MIC CA Flashcards
How does varicella-zoster virus present clinically?
A mild prodrome of fever and malaise may occur 1 to 2 days before rash onset, particularly in adults. In children, the rash is often the first sign of disease.
Incubation period for varicella
14 to 16 days after exposure to a varicella or a herpes zoster rash, with a range of 10 to 21 days.
Varicella in Unvaccinated Persons presentation
The rash is generalized and pruritic. It progresses rapidly from macular to papular to vesicular lesions before crusting.
Lesions are typically present in all stages of development at the same time. The rash usually appears first on the chest, back, and face, then spreads over the entire body.
The lesions are usually most concentrated on the chest and back.
Symptoms typically last 4 to 7 days.
- Breakthrough varicella is infection with wild-type varicella-zoster virus (VZV) occurring in a vaccinated person more than _____________ days after varicella vaccination.
- Varicella in Vaccinated Persons (Breakthrough Varicella) presentation
- More than 42 days after varicella vaccination.
- Breakthrough varicella is usually mild. Patients typically are afebrile or have low fever and develop fewer than 50 skin lesions. They usually have a shorter illness compared to unvaccinated people who get varicella. The rash is more likely to be predominantly maculopapular rather than vesicular.
Since the clinical features of breakthrough varicella are often mild, it can be difficult to make a diagnosis on clinical presentation alone.
Laboratory testing is increasingly important for confirming varicella and appropriately managing the patients and their contacts.
Breakthrough varicella occurs less frequently among those who have received two doses of vaccine compared with those who have received only one dose; disease may be even milder among two-dose vaccine recipients, although the information about this is limited.
Transmission of VZV
Varicella is highly contagious. The virus can be spread from person to person by direct contact, inhalation of aerosols from vesicular fluid of skin lesions of acute varicella or zoster, and possibly through infected respiratory secretions that also may be aerosolized. A person with varicella is considered contagious beginning one to two days before rash onset until all the chickenpox lesions have crusted. Vaccinated people may develop lesions that do not crust. These people are considered contagious until no new lesions have appeared for 24 hours.
It takes from 10 to 21 days after exposure to the virus for someone to develop varicella. Based on studies of transmission among household members, about 90% of susceptible close contacts will get varicella after exposure to a person with disease.
People with breakthrough varicella are also contagious. One study of varicella transmission in household settings found that people with mild breakthrough varicella (<50 lesions) who were vaccinated with one dose of varicella vaccine were one-third as contagious as unvaccinated people with varicella. However, people with breakthrough varicella with 50 or more lesions were just as contagious as unvaccinated people with the disease.
Varicella is less contagious than measles, but more contagious than mumps and rubella.
Complications of VZV
The most common complications from varicella are:
In children: Bacterial infections of the skin and soft tissues
In adults: Pneumonia
Severe complications caused by the virus include cerebellar ataxia, encephalitis, viral pneumonia, and hemorrhagic conditions.
Other severe complications are due to bacterial infections and include:
- Septicemia
- Toxic shock syndrome
- Necrotizing fasciitis
- Osteomyelitis
- Bacterial pneumonia
- Septic arthritis
Pregnant women who get varicella are at risk for serious complications, primarily pneumonia, and in some cases, may die as a result of varicella.
Some studies have suggested that both the frequency and severity of VZV pneumonia are higher when varicella is acquired during the third trimester, although other studies have not supported this observation.
Consequences on foetus/ baby if infected during pregnancy VZV
If a pregnant woman gets varicella in her first or early second trimester, her baby has a small risk (0.4 to 2.0%) of being born with congenital varicella syndrome. The baby may have scarring on the skin; abnormalities in limbs, brain, and eyes, and low birth weight.
If a woman develops varicella rash from 5 days before to 2 days after delivery, the newborn will be at risk for neonatal varicella. Historically, the mortality rate for neonatal varicella was reported to be about 30%, but the availability of VZV immune globulin and intensive supportive care have reduced the mortality to about 7%.
Managing People at High Risk for Severe Varicella
(YES) For people exposed to varicella or herpes zoster who cannot receive varicella vaccine, varicella-zoster immune globulin can prevent varicella from developing or lessen the severity of the disease.
Varicella-zoster immune globulin is recommended for people who cannot receive the vaccine and 1) who lack evidence of immunity to varicella, 2) whose exposure is likely to result in infection, and 3) are at high risk for severe varicella.
