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Microbiology > E2- Viral Skin Infections > Flashcards

E2- Viral Skin Infections Flashcards

1
Q

In which populations can Measles be severe in?

A

Can be severe in malnourished and/or vitamin A deficient persons

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2
Q

What is the causative agent of measles?

A

Rubeola

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3
Q

What are the four stages of Measles infection?

A
  1. Incubation
  2. Prodromal
  3. Rash
  4. Resolution
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4
Q

Where does Measles replicate?

Measles disseminates to other tissues by what?

A

Respiratory epithelium and lymph nodes

Monocytes

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5
Q

Multiplication of virus in respiratory epithelium and lymph nodes and dissemination to other tissues by monocytes is seen in which stage of Measles?

A

Incubation period

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6
Q

What is the characteristic presentation in the prodromal stage of Measles?

A

High fever
Coryza, persistent cough, conjunctivitis (the 3 Cs)
Koplik’s spots on buccal mucosa (diagnostic)

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7
Q

What is diagnostic for Measles?

A

Koplik’s spots on buccal mucosa

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8
Q

When does a Measles rash appear?

A

3-4 days after prodrome initiates

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9
Q

What is seen in the rash stage of Measles?

A 
Highest fever (sickest patient)
Begins below ears, spreads
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10
Q

What is seen in the resolution stage of Measles?

A

Rise in antibody titers, viremia stops

Rash fades in same order that it appears

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11
Q

What are complications of Measles?

A

Pneumonia
Diarrhea
CNS involvement (Encephalitis)

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12
Q

What is the most common cause of Measles death?

A

Pneumonia (bacterial superinfection common)

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13
Q

What CNS effects can Measles cause?

A

Acute symptomatic encephalitis
High fatality rate
SSPE - subacute sclerosing panencephalitis (very rare in U.S.)

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14
Q

Besides humans, what is the only other species that can act as a Measles host?

A

Monkeys

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15
Q

Is there a healthy carrier state of Measles?

A

NO

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16
Q

What age group is most commonly affected by Measles?

A

Disease of children (most immune by age 10)

Rare in infants under 6 mo (maternal immunity)

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17
Q

How is Measles transmitted?

A

Respiratory droplets (highly contagious)

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18
Q

How is Measles dx?

A

Rash and/or Koplik’s spots
Serology
Fluorescent antibody test on cells obtained from swabs of pharynx, nasal and buccal cavities
(multi-nucleated giant cells)

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19
Q

How is Measles controlled?

A

MMR vaccine

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20
Q

What can you use for patients exposed to measles who are non-immune subjects?

A 
Immune globin (BayGam)
- must be used within 6 days of exposure
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21
Q

When is the MMR vaccine given?

A

15 months -first dose
4-6 -second dose
+/- 3rd dose
May vaccinate children under 15 mo with monovalent measles vaccine if exposure is likely

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22
Q

What type of MMR vaccine is used in the US?

A

MMR II

Live, attenuated vaccine, not suitable for all patients

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23
Q

What percent of the population must be vaccinated to halt Measles persistence in the population?

A

95%

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24
Q

What is the most common cause of Measles outbreaks in the US?

A

Non-vaccinated person and air travel to foreign locations

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25
Q

What is the causative agent of German Measles?

A

Rubella

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26
Q

What is probably needed for Rubella infection?

A

Close and prolonged contact

many children often escaped infection

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27
Q

Maternal infection (viremia) during _____ may lead to placental infection and fetal infection.

A

First trimester of pregnancy

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28
Q

What is a complication of Rubella?

A

Congenital Rubella Syndrome (CRS)

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29
Q

How does Congenital Rubella Syndrome (CRS) present?

A

Cardiac defects
Eye defects (cataracts, glaucoma)
Hearing loss
CNS involvement

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30
Q

Who should never receive the MMR vaccine?

A

Pregnant women (especially in first trimester; live vaccine)

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31
Q

If non-immune mother is exposed to Rubella, what may you give prophylatically?

A

Immunoglobin (IVIG)

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32
Q

What two properties influence the disease capacity of HSV?

A

Capacity to invade and replicate in CNS

Ability to establish latent infections

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33
Q

HSV will cause a _____ that will resolve and establish a ____ state of latency subject to reactivation

A

HSA will cause a primary infection (may be asymptomatic) that will resolve and establish a quasi-stable state of latency subject to reactivation (recrudenscence)

34
Q

How does HSV present?

A

Shallow vesicles on an erythematous base

Ballooning pathology, vesicles crust over (painful)

35
Q

How does the HSV virus remain latent?

A

Retrograde transport of virus through sensory neurons and ultimate infection of the dorsal root ganglia

36
Q

How long does HSV latency last?

A

Life-long

37
Q

What are some things that can reactivate HSV?

A

Sunlight, stress, menses, nutrition

38
Q

What halts continued spread of HSV?

