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Peds Patho Exam 3 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Which infections occur due to herpes virus? (5)

A
  1. Herpes simplex
  2. Varicella zoster
  3. Epstein Barr virus
  4. Roseola (HHV6, HHV7, ECHO16)
  5. HHV 8
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2
Q

Primary herpes infections (3)

A
  1. VZV - Varicella (chicken pox)
  2. HSV - oral mucocutaneous disease, genital ulcer disease, encephalitis
  3. CMV - mononucleosis-like viral illness
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3
Q

Reactivation of herpes infections (3)

A
  1. VZV - Shingles reactivates later in life in dermatomes of affected neurons
  2. HSV - recurrent mucocutaneous lesions or genital ulcer disease
  3. CMV - intermittent viral excretion? site of latency is not a neruon but rather a mononuclear cell
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4
Q

HSV Manifestations (7)

A
  1. Primary Gingivostomatitis
  2. Genital Ulcer Disease
  3. Neonatal Herpes
  4. Encephalitis
  5. Eczema herpeticum: Lesions concentrated in eczematous areas
  6. Keratoconjunctivitis
  7. Herpes Whitlow
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5
Q

Primary Gingivostomatitis (4)

A
  1. Direct contact with oral secretions/lesions of symptomatic or asymptomatic shedding
  2. HSV-1 in 90% of the cases (HSV-2 is 10%)
  3. Incubation period: 2 days - 2 weeks
  4. Asymptomatic primary shedding can occur
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6
Q

Primary Gingivostomatitis Clinical Manifestations (4)

A
  1. Fever and irritability
  2. Ulcers/gingivia, mucosa, autoinoculation
  3. Inability to eat
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7
Q

When is Primary Gingivostomatitis virus shedding highest

A

1-2 weeks, then intermittently

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8
Q

HSV Encephalitis (7)

A
  1. Necrotizing hemorrhagic encephalitis that occurs in the temporal lobe (except in neonates where it is not localized)
  2. HSV-1 is most common cause, except in neonates
  3. Can result from primary or recurrent disease
  4. Acute onset of fever, altered LOC
  5. Personality changes and convulsions
  6. Focal neurological changes
  7. Coma and death if untreated
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9
Q

Neonatal Herpes (5)

A
  1. Usually associated with primary maternal genital disease (HSV-2)*
  2. Infected during vaginal delivery or if >/= 4 hours prolonged rupture of membranes
    * Increased chance of transmission if primary vs reactivated
  3. Intrauterine infection is rare
  4. Premature birth increases risk
  5. Usually presents late in first week or 2nd week of life (up to 4-6 weeks of age)
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10
Q

Neonatal Herpes Type of Disease (4)

A
  1. Skin, eye, mouth disease –> vesicular lesions in areas of trauma (occiput, umbilicus, etc)
  2. Eye – conjunctivitis, keratitis, chorioretinitis
  3. Up to 30% may disseminate
  4. CNS disease w/o involvement of other organs (doesn’t disseminate to other organs)
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11
Q

HSV Reactivation (6)

A
  1. Recurrent herpes labialis (cold sores) & Genital Ulcer Disease (HSV-2&raquo_space; 1)
  2. Trigger: Stress, UV light, Menses
  3. Prodrome: tingling, etc.
  4. Less extensive lesions than in primary disease
    * e.g. oral lesions only on the vermilion border
  5. Viral shedding: highest titer in 1st 24 hours, low titer for < 5 days
  6. Asymptomatic shedding
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12
Q

HSV in Immunocompromised Individuals (9)

A
  1. Gingivostomatitis
  2. Genital Herpes
  3. Keratoconjunctivitis
  4. Cutaneous herpes
  5. Esophagitis
  6. Pneumonitis
  7. Hepatitis
  8. Disseminated disease; disseminating to other organs
    * Ex: herpes simplex in oral pharynx will disseminate into the esophagus
  9. Primary site of infection will look worst
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13
Q

Clinical Manifestations of Chicken Pox in Healthy Individuals (6)

