Herpes simplex infection, Varicella Zoster, Rubella, Parvovirus infection Flashcards
Herpes simplex infection
- source of infection
- route of infection
- incubation period
- HSV 1 – skin and mucosal infection, HSV 2 – genital
1. humans
2. air-droplet, direct contact
3. 3-7 days
Herpes simplex infection
-clinical manifestations (6)
- Herpes gingivostomatitis – HSV-1, 6 months – 3 y.o children, IP: 2-12 days, onset is acute – child becomes restless/irritable/complains of pain/ refuses to eat, disease progresses for 4-5 days
- Herpes zoster – on the area of the lips, blisters, rash hurts/ itching, lymph nodes may be enlarged, tends to recur
- Ocular herpes simplex – most common injury to one eye, sudden/sharp pain, photophobia, tearing, flushing and edema of the eyelids, ulcers appear on the cornea, visual impairment
- Whitlow finger – vulnerable distal phalanges – redness, swelling, pain, herpes rash (caused by child sucking thumb)
- Herpes encephalitis – lesions in the temporal lobes of the brain, sudden fever, malaise, headache, behavioral changes, mental, orientation, memory disorders, hallucinations
- Herpes eczema – elevated IgE, eosinophilia, allergic background of the patient – caused by impaired cellular immunity of atopic skin and impaired cytokine production.
Herpes simplex infection
- diagnosis
- treatment
- PCR, detection in CSF
2. treatment of primary diseases should be continued, Acyclovir, treatment of secondary bacterial infections
Varicella Zoster
- source of infection
- route of infection
- Primary manifestations: chicken pox
- VZV persists lifelong in the ganglia of sensory neurons in the spinal cord –> reactivation of latent VZV manifest as shingles
- sick person
- direct contact with the rash, aerosol, vertical transmission
Varicella Zoster
-when does the patient spreads the infection?
The patient spreads the infection for the last 2 days of the incubation period and 5 days after the appearance of the last rash element
Varicella Zoster - Congenital chickenpox syndrome
- when a pregnant woman develops chickenpox in the first 5 months of pregnancy, the newborn will have it
- Characterized by: intrauterine growth retardation, microcephaly, hydrocephalus, cortical atrophy and mental retardation, limb hypoplasia, eye disorders, skin scars
Varicella Zoster - Congenital chicken pox
if a pregnant woman is exposed to VZV or develops chickenpox 2 weeks or less before delivery, the baby is born with chickenpox symptoms or develops them 5-10 days of life
- Vesicular rash, fever
- Possible hemorrhagic syndrome
- Impaired consciousness, convulsions
- The disease may manifest as viral pneumonia, hepatitis, meningoencephalitis
Varicella Zoster - Neonatal chickenpox
when a newborn is exposed to VZV infection and becomes ill after birth
Varicella Zoster
- pathogenesis
- diagnosis
- treatment
- prevention
- Ocular compound, upper respiratory mucosa infection –> replication in regional lymph nodes –> primary viremia –> replication in liver, spleen, parenchyma organs –> secondary viremia –> skin infection, vesicular rash
- epidemiological history, serology, PCR, blood tests (blood count, CRP), chest radiography, lumbar puncture – if neurological symptoms are present, skin bacteriology
- acyclovir
- Symptomatic treatment: anti pyrectics, anti-histamines, fluids, skin hygiene - vaccination
Shingles
- prodrome
- after 1-14 days
- treatment
- headache, weakness, fever
- rash of clustered papules, blisters, full of clear liquid. Spilled areas hurt, burn, sting.
- antiviral drugs, acetaminophen to reduce pain
Chicken pox
- incubation period
- stages of the disease
- complications
- 11-21 days
- Prodrome: fever, malaise and/or pharyngitis, decreased appetite
- Rash period: generalized herpes rash
- Reconvalescention
- After recovery, hypo/hyperpigmentation areas may remain at the site of the former rash
- Rash can be localized throughout the body - secondary bacterial skin infections (most commonly S. aureus and group A Streptococci), thrombocytopenia (due to bone marrow suppression), other respiratory infections, neurological complications (cerebellum ataxia, encephalitis), viral pneumonia
Rubella
- source of infection
- route of infection
- the patient can infect others from…
- incubation period
- Pathogenic only to humans
- Poorly resistant to the environment
- sick humans
- air, transplacental
- The patient can infect other from 7 days before the onset of symptoms to 7 days after the onset of the rash
- 14-21 days
Rubella
-symptoms (3)
- short term fever, enlarged lymph nodes, maculopapular skin rash
- Prodromal period is short (1-2 days), general weakness, subfebrile
- Rash begins in face and neck, small pink spots do not tend to merge –> rash spreads after 24h –> surface of limbs, joints, buttocks –> disappears after 1-5 days
Rubella
- complications
- diagnosis
- differential diagnosis
- treatment
- arthralgia/arthritis (more common in adults), post-infectious thrombocytopenia (more common in children), encephalitis, Guillain-Barre syndrome, Peripheral neuritis, myocarditis/ pericarditis
- serology (specific IgM antibodies or increase IgG antibodies super much), PCR
- allergic or drug induced rash, Kawasaki disease
- symptomatic
Congenital Rubella syndrome (CRS)
- symptoms
- most common symptom
- treatment
- prevention
- microcephaly, heart disease, petechiae and purpura, eye anomalies
- hearing and visual impairment
- long term treatment is necessary to prevent further complications, hearing tracking
- Children are not allowed in group 7 days from the start of the rash - vaccine
Parvovirus infection (3)
- Infectious erythema, fifth disease
- B19 parvoviruses
- Parvoviruses pathogenic to humans are not pathogenic to animals and vice-versa
Parvovirus infection
- seasonality
- age
- route of infection
- complications
- end of winter, spring
- 5-15 years
- air droplet
- rare
Parvovirus infection
-clinical forms (4)
- infectious erythema
- arthritis and/or arthralgia
- aplastic crisis – due to hemoglobinopathy
- fetal parvovirus infection
***Papular purpuric glove and socks syndrome (PPGSS) – rare cases
Parvovirus infection
-Infectious erythema
o most common clinical manifestation in children
o Incubation period: 4-14 days
o Prodrome period one week before rash subfebrile fever, headache, muscle aches, symptoms of upper respiratory tract infection
o Rash period 15-17 days – normal temperature
o “Slapping symptom” – erythema of the cheeks, pallor around mouth
o Rash on the torso, buttocks, limb extensor surfaces, may be itchy
o Join paint, swelling
Parvovirus infection
-Arthritis and/or arthralgia
o Most common in adults
o Joints are symmetrically damaged
Parvovirus infection
-Aplastic crisis – due to hemoglobinopathy
o Severe viremia, without rash, in 1-2 weeks goes away, requires EM transfusions, can infect others (isolation required)
- chronic B19 infection (chronic anemia) - for immunosuppressed patients
Parvovirus infection
-Fetal parvovirus infection
o Severe anemia, amniotic fluid pathology, myocarditis, fetal heart failure
o Most dangerous up to 20 weeks –> fetal loss can occur at any moment
Parvovirus infection
- diagnosis
- treatment
- prevention
- serology (specific antibodies – anti-B19 persists for 2-3 months, paired anti-B19 IgG tilters – after 4-6 weeks), PCR (rare), fetal ultrasound
- usually not needed, symptomatic
- no vaccine
Parvovirus infection
-when are the patients infectious?
With the onset of parvovirus B19, patients no long infect others, no isolation required, with the exception of transient aplastic crisis and chronic B19 infection
