
Unimmunized
Immunocompromised

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18
Q

Individuals at risk of severe illness and complications should be given measles immunoglobulin if presenting within _____ of exposure

A

6 days

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19
Q

Measles immunoglobulin dosage

A

IM - 0.5 mL/kg; maximum dose: 15 mL

IV - 400 mg/kg

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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

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21
Q

Measles vaccine administration

A

At 12 to 15 months

Prior to school entry, between 4 and 6 years old

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22
Q

Enveloped positive-stranded RNA virus in the Togaviridae family

A

Rubella

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23
Q

Rubella-infected individuals shed virus for

A

5 to 7 days before and up to 14 days after onset of rash

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24
Q

Risk of transplacental infection is greatest to a fetus exposed to the virus in the

A

First trimester

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25
Q

Congenitally infected infants may shed the virus through urine, blood, and nasopharyngeal secretions for up to _____ after birth

A

12 months

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26
Q

Individuals at risk of severe illness and complications should be given measles immunoglobulin if presenting within _____ of exposure

A

6 days

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27
Q

Measles immunoglobulin dosage

A

IM - 0.5 mL/kg; maximum dose: 15 mL

IV - 400 mg/kg

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28
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

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29
Q

Measles vaccine administration

A

At 12 to 15 months

Prior to school entry, between 4 and 6 years old

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30
Q

Enveloped positive-stranded RNA virus in the Togaviridae family

A

Rubella

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31
Q

Rubella-infected individuals shed virus for

A

5 to 7 days before and up to 14 days after onset of rash

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32
Q

Risk of transplacental infection with rubella is greatest to a fetus exposed to the virus in the

A

First trimester

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33
Q

Rubella-specific IgM antibody can be detected up to

A

8 weeks after infection

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34
Q

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

A

Forchheimer spots

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35
Q

Y/N: Forchheimer spots is diagnostic for rubella

A

No - not diagnostic

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36
Q

The rash of rubella usually begins to disappear in

A

2 to 3 days

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37
Q

Lymphadenopathy in rubella is usually most severe in the

A

Posterior cervical, suboccipital, and postauricular lymph nodes

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38
Q

Lymphadenopathy in rubella is noted up to _____ before the rash appears

A

7 days

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39
Q

Adults, particularly women (up to 70%), may develop _____ with rubella infection

A

Arthritis of small and large joints

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40
Q

Joint symptoms in rubella often first appear

A

As the rash fades

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41
Q

Rubella-specific IgM antibody can be detected up to

A

8 weeks after infection

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42
Q

Neonatal manifestations of congenital rubella infection

A 
Growth retardation
Interstitial pneumonitis
Radiolucent bone disease
Hepatosplenomegaly
Thrombocytopenia
Dermal erythropoiesis ("blueberry muffin lesions")
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43
Q

Rubella IgM antibody can be detected from _____ to _____

A

Birth

1 month of age

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44
Q

The B19 virus belongs to the family Parvoviridae and the genus

A

Erythrovirus

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45
Q

Limited data indicate that _____ as postexposure prophylaxis for rubella-susceptible patients may decrease infection, viral shedding, and rate of viremia

A

IM immunoglobulin (0.55 mL/kg)

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46
Q

Contact isolation is recommended for infants with rubella until they are at least ____ old or repeated cultures are negative after _____ of age

A

12 months

3 months

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47
Q

It is imperative that individuals at risk for rubella infection are immunized, such as

A

Health care workers
Military recruits
College students
Recent immigrants

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48
Q

Receptor of parvovirus

A

Blood group P antigen (globoside)

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49
Q

Pruritic erythema, edema, and petechiae of the hands and feet, fever and oral erosions in adolescents

A

Papular purpuric gloves-and-socks syndrome

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50
Q

Persons with erythema infectiosum are infectious

A

Only before the onset of the rash

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51
Q

Causative agent of erythema infectiosum and papular purpuric gloves-and-socks syndrome

A

Parvovirus B19

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52
Q

Smallest single-stranded DNA-containing virus known to infect humans
Lacks an envelope and contains single-stranded DNA

A

Parvovirus B19

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53
Q

Y/N: Animal parvoviruses are thought to be transmissible to humans

A

No - not thought to be transmissible

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54
Q

The more serious manifestations of parvovirus infection relate to the fact that the virus infects and lyses

A

Erythroid progenitor cells

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55
Q

Receptor of parvovirus

A

Blood group P antigen (globoside)