A
  1. Contact/conjunctiva, oropharyngeal mucosa
    a. Can occur by contact with the dandruff of the skin
    b. Direct contact from oro-pharynx
    c. Not a respiratory virus; coming in contact with gross secretions
  2. Prodromal fever, irritability
  3. Papules→Vesicles →Pustules →Crusts
    a. Usually get three waves of these
  4. New lesions for 3-7 days → Crusting 1-2 weeks
    a. If the child has new lesions for more than 7 days then there is a chance that the child is immunocompromised
  5. ≤ 5 to > 500 (mean: 300)
  6. Scarring only with secondary infection
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14
Q

Chicken pox incubation period

A

12 - 21 days

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15
Q

Chicken pox lesions

A

Papules→Vesicles →Pustules →Crusts

*New lesions for 3-7 days → Crusting 1-2 weeks

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16
Q

Complications of Varicella (5)

A
  1. Cerebellar Ataxia, Encephalitis
    * Encephalitis is less common but more damaging
  2. Arthritis, Hepatitis
  3. Hemorrhagic Varicella
    * Fairly rare
    * Can occur if on long-term steroids (ex: asthma)
  4. Invasive Group A Streptococcal Infections
  5. Reye’s Syndrome
    * Severe hepatitis/liver toxicity
    * Neurological depression
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17
Q

CMV Manifestations in Healthy Individuals (5)

A
  1. Mononucleosis-like syndrome (esp in adolescents and adults)
  2. Fever, malaise
  3. Adenopathy, Splenomegaly, Pharyngitis
    * Less prominent and less common than with EBV
  4. Mild hepatitis, Heterophile negative, Atypical lymphocytosis
  5. Complications are rare: Guillain-Barre, Granulomatous hepatitis, Meningoencephalitis, Myocarditis
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18
Q

CMV In Younger Healthy Children (3)

A
  1. Asymptomatic
  2. Non-specific viral infection
  3. Mild, self-limited pneumonitis
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19
Q

CMV transmission

A

contact of infected salivary, urine, cervical secretions and semen

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20
Q

CMV in transfusion and transplant recipients (2)

A
  1. Latent virus/leukocytes

2. organs of seropositive donors

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21
Q

CMV incubation in immunocompromised individuals

A

Clinical symptoms occur usually 3-12 weeks after blood transfusion and 4 weeks-4 months after organ transplant

22
Q

CMV Clinical Manifestations: Immunocompromised Individuals (3)

A
  1. Primary infections are more severe than reactivation in persons infected prior to onset of immunosuppression
  2. Worst case scenario: Organ/ seropositive donor → seronegative recipient
  3. Organ Transplants:
    a. Higher morbidity, mortality in Bone Marrow, liver, heart, heart-lung vs. renal transplant recipients
    b. ↑ risk with ↑ immunosuppression: OKT3 antiserum, cyclophosphamide, azathioprine, addition of steroids to regimen
23
Q

EBV Manifestations (5)

A
  1. Fever
  2. Mononucleosis Syndrome in adolescents= Hepatosplenomegaly and cervical lymphadenopathy
  3. Non-specific illness in infants and young children
  4. Biphasic course
  5. If you give amox, they will get a characteristic rash
24
Q

EBV Transmission and Incubation

A

Transmission: close personal contact

Incubation: 30-50 days

25
Q

Complications of EBV (9)

A
  1. Rash w/ ampicillin
  2. Splenic rupture (surgical emergency)
  3. Aplastic anemia
  4. Severe headache/ encephalitis/ aseptic meningitis
  5. X-linked Lymphoproliferative disorder
  6. Post-transplant Lymphoproliferative disorder
  7. Burkitt’s lymphoma
  8. Undifferentiated CNS B cell lymphomas/ AIDS
  9. Nasopharyngeal Carcinoma
26
Q

Roseola/Sixth Disease (6)

A
  1. 3-5 days of high fever followed by resolution of fever + rash
  2. Rash is trunk –> neck and face and proximal extremities
  3. Rash fades in 1-3 days
  4. Majority is caused by HHV-6
  5. 80% occurs before 2 years old
  6. Asymptomatic viral shedding throughout adulthood
27
Q