The American Academy of Pediatrics (AAP) recommends that certain groups at increased risk for moderate to severe varicella be considered for oral acyclovir or valacyclovir treatment. These high risk groups include:
Healthy people older than 12 years of age
People with chronic cutaneous or pulmonary disorders
People receiving long-term salicylate therapy
People receiving short, intermittent, or aerosolized courses of corticosteroids
Some healthcare providers may elect to use oral acyclovir or valacyclovir for secondary cases within a household. For maximum benefit, oral acyclovir or valacyclovir therapy should be given within the first 24 hours after the varicella rash starts.
Intravenous acyclovir therapy is recommended for severe disease (e.g., disseminated VZV such as pneumonia, encephalitis, thrombocytopenia, severe hepatitis) and for varicella in immunocompromised patients (including patients being treated with high-dose corticosteroid therapy for >14 days).
Famciclovir is available for treatment of VZV infections in adults, but its efficacy and safety have not been established for children. In cases of infections caused by acyclovir-resistant VZV strains, which usually occur in immunocompromised people, Foscarnet should be used to treat the VZV infection, but consultation with an infectious disease specialist is recommended.
Availability of vaccine VZV
(YES) Two doses of varicella vaccine are recommended for all children, adolescents, and adults without evidence of immunity to varicella. Those who previously received one dose of varicella vaccine should receive their second dose for best protection against the disease.
How does HFMD virus present clinically?
Incubation period is 3–6 days, and illness usually is self-limited, with recovery within 7–10 days.
Patients usually present with fever and malaise; then sore throat and painful vesicles (herpangina) appear in the mouth, involving the buccal mucosa, tongue, or hard palate, and a peripheral rash, usually papulovesicular, appears on the hands (palms), feet (soles), or less often on the buttocks, genitals, elbows, and knees.
In rare cases, patients can develop brainstem encephalitis, aseptic meningitis, myocarditis, or pulmonary edema and can die from complications.
Additionally, HFMD can have an atypical presentation, often in adults, beginning with a rash or lesion that enlarges and coalesces to form bullae; a thorough travel history or history of recent exposure to others with the infection is critical to making the diagnosis. Onychomadesis (shedding of the nails) and desquamation of the palms or soles can occur during convalescence
Transmission of VZV
Transmission occurs by direct person-to-person contact with the saliva, nose and throat secretions, vesicle fluid, or stool of an infected person and through contact with contaminated surfaces and objects (e.g., common diapering areas, shared toys, eating utensils).
Vaccine for HFMD
There is no vaccine in the United States to protect against the viruses that cause HFMD. Researchers are working to develop vaccines to help prevent HFMD in the future.
How does measles virus present clinically?
easles is an acute viral respiratory illness. It is characterized by a prodrome of fever (as high as 105°F) and malaise, cough, coryza, and conjunctivitis -the three “C”s -, a pathognomonic enanthema (Koplik spots) followed by a maculopapular rash.
The rash usually appears about 14 days after a person is exposed. The rash spreads from the head to the trunk to the lower extremities.
Patients are considered to be contagious from 4 days before to 4 days after the rash appears. Of note, sometimes immunocompromised patients do not develop the rash.
Complications of measles
Common complications from measles include otitis media, bronchopneumonia, laryngotracheobronchitis, and diarrhea.
Even in previously healthy children, measles can cause serious illness requiring hospitalization.
One out of every 1,000 measles cases will develop acute encephalitis, which often results in permanent brain damage.
One to three out of every 1,000 children who become infected with measles will die from respiratory and neurologic complications.
Subacute sclerosing panencephalitis (SSPE) is a rare, but fatal degenerative disease of the central nervous system characterized by behavioral and intellectual deterioration and seizures that generally develop 7 to 10 years after measles infection.
Transmission of measles
Measles is one of the most contagious of all infectious diseases; up to 9 out of 10 susceptible persons with close contact to a measles patient will develop measles.
The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air for up to two hours after an infected person leaves an area.
Vaccination measles
Yes
Measles can be prevented with measles-containing vaccine, which is primarily administered as the combination measles-mumps-rubella (MMR) vaccine.
The combination measles-mumps-rubella-varicella (MMRV) vaccine can be used for children aged 12 months through 12 years for protection against measles, mumps, rubella and varicella. Single-antigen measles vaccine is not available.
One dose of MMR vaccine is approximately 93% effective at preventing measles; two doses are approximately 97% effective. Almost everyone who does not respond to the measles component of the first dose of MMR vaccine at age 12 months or older will respond to the second dose. Therefore, the second dose of MMR is administered to address primary vaccine failure
Treatment for measles
No.
There is no specific antiviral therapy for measles. Medical care is supportive and to help relieve symptoms and address complications such as bacterial infections.
Severe measles cases among children, such as those who are hospitalized, should be treated with vitamin A. Vitamin A should be administered immediately on diagnosis and repeated the next day.
How does mumps virus present clinically?
