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omopor > L8: viral infections pt 1 (up till vzv) > Flashcards

L8: viral infections pt 1 (up till vzv) Flashcards

1
Q

what are the 2 patterns of infections

A

lytic and cytopathic viruses

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2
Q

what is the difference between lytic and cytopathic virus

A

lytic causes destruction of host cells leading to ulceration wherease cytopathic is after infect host cell, the host cell is disrupted/ dysregulated

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3
Q

examples of lytic virus

A

hsv, vzv, coxsackie

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4
Q

examples of cytopathic virus

A

CMV, EBV, HHV 6,7,8

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5
Q

varicella zoster virus is hhv what

A

HHV 3

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6
Q

what is HHV 4 and 5

A

HHV 4= EBV
HHV 5= CMV

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7
Q

what is HHV 8

A

kaposi’s sarcoma herpesvirus

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8
Q

what is the most common cause of oral viral infections

A

herpes simplex virus

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9
Q

what signs are seen in the initial phase of HSV

A

systemic signs: fever, malaise, pharyngitis
oral and facial lesgions

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10
Q

what signs do we see in a primary oral HSV infection

A
  • vesicular lesions -> pseudomembranous ulcers
  • gingivostomatitis/ pharyngitis
  • significant pain
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11
Q

the 2 HSV spread via what

A

both spread via direct contact with mucous membrane
- HSV 1 = by saliva
- HSV 2 = by sex

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12
Q

is HSV infectious?

A

yes, both the symptomatic active lesions and asymptomatic viral shedding are

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13
Q

HSV lie latent in ____ and recurrence is triggered by ___, _____, ___, ___

A
  • CNS trigeminal ganglia cells
  • triggered by immunodeficiency, UV light, trauma, stress
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14
Q

what does “prodormal signs” refer to

A

the period between appearance of initial symptoms and full blown rash

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15
Q

what are the prodromal signs of primary orofacial HSV

A
  • 12-24 hours prior to appearance of oral lesions will have:
    malaise, fever, myalgia and sore throat

also might have pharyngitis, cervical lympadenopathy

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16
Q

what are the other signs of primary herpetic gingivostomatitis aka orofacial HSV

A

painful, enlarged, erythematous gingiva

pinhead vesicles rupture -> ulcers coalescence and form crops of ulcers (sudden onset of oral lesions)

occurs on attached AND unattached oral mucosa

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17
Q

what differentiates a primary orofacial HSV infection from a secondary one?

A

primary will have sudden onset of oral lesions on both attached and unattached mucosa whereas secondary is only attached

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18
Q

duration of oral lesions in primary orofacial HSV is

A

7-10 days

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19
Q

how to diagnose orofacial HSV?

A
  • Clinical hx and pattern of lesions is quite a reliable method
  • viral cultures are most definitive but not always done because need time to process plus need intact vesicles since the ruptured ones are contaminated
  • biopsy is more invasive
  • PCR of viral DNA
  • direct fluorescent assay for HSV antigen
  • serology
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20
Q

what are the results of serology for a positive orofacial HSV case

A
  • antibody titers will be positive 4-8 days after initial exposure
  • but requires 2 tests - on presentation and 1 month later
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21
Q

histopatho of HSV

  • ________ epithelium
  • __________ cell, ballooning ________
  • ________ of chromatin with nuclear clearing and ______
  • intracellular _______ from ______ vesicle with _____ cell infiltrate
  • _______ cells with area of ulcer (viral altered keratinocytes)
A
  • acantholytic epithelium
  • multinucleated cell, ballooning degeneration
  • margination of chromatin with nuclear clearing and enlargement
  • intracellular oedema from intraepithelial vesicle with inflammatory cell infiltrate
  • Tzanck cells with area of ulcer (viral altered keratinocytes)
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22
Q

histopatho of HSV
- _____ epithelium
- _______ cell, ____________ degeneration
- margination of ______ with _______ _______ and enlargement
- ______ oedema from _________ ______ with inflammatory cell infiltrate
- Tzanck cells with area of _______ (viral altered _____)

A
  • acantholytic epithelium
  • multinucleated cell, ballooning degeneration
  • margination of chromatin with nuclear clearing and enlargement
  • intracellular oedema from intraepithelial vesicle with inflammatory cell infiltrate
  • Tzanck cells with area of ulcer (viral altered keratinocytes)
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23
Q

mx of HSV in healthy px

A

supportive care and symptomic mx
- bland rinse or with salt water to remove necrotic debri
- topical LA
- oral analgesics
- adequate nutrition and fluid replacement

avoid self innoculation to other regions

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24
Q

what topical anesthetic agents can be given to HSV px

A
  • viscous lidocaine 2%
  • diphenhydramine aka difflam
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25
Q

what is the systemic therapy given for primary HSV infection

A
  • anti viral agents like acyclovir (5x a day 200mg)
  • ## usually not given to healthy px as it may affect abiity to develop immunity
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26
Q

ddx of HSV infection

A

identical clinical findings got:
ANUG, VZV, herpangiana, HFMD

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27
Q

reccurent HSV infections occur where?