Other Clinical Entities of HHV6 and HHV7

A

Non-specific febrile illness/ healthy children:

  1. High fever for 3-7 days
  2. Febrile seizures
  3. Encephalitis?

Reactivation in immunocompromised patients?
- Fever, hepatitis, bone marrow suppression, pneumonia, encephalitis

28
Q

Measles (4)

A
  1. Highly contagious RNA virus in paramyxovirus family
  2. Manifestations = fever, cough, coryza, conjunctivitis –> rash
  3. Incubation period is 8-12 days
  4. KOPLICK’S SPOTS
29
Q

Complications of Measles (7)

A
  1. Otitis media
  2. Bronchopneumonia/ laryngotracheobronchitis
  3. Diarrhea
  4. Encephalitis (1/1000 cases) w/ brain damage
  5. Death (1-3/1000 cases) due to encephalitis or respiratory complications
  6. Increased mortality in malnutrition, Vitamin A deficiency, immunosuppression
    * Give vitamin A prophylactics to px severe disease
  7. Subacute Sclerosing Panencephalitis; May be aberrant immune response to original measles infection
30
Q

Rubella (2)

A
  1. Rash and conjunctivitis milder than in measles

2. Posterior auricular lymph node involvement

31
Q

Congenital Rubella w/ manifestations (8)

A
  1. 20% Risk with maternal rubella in 1st or 2nd trimester
    * Earlier the infection, more severe the defects

Signs and Symptoms of Congenital Rubella:

  1. Congenital heart disease
  2. Deafness and Mental Retardation
  3. Cataracts, glaucoma, microphthalmia, chorioretinitis
  4. Low Birth Weight
  5. Purpura
  6. Classic blueberry muffin rash
  7. Floppy and hypotonic
32
Q

Paralytic polio (6)

A
  1. Enterovirus family that occurs as primary infection in the gut
  2. Most infections (>95%) are asymptomatic
  3. Non-specific illness w/ fever and sore throat in 4-8%
  4. Aspectic meningitis +/- parasthesia in 1-5%
  5. Rapid onset of paralysis in 0.1-2%
  6. Destroys motor neurons
33
Q

What are coxsackie viruses?

A

RNA enteroviral infections (non-polio enteroviruses)

34
Q

Location of HSV vs Enterovirus infection rash

A

HSV –> in anterior part of mouth

Enterovirus –> posterior part at tonsillar pillars

35
Q

Clinical Manifestations of Non-Polio Enteroviral Infections: Respiratory illness (6)

A
  1. Herpangina
  2. Coryza
  3. Pharyngitis
  4. Laryngotracheitis/ Bronchitis
  5. Pneumonia
  6. Pleurodynia
36
Q

Clinical Manifestations of Non-Polio Enteroviral Infections: Respiratory illness: GI, Cardiac, Other (7)

A

Gastrointestinal:

  1. Vomiting/ diarrhea
  2. Hepatitis, Pancreatitis
  3. Neocrotizing enterocolitis

Cardiovascular (Myo-, pericarditis)
4. Skin (hand foot & mouth disease)

  1. Acute hemorrhagic conjunctivitis
  2. Neurologic: Aseptic meningitis/ Encephalitis
  3. Persistent CNS infection/ B cell deficiency
37
Q

Common Enterovirus Serotypes (7)

A

a. Echo 22
b. Cox B5; Echo 5, 11, 33
c. Cox B2, B3, B4, B5; Echo 5, 11, 33
d. Cox B1 -5
e. Cox A16; Enterovirus 71
f. Cox A24v; Enterovirus 70
g. Cox B2 - 5; Echo 3, 9, 11, 17/ Enterovirus 71

38
Q

Fifth Disease (6)

A
  1. PARVOVIRUS B19
  2. DNA virus
  3. Fever followed by rash
  4. Fetal infection during first half of pregnancy –> hydrops fetalis in 2-6%
  5. Severe anemia and chronic bone marrow failure in AIDS and other immunodeficiencies
  6. aplastic crisis/SCD
39
Q

Duke’s Disease (7)

