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Unit 3 Microbio > L21: Viral skin infections > Flashcards

L21: Viral skin infections Flashcards

1
Q

Rubeola aka

A

Measles

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2
Q

Who gets severe measles?

A

Malnourished

Vitamin A deficiency

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3
Q

4 Stages of the measles

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

Incubation of the measles

A

10-14 days
Multiplies in respiratory epithelium and lymph nodes
Monocytes disseminate to other tissues=viremia

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5
Q

Prodrome of the measles

A

1-12 days post infection
High fever
3 C’s, Koplik’s spots

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6
Q

3 C’s of the measles

A

Prodrome
Coryza (rhinitis)
Cough
Conjunctivitis

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7
Q

Koplik’s spots

A

Buccal mucosa
Diagnostic of measles
Prodrome (precede rash)

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8
Q

Measles rash

A

appears 3-4 days after prodrome starts
Highest fever
Begins below ears, spread extensively, lesions may merge

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9
Q

Measles resolution

A

Viremia ends
Rise in Ab titers
Rash fades in same order it appears

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10
Q

Complication that causes the most measles deaths

A

Pneumonia
Greatest risk: malnourished, older
Bacterial superinfection common

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11
Q

Measles CNS involvement

A

Acute symptomatic encephalitis
High fatality
Subacute sclerosing panecephalitis (very rare)

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12
Q

Measles hosts

A

Humans and monkeys

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13
Q

Who is measles rare in?

A

<6 months (maternal immunity)

>10 years, as most are exposed by this age

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14
Q

How is measles transmitted?

A

HIGHLY CONTAGIOUS

Respiratory droplets

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15
Q

Diagnose the measles:

A

Rash, koplik’s spots
Serology
Fluorescent antibody: Multinucleated giant cells

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16
Q

Multinucleated giant cells

A

Measles

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17
Q

MMR vaccine schedule

A

15 months

4-6 years

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18
Q

If you think a kid younger than 15 months has been exposed to the measles

A

Vaccinate with monovalent measles vaccine

Revaccinate with MMR at 15 months

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19
Q

When to give a 3rd measles booster

A

recent outbreaks

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20
Q

Measles vaccine in the US

A

MMR II

Live attenuated, uses Jeryl Lynn mumps virus strain

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21
Q

Why isn’t the original MMR used?

A

Had a side effect of meningitis which resolves

Cheaper to make

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22
Q

BayGam

A

measles immune globulin for exposed non-immune subjects (6 days)

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23
Q

What was wrong with the 1st measles vaccines tested before MMR/MMR II?

A

Patients were sensitized but not immune, causing atypical measles which appeared like Rocky mountain spotted fever (hemorrhagic petechiae)

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24
Q

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

A

95%

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25
Q

Measles outbreaks occur in the _____ population

Mumps outbreaks occur in the _____ population

A

Measles: unvaccinated, air travel to foreign locations
Mumps: vaccinated, “breakthrough”

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26
Q

German measles aka

A

Rubella (“little red”)

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27
Q

The only human togavirus

A

Rubella

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28
Q

How is rubella transmitted?

A

Close and prolonged contact

Children often escape infection…

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29
Q

Rubella presentation

A

Mild exanthematous disease that superficially resembles the measles

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30
Q

Congenital Rubella Syndrome (CRS)

A

Maternal infection leads to placental and fetal infection

Substantial Risk fo fetus

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31
Q

Congenital Rubella Syndrome Cardiac defects

A

Pulmonary artery stenosis

Patent ductus arteriosis

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32
Q

Congenital Rubella Syndrome Eye defects

A

Cataracts

Glaucoma

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33
Q

Congenital Rubella Syndrome, other defects

A

Profound hearing loss

CNS involvment

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34
Q

What led to the initial recognition of Congenital Rubella Syndrome?

A

neonatal glaucoma (cataracts?)

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35
Q

What is the biggest element in outcome of Congenital Rubella Syndrome?

A

Timing of maternal infection:
Worst outcome in first month (50%), second and third months
By 4th month risk is exceedingly low

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36
Q

Who can’t get MMR?

A

Pregnant patients

MMR II: egg or neomycin sensitivity

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37
Q

You have documented rubella exposure of a non-immune mother in her 1st trimester….

A

administer IV immunoglobulin (IVIG) as prophylaxis

but it might not really help much…

38
Q

2 unique properties of HSV

A
  1. Capacity to invade and replicate in CNS

2. Ability to establish latent infections

39
Q

HSV primary infection

A

May be asymptomatic
Resolves, goes into lifelong latency
Lesions heal without scarring

40
Q

How does HSV remain latent?

A

Retrograde transport of virus through sensory neurons leading to infection of dorsal root ganglia

41
Q

How can HSV be reactivated?

A

Many ways: sunlight, stress, menses, nutrition

42
Q

How is continued spread of latent HSV halted?

