Micro Enteric Viruses 2 Flashcards
what does coxsackie A cause?
herpangina, hand-foot-and-mouth disease, acute hemorrhagic conjunctivitis
what is herpangina?
-acute febrile illness with small vesicular or ulcerative lesions on the posterior oropharyngeal structures that typically occurs in summer - mild and self-limited - typically children
what causes herpangina?
MC coxsackie A, but also by coxsackie B and other enteroviruses
what is hand-foot-and-mouth disease?
- spread by fecal-oral or contact with skin lesion/oral secretions
- viral invasion of mucus membranes causing widespread apoptosis with characteristic lesion formation (looks like chicken pox which is typically trunk)
- dehydration from refusal to drink/eat with sores
what causes hand foot and mouth disease?
MC coxsackie A, also coxsackie B and other enteroviruses
what is acute hemorrhagic conjunctivitis?
rapid onset painful conjunctivitis usually in young teens - unpleasant but short
-no treatment available
what causes acute hemorrhagic conjuncitivitis?
coxsackie group A24 also enterovirus
acute hemorrhagic conjunctivitis complications
rarely neurological sequelae - poliolike paralysis (1/10,000)
what does coxsackie A typically cause?
herpangina, hand foot mouth disease, acute hemorrhagic conunctivitis
what does coxsackie B typically cause?
viral myocarditis, pleurodynia
viral myocarditis pathogenesis
sequel in 1-4% coxsackie B gastroenteritis, necrosis of myocytes, inflammatory infiltrate interferes with heart function and may progress to CHF and pulmonary edema
what is seen on viral myocarditis exam - adults, infants, children?
- adults: heart failure, chest pain, dysrhythmia, RECENT HISTORY OF FLULIKE ILLNESS
- infants: irritability, lethary, periodic episodes of pallor, fever, hypothermia, tachypnea, anorexia, failure to thrive
- children: lack of energy, general malaise
viral myocarditis labwork
CBC (anemia, lymphcytosis, neutropenia), blood cultures to rule out bacterial infection, C-reactive protein and sedimentation rates (markers of inflammation), creatinine kinase, troponin 1 (myocardial damage)
histologic findings viral myocarditis (can be done on children and adults - not infants or super ill)
- focal or diffuse interstitial infiltrate of mononuclear cells, lymphocytes, plasma cells, eosinophils
- necrosis and diarrangement of myocytes
- fibroblasts in chronic and healing stages
what is pleurodynia
infection of striated muscle in chest (muscle necrosis around lung) - sudden occurrence of lancinating chest pain attacks
what causes pleurodynia?
coxsackie B and other enteroviruses
pleurodynia symptoms
pain is paroxysmal, occurring in attacks separated by min-hr
- between attacks, patients usually have constant, dull pleuritic pain
- usually 3-5 days
pleurodynia exam
3-5 days of fever, malaise, headache, sore throat/rhinitis/dry cough/n/v/diarrhea, pleural friction rub, herpangina or other mild coxsackie symptoms
what is seen on x ray of pleurodynia?
normal! because heart and lung are normal - muscle is abnormal (used for exclusion)
when is pleurodynia life-threatening?
newborns
aspectic meningitis pathogenesis
enterovirus breaches CNS, infects leptomeninges and immune response creates inflammation - normally self-limited but must rule out infection by bacteria or fungi
what is the classic tetrad for aseptic meningitis?
fever, meningisumus, irritability, photophobia
aspectic meningitis labwork
CSF: culture, gram stain, acid-fast stain; PCR for viruses; WBC count, protein level, glucose level (normal level for viruses, low for bacteria)
treatment for aseptic meningitis
rest, hydration, analgesics, anti-inflammatories
symptoms of aseptic meningitis in babies/toddlers
fever, cold hands and feet, refusing food or vomiting, fretful, pale/blotchy skin, blank staring, drowsy, stiff neck, high pitched scream
