CH7 - Viral Infections - Enteroviruses thru MMR

Question 1

What are the 3 classifications of Enteroviruses?

Answer 1

1. Echoviruses
2. Coxsackieviruses A and B
3. Polioviruses

Question 2

What 2 conditions have been associated with enterovirus infection?

Answer 2

1. Type 1 DM

2. Dilated cardiomyopathy

Question 3

What is the gender/age predominance for enterovirus infection? Why?

Answer 3

Males under 20 years

Females 20 years and older due to exposure as caregivers to infected children

Question 4

What are the 3 clinical presentations for enteroviruses discussed in Neville?

Answer 4

1. Herpangina
2. Hand-foot-and-mouth disease
3. Acute lymphonodular pharyngitis

Lots of crossover between these presentations

Question 5

So, a shit ton types of coxsackievirus can cause herpangina. What is one?

Answer 5

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

Question 6

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?

Answer 6

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.

Question 7

Which type of coxsackievirus is associated with acute lymphonoudular pharyngitis?

Answer 7

A10

Question 8

What is the major route of transmission for enteroviruses?

Answer 8

fecal-oral (during acute phase - saliva or respiratory droplets)

Question 9

Which coxsackievirus has been associated with fetal and nonfetal death and cardiac anomalies in infants who survive?

Answer 9

coxsackievirus B

Question 10

Hand-foot-and-mouth clinical presentations:

Oral?
Cutaneous?

Answer 10

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

Question 11

What is the term for enterovirus (Hand-foot-and-mouth disease) in some cases, nail loss or ridges may ensue after several weeks

Answer 11

Beau lines

Question 12

Enterovirus diagnosis:

mucosal lesions only?
Cutaneouls lesions only?

Answer 12

mucosal: fecal

cutaneous cultures from the cutaneous lesions

Question 13

What is the alternate name for Measles? What family? What is a nickname for measles?

Answer 13

Rubeola..Paramyxoviridae…nickname: 9-day measles

Question 14

When do most cases of measles arise? How is it spread?

Answer 14

late winter, early spring…respiratory droplets

Question 15

Go through the 9 days of measles:

Answer 15

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

Question 16

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?

Answer 16

Koplik spots…typically the buccal/labial mucosa (less often soft palate)

Question 17

Which measles patients are most at risk for keratoconjuntivitis leading to blindness?

Answer 17

Vit A deficient (Vit A is recommended during treatment of any Measles infection)

Question 18

Thats wild: what mechanism in Measles can lead to appendicitis?

Answer 18

vascular obstruction 2/2 swelling of pyers patches

Question 19

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.

Answer 19

subacute sclerosing panencephalitis (SSPE)

Question 20

Besides Koplik spots, what are 4 other oral manifestations of measles?

Answer 20

1. Candidiasis
2. NUG/NUS
3. Pitted enamel hypoplasia of developing teeth
4. enlargment of accessory lymphoid tissues (lingual/pharyngeal tonsils)

Question 21

What is the characteristic cell seen in Measles?

Answer 21

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

Question 22

While most measles is diagnosed clinically during outbreaks, what serum results can be expected?

Answer 22

IgM antibody assay (arise 1-3 days after exanthem). can also confirm hx of infection with IgG titers, culture, and RTPCR

Question 23

What is the biggest concern of Rubella infection? When do these infections usually occur? How?

Answer 23

birth defects in the developing fetus…like Rubeola late winter early spring..respiratory droplets

Question 24

What kind of virus is Rubella?

Answer 24

German measles, Togavirus (Germans wear pretty (bella) togas)

Question 25

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

Answer 25

Forchheimer sign (German name, nice) 20% of cases

Question 26

What is the triad of Congenital Rubella Syndrome (CRS)?

Answer 26

1. Deafness (80%)
2. Heart Disease
3. Cataracts

Question 27

Whats the mainstay for Rubella diagnosis?

Answer 27

serology (viral culture and PCR possible too)

Question 28

What kind of virus is Mumps? What’s the alternate name?

Answer 28

Paramyxoviridae (same family as Measles (Rubeola), Endemic parotitis

Question 29

What are the target tissues/organs for Mumps?
How is is transmitted?
When does Mumps typically occur?

Answer 29

Exocrine glands (Salivary glands, pancreas, choroid plexus, mature ovaries and testes).

Respiratory droplets, saliva, urine

Winter, spring

Question 30

Mumps: how often is there unilateral parotid swelling?

How often do postpubertal males develop epididymo-orchitis?

Answer 30

25% unilateral…25% develop epididymo-orchitis (unilateral swelling, resolution, 13% sterility/subfertility)

Question 31

What is the most common intraoral manifestation of Mumps?

Answer 31

Redness and enlargment of Wharton or Stensen duct openings

Question 32

Besides the clinical signs, how is Mumps diagnosed?

Answer 32

Antibodies:
1. mumps-specific IgM
OR 4x increase in mumps-specific IgG

2. Swab from parotid secretions for viral culture or PCR