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446- ID and transplant > Chickenpox + Shingles > Flashcards

Chickenpox + Shingles Flashcards

1
Q

which of the following is false regarding human herpesviruses
1. there is a property of latency with specific host cells
2. different viruses may exhibit different clinical sx
3. chicken pox is caused by varicella zoster virus 3
4. there are 6 herpes viruses that routinely infect only humans

A

4- there are 8

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2
Q

acute infection with varicella zoster causes

A

chickenpox/ varicella

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3
Q

reactivation with varicella zoster causes

A

shingles or herpes zoster

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4
Q

how can the herpes simplex 1 virus be reactivated

A

fever, sunlight to face, menstruation, stress, etc

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5
Q

how can the varicella virus be reactivated

A

age, x ray irradiation

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6
Q

herpes zoster begins as _______ which evolve into ______ that coalesce into ______________ with _________ component

A

erythematous papules
evolve into vesicles
coalesce into large confluent blisters with hemorrhagic component

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7
Q

herpes zosters lesions continue to form over

A

3-5d

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8
Q

healing of herpes zoster lesions occurs over

A

2wks

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9
Q

what are some permanent changes that may happen after herpes zoster

A

scarring and discoloration

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10
Q

what are the most commonly affected dermatomes by herpes zoster

A

T1-L2

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11
Q

hallmark characteristic of herpes zoster is

A

unilateral- does not cross body’s midline

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12
Q

~20% patients have systemic sx from herpes zoster, including

A

fever, HA, malaise, fatigue

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13
Q

herpes zoster is diagnosed ________

A

clinically

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14
Q

why might confirmatory lab tests be used for herpes zoster dx

A

to differentiate from HSV (dep on location of rash) or in pts with typical pain but no rash

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15
Q

3 lab tests you can use for herpes zoster dx

A

PCR
immunohistochemistry
viral culture from vesicular fluid

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16
Q

describe immunohistochemistry for herpes zoster dx

A

cells scraped from base of lesion + stained with fluorescein conjugated monoclonal Abs to detect viral glycoprotein

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17
Q

which is more sensitive
1 .immunohistochemistry
2. culture

A

1

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18
Q

list 3 differential dx for herpes zoster

A

herpes simplex virus
contact dermatitis
impetigo
cellulitis
candidiasis
dermatitis herpetiformis (skin manifestation of celiac disease)
drug eruptions

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19
Q

what is the most common complication of HZ

A

post herpetic neuralgia

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20
Q

3 major risk factors for HZ

A

> 50yrs
HIV
other immunosuppression (ex- CS, chemo)

21
Q

which of the following is true
1.HIV increases the risk of HZ by 10x
2. there is an increasing trend of shingles in the US
3. there is a decreasing trend of shingles in Japan
4. being >40yrs is a major RF for HZ

A

2

22
Q

acute herpetic neuralgia is

A

pain preceding or accompanying rash that persists up to 30 days from onset

23
Q

subacute herpetic neuralgia is

A

pain that persists beyond rash healing but resolves within 3-4mths

24
Q

what is post herpetic neuralgia

A

pain >3-4mths from initial onset rash

25
Q

pain preceding or accompanying rash that persists up to 30 days from onset

A

acute herpetic neuralgia

26
Q

pain that persists beyond rash healing but resolves within 3-4mths

A

subacute herpetic neuralgia

27
Q

incidence of PHN increases with
1. age
2. worse initial shingles pain
3. larger area of initial shingles
4. all of the above

A

4

28
Q

3 types of PHN

A

constant pain without stimulus
intermittent pain without stimulus
evoked pain (allodynia and/or hyperalgesia)

29
Q

PHN can persist for

A

mths-yrs

30
Q

4 major RF for PHN

A

older age, severe acute pain, greater rash severity, immunosuppressive conditions

31
Q

list 3 nonpharm ways to prevent spread of HSV/ comfort measures

A

Keep rash clean + dry to reduce risk of bacterial superinfection
Prevent transmission of virus to another person: keep fluid filled blisters/rash covered, wash hands often, do not touch or scratch rash
Avoid topical antibiotics and dressing with adhesives- can cause irritation + delay rash healing
Sterile wet (hydrocolloid) dressings to ↓ discomfort in somepts (Ex- Tegaderm (3M), bandaid)
Wear loose fitting clothing for comfort

32
Q

systemic antivirals if started within 72hrs of rash can

A

Reduce acute pain
Accelerate rash healing by 1-2 days and decrease formation of new lesions
Reduce period for viral shedding

33
Q

T or F: antivirals prevent PHN

A

insufficient evidence- may reduce intensity, duration, incidence of prolonged pain by decreasing neural damage (inhibits viral replication)

34
Q

which 3 antivirals are used in HZ

A

famciclovir
valacyclovir
acyclovir

35
Q

rank the antivirals on worst to best resolution of pain
famciclovir
acyclovir
valacyclovir

A

acyclovir < famciclovir = valacyclovir

36
Q

SEs of HZ antivirals

A

generally well tolerated- nausea, HA most common sx

37
Q

fam/vala/ acyclovir are _________ eliminated

A

renally

38
Q

T or F: herpes zoster vaccines are used to protect against infection with virus

A

F- already infected, only intended to boost T cell immunity to avoid reactivation

39
Q

how is famciclovir dosed for HZ

A

500mg TID F7d

40
Q

how is valacyclovir dosed for HZ

A

1000mg TID F7d

41
Q

how is acyclovir dosed for HZ

A

800mg 5x/d F7d

42
Q

in pts presenting <72hrs since rash onset, cost benefit favors tx of pts:

A

> 50yrs, esp those with severe pain and large area of skin involved

optional for younger pts with mild pain/ limited skin involved

43
Q

in pts presenting >72hrs since rash, should they receive antivirals?

A

consider if continued new vesicles, immuncomp, or has complications (ex- ocular, motor, neuro)

44
Q

tx of mild acute HZ pain

A

NSAIDs, APAP

45
Q

tx of mod acute HZ pain

A

tramadol (can adjuvant w/ gabapentin or TCAs)

46
Q

tx of severe acute HZ pain

A

opioids, CS

47
Q

PHN tx for pain

A

TCAs
SNRIs (venla)
gabapentin or pregabalin
opioids
topical lido
cannabinoids

48
Q

Studies show _________________________or _______________________________yield greater reductions in PHN pain than either alone

A

gabapentin + nortrityline
gabapentin + morphine

49
Q

ramsay hunt sx can cause

A

facial paralysis and hearing loss in affected ear

446- ID and transplant (18 decks)

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