A

4th Disease

  1. Staphylococcal scalded skin syndrome.
  2. Fever, nausea, vomiting, and diarrhea, along with typical viral symptoms of photophobia, lymphadenopathy, sore throat, and possibly encephalitis.
  3. Rash may appear at any time during the illness.
  4. Rash is usually gerenalized.
  5. The rash consists of erythematous maculopapules with areas of confluence and may be urticarial, vesicular, or sometimes petechial.
  6. The palms and soles may be involved.
  7. Usually, the rash fades without pigmentation or scaling.
40
Q

Scarlet fever: what it is and manifestations (7)

A
  1. Group A strep
    * Pyrogenic exotoxins A,B,C act as superantigens

Manifestations:

  1. Pharyngitis
  2. Fever
  3. Sandpaper-like rash with perioral sparing
  4. Strawberry tongue
  5. Pastia’s lines
  6. Beau’s lines (occur several weeks post-scarlet fever)
    * Growth arrest of nails and peeling of skin
41
Q

other illnesses due to group A strep (3)

A
  1. Streptococcal Pharyngitis
  2. Post-Streptococcal Suppurative Complications
    a. Rheumatic fever - After pharyngitis, Type 5 M-protein strains
  3. Post-streptococcal Glomerulonephritis
    a. After impetigo or pharyngitis
    b. “Nephritogenic strains”
42
Q

Definition of CA-MRSA (4)

A
  1. Cultured from outpatients or hospitalized patients within 72 hours of admission
  2. No exposure to a healthcare facility in the last year
  3. Resistant to two or fewer classes of antibiotics
  4. Molecular characteristics
43
Q

Pertussis (4)

A
  1. Gram negative bacillus
  2. Infection in the respiratory epithelium down to the bronchi
  3. Causes strong inflammatory response; get a lot of gunk and debris in the respiratory tract and coughing is an effort to get this out
  4. Whoop due to air in a narrow airway
44
Q

Characteristic Stages of Pertussis

A
  1. Catarrhal - coryoza, low grade fever and mild coughing
  2. Paroxysmal - long episodes of coughing –> as less oxygen gets in, the child becomes blue/pale
    * Refractory period post-paroxysmal
  3. Convalescent
    * Coughing isn’t as bad; lasts 1-2 months
45
Q

Pertussis Complications (8)

A
  1. Secondary pneumonias (most common/in 16%)
  2. Acute otitis media
  3. Cerebral hemorrhages; developing hypoxia because not enough oxygen is getting in
    * Very severe cases
  4. Convulsions
  5. Transient hemiplegia
  6. Encephalopathy
  7. Death
  8. Failure to Thrive
46
Q

Influenza antigenic drift (2)

A
  1. Frequent point mutation during replication in a subtype
    * When there are point mutations in the genes
  2. Causes virus to be a little different each year
47
Q

Influenza antigenic shift

A

Appearance of a “new” subtype after genetic reassortment

Ex: H1N1 and H3N2 reassort to give H1N2

*Entirely different virus that presents differently to the immune system

48
Q

Influenza Transmission and Incubation

A

Transmission: airborne via large particles/cough or contact with respiratory droplets/surfaces

Incubation: 1-4 days

49
Q

Influenza viral shedding

A

1-2 days prior to symptoms through day 10 of symptoms = viral shedding in respiratory secretions
*Longer in young children and immunocompromised

50
Q

Influenza Manifestations (7)

A
  1. Non-productive cough
  2. Fever
  3. Myalgia
  4. Headaches
  5. Sore throat
  6. Runny nose

^For 3-7 days

  1. In children: otitis media, N/V
51
Q

Influenza complications (5)

A
  1. Pneumonia with secondary bacterial infection
  2. Encephalitis
  3. Myocarditis
  4. Febrile seizures
  5. Transverse myelitis
52
Q

VZV, HSV, CMV Latency

A

VZV: neurons and satellite cells of many dorsal root and trigeminal ganglia

HSV: neurons of sensory ganglia corresponding to mucocutaneous lesions

CMV: myeloid precursor cells

Peds Patho Exam 3 (7 decks)

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