A

at primary site of innoculation or in the adjacent areas of surface epithelium supplied by the ganglion

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28
Q

prodromal symptoms of RECURRENT hsv

A

tingling, burning, itching, erythema

29
Q

where does recurrent HSV infection affect in healthy px

A

the keratinized mucosa bound to bone (hard palate, attached gingiva)

30
Q

describe the process of a recurrent HSV infection (like what are the signs presented)

A

initial lesion is multiple small raised vesicles confined to a small area -> vesicles rupture and crust

takes 7-10 days to heal

31
Q

location of recurrent HSV infection in immunocompromised px?

A
  • affects both keratinized and non keratinized mucosa
  • need tx otherwise lesions will spread and worsen
  • not confined to oral mucosa, can have skin lesions too
32
Q

if there is a HSV infection in the immunocompromised px, he can be co infected with what?

A

CMV

33
Q

the lesions in recurrent HSV in immunocompromised have a central zone of what

A

central zone of superficial necrosis with raised yellow border

34
Q

90% of adults are seropositive for what virus

A

Varicella zoster virus

35
Q

in the vzv virus, which is responsible for primary and secondary infection?

A

primary: varicella
secondary: herpes zoster

36
Q

vzv lies latent where?

A

sensory nerve ganglia, dorsal root ganglia

37
Q

vzv spread via what

A
  • respiratory droplets
  • direct contact with active lesions
38
Q

risk factors for recurrence of VZV

A
  • hiv infection, malignancies
  • radiation
  • immunosuppressive agents
  • alcohol abuse
  • stress, old age (because as age increase, cell mediated immunity decreases and risk increases)
39
Q

systemic signs of primary vzv infection (varicella)

A

fever, malaise, pharyngitis, rhinitis

40
Q

dermatologic findings of primary vzv infection

initial stages got what?
then stages of the lesion progress from erythema to ___ to ____ to ____
lesions continue to erupt for _____ days, old lesions can intermix with ____
contagious from ____

A

initial got pruritic rash (exanthem) which involved face and trunk then spreads to extremities

  • stages:
    erythema -> vesicle (dewdrop on rose petal) -> pustule -> crusting

lesions continue to erupt for 4-7 days, old lesions intermix with new lesions

  • contagious from 2 days before rash until all lesions crust
41
Q

what is described as dewdrop on rose petal?

A

a primary vzv infection vesicle.
this is the 2nd stage of the lesion, following erythema

42
Q

oral findings of primary vzv infection

  • can precede ___
  • common sites are ______, palate, _____, ____-
  • lesions tend to be painful or painless?
  • stages of oral lesions progress from vesicles then ______
  • lasts for ____ days
A
  • can precede skin lesions
  • common sites are vermillion border of lips, palate, buccal mucosa, gingiva
  • painless
  • vesicles rupture then form ulcers of 1-3mm (number of ulcers range from 1-30)
  • lasts for 5-10 days
43
Q

complications of primary VZV infection

A
  • reyes syndrome (if aspirin is used in kids less than 12 yo)
  • secondary skin infections
  • encephalitis
  • pneumonia
  • cerebellar ataxia
  • gi distrubances
  • hematologic events - pancytopenia, thrombocytopenia, hemolytic anemia, sickle cell crisis
44
Q

what type of hematologic events can be complications of varicella infection?

A

pancytopenia, thrombocytopenia, hemolytic anemia, sickle cell crisis

45
Q

histopatho features of varicella infection **

  • acantholysis with formation of ____
  • virus laden ____ exhibits margination of ________ and multinucleation
A
  • acantholysis with formation of Tzanck cells
  • virus laden epithelial cell exhibits margination of chromatin and multinucleation
46
Q

histopatho features of varicella infection **
- _______ with formation of Tzanck cells
- virus laden epithelial cell exhibits __________

A
  • acantholysis with formation of Tzanck cells
  • virus laden epithelial cell exhibits margination of chromatin and multinucleation
47
Q

how to diagnose vzv?