Mumps usually involves pain, tenderness, and swelling in one or both parotid salivary glands (cheek and jaw area). Swelling usually peaks in 1 to 3 days and then subsides during the next week. The swollen tissue pushes the angle of the ear up and out. As swelling worsens, the angle of the jawbone below the ear is no longer visible. Often, the jawbone cannot be felt because of swelling of the parotid. One parotid may swell before the other, and in 25% of patients, only one side swells. Other salivary glands (submandibular and sublingual) under the floor of the mouth also may swell but do so less frequently (10%).
Nonspecific prodromal symptoms may precede parotitis by several days, including low-grade fever which may last 3 to 4 days, myalgia, anorexia, malaise, and headache. Parotitis usually lasts on average 5 days and most cases resolve after 10 days. Mumps infection may also present only with nonspecific or primarily respiratory symptoms, or may be asymptomatic. Reinfection after natural infection and recurrent parotitis, when parotitis on one side resolves but is followed weeks to months later by parotitis on the other side, can also occur in mumps patients.
Standard precautions are the ________________________. Standard precautions are meant to reduce the risk of transmission of ___________________ and other pathogens from both recognised and unrecognised sources and are to be used, as a _____________, in the care of _______ patients.
blood-borne , minimum, all
5 moments of hand hygiene
1)
2)
3)
4)
5)
1) Before a touching a patient
2) Before clean/aseptic techniques
3) After body fluid exposure risk
4) After touching a patient
5) After touching patient’s surrounding
Handling of linen
Normal soiled linen
Green, canvas
Grossly bood-contaminated linen
Orange
Linen from SARS, COVID-19, cholera, typhoid cases
Red and orange
Red water soluble bad MUST be double-bagged in orange bag
Transmission-based precautions are the ________________________. To be used in addition to __________________.
second-tier of basic infection control. Standard precautions
Contact precaution
single bed, cohort cubicle
MRSA, VRE, CDIFF, CP-CRE, MDR A.BAUMANII
- Hand hygiene
- Wear gloves
- Wear long-sleeved gown for substantial contact with the patient
- Use dedicated equipment or disinfect it before using on another patient
Droplet precaution
single bed
Influenza, Mumps, Rubella, Invasive Neisseiria Meningitis
- Perform hand hygiene
- Wear surgical mask within 1 metre of the patient
- Wear protective eyewear if anticipating splashes to eyes/face
Airbone precautions
SIngle, negative pressure room
Measles, Chicken pox, PTB
- Perform hand hygiene
- Wear an N95 mask
- Keep the door closed at all times
n95 is not required if you are immune to chickenpox, shingles (zoster) or measles through past infection or vaccination.
Protective isolation
Single bed, positive pressure room
Severely immunocompromised host
Staff and visitors with communicable diseases (including respiratory tract infections) should NOT enter
Full precautions
Single bed, negative pressure
HCID (Eg., EVD)
- Perform hand hygiene
- Wear a long-sleeved gown
- Wear an N95 mask
- Use protective eyewear
- Wear gloves
- Use dedicated equipment or disinfect it before using on another patient
Mumps (transmission)
The mumps virus replicates in the upper respiratory tract and is transmitted person to person through direct contact with saliva or respiratory droplets of a person infected with mumps. The risk of spreading the virus increases the longer and the closer the contact a person has with someone who has mumps. The infectious period is considered from 2 days before to 5 days after parotitis onset, although virus has been isolated from saliva as early as 7 days prior to and up to 9 days after parotitis onset. Mumps virus has also been isolated up to 14 days in urine and semen.
When a person is ill with mumps, they should avoid contact with others from the time of diagnosis until 5 days after the onset of parotitis by staying home from work or school and staying in a separate room if possible.
Complications of mumps
Mumps complications include orchitis, oophoritis, mastitis, meningitis, encephalitis, pancreatitis, and hearing loss. Complications can occur in the absence of parotitis and occur less frequently in vaccinated patients. Some complications of mumps are known to occur more frequently among adults than children.
Orchitis occurs in approximately 30% of unvaccinated and 6% of vaccinated post-pubertal male mumps patients. In 60% to 83% of males with mumps orchitis, only one testis is affected. Mumps orchitis has not been linked to infertility, but may result in testicular atrophy and hypofertility. Among adolescent and adult female mumps patients in the United States in the post-vaccine era, rates of oophoritis and mastitis have been ≤1%. However, these complications may be more difficult to recognize and are likely underreported. Pancreatitis, deafness, meningitis, and encephalitis have been reported in less than 1% of cases in recent U.S. outbreaks. Cases of nephritis and myocarditis and other sequelae, including paralysis, seizures, cranial nerve palsies, and hydrocephalus, in mumps patients have been reported but are very rare. Death from mumps is exceedingly rare. There have been no mumps-related deaths reported in the United States during recent mumps outbreaks.