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56
Q

Y/N: Most infections caused by B19 in children are asymptomatic and unrecognized

A

Yes

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57
Q

Most common clinical picture associated with parvovirus B19

A

Fifth disease

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58
Q

Fifth disease eruption typically lasts

A

5 to 9 days

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59
Q

Parvovirus B19 IgM can be detected within _____ and is present for up to _____ in many cases

A

A few days after onset of illness

6 months

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60
Q

Primary manifestation of B19 viral infection in adults

A

Acute arthropathy

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61
Q

Acute arthrophathy in adults occurs mainly in _____ and affects the _____

A

Women

Knees and small joints of the hands

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62
Q

The constitutional symptoms of parvovirus B19 are usually (less/more) severe in adults than in children

A

More

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63
Q

Chronic anemia B19 usually resolves if treated with

A

IV gamma-globulin

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64
Q

Papular purpuric gloves-and-socks syndrome seems to affect

A

Teenagers and adults

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65
Q

May be necessary in transient aplastic crisis, and most patients recover in week

A

Red blood cell transfusion

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66
Q

Parvovirus B19 IgM can be detected within _____ and is present for up to _____ in many cases

A

A few days after onset of illness

6 months

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67
Q

Parvorirus B19 IgG can be identified by the _____ of illness and lasts for _____

A

Seventh day

Years

68
Q

Considered the test of choice in an immunocompromised patient, and to confirm fetal infection with parvovirus B19

A

PCR

69
Q

Caveat to PCR testing in parvovirus B19 infection

A

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
Q

Also known as human herpesvirus 4

Enveloped, double-stranded DNA virus

A

Epstein-Barr virus

71
Q

Parvovirus B19 is the most common causes of _____ in patients with chronic hemolytic anemias

A

Transient aplastic crisis

72
Q

Morbilliform exanthem after primary infection with infectious mononucleosis is most common after administration of

A

Ampicillin or amoxicillin

73
Q

Most common complication of intrauterine infection with B19

A

Nonimmune fetal hydrops

74
Q

Approximately _____% of women of childbearing age are immune to parvovirus infection because of prior infection

A

50

75
Q

Risk factors for early seropositivity with EBV

A

Lower household income
Parental education level
Uninsured status
Being Mexican American or Black (non-Hispanic)

76
Q

Y/N: Patients with aplastic crisis or immunosuppression with chronic B19 anemia may have high-titer viremia and are particularly infectious

A

Yes

77
Q

Also known as human herpesvirus 4

A

Epstein-Barr virus

78
Q

Characterized by the triad of fever, lymphadenopathy, and pharyngitis
Caused by EBV

A

Infectious mononucleosis

79
Q

Morbilliform exanthem after primary infection with EBV is most common after administration of

A

Ampicillin or amoxicillin

80
Q

Malignancies associated with EBV

A

Oral hairy leukoplakia
Nasopharyngeal carcinoma
Kikuchi histiocytic necrotizing lymphadenitis
Certain types of cutaneous T-cell lymphoma

81
Q

EBV is a worldwide pathogen with more than ____% of adults latently infected

A

90

82
Q

Risk factors for early seropositivity with EBV

A

Lower household income
Parental education level
Uninsured status
Being Mexican American or Black (non-Hispanic)

83
Q

Type of EBV which is found worldwide

A

EBV-1

84
Q

Infectious mononucleosis is also referred to as the

A

“Kissing disease”

85
Q

EBV is typically transmitted via

A

Saliva

86
Q

After infectious mononucleosis, viral shedding continues for a median duration of

A

6 months

87
Q

EBV infects B lymphocytes through the binding of the EBV glycoprotein _____ with _____ on the surface of B cells

A

gp350

CD21

88
Q

A clonal expansion of _____ allows recovery from primary and reactivation infection and is the source of the atypical lymphocytes associated with EBV infection

A

Cytotoxic T lymphocytes

89
Q

Inherited immunodeficiencies particularly associated with impaired immune responses to EBV infection

A

X-linked lymphoproliferative disease

GATA2 deficiency

90
Q

Most common manifestation of EBV infection in adolescents and adults

A

Infectious mononucleosis

91
Q

Lymphomatoid granulomatosis requires the initiation of

A

Chemotherapy

92
Q

Suggestive features of primary EBV infection

A

Splenomegaly, posterior, as opposed to anterior
Cervical lymphadenopathy
Lymphocytosis with a predominance of atypical lymphocytes (defined as more than 10% of total lymphocytes)