A

Cell and humoral immune process

39
Q

____ will occur even in the presence of active humoral and cellular immunity?

A

Recrudescence

40
Q

The probability of recrudescence is greater in individuals with what?

A

Larger and more extensive initial outbreaks

41
Q

What species can act as a reservoir for HSV?

A

Humans

42
Q

How is HSV spread?

A

Contact with vesicular fluid, saliva, and secretions

43
Q

Is asymptomatic HSV shedding possible?

A

YES

44
Q

What type of HSV infection is most common and when does it usually occur?

A

HSV-1

Early in life

45
Q

What type of HSV infection usually occurs later in life and is associated with sexual activity?

A

HSV-2

46
Q

HSV disseminates in the absence of ____.

A

Immune response

47
Q

How is HSV dx?

A 
Direct samples of tissue
Ballooning pathology
Presence of enlarged and fused cells 
FA assay for vital antigens
Culture 
PCR
Antibody tests
48
Q

What is the causative agent of chickenpox and shingles?

A

Varicella-zoster virus (VZV)

herpes zoster

49
Q

How does chickenpox present?

A

Asymmetrical vesicular rash
Follows dermatomal pattern
Fever, malaise, headache, neuralgia
Lesions pruritic

50
Q

How does chickenpox virus spread?

A

Conjunctiva or respiratory tract mucosa

virus also present in vesicles

51
Q

Where does chickenpox replicate? When?

A

Lymph nodes primary viremia 4-6 days after infection

Liver and spleen secondary viremia (coincident with rash) 10-14 days after infection

52
Q

Who are the only species can act as a reservoir for VZV?

A

Humans

53
Q

When is a pt that is infected with VZV most contagious?

A

1-2 days before appearance of lesions and 4-5 days after

54
Q

How is chickenpox dx?

A

Clinical findings

Rash and fever

55
Q

VZV may be tricky to distinguish from HSV in what patients?

A

Immunocompromised and neonates

56
Q

Is aspirin recommended for tx of chickenpox? Why?

A

No, Reyes syndrome risk

57
Q

What vaccine can be used to prevent chickenpox?

A

Varivax (live vaccine)

58
Q

Can you still get chickenpox if you have been vaccinated?

A

Yes

59
Q

_____ during pregnancy can produce significant disease.

A

Congenital/neonatal VZV

60
Q

Why might some parents have a Rubella “Party?”

A

They believe that obtaining the actually infection is superior to the vaccine because they will obtain life-long immunity (FALSE)

61
Q

What can VZV can remerge as ____

A

Shingles

62
Q

How does Shingles present?

A

Painful lesions in unilateral dermatomal distribution (searing, burning, stabbing)
Pain may precede rash by days to weeks
Area of redness evolves to papules to vesicles in 24 hour period
Low grade fevers, anorexia

63
Q

What nerves may Shingles involve?

A

Ophthalmic branch of the 5th cranial nerve (ocular involvement)

64
Q

What is the most common complication of Shingles?

A

Postherpetic neuralgia

65
Q

What is an absolute prerequisite for Shingles?

A

Chickenpox or Varivax vaccination (not directly transmissible)

66
Q

How is Shingles prevented?

A

Zostavax vaccine

Shingrix vaccine

67
Q

Who is Zostavax indicated for?

A

Pts over 50

Same virus used in Varivax, but higher potency

68
Q

Who is Shingrix indicated for?

A

Prior Zostavax recipients, may replace Zostavax

69
Q

What is Roseola Infantum (6th Disease) caused by?

A

Human Herpes Virus-6

HHV-6

70
Q

What is one of the most regularly acquired viral infections of childhood?

A

HHV-6

71
Q

How does HHV-6 present?

A

Sequence of fever followed by a sudden rose-colored rash

72
Q

How is HHV-6 dx?

A

Detection of antibody by EIA

DNA sequence detection by PCR amplification

73
Q

What causes Erythema infectiosum (fifth disease)?

A

Parvovirus B19

74
Q

How does Parvovirus present?

A

Prodromal illness of several days duration with mild symptoms
Followed by maculopapular rash (slapped cheek appearance, circumoral sparing)
Arthralgia, arthritis (in adults)

75
Q

What age population has the highest incidence of Parvovirus?

A

School age children (elementary schools)

76
Q

How is Parvovirus dx?

A

Facial rash helpful
Detection of anti B19 IgM antibody
Epidemic outbreaks aid diagnosis

77
Q

HPV 6 and 11 produce what?

A

Anogenital warts

78
Q

HPV 16 and 18 produce what?

A

Cervical dysplasia and cancer

79
Q

How is HPV prevented?

A

Vaccines are available to prevent HPV sexually transmitted infection
Gardasil 9- HPV 6, 11, 16, 15, and 5 others

80
Q

What age groups can you give the Gardasil vaccine to?

A

Males and females ages 9-45

81
Q

What is seen on a positive FA test for measles?

A

Multinucleated giant cells.

Microbiology (23 decks)

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