Mumps (pregnancy)
Mumps that occurs in pregnant women is generally benign and not more severe than in women who are not pregnant. Like other infections, there is a theoretical risk that mumps during the early months of pregnancy may cause complications.
Most studies on the effects of gestational mumps on the fetus were conducted in the 1950s–60s when the disease was more common before mumps vaccine was available. One study from 1966 reported an association between mumps infection during the first trimester of pregnancy and an increase in the rate of spontaneous abortion or intrauterine fetal death1, but this result has not been observed in other studies2. One study of low birth weight in relation to mumps during pregnancy found no significant association1. While there are case reports of congenital malformations in infants born to mothers who had mumps during pregnancy, the only prospective, controlled study found rates of malformations were similar between mothers who had mumps and those who did not have mumps during pregnancy
Any vaccine available for mumps?
Vaccination is the best way to prevent mumps and mumps complications. This vaccine is included in the combination measles-mumps-rubella (MMR) and measles-mumps-rubella-varicella (MMRV) vaccines. Two doses of mumps vaccine are 88% (range 32% to 95%) effective at preventing the disease; one dose is 78% (range 49% to 91%) effective.
Any treatment available for mumps
No
Rubella clinical presentation
Rubella is a viral illness that can lead to complications and death. It is characterized by a mild, maculopapular rash along with lymphadenopathy, and a slight fever. The rash usually starts on the face, becomes generalized within 24 hours, and lasts a median of 3 days; it occurs in 50% to 80% of infected people, Lymphadenopathy, which may precede rash, often involves posterior auricular or suboccipital lymph nodes, can be generalized, and lasts between 5 and 8 days. About 25% to 50% of infections are asymptomatic.
Clinical diagnosis of rubella virus is unreliable and should not be considered in assessing immune status. Up to half of all infections may be subclinical or unapparent. Many rubella infections are not recognized because the rash resembles many other rash illnesses.
Transmission of rubella
Rubella is transmitted primarily through direct or droplet contact from nasopharyngeal secretions. Humans are the only natural hosts. In temperate climates, infections usually occur during late winter and early spring.
The average incubation period of rubella virus is 17 days, with a range of 12 to 23 days. People infected with rubella are most contagious when the rash is erupting, but they can be contagious from 7 days before to 7 days after the rash appears.
Complication of rubella
Arthralgia or arthritis may occur in up to 70% of adult women with rubella. Rare complications include thrombocytopenic purpura and encephalitis.
Consequence on foetus (rubella)
When rubella infection occurs during pregnancy, especially during the first trimester, serious consequences can result. These include miscarriages, fetal deaths/stillbirths, and severe birth defects known as CRS. The most common congenital defects are cataracts, heart defects, and hearing impairment.
Vaccination for rubella
ubella can be prevented with rubella-containing vaccine, which is primarily administered as the combination measles-mumps-rubella (MMR) vaccine. The combination measles-mumps-rubella-varicella (MMRV) vaccine can be used for children aged 12 months through 12 years for protection against measles, mumps, rubella and varicella. Single-antigen rubella vaccine is not available.
One dose of MMR vaccine is about 97% effective at preventing rubella if exposed to the virus.
Treatment for rubella
here is no specific antiviral therapy for rubella infection.
Healthcare providers should:
Consider rubella in unvaccinated patients with febrile rash illness and other rubella symptoms, especially if the person recently traveled internationally or was exposed to a person with a confirmed rubella case.
Promptly isolate people suspected to have rubella and report them to the local health department
Collect nasopharyngeal swabs, throat swabs, or urine specimens for viral detection by polymerase chain reaction (PCR) testing and molecular typing, and blood for serology testing.
Common cold clinical presentation
Many people will have no symptoms. Among those who develop symptoms, they typically last about 7 days but can last up to two weeks. Symptoms may include:
Cough
Sneeze
Runny Nose
Nasal congestion
Sore throat
Headache
Body Aches
Fever
Transmission of common cold
Rhinoviruses are spread through respiratory droplets that are released when an infected person coughs or sneezes. These droplets can enter another person’s body if they breathe them in, or if they touch a surface contaminated with the virus and then touch their eyes, nose, or mouth. Rhinoviruses can also be spread through close personal contact with an infected person, such as shaking hands or hugging.
Complications of common cold
More severe illness is less common but can include asthma exacerbations, bronchioliti middle ear infections, sinusitis, bronchitis, or pneumonia. These symptoms can mirror other respiratory infections.
