Miscellaneous Viruses

Question 1

Give examples of respiratory tract viruses.

Answer 1

Rhinovirus

Coronavirus

Adenovirus

Respiratory syncytial virus

Question 2

Transmission of resp viruses.

Answer 2

Driect contact

Infected fomites

Airborne droplets

Question 3

Presentation of respiratory viruses.

Answer 3

Coryza

Pharyngitis

Croup

Brochiolitis

Pneumonia

Question 4

Diagnosis of resp viruses.

Answer 4

Clinical usually

If severe disease then viral culture and antigen detection + PCR

Question 5

Treatment of resp viruses.

Answer 5

Supportive in uncomplicated disease/immunocompetent.

There is limited evidence for specific treatment in high-risk/complicated and immunosuppressed patients.

Question 6

Presentation of HPV 1 and 2.

Answer 6

Skin Warts with verrucas

Treatment can be with topical salicylic acid and freezing. But usually no treatment is needed.

Question 7

Presentation of HPV 6 and 11.

Answer 7

Anogenital warts.

The treatment is with topical podophyllin, imiquimod or ablation.

Question 8

What does HPV 16 and 18 cause?

Answer 8

Cervical cancer

Question 9

Explain polyoma virus.

Answer 9

A very common virus for people to have, such as CMV.

Over 90% of people are infected, usually due to parents passing it on to children.

It is asymptomatic unless the patient is immunosuppressed.

BK-virus is a type of polyoma virus that ca cause renal transplant nephropathy.

JC-virus is a polyoma virus that can cause progressive multifocal leucoencephalopathy.

MCV is Merkel Cell polyomavirus and can cause Merkel Cell Carcinoma.

Question 10

How is measles transmitted?

Answer 10

By respiratory droplets. It is highly infective.

Question 11

Incubation of measles.

Answer 11

10-18d

Question 12

Presentation of measles.

Answer 12

Fever, conjunctivitis, coryza, diarrhoea, Koplik spots.

Then generalised maculopapular rash occurs classicaly in the face and neck and then spreading to trunk and limbs.

Question 13

Complications of measles.

Answer 13

Secondary infection

Acute demyelinating encephalitis

Subacute sclerosing panencephalitis

Question 14

Explain secondary infection of measles.

Answer 14

Secondary infections such as;

Bacterial pneumonia

Otitis media

Ocular herpes simplex

Oral/GI candidiasis

can happen in measles infection.

Question 15

Explain acute demyelinating encephalitis due to measles infection.

Answer 15

1 in 1000.

Usually within 2 weeks of rash.

Seizures, fever, irritability and hedache as well as reduced conscious levels.

Question 16

Explain subacute sclerosing panencephalitis as a complication of measles.

Answer 16

5-10 years after the initial infection.

This leads to a disturbance in intellect, personality, seizures, motor dysfunction and decerebration.

There is no effective treatment available for this.

Question 17

Diagnosis of measles.

Answer 17

Usually clinical.

However can also be done by IgM or antigen in saliva and urine.

Question 18

Treatment of measles.

Answer 18

Usually preventative by vaccination.

Human immunoglobulin within 3 days of exposure in non-immune patients.

Supportive treatment.

There seems to not be any benefit of giving dexamethasone in encephalitis due to measles.

Question 19

Transmission of mumps.

Answer 19

Respiratory droplet spread.

Question 20

Incubation of mumps.

Answer 20

14-21 days

Question 21

Complications of mumps.

Answer 21

It was a common cause of encephalitis pre-vaccination.

Meningoencephalitis

Epididymo-orchitis if pubertal/post-pubertal infection.

Oophoritis

Pancreatitis

Deafness

Question 22

Presentation of mumps.

Answer 22

Can be subclinical.

Usually starts of with a prodrome of fever, myalgia and headache.

The infection usually settles in the salivary glands causing them to swell. It is more common for the parotid to swell than the submandibular.

Question 23

Diagnosis of mumps.

Answer 23

Clinical

If there is need for confirmation in e.g. meningitis/encephalitis or if diagnosis is uncertain clinically you can do mumps specific IgM/IgA and PCR.

Question 24

Treatment of mumps.

Answer 24

Supportive

Question 25

Transmission of rubella.

Answer 25

Respiratory droplets

Question 26

Presentation of rubella.

Answer 26

Usually mild/subclinical.

There is a prodrome of fever, conjunctivits, rhinorrhoea.

A rash can develop that is generalised, pink and maculopapular.

You can also get lymphadenopathy that is occipital, cervical and post-auricular.

Question 27

Explain congenital rubella infection.

Answer 27

This is the big worry in Rubella.

Up to 90% risk of fetal malformation if this occurs in the first trimester.

There is sensorineural hearing loss and retinopathy if it occurs in the 2nd trimester.

IgM and IgG testing should be offered.

Immunoglobulin may decrease the viral load but it will not prevent infection.

Question 28

Prevention of rubella.

Answer 28

Vaccinate pre-pregnancy

This is because live vaccines are CId in pregnancy.