93
Q

Y/N: EBV infection during pregnancy is thought to be teratogenic

A

No - not thought to be teratogenic

94
Q

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

A

Lipschutz ulcers

95
Q

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

A

Nasal-type extranodal natural killer/T cell lymphoma (ENK/T)

96
Q

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

A

Hydroa vacciniforme-like disease

97
Q

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

A

Lymphomatoid granulomatosis

98
Q

Lymphomatoid granulomatosis requires the initiation of

A

Chemotherapy

99
Q

Suggestive features of primary EBV infection

A

Splenomegaly, posterior, as opposed to anterior
Cervical lymphadenopathy
Lymphocytosis with a predominance of atypical lymphocytes (defined as more than 10% of total lymphocytes)

100
Q

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

A

Monospot test

101
Q

Sensitivity of rapid diagnosis heterophile antibody tests for EBV is approximately _____%

A

85

102
Q

EBV _____ studies frequently used to monitor for posttransplantation lymphoproliferative disease as trending high viral loads serve as a marker for impending posttransplantation lymphoproliferative disease

A

Serum PCR

103
Q

Often employed to confirm EBV infection in young children and when a suspicion for EBV infection remains high despite a negative heterophile antibody test

A

EBV-specific antibodies

104
Q

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

A

Acute infection

3 months

105
Q

EBV nuclear antigen (EBNA) is expressed when _____; consequently IgG to EBNA becomes positive usually _____ after symptoms develop

A

The virus establishes latency

6 to 12 weeks

106
Q

A positive IgM BVA and negative IgG EBNA confirms

A

Acute infection

107
Q

A positive _____ argues against an acute EBV infection

A

IgG EBNA

108
Q

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

A

Anti-D

Anti-R

109
Q

EBV _____ studies frequently used to monitor for posttransplantation lymphoproliferative disease as trending high viral loads serve as a marker for impending posttransplantation lymphoproliferative disease

A

Serum PCR

110
Q

Monomorphic dome-shaped or flat-topped papules symmetrically distributed on face and extensor extremities
Associated with multiple viral triggers and immunizations

A

Gianotti-Crosti syndrome

111
Q

Gianotti-Crosti syndrome is also known as

A

Infantile papular acrodermatitis

Papular acrodermatitis of childhood

112
Q

Host risk factors associated with GCS

A

Young age

History of atopic dermatitis

113
Q

Cutaneous findings in the newborn with congenital HCMV infection

A

Petechial rash
Jaundice
Blueberry muffin lesions

114
Q

GCS is historically associated with _____ infection, but now more often triggered by _____

A

Hepatitis B

Epstein-Barr virus

115
Q

Most common accompanying symptom of GCS

A

Pruritus

116
Q

GCS usually fades over

A

10 to 60 days

Might last longer than most rashes associated with viruses

117
Q

Also known as human herpesvirus 5

A

Human cytomegalovirus

118
Q

Congenital infection with HCMV is a major cause of

A

Hearing loss

119
Q

Most common congenital viral infection in humans

A

HCMV

120
Q

Cutaneous findings in the newborn with congenital HCMV infection

A

Petechial rash
Jaundice
Blueberry muffin lesions

121
Q

Perinatal infection with HCMV is very different from congenital HCMV infection, and is

A

Without diffuse visceral or CNS involvement

122
Q

Cutaneous findings in perinatal HCMV infection

A

None

123
Q

Approximately _____% of infectious mononucleosis cases are caused by HCMV`

A

10

124
Q

Unlike EBV mononucleosis, HCMV-induced mononucleosis patients do not typically have

A

Pharyngitis and lymphadenopathy

125
Q

HHV-6 primary infection often presents either as _____ or _____

A 
Acute febrile illness
Exanthem subitum (roseola infantum, sixth disease)
126
Q

Most common cutaneous manifestations of HCMV disease in immunocompromised patients

A

Perianal and rectal ulceration

127
Q

Gold standard for diagnosis of HCMV infection

A

Viral culture from blood

128
Q

Can be used to identify primary infection in children younger than 12 months of age as they shed HCMV for longer periods of time

A

PCR

129
Q

In immunocompromised patients, _____ for CMV is the most widely used test for diagnosis, and monitoring response to treatment