Any treatment/ vaccine for common cold?
There is no vaccine, treatment, or medication to prevent or cure rhinoviruses. You should take the following actions:
Drink plenty of fluids
Get plenty of rest
Clinical presentation of Covid-19
People with COVID-19 may be asymptomatic or may commonly experience one or more of the following symptoms:
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Myalgia (Muscle or body aches)
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
The clinical presentation of COVID-19 ranges from asymptomatic to severe illness, and COVID-19 symptoms may change over the course of illness.
COVID-19 symptoms can be difficult to differentiate from and can overlap with other viral respiratory illnesses such as influenza(flu) and respiratory syncytial virus (RSV). Because symptoms may progress quickly, close follow-up is needed, especially for:
older adults
people with disabilities
people with immunocompromising conditions, and
people with medical conditions that place them at greater risk for severe illness or death.T
Transmission. (COVID 19)
Droplet precaution
People infected with SARS-CoV-2 can transmit the virus even if they are asymptomatic or presymptomatic.
Peak transmissibility appears to occur early during the infectious period (prior to symptom onset until a few days after), but infected persons can shed infectious virus up to 10 days following infection.(22) Both vaccinated and unvaccinated people can transmit SARS-CoV-2.
Any treatment available for COVID 19?
Yes
Complications of COVID-19
Clinical treatment recommendations for people with severe to critical COVID-19 are based on the severity of illness. Management often includes care of complications of severe illness, including:
hypoxemic respiratory failure/ARDS,
sepsis and septic shock,
elevation in inflammatory cytokines,
and complications from prolonged hospitalization, including thromboembolism, hospital-acquired pneumonia, and hospital-acquired bacterial and fungal infections.
Additionally, patients with COVID-19 may experience an exacerbation of underlying comorbidities or new onset of cardiac, endocrine, hepatic, renal, gastrointestinal, or central nervous system disease.
Consequence on foetus COVID 19
Pregnant people with COVID-19 (compared to pregnant people without COVID-19) are at increased risk of preterm birth and stillbirth and might be at increased risk of pregnancy complications, including pre-eclampsia.
Influenza clinical presentation
Flu Symptoms
Influenza (flu) can cause mild to severe illness, and at times can lead to death. Flu symptoms usually come on suddenly. People who have flu often feel some or all of these symptoms:
fever or feeling feverish/chills
cough
sore throat
runny or stuffy nose
muscle or body aches
headaches
fatigue (tiredness)
some people may have vomiting and diarrhea, though this is more common in children than adults.
*It’s important to note that not everyone with flu will have a fever
Transmission of influenza
Most experts believe that flu viruses spread mainly by tiny droplets (respiratory droptlets) made when people with flu cough, sneeze, or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching their own mouth, nose or possibly their eyes.
Complications of influenza
Complications of flu can include bacterial pneumonia, ear infections, sinus infections and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.
Treatment available for influenza?
There are flu antiviral drugs that can be used to treat flu illness.
Flu illness can be more severe for certain people. True or false?
True
Certain groups of people are at a higher risk of developing serious flu complications. These groups of people include children younger than 5 years old, adults 65 years old or older, pregnant people, and people with certain chronic health conditions.
Vaccine available for Flu?
Yes.
CLinical presentation of respiratory syncytial virus infection
People infected with RSV usually show symptoms within 4 to 6 days after getting infected. Symptoms of RSV infection usually include
Runny nose
Decrease in appetite
Coughing
Sneezing
Fever
Wheezing
These symptoms usually appear in stages and not all at once. In very young infants with RSV, the only symptoms may be irritability, decreased activity, and breathing difficulties.
Adults who get infected with RSV usually have mild or no symptoms. Symptoms are usually consistent with an upper respiratory tract infection, which can include rhinorrhea, pharyngitis, cough, headache, fatigue, and fever. Disease usually lasts less than 5 days.
Some adults, however, may have more severe symptoms consistent with a lower respiratory tract infection, such as pneumonia. Epidemiologic evidence indicates that people 60 and older who are at highest risk of severe RSV disease include those with any of the following chronic conditions:
Lung disease (such as chronic obstructive pulmonary disease [COPD] and asthma)
Chronic cardiovascular diseases (such as congestive heart failure and coronary artery disease)
Diabetes mellitus
Neurologic conditions
Kidney disorders
Liver disorders
Hematologic disorders
Immune compromise
Other underlying conditions that a healthcare provider determines might increase the risk for severe respiratory disease
Other underlying factors that the provider determines might increase the risk of severe RSV-associated respiratory illness may include the following:
Frailty
Advanced age
Residence in a nursing home or other long-term care facility
Other underlying factors that a healthcare provider determines might increase the risk for severe respiratory disease
RSV can sometimes also lead to exacerbation of serious conditions such as:
Asthma
Chronic obstructive pulmonary disease (COPD)
Congestive heart failure
Transmission of RSV
RSV can spread when
An infected person coughs or sneezes
You get virus droplets from a cough or sneeze in your eyes, nose, or mouth
You have direct contact with the virus, like kissing the face of a child with RSV
You touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands
Vaccines available for RSV?
