CH7 - Viral Infections - Enteroviruses thru MMR Flashcards
What are the 3 classifications of Enteroviruses?
- Echoviruses
- Coxsackieviruses A and B
- Polioviruses
What 2 conditions have been associated with enterovirus infection?
- Type 1 DM
2. Dilated cardiomyopathy
What is the gender/age predominance for enterovirus infection? Why?
Males under 20 years
Females 20 years and older due to exposure as caregivers to infected children
What are the 3 clinical presentations for enteroviruses discussed in Neville?
- Herpangina
- Hand-foot-and-mouth disease
- Acute lymphonodular pharyngitis
Lots of crossover between these presentations
So, a shit ton types of coxsackievirus can cause herpangina. What is one?
Herpangina: Coxsackievirus A1 (but also A6, A8, A10, or A22. A7, A9, A16; B2 to B6; echovirus 9, 16, or 17; or enterovirus 71 LOL
So, a shit ton types of coxsackievirus can cause hand-foot-and-mouth disease. What is one?
Also, which type has caused several outbreaks in the Asia-Pacific region? What type of major complication may occur?
hand-foot-and-mouth disease: A16 A5, A9, or A10;
echovirus 11; or enterovirus 71.
In particular, in the Asia-Pacific region over the past few decades, enterovirus 71 has caused several large outbreaks of hand-foot-and-mouth disease, often associated with major neurologic complications.
Which type of coxsackievirus is associated with acute lymphonoudular pharyngitis?
A10
What is the major route of transmission for enteroviruses?
fecal-oral (during acute phase - saliva or respiratory droplets)
Which coxsackievirus has been associated with fetal and nonfetal death and cardiac anomalies in infants who survive?
coxsackievirus B
Hand-foot-and-mouth clinical presentations:
Oral?
Cutaneous?
Oral: resemble herpangina but may be more numerous and more frequently involve the anterior mouth (Buc/Lab mucosa, tongue most common)
Cutaneous: borders of the palms and soles and ventral surfaces and sides of the fingers and toes
What is the term for enterovirus (Hand-foot-and-mouth disease) in some cases, nail loss or ridges may ensue after several weeks
Beau lines
Enterovirus diagnosis:
mucosal lesions only?
Cutaneouls lesions only?
mucosal: fecal
cutaneous cultures from the cutaneous lesions
What is the alternate name for Measles? What family? What is a nickname for measles?
Rubeola..Paramyxoviridae…nickname: 9-day measles
When do most cases of measles arise? How is it spread?
late winter, early spring…respiratory droplets
Go through the 9 days of measles:
First 3 days: Coryza (runny nose), Cough (brassy,uncomfortable), Conjunctivitis (red, watery, photophobic eyes)…KOPLIK SPOTS
Second three days: Koplik spots fade, fever continues, maculopapular and erythematous (morbiliform) rash. Face first, then spreads down. Blanch on pressure. Abdominal pain and lymphatic involvment
Last 3 days: Fever ends, rash fades, replaced by brown pigment, desquamation of areas with the rash
Measles (Rubeola) These lesions represent foci of epithelial necrosis and appear as numerous small, blue-white macules (or “grains of salt”) surrounded by erythema…WHERE does this occur?
Koplik spots…typically the buccal/labial mucosa (less often soft palate)
Which measles patients are most at risk for keratoconjuntivitis leading to blindness?
Vit A deficient (Vit A is recommended during treatment of any Measles infection)
Thats wild: what mechanism in Measles can lead to appendicitis?
vascular obstruction 2/2 swelling of pyers patches
Measles: Encephalitis develops in approximately
1 in 1000 cases, often resulting in death or permanent brain damage and intellectual disability. In about 1 in 100,000 cases, a delayed complication termed arises as late as 11 years after the initial infection. This degenerative CNS disorder leads to personality changes, seizures, coma, and death. Widespread vaccine use virtually eliminated this in developed nations.
subacute sclerosing panencephalitis (SSPE)
Besides Koplik spots, what are 4 other oral manifestations of measles?
- Candidiasis
- NUG/NUS
- Pitted enamel hypoplasia of developing teeth
- enlargment of accessory lymphoid tissues (lingual/pharyngeal tonsils)
What is the characteristic cell seen in Measles?
Warthin-Finkeldey giant cells (Warthin was from U Michigan, also Warthin tumor and Warthin-Starry for syphilis. Also worked closely with Lynch (Creighton) for hereditary cancers).
also seen in: lymphoma, Kimura, AIDS LPDs, and SLE
While most measles is diagnosed clinically during outbreaks, what serum results can be expected?
IgM antibody assay (arise 1-3 days after exanthem). can also confirm hx of infection with IgG titers, culture, and RTPCR
What is the biggest concern of Rubella infection? When do these infections usually occur? How?
birth defects in the developing fetus…like Rubeola late winter early spring..respiratory droplets
What kind of virus is Rubella?
German measles, Togavirus (Germans wear pretty (bella) togas)
What is the oral manifestation of Rubella?
small, discrete, dark-red papules that develop on the soft palate and may extend onto the hard palate
Forchheimer sign (German name, nice) 20% of cases
What is the triad of Congenital Rubella Syndrome (CRS)?
- Deafness (80%)
- Heart Disease
- Cataracts
Whats the mainstay for Rubella diagnosis?
serology (viral culture and PCR possible too)
What kind of virus is Mumps? What’s the alternate name?
Paramyxoviridae (same family as Measles (Rubeola), Endemic parotitis
What are the target tissues/organs for Mumps?
How is is transmitted?
When does Mumps typically occur?
Exocrine glands (Salivary glands, pancreas, choroid plexus, mature ovaries and testes).
Respiratory droplets, saliva, urine
Winter, spring
Mumps: how often is there unilateral parotid swelling?
How often do postpubertal males develop epididymo-orchitis?
25% unilateral…25% develop epididymo-orchitis (unilateral swelling, resolution, 13% sterility/subfertility)
What is the most common intraoral manifestation of Mumps?
Redness and enlargment of Wharton or Stensen duct openings
Besides the clinical signs, how is Mumps diagnosed?
Antibodies:
1. mumps-specific IgM
OR 4x increase in mumps-specific IgG
- Swab from parotid secretions for viral culture or PCR
