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Medical Microbiology > Paediatric Viral Diseases > Flashcards

Paediatric Viral Diseases Flashcards

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Biology 101 flashcards USMLE® Step 1 flashcards
1
Q

Why are different strains of viruses important?

A

Immunity against one strain does not protect against other strains, e.g. rhinovirus
Viruses can continually evolve to form new strains, e.g. influenza

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2
Q

How is measles transmitted?

A

Airborne

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3
Q

How is diphtheria transmitted?

A

Saliva

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4
Q

How is smallpox transmitted?

A

Airborne droplet

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5
Q

How is polio transmitted?

A

Faecal-oral route

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6
Q

How is rubella transmitted?

A

Airborne droplet

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7
Q

How is mumps transmitted?

A

Airborne droplet

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8
Q

How is HIV/AIDS transmitted?

A

Sexual contact

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9
Q

How is pertussis transmitted?

A

Airborne droplet

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10
Q

How is SARS transmitted?

A

Airborne droplet

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11
Q

How is influenza transmitted?

A

Airborne droplet

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12
Q

How is ebola transmitted?

A

Bodily fluids

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13
Q

What are the different ways viruses are acquired and spread?

A

Respiratory
Faecal-oral
Close exposure/skin or mucous membrane contact
Contact with blood
Animal vectors

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14
Q

How are viruses spread by respiratory pathways?

A

Droplets - contaminated environment, exposure to mucous membranes
Aerosol - breathed directly in

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15
Q

How are viruses spread by faecal-oral route?

A

Food and water
Contaminated environment
e.g. norovirus, enterovirus, hepA, hepE

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16
Q

What are examples of blood-borne viruses and how are they spread?

A

HIV, HepB, HepC
Contamination of cuts
Inoculation of mucous membranes
Through the skin - ‘needlestick injury’

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17
Q

How can the risk of spreading blood-borne viruses be reduced?

A

Universal precautions
Testing of healthcare workers performing exposure prone procedures (EPPs)
Infection control especially important in dialysis

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18
Q

What are some animal vectors that can spread viruses?

A

Arthropods - insects, ticks e.g. dengue
Warm-blooded animal - dog bite e.g. rabies

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19
Q

How can viruses spread from close exposure?

A

Skin to skin/mucous membranes
e.g. HSV

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20
Q

How are viruses spread by sexual transmission?

A

Virus in body fluids - semen, saliva e.g. HIV
Via mucous membranes

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21
Q

How can viral infection be prevented pre exposure?

A

Hygiene
Avoidance
Pre-exposure vaccination

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22
Q

How can viral infection be prevented post exposure?

A

Post-exposure prophylaxis - Immunoglobulin, vaccination

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23
Q

What family does RSV belong to?

A

Paromyxoviridae

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24
Q

What are the subtypes of RSV?

A

A and B

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25
Q

How is RSV transmitted?

A

Droplet

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26
Q

Describe respiratory syncytial virus (RSV)

A

ssRNA 15-19kb length
Most common cause of bronchiolitis and pneumonia in children < 1yo
By age 3-5yrs infection is universal
Seasonal - winter in temperate zones and rainy season in tropics
Can lead to death and closure of units
Serious infection is life threatening for people having BMT

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27
Q

What infection does RSV cause?

A

Upper and lower respiratory tract infection

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28
Q

What does RSV cause in young children?

A

Laryngotracheobronchitis (croup)
Barking cough and breathlessness

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29
Q

What does RSV cause in adults?

A

Common cold
Flu-like illness

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30
Q

How is RSV diagnosed?

A

PCR

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31
Q

How can RSV be prevented in babies?

A

Intramuscular injections of Palivizumab

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32
Q

How is RSV treated?

A

Hydration
Oxygen
General nursing care
Antibaterials if secondary infection suspected with/without Ribavirin - toxic so rarely used but may improve lung function

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33
Q

What type of virus is rubella?

A

RNA
Enveloped virus

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34
Q

What family does rubella belong to?

A

Matonaviridae

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35
Q

What are symptoms of rubella in children?

A

Fever
Runny nose
Red eyes
Fine pink maculopapular rash that starts on face then trunk then arms and legs

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36
Q

What else can occur in rubella infection?

A

Posterior auricular lymphadenopathy - enlarged lymph nodes behind the ear

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37
Q

What are symptoms of congenital rubella?

A

Cataracts, glaucoma
Heart defects
Deafness
Developmental delay
Low birth weight

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38
Q

How is rubella transmitted?