A
  • clinical presentation
  • hx of exposure to vzv within last 3 weeks and presence of exanthem
  • cytological smears
  • cell culture/ immunofluorescence stains for VZV antibodies
  • antibodies titers to VZV
48
Q

tx of varicella infection

A
  • supportiv care
  • no antiviral therapy needed in healthy px (but may be implemented in older children with severe disease)
  • in immunocompromised px, purified VZV Ig can be given to modify clinical manifestations
49
Q

prevention of vzv infection can be done by

A
  • vzv vaccine (live attenuated virus)
  • but efficacy of this decreases with time and only exposure to wild type virus provides lifetime immunity
50
Q

what kind of vaccine is vzv vaccine

A

live attenuated virus

51
Q

shingles is known as what virus?

A

recurrent vzv infection aka herpes zoster infection

52
Q

risk of reactivation of latent vzv virus increases with

A

-age
- hiv infection
- radiation
- tx with cytotoxic or immunosuppressive agents
- presence of malignancies
- alcohol abuse
- stress

53
Q

ddx of varicella infection aka primary vzv infection?

A
  • hsv
  • drug induced stomatitis
54
Q

prodromal symptoms occur in how many percent of people with shingles?

A

90%
10% wont have prodromal symptoms

55
Q

what are the prodromal symptoms that occur in shingles?

A
  • fever, malaise, headache
  • tingling, burning, itchin
56
Q

prodromal symptoms in shingles usually affect how many dermatomes?

A

one

57
Q

what are the acute symptoms of recurrent vzv infection aka shingles?
- clusters of _____ on erythematous base which ________
- _______ occurs and resolves in healthy individuals
- coalescing _______ oral ulcerations

A
  • clusters of fluid filled vesicles on erythematous base which ulcerates
  • crusting occurs and resolves in healthy individuals
  • coalescing pseudomembranous oral ulcerations
58
Q

acute symptoms of recurrent vzv infection aka shingles:
- clusters of fluid filled vesicles on ________
- _____ occurs and _______ in healthy individuals
- _____ pseudomembranous ______

A
  • clusters of fluid filled vesicles on erythematous base which ulcerates
  • crusting occurs and resolves in healthy individuals
  • coalescing pseudomembranous oral ulcerations
59
Q

chronic symptoms of recurrent vzv infection aka shingles

A
  • in 15 % of px
  • persistent pain longer than 3 months (post herpetic neuralgia)
  • increase prevalence with older age
60
Q

how are the oral lesions like in shingles

  • involves what type of mucosa?
  • extends to where and occur in conjunction with involvement of ____
  • ______ of teeth in affected quadrant
  • _____ necrosis and which is secondary to damage of ______ (known as _____)
A
  • involves both keratinized and non keratinized mucosa
  • extends to midline and occurs in conjunction with involvement of overlying skin
  • devitalisation of teeth in affected quadrant
  • bone necrosis, damage of blood vessels aka focal ischemic necrosis
61
Q

complications of shingles

A
  • ocular involvement (common) -> can cause permanent blindless
  • ramsay hunt syndrome: facial paralysis associated with herpes zoster of EAC/ face. also have hearing deficits, vertigo
  • post herpetic neuralgia (common): pain persists more than 3 months after presentation of initial rash. usually in older px.
62
Q

ramsay hunt syndrome is a complication of what infection

A

herpes zoster, aka recurrent vzv infection (shingles)

63
Q

what are the characteristics of the pain in post herpetic neuralgia?

A
  • burning, throbbing, aching, stabbing
  • triggered by light stroking of area
  • resolution of pain is gradual
64
Q

how to treat post herpetic neuralgia

A

use anti viral agents long term eg famaciclovir

65
Q

how to treat post herpetic neuralgia

A

use anti viral agents long term eg famaciclovir
dont give steroids because its not good for viral infection (systemic steroids of unclear benefit)

66
Q

mx of shingles

A
  • supportive and symptomatic relief by antipyretics and antipruritics
  • antiviral meds eg acyclovir, valacyclovir, famiciclovir
    - antivirals used to accelerate healing, but only effective if started within 72 hours
67
Q

ddx of shingles

A
  • hsv
  • drug induced stomatitis
68
Q

what are lidoderm patches and zostrix cream used for?

A

symptom relief for shingles aka recurrent vzv infection
targets the post herpetic neuralgia

omopor (11 decks)

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