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Year 2 Microbiology > Microbiology of Viral Skin Infections > Flashcards

Microbiology of Viral Skin Infections Flashcards

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1
Q

What are chickenpox and shingles both caused by?

A

Varicella zoster virus:
Chickenpox is Varicella
Shingles is Zoster

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2
Q

Describe chickenpox virus

A

Primary infection is normally in childhood with a generalised rash and fever

Virus establishes latency

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3
Q

Describe shingles

A

Reactivation of varicella zoster virus typically occurs in old age and in immunocompromised patients

Follows a dermatomal pattern

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4
Q

Symptoms and progression of chickenpox?

A

Macules to papules to vesicles to scabs to recovery; the lesions are centripetal and the density varies. Skin is very inflamed

Fever

Itch

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5
Q

Complications of chickenpox?

A

Secondary bacterial infection

Pneumonitis

Haemorrhagic rash (purpuric confluent lesions)

Scarring

Encephalitis

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6
Q

Predictors of severity of chickenpox?

A

Extremes of age

Depressed cell-mediated immunity

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7
Q

How does neonatal chickenpox (VZV) occur?

A

Secondary to chickenpox in the mother, in late pregnancy; this has a higher mortality

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8
Q

Prevention of neonatal VZV?

A

Varicella Zoster immune globulin in susceptible women

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9
Q

Progression of shingles?

A

Tingling/pain to erythema to vesicles to crusts

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10
Q

Describe shingles zoster assoc. pain?

A

Neuralgic in character

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11
Q

What is post-herpetic neuralgia?

A

When the pain persists beyond 4 weeks, this is what it is called; part. occurs in the elderly and in those with trigeminal distribution zoster

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12
Q

Scarring in shingles?

A

Not common

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13
Q

Different distributions of shingles?

A

Ophthalmic zoster - reactivation of dormant VZV residing within the ophthalmic nerve (of the trigeminal nerve) and requires an urgent ophthalmic referral

Maxillary division of trigeminal nerve (around left cheek and side of the nose)

Mandibular division of the trigeminal nerve (affects right side of the face, from the temple to the chin)

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14
Q

When does ophthalmic zoster occur?

A

Can happen in children, esp. if chickenpox is in utero or if they become immunocompromised

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15
Q

What is Ramsay-Hunt syndrome?

A

AKA herpes zoster otticus OR geniculate ganglion - caused by reactivation of VZV in the geniculate ganglion

Leads to vesicles and pain in the auditory canal and throat

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16
Q

Symptoms of Ramsay-Hunt syndrome?

A

Facial palsy (7th nerve palsy) - poorer prognosis than Bell’s palsy (idiopathic 7th nerve palsy - both are caused by VZV but Ramsay-Hunt Syndrome has a poorer prognosis and is accompanied by the following symptoms)

Irritation of the vestibulocochlear (8th) cranial nerve:
Deafness
Vertigo
Tinnitus

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17
Q

Why is the VZV chickenpox vaccine used for shingles?

A

Can be used in high titre in the elderly to reduce impact of shingles:
Reduces incidence of shingles by 38% and post-herpetic neuralgia by 67%

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18
Q

What is primary gingivostomatitis?

A

Combo of stomatitis and gingivitis; this is often the initial presentation of the first/primary herpes simplex viral infection (tends to occur in pre-school children)

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19
Q

Symptoms of primary gingivostomatitis?

A

Extensive ulceration in and around the mouth that last around a week

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20
Q

What happens when Herpes Simplex Virus recurs?

A

Blistering rash at the vermillion border that can spread to the finger (herpetic whitlow) or eczema herpeticum (can be life-threatening)

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21
Q

Difference between HSV type 1 and 2?

A

HSV Type 1:
Main cause of oral lesions and causes half of genital herpes; also causes encephalitis

HSV Type 2:
Rare cause of oral lesions but causes half of genital herpes; also causes encephalitis/disseminated infection (part. in neonates)

22
Q

VZV and HSV therapy?

A

Aciclovir is an analogue of guanosine that is incorporated into viral DNA, inhibiting replication

This is an effective and non-toxic anti-viral; it does not eliminate the latent virus

23
Q

What is erythema multiforme?

A

Hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus (HSV), or drug reactions

24
Q

Characteristics of erythema multiforme?

A

Target lesions with erythema shown

25
Q

What is molluscum contagiosum and its characteristics?