A

Quantitative nucleic acid amplification testing

130
Q

Characteristic histologic feature of CMV infection

A

Cytomegalic cells with nuclear inclusions

Enlarged endothelial cells with large intranuclear inclusions and a clear halo (owl’s eye cells)

131
Q

Improves hearing and neurodevelopmental outcomes in patients with symptomatic congenital HCMV infection

A

Oral valganciclovir

132
Q

HHV-6 primary infection often presents either as _____ or _____

A 
Acute febrile illness
Exanthem subitum (roseola infantum, sixth disease)
133
Q

HHV-6 is a common viral infection with up to _____% of the population acquiring the infection by 2 years of age

A

80

134
Q

Primary infection with HHV-6 typically occurs between the ages of

A

6 months and 2 years when maternal passive immunity wanes

135
Q

HHV-6 primary infection exhibits seasonal variation with the highest incidence in

A

Spring

136
Q

HHV-(6a/6b) causes ES and reactivates in immunocompromised hosts. It is unclear what diseases, if any, are caused by HHV-(6a/6b)

A

6b

6a

137
Q

HHV-6 preferentially infects

A

Activated CD4+ T lymphocytes

138
Q

Cellular receptor for HHV-6 infection

A

Immune regulatory protein CD46

139
Q

HHV-6 transmission occurs via

A

Shared saliva

140
Q

Hallmark of exanthem subitum

A

“Rose”-colored macules and papules surrounded by a white halo

141
Q

Exanthem subitum lasts for

A

3 to 5 days

142
Q

A unique feature of ES is that it presents

A

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
Q

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

A

Nagayama spots

144
Q

Other diseases associated with HHV-6

A

Pityriasis rosea
Rosai-Dorfman disease
Drug-induced hypersensitivity syndrome

145
Q

Diagnosis of HHV-7 active infection can only be made from

A

Acellular material such as CSF, serum, or plasma

Because the virus is latent in peripheral blood mononuclear cells and tissue

146
Q

_____% of ES are caused by HHV-7

A

10

147
Q

Primary infection with HHV-7 occurs during childhood, but (earlier/later) than, and at a (slower/faster) rate than, infection with HHV-6

A

Later

Slower

148
Q

HHV-7 is a member of the _____ family

A

Beta-Herpesviridae

149
Q

HHV-7 establishes persistent infection in the _____, and transmission is likely through _____

A

Salivary glands

Saliva

150
Q

Reactivation of HHV-7 occurs (less/more) often than reactivation of HHV-6

A

More

151
Q

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

A

Lighter

152
Q

Diagnosis of HHV-7 active infection can only be made from

A

Acellular material such as CSF, serum, or plasma

Because the virus is latent in peripheral blood mononuclear cells and tissue

153
Q

Enteroviruses are small, single-stranded RNA picornaviruses and include

A

Echovirus
Coxsackieviruses A and B
Poliovirus

154
Q

Most common cause of aseptic (viral) meningitis

A

Nonpolio enteroviruses

155
Q

Viral exanthem seen most commonly in children in summer and fall
Erosions in the mouth and papulovesicles on the palms and soles

A

Hand-foot-mouth disease

156
Q

HFMD is caused by

A

Coxsackievirus A16

Enterovirus 71

157
Q

HFMD transmission

A

Fecal-oral route

Less commonly, respiratory inhalation

158
Q

HMFD vesicles quickly erode and form yellow to gray, oval or “_____-shaped” erosions surrounded by an erythematous halo

A

Football

159
Q

Most common serious complication associated with HFMD

A

Aseptic meningitis

160
Q

(Coxsackievirus A16/Enterovirus 71), an important cause of HFMD outbreaks in Asia, is associated with severe illness

A

Enterovirus 71

Severe neurologic disease

161
Q

Oral ulcerations, a defining feature in classic HFMD, found in nearly 100% of patients, are seen less frequently in _____ infection

A

Coxsackievirus A6

162
Q

2 most common complications for CVA6

A

Desquamation of the hands and feet

Onychomadesis

163
Q

Enteroviruses which cause eruptive pseudoangiomatosis

A

Echovirus 25

Echovirus 32

164
Q

Pink papules that start in a large flexural region, become bilateral, but remain asymmetric

A

Unilateral laterothoracic exanthem

165
Q

Unilateral laterothoracic exanthem is also called

A

Asymmetric periflexural exanthem of childhood

166
Q

Unilateral laterothoracic exanthem has a seasonal variation and occurs most frequently in

A

Late winter and early spring

Fitz 9th (108 decks)

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