A

Respiratory spread and droplets
Highly infectious
Humans are the only host
May be infectious from one week before rash appears and remain infectious for another week after it appears

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39
Q

How is rubella diagnosed?

A

PCR
Detection of IgM by serology

40
Q

How is rubella prevented pre-exposure?

A

MMR vaccine

41
Q

How is rubella prevented post-exposure?

A

Post-exposure prophylaxis with MMR vaccination or human normal immunoglobulin (HNIG)

42
Q

How is HNIG done for rubella?

A

HNIG from pooled plasma from donors outside the UK
Ideally administered within 72hrs of exposure but up to 6 days

43
Q

Who is HNIG used for?

A

In pregnancy
Infants <6months
Immunosuppressed
In other groups MMR is used

44
Q

What type of virus is measles?

A

Single stranded RNA
Enveloped helical

45
Q

What family does the measles virus belong to?

A

Paramyxovirus

46
Q

What genus does measles virus belong to?

A

Morbillivirus

47
Q

What are some other paramyxoviruses?

A

Mumps
Parainfluenza
RSV
Metapneumovirus

48
Q

What is the incubation period of measles?

A

Typically 10 days but can range from 7 to 18 days
May be prolonged in immunocompromised
Individuals are highly infectious from beginning of their illness
After recovery there is life long immunity

49
Q

How is measles transmitted?

A

Droplet infection e.g. coughs and sneezes

50
Q

What are symptoms of measles virus?

A

Start with high fever, conjunctivitis, cough, runny nose and sometimes diarrhoea before a maculopapular rash develops
Rash is often intense and blotchy and will last about a week starting on the face

51
Q

What can be seen with measles infection?

A

Koplik spots - small white spots on inside of cheeks

52
Q

What are some complications of measles infection?

A

Pneumonia
Ear infections
More rarely meningitis and encephalitis

53
Q

What is subacute sclerosing panencephalitis (SSPE)?

A

A fatal neurodegenerative complication of measles
Occurs many years later (7-10yrs)
Characteristic changes in EEG

54
Q

How does SSPE present?

A

Mood changes
Sleeplessness
Forgetfulness which rapidly progresses over 1-3 years

55
Q

What happens if you get measles in pregnancy?

A

If infection occurs during pregnancy and individual is not immune may result in miscarriage, stillbirth or pre-term delivery

56
Q

Who are the at risk groups for measles infection?

A

Immunocompromised patients - infection may be severe and possible fatal
Pregnant women - may cause miscarriage or premature labour
Infants < 1 year - infection may be very severe and possibly fatal

57
Q

How is measles diagnosed?

A

PCR - oral swab, throat swab
Positive during prodrome (early signs and symptoms) and when rash is present

58
Q

What family does mumps virus belong to?

A

Paramyxovirus

59
Q

What is the incubation period for mumps?

A

16-18 days

60
Q

Describe mumps infection

A

Highly contagious
Spread via respiratory secretions
Pain and swelling in parotid (salivary glands)
Prodrome - fever, headache, malaise

61
Q

What are some rare serious complication of mumps in hcildren?

A

Orchitis (testicular swelling)
Meningitis
Encephalitis
Hearing loss
Pancreatitis

62
Q

How is mumps prevented?

A

MMR vaccine

63
Q

How is mumps diagnosed?

A

Saliva swap and serology for IgG/IgM

64
Q

Describe chickenpox

A

Usually occurs in childhood <10yo
Caused by varicella zoster virus (VZV)
90% British adults are immune
Usually mild illness
More severe in adults with higher rates of complications
Mild prodrome

65
Q

Who are the groups at risk of severe disease with chickenpox?

A

Pregnant women
Premature babies (<28weeks)
Neonates born to susceptible mothers
Immunocompromised patients

66
Q

What is the incubation period of chickenpox?

A

10-21 days

67
Q

What does VZV cause?

A

Chickenpox and shingles

68
Q

What type of virus is VZV?

A

Herpes virus

69
Q

Describe VZV

A

Chickenpox is primary systemic infection with lifelong immunity to chickenpox - travels from skin to root ganglion along sensory nerves
Shingles occurs due to reactivation from root ganglia, up sensory nerves, to the skin - usually in one dermatome

70
Q

How is VZV transmitted?

A

Direct contact with lesions or by respiratory spread from someone with chickenpox

71
Q

What are complications of VZV?

A

Bacterial superinfection with Staph and Strep
Encephalitis
Pneumonia

72
Q

Describe chickenpox rash

A

Prodrome of malaise, fever