Yes.
Any treatment for RSV
No. Antiviral medication is not routinely recommended to fight infection. Most RSV infections go away on their own in a week or two. However, RSV can cause severe illness in some people.
CMV
Cytomegalovirus
Clinical presentation of CMV
Most healthy people who acquire cytomegalovirus (CMV) after birth have few symptoms and no long-term health consequences. Some people who acquire CMV infection may experience a mononucleosis-like condition with prolonged fever and hepatitis. Once a person becomes infected, the virus remains latent and may reactivate occasionally. Reactivation of CMV infection rarely causes disease unless the person’s immune system is suppressed due to therapeutic drugs or disease.
For most people, CMV infection is not a serious health problem. However, certain groups are at high risk for serious complications from CMV infection:
Infants infected in utero (congenital CMV infection)
Very low birth weight and premature infants
People with compromised immune systems, such as from organ and bone marrow transplants, and people infected with human immunodeficiency virus (HIV)
Transmission of CMV
CMV is transmitted by direct contact with infectious body fluids, such as urine, saliva, blood, tears, semen, and breast milk. CMV can be transmitted sexually and through transplanted organs and blood transfusions.
CMV can be transmitted to infants through contact with the mother’s genital secretions during delivery or through breast milk.
Any treatment available for CMV?
No treatment is currently indicated for CMV infection in healthy people. Antiviral treatment is used for people with compromised immune systems who have either sight-related or life-threatening illnesses due to CMV infection.
Consequence on foetus CMV
A woman who has a primary CMV infection during pregnancy is more likely to pass CMV to her fetus than a woman who has a subsequent infection during pregnancy.
Infants born <30 weeks gestational age and <1500g who acquire CMV from breast milk may be at risk of developing a late-onset sepsis-like syndrome.
Sign and symptoms of CMV in infants
ost infants with congenital CMV infection never have health problems. About 10% of infants with congenital CMV infection will have health problems at birth, which include:
Rash
Jaundice (yellowing of the skin or whites of the eyes)
Microcephaly (small head)
Low birth weight
Intrauterine growth restriction (low weight)
Hepatosplenomegaly (enlarged liver and spleen)
Seizures
Retinitis (damaged eye retina)
About 40 to 60% of infants born with signs of congenital CMV disease at birth will have long-term health problems, such as:
Hearing loss
Vision loss
Intellectual disability
Microcephaly (small head)
Lack of coordination or weakness
Seizures
Some babies may have hearing loss that may or may not be detected by newborn hearing test.
Treatment of CMV
For infants with signs of congenital CMV disease at birth, antiviral medications, such as ganciclovir or valganciclovir, may improve hearing and developmental outcomes. Ganciclovir can have serious side effects and has only been studied in infants with symptomatic congenital CMV disease.
any vaccines for CMV?
Vaccines are still in the research and development stage.
EBV
Epstein Barr Virus
Clinical presentation of EBV
Symptoms of EBV infection can include
fatigue
fever
inflamed throat
swollen lymph nodes in the neck
enlarged spleen
swollen liver
rash
Transmission of EBV
EBV spreads most commonly through bodily fluids, especially saliva. However, EBV can also spread through blood and semen during sexual contact, blood transfusions, and organ transplantations.
EBV can be spread by using objects, such as a toothbrush or drinking glass, that an infected person recently used. The virus probably survives on an object at least as long as the object remains moist.
The first time you get infected with EBV (primary EBV infection) you can spread the virus for weeks and even before you have symptoms. Once the virus is in your body, it stays there in a latent (inactive) state. If the virus reactivates, you can potentially spread EBV to others no matter how much time has passed since the initial infection.
Any vaccine/ treatment for EBV?
There is no vaccine to protect against EBV infection.
There is no specific treatment for EBV. However, some things can be done to help relieve symptoms, including
drinking fluids to stay hydrated
getting plenty of rest
taking over-the-counter medications for pain and fever
EBV infection can affect a person’s brain, spinal cord, and nerves.
It can cause conditions such as—
EBV infection can affect a person’s brain, spinal cord, and nerves.
