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a;lskdjf > 8 - Viral Diseases > Flashcards

8 - Viral Diseases Flashcards

1
Q

Lower extremity viral infections

A
  • Verruca (warts)
  • Molluscum Contagiosum
  • Herpes Simplex
  • Herpes Zoster
  • Hand, Foot and Mouth Disease
  • Foot and Mouth Disease
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2
Q

Verruva general characteristics

A
  • Human Papova Virus (>100 types HPV)
  • Requires a host for survival; multiplies within epidermal cell nucleus
  • Variable incubation (1-20 months)
  • Direct inoculation
  • Peak incidence between age 12-16
  • Spontaneous regression
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3
Q

Verruca host response

A
  • Presence of circulating antibodies
  • Clinical evidence suggesting immune response
    o Increased incidence during immunosuppressive therapy
    o Increased incidence in persons with cell-mediated defects and immunodeficiency diseases
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4
Q

Verruca diagnosis

A
  • Clinical suspicion
  • Histopathology
    o Epidermal hyperplasia (thickening of the epidermis)
    o Inclusion bodies (i.e. Negri body)
    o Papillomatosis (lesion raised above skin level) ***
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5
Q

Verruca treatment

A
  • Topical keratolytic therapy
  • Chemosurgical-occlusive techniques
  • Bleomycin sulfate intralesional injection
  • Cryosurgery (liquid nitrogen = -320° F)
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6
Q

Verruva surgical treatemnet

A

o Curettage (scraping/scooping)
o Electrodessication
o Laser
o Excision (not recommended for bottom of foot)

NOTE: the depth of the epidermis is 1.5 mm, this means you should aim for 1-1.2 mm for your excision depth

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7
Q

Verruca differential diagnosis

A
  • Calluses - from biomechanical defect (skin lines go through)
  • Plugged sweat duct - Small hyperkeratotic punctate lesions (skin lines go through)
  • IPK (intractable plantar keratosis) - callus which forms under bone
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8
Q

Common warts (verruca vulgaris)

A
  • 70% of warts are common warts
  • Causative agent  HPV 2 & 4
  • Grey or brown papules with keratinized pitted surface
  • Vascular elements
  • Frequently multiple, may reach a size of 2 cm in diameter
  • Periungual/subungual
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9
Q

Plane warts (verruca plana)

A
  • 3.5% of warts are plane warts
  • Causative agent  HPV 3 & 10
  • Small flat skin lesions
  • Skin colored or slightly pigmented
  • Multiple and linear
  • Koebnerization
    o You see spread of virus by aggravating it (typically by scratching)
  • Spontaneous remission
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10
Q

Filiform or digitate warts

A
  • 2.0% of warts are filiform or digitate warts
  • Causative agent  HPV 6 & 11
  • Face, neck, genital region
  • Finger-like projections from a single base (look like skin tag)
  • Bleed easily
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11
Q

Plantar warts

Verruca plantaris

A
  • 24% of warts are plantar warts
  • Causative agent  HPV 1; Mosaic HPV 2
  • Location on sole of foot imparts distinctiveness
  • Role of pressure/weight bearing
  • Variable size and number
  • Spatial orientation
  • Vascular elements
  • Pain on side to side pressure
    o If you squeeze it side to side, patient will have excessive pain
    o If you press on the surface, there will be some pain, but not severe
    Lack of skin lines, bottom of foot, side to side pain
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12
Q

Herpes simplex general characteristics and clinical course

A

General
- DNA virus with two forms:
o Primary: 2 forms on foot (herpetic whitlow, eczema herpeticum)
o Recurrent (lesions usually at same site)
- Types:
o Non-genital HSV 1 (90% oral)
o Genital HSV 2 (90% genital)

Clinical
- Primary  Virus enters skin-peripheral nerve-dorsal root ganglion
- Life-long latent infection
- Systemic symptoms 3-5 days after lesions appear
o Febrile illness with associated lymphangitis
o Can be mistaken for a bacterial infection
- Healing occurs in 7-10 days
- Recurrent: 2-3 events per year, more often with HSV-2
- Triggering events (stress, sunlight, menstruation, diet)
- Lack systemic signs, not as severe
- 5-14 day attack