A

cell and humoral immune processes

43
Q

Rule of thumb for HSV recrudescence

A

probability of recurrence is greater in individuals with larger and more extensive initial outbreaks

44
Q

HSV reservoir

A

humans only

45
Q

HSV1

A

common, oral

infection occurs early in life

46
Q

HSV2

A

occurs later

genital, correlated with sexual activity

47
Q

HSV spread

A

vesicular fluid, saliva, secretions

asymptomatic shedding is possible

48
Q

Dendritic pattern

A

HSV recurrence in the cornea

49
Q

Whitlow

A

a herpetic lesion in skin, medical and dental personnel at high risk

50
Q

Direct samples of HSV:

A 
Ballooning pathology
Enlarged and fused cells on Tzanck smear
FA assay for viral antigens
Culture on HeLa, Hep-2 cell lines
PCR
Antibody tests
51
Q

Do HSV antivirals prevent transmission?

A

No

52
Q

Famciclovir

A

HSV antiviral

53
Q

Acyclovir/Valacyclovir

A

HSV antivirals
Guanosine analogues that lack 3’ OH group
inhibit thymidine kinase when it phosphorylates them, halting viral DNA replcation

54
Q

Varicella-zoster virus (VZV) is a

A

Herpes virus

55
Q

VZV presentation

A

asymmetrical vesicular rash that follows dermatomal pattern
pruritic lesions
prodrome: fever, malaise, HA, neuralgia, anorexia (absent in younger children)

56
Q

VZV infects through

A

conjuctiva

respiratory tract mucosa

57
Q

VZV replicates in ______ during primary viremia

A

regional lymph nodes

primary viremia occurs 4-6 days after infection

58
Q

VZV replicates in ______ during secondary viremia

A

liver and spleen

secondary viremia+rash occur 10-14 days after infection

59
Q

VZV reservoir, seasonality, age group

A

Humans
Winter-spring
5-9 years

60
Q

When is VZV most contagious?

A

1-2 days before lesions appear

4-5 days after lesions appear

61
Q

Don’t give ____ for chicken pox

A

Aspirin

Reye’s syndrome risk

62
Q

Antiviral which is effective for VZV?

Immune serum?

A

Acyclovir

VariZig: for high risk+exposure

63
Q

Chickenpox vaccine

A

Varivax
No aspirin for 28 days after
2 rounds to reduce breakthrough cases

64
Q

Congenital/neonatal VZV

A

Significant disease/damage

65
Q

Shingles risk factor

A

AGE

1/2 of individuals over 85 will experience an outbreak

66
Q

Shingles presentation

A

PAIN which may precede rash by days to week
Searing, burning, stabbing
Redness to papules to vesicles in 24 hours
Low grade fever, anorexia

67
Q

Zoster means

A

“Belt/stripe”

unilateral dermatomal distribution with sharp limits

68
Q

How often does ophthalmic branch of CN V become involved in shingles?
Ocular involvement?

A

10%

20%

69
Q

Most common complication of shingles

A

Postherpetic neuralgia: pain lasts months

70
Q

Is shingles transmissible?

A

NO

You have to have had the chickenpox to get it

71
Q

Shingles vaccines

A

Zostavax

Shingrix

72
Q

Zostavax

A

this is the same as Varivax but much higher potency

ONLY for pts >50 who have had chickenpox

73
Q

Shingrix

A

adjuvanted, recombinant

recommended even if pt has had zostavax

74
Q

Human Herpes Virus 6 (HHV-6) aka

A

6th disease
Roseola Infantum
Exanthum subitum

75
Q

HHV-6 disease progression

A

very high fever (2-5 days, 39-41 C) yet well apearing

followed by rose-colored rash

76
Q

HHV-6 diagnsosi

A

EIA detects antibody

PCR amplifies DNA sequence for detection

77
Q

HHV-6 treatment and prevention

A

No antivirals, no isolation, no prevention

78
Q

Parvovirus B19 aka

A

5th disease
Erythema infectiosum
Slapped cheek

79
Q

Parvovirus B19 presentation

A

prodrome followed by rash:
slapped cheek, circumoral pallor
+/- lacy maculopapular rash of limbs and trunk
resolves in 1-2 weeks

80
Q

Parvovirus B19 prodrome

A

several days, mild:

fever, HA, malaise, myalgia, URI sx, N/V

81
Q

Connective tissue manifestations of Parvovirus B19

A

Arthralgia and/or arthritis (after rash)

can be quick severe

82
Q

Parvovirus B19 in adults

A

arthralgia and/or arthritis alone without any preceding or concurrent symptoms

83
Q

Parvovirus B19 season? location? age?

A

Late winter/spring
Worldwide
School age children

84
Q

Parvovirus B19 diagnosis

A

anti-B19 IgM antibody
facial rash
epidemic outbreak?

85
Q

Parvovirus B19 + anemia

A

Immunoglobulin

86
Q

Parvovirus B19 treatment

A

NSAIDs, supportive

87
Q

anogenital warts

A

HPV 6, 11

88
Q

cervical dysplasia and cancer

A

HPV 16, 18

89
Q

Gardasil 9 protects against

A

HPV 6, 11, 16, 18 + 5 others

90
Q

Gardasil 9 can be given to

A

anyone aged 9-45

Unit 3 Microbio (13 decks)

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