It can cause conditions such as—
Viral meningitis (swelling of the tissues that cover the brain and spinal cord)
Encephalitis (swelling of the brain)
Optic neuritis (swelling of the eye nerve)
Transverse myelitis (swelling of the spinal cord)
Facial nerve palsies (paralysis of facial muscles)
Guillain-Barré syndrome (an immune system disease)
Acute cerebellar ataxia (sudden uncoordinated muscle movement)
Hemiplegia (paralysis on one side of the body)
Sleep disorders
Psychoses
EBV infection can affect a person’s blood and bone marrow. The virus can cause the body to produce an excessive number of white blood cells called lymphocytes (lymphocytosis).
EBV can also weaken the immune system, making it more difficult for the body to fight infection.
Examples of some of these conditions include—
Neutropenia with secondary infections
Hemophagocytic syndrome (hemophagocytic lymphohistiocytosis)
Acquired hypogammaglobulinemia
X-linked lymphoproliferative disease
EBV infection can also cause—
Pneumonia (injury of the lungs)
Interstitial lung disease (a large group of disorders, most of which cause scarring of lung tissue)
Pancreatitis (swelling of the pancreas)
Myocarditis (swelling of the heart muscle)
Oral cavity-oral hairy leukoplakia (raised, white patches on the tongue), which is usually seen in people infected with HIV
Cancers associated with EBV infection include—
Burkitt’s lymphoma (cancer of the lymphatic system)
Nasopharyngeal carcinoma (cancer of the upper throat)
Hodgkin’s disease and non-Hodgkin’s lymphoma (cancers of the lymphatic system)
Post-transplant lymphoproliferative disorder (white blood cells are produced in excess)
Other tumors including leiomyosarcomas (cancer in the soft tissue) and T-cell lymphomas
Complications of EBV infection include—
Peritonsillar abscesses (pus-filled tissue near the tonsils)
Acute bacterial sinusitis (bacterial infection of the sinus cavities)
Suppurative lymph nodes (swelling of lymph nodes)
Mastoiditis (bacterial infection of the mastoid bone of the skull)
Sialadenitis (swelling and injury of salivary glands)
Blockage of the air passages in the nose and throat
Zika transmission
Zika virus is transmitted to humans primarily through the bite of an infected Aedes species mosquito.
The mosquito vectors typically breed in domestic water-holding containers; they are aggressive daytime biters and feed both indoors and outdoors near dwellings. Nonhuman and human primates are likely the main reservoirs of the virus, and anthroponotic (human-to-vector-to-human) transmission occurs during outbreaks.
Perinatal, in utero, and possible sexual and transfusion transmission events have also been reported. Zika virus RNA has been identified in asymptomatic blood donors during an ongoing outbreak.
Clinical signs of Zika
Many people infected with Zika virus are asymptomatic. Characteristic clinical findings are acute onset of fever with maculopapular rash, arthralgia, or conjunctivitis. Other commonly reported symptoms include myalgia and headache.
Clinical illness is usually mild with symptoms lasting for several days to a week. Severe disease requiring hospitalization is uncommon and case fatality is low. However, there have been cases of Guillain-Barré syndrome reported in patients following suspected Zika virus infection. Recently, CDC concluded that Zika virus infection during pregnancy is a cause of microcephaly and other severe fetal brain defects.
Treatment/ vaccine for Zika?
No specific antiviral treatment is available for Zika virus disease. Treatment is generally supportive and can include rest, fluids, and use of analgesics and antipyretics.
There is no vaccine to prevent or medicine to treat Zika.
Consequences on foetus (zika)
Zika virus can be passed from a pregnant woman to her fetus.
Infection during pregnancy can cause a birth defect called microcephaly and other severe fetal brain defects
Clinical signs of Dengue
Clinical findings include:
nausea, vomiting, rash, aches and pains, a positive tourniquet test, leukopenia, and the
following warning signs: abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy, restlessness, and liver enlargement.
The presence of a warning sign may predict severe dengue in a patient.
Severe dengue is defined by dengue with any of the following symptoms:
- Severe plasma leakage
leading to Shock (DSS)
Fluid accumulation with respiratory distress - Severe haemorrhage
- Severe organ impairment
- Liver: AST or ALT >=1000
-CNS : Impaired consciousness
-Heart and other organs
Clinical phases of dengue
- Febrile
- Critical phase ( which may lead to Severe dengue)
- Recovery Phase
Febrile phase
typically develop high-grade fever suddenly
fever usually lasts 2–7 days
often accompanied by facial flushing, skin erythema, generalized body
ache, myalgia, arthralgia and headache
anorexia, nausea and vomiting are common
some patients may have sore throat, injected pharynx and conjunctival
injection
can be difficult to distinguish dengue clinically from other infections
clinical features are indistinguishable between severe and non-severe
dengue cases - monitor for warning signs (progression to critical phase)
mild haemorrhagic manifestations like petechiae and mucosal membrane bleeding (e.g. nose and gums) may be seen
positive tourniquet test in this phase increases the probability of dengue
FBC – drop in total white cell count?