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13
Q

Herpes simplex diagnosis and treatment

A 
Diagnosis
-	Clinical suspicion
-	Tissue culture
-	Histopathology (lower sensitivity)
o	Tzanck test
o	Ballooning degeneration
o	Acantholysis
o	Large multi-nucleated cells
Treatment 
-	Medical Management
o	Topical
	Acyclovir (Zovirax)
	Penciclovir (Denavir)
o	Oral
	Acyclovir 
	Famciclovir (Famvir)
	Valacyclovir (Valtrex)
-	Supportive, no cure
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14
Q

Herpes simplex lesions

A
  • Sudden onset, itching and burning
  • 5-7 days small-grouped vesicles on an erythematous base
  • Dermatomal distribution
  • Painful
  • Secondary lesions are crusts
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15
Q

Herpes zoster (shingles) general characteristics

A
  • Varicella virus (Chickenpox)
  • Reactivation of latent viral infection
  • Incidence
    o 66% over 45 years of age
    o Increased in patients with lymphomas
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16
Q

Herpes zoster (shingles) clinical course

A
  • Pain localized to the area of one or more dorsal roots
    o Thoracic, cervical and trigeminal nerves most often
    o May involve leg
  • 2-5 days later erythematous papules following one or two dermatomes
  • Rapid progression to vesicular then pustular eruption
  • Usually unilateral distribution
  • Paresis of the involved muscle groups not uncommon
  • Enlarged regional nodes
  • Recovery in 2-4 weeks
  • Postherpetic pain
17
Q

Herpes zoster (shingles) diagnosis

A
  • Clinical suspicion
  • Tissue culture
  • Histopathology
    o Tzanck test
    o Ballooning degeneration
    o Acantholysis with resultant vesicle formation
18
Q

Herpes zoster (shingles) treatment

A
  • Supportive
  • Topical preparations
  • Oral Medications (early)
  • Systemic steroids
  • Intradermal cortisone injection for post-zoster neuralgia
  • Pain management with analgesics
19
Q

Hand, foot and mouth disease general characteristics

A
  • Coxsackie A16 and A5 virus (Enterovirus, Picornavirus)

- Children: Late summer, early fall

20
Q

Hand, foot and mouth disease clinical course

A
  • Flu-like; sore throat before lesions
  • Painful stomatitis
  • Acute vesicular eruption
  • Light grey vesicles in red areola
  • Dorsal and periungual location (palms/soles)
  • Painful
  • 4-7 days duration
21
Q

Hand, foot and mouth disease diagnosis

A
  • Clinical Suspicion

- Tzanck test

22
Q

Hand, foot and mouth disease treatment

A
  • Supportive
23
Q

Foot and mouth disease general characteristics

A
  • Non-human picornaviruses
  • Epidemic disease of farm animals
  • Rare in humans
  • Contact with infected animal; NOT human to human transmission
24
Q

Foot and mouth disease clinical course

A
  • Flu-like symptoms
  • Swelling, itching, burning
  • Vesicular eruption of the oral mucous membranes, palms, soles, interdigital sites
  • Progress to ulcerations
  • 7-14 days
25
Q

Molluscum contagiosum general characteristics

A
  • DNA pox virus (Poxviridae)
  • Common in children and adolescents
  • Highly communicable and infectious
  • Transmission by direct contact
  • Incubation period of 14-50 days
  • Face, upper body, and lower extremities
26
Q

Molluscum contagiosum lesions

A
  • 3 to 5 mm in diameter, pearly white or translucent in color
  • Dome shaped papules with central umbilification (slight indentation)
    o Umbilification is the HALLMARK
  • Variable distribution; solitary or clusters, but rarely affect feet
  • Self-limiting; 2-9 months
27
Q

Molluscum contagiosum diagnosis

A
  • Clinical suspicion
  • Histopathology
    o KOH wet mount shows “molluscum bodies”
    o Tzanck test (for multinucleated giant cells) demonstrates “ground glass” inclusion bodies
     You will also see these in herpes, varicella, zoster, etc.
28
Q

Molluscum contagiosum treatmetn

A
  • Self-limiting
  • Curette and electrodessication
  • Cryosurgery
  • Topical acid therapy

a;lskdjf (11 decks)

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