A

Common viral skin infection of childhood that causes fleshy, firm, umbilicated, pearlescent nodules (1-2mm in diameter)

May also be sexually transmitted

26
Q

Time frame of molluscum contagiosum?

A

Self-limiting but takes months to disappear

27
Q

Treatment of molluscum contagiosum?

A

Can be treated with local application of liquid nitrogen

28
Q

Cause of viral warts?

A

Human Papilloma Virus (HPV); most common in children

Called VERRUCAS if they are on the feet

29
Q

Treatment of viral warts?

A

Self-limiting and uncomplicated

Treated with topial salicylic acid

30
Q

Other diseases caused by HPVs?

A

Over 80 types of HPV; they can cause:
Genital warts
Cervical cancer
Head and neck cancer

31
Q

What is herpangina?

A

Self-limiting viral infection causes a blistering rash of the back of the mouth; caused by enteroviruses (e.g: coxsackie virus, echovirus), NOT herpes virus

32
Q

Ix for herpangina?

A

Swab of lesion

Sample of stool for enterovirus PCR

33
Q

What is hand, foot and mouth disease?

A

Common mild and short-lasting viral infection (enteroviruses, esp. Coxsackie virus) most often affecting young children and can cause family outbreaks

Characterised by blisters on the hands, feet and mouth

34
Q

Complications of hand, foot and mouth disease?

A

Brain-stem encephalitis

Fatal cases due to pulmonary oedema of neurogenic origin

35
Q

What is a viral cause of rash and acute arthritis?

A

Erythema infectiosum (slapped cheek disease) is caused by parvovirus B19

36
Q

Signs of erythema infectiosum?

A

As the rash on the face fades, a lacy macular rash appears on the body

In adults, the rash may be absent and an acute polyarthritis of the small joints of the hands may be more prominent

37
Q

Complications of parvovirus B19?

A

Spontaneous abortion;
Fetal hydrops as precursor

Aplastic crises:
Sudden drop in Hb (seen in patients with a short rbc life span, e.g: sickle cell anaemia)

Chronic anaemia in immunosuppressed patients

38
Q

Ix for erythema infectiosum?

A

By antibody testing rather than skin swabs, e.g: parvovirus B19 IgM test

39
Q

What is orf?

A

Sheep equivalent is called “scabby mouth; causes a firm, fleshy nodule on the hands of farmers

It is self-limiting and is a clinical diagnosis

40
Q

Characteristics of primary, secondary and tertiary syphilis infection?

A

Primary - chancre (painless ulcer) at site of entry

Secondary:
Red rash over body, prominent on soles of feet and palms of hands
Mucous membrane “snail track” ulcers, i.e: pseudomembranous lesions and erosions of the tongue, hard and soft palate and tonsils

Tertiary - there are gummas (soft non-cancerous growths), neurological, or heart symptoms

41
Q

Cause of syphilis?

A

Bacterium (Treponema pallidum)

42
Q

Diagnosis of syphilis?

A

More common in males due to homosexual sex

Blood test or swab of chancre for PCR

43
Q

Treatment of syphilis?

A

Penicillin injections

44
Q

Cause of lyme disease?

A

Bacterium, Borrelia burgdorferi, carried by ticks (vector) which must be attacked for 24 hours in order for infection to occur

Prevention by early detection and removal of biting ticks

45
Q

Presentation of lyme disease?

A

Early - erythema migrans is diagnostic and does not need lab confirmation (characteristic target lesion)

Late - heart block, nerve palsies and arthritis

46
Q

Treatment of lyme disease?

A

Doxycycline or amoxicillin

Asymptomatic tick bites need no antibiotic prophylaxis (in the UK)

47
Q

Lab confirmation of lyme disease?

A

Mainly for late presentations and is a blood test for antibody to the organism

48
Q

What is Zika?

A

Spread by the mosquito Aedes aegypti and can be sexually transmitted

49
Q

Symptoms of Zika?

A 
Mild fever
Rash (mostly maculopapular)
Headaches
Arthralgia
Myalgia
Non-purulent conjunctivitis
50
Q

Time frame of Zika?

A

Symptom onset: 3–12 days after exposure

Symptoms resolution: 2–7 days after onset

51
Q

Complications of Zika?

A

Microcephaly (brain does not develop properly)

Guillain-Barre syndrome

Year 2 Microbiology (7 decks)

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