Treatment of Dengue
No treatment: No specific antiviral agents exist for dengue.
Availability of vaccine dengue
Dengvaxia is the only dengue vaccine approved by the U.S. Food and Drug Administration and recommended for routine use by the Advisory Committee on Immunization Practices. It is made by Sanofi Pasteur. The vaccine prevents dengue caused by all four dengue virus serotypes.
Transmission of dengue
Dengue viruses are spread to people through the bites of infected Aedes species mosquitoes (Ae. aegypti or Ae. albopictus). These are the same types of mosquitoes that spread Zika and chikungunya viruses.
Rarely, dengue can be spread through blood transfusion, organ transplant, or through a needle stick injury.
From mother to child (Dengue)
Pregnant woman already infected with dengue can pass the virus to her fetus during pregnancy or around the time of birth.
To date, there has been one documented report of dengue spread through breast milk. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas with risk of dengue.
Importance of pulse pressure in dengue
Importance of pulse pressure :
The patient is considered to have shock if :
- the pulse pressure (i.e. systolic BP - diastolic BP) is ≤20 mm Hg in children
or he/she has signs of : - of poor capillary perfusion (cold extremities, delayed capillary refill, or rapid pulse rate).
- In adults, the pulse pressure of ≤ 20 mmHg may indicate a more severe shock.
Profound shock -> ____________ -> multiple organ failure —-> _______________ —-> massive bleeding
- with thrombocytopenia , hypoxia, acidosis
- advanced disseminated intravascular coagulation
A stepwise approach to the management of dengue
I. Overall assesment
II. Diagnosis, assessment of disease phase and severity
III. Management
Blood tests requested during assessment DENGUE
WCC
Platelet
Baseline
Haematocrit ( HCT)
Complications of severe dengue
Electrolyte imbalance (Hyponatraemia, potassium, calcium)
* Hypo / hyperglycaemia
* Metabolic acidosis
* Fluid overload
* Acute respiratory distress syndrome
* Hospital acquired pneumonia
* Renal failure requiring dialysis
* Liver failure
* Encephalopathy
Diagnostic tests for Dengue
- PCR to look for Dengue virus (send blood in FBC blood tube)
- Serum for POCT (Dengue Duo)
- Serum for Dengue antibody testing
Warning signs of Dengue
- abdominal pain
- persistent vomiting
-clinical fluid accumulation
- mucosal bleeding
- lethargy, restlessness
- liver enlargement > 2cm
- Laboratory : increase in HCT concurrent with decrease in platelet count
Discharge criteria (Clinical)
- No fever for 48 hours
-Improvement in clinical status (general well-being, appetite, haemodynamic status, urine output, no respiratory distress)
Discharge criteria (Laboratory)
Increasing trend of platelet
Stable haematocrit without intravenous fluids
Probable dengue
Live in/ travel to dengue endemic are.
Fever and 2 of the following criteria:
- Nausea, vomiting
- Rash
- Aches and pains
- Tourniquet test positive
- Leukopenia
- Any warning sign
Commensal bacteria
also called “normal flora”
bacteria that are normally found on the human body
usually not harmful
may contribute beneficial effects
Necrotising fasciitis
Beta haemolytic group A strep
Is antibiotic indicated for gastroenteritis?
Usually self limiting-antibiotic not normally indicated
Is antibiotic indicated for enteric feve/ typhoid fever
Unlike gastroenteritis, antibiotic MUST be given
Commonest cause of bacterial pharyngitis
Beta haem group A strep
Complications of bacterial pharyngitis
Rheumatic fever
Glomerulonephritis
(both are immune-mediated, post infection)
Benzlypeniciliin
For strep only
Amoxicillin/ Ampicillin
Like Benzylpen + Enterococcus + Listeria
Cloxacillin
For MSSA and Beta-haem Streptococci only
Ceftriaxone
Does not cover enterococci
For reliable anerobic coverage (both gram positive and negative), use ________________
Metronidazole
What is gram stain
Appearance of bacteria under the microscope
Why purple (gram positive) ?
Thick peptidoglycan
Why pink (gram negative)?
Thin peptidoglycan
Investigation for bacteria
microscopy (gram stain), Culture & Sensitivity (C&S usually takes 3 days to be ready)
Colonisation
presence of bacteria without infection
usually moist, warm body areas
increases in:
hospitalised patients
patients with medical conditions
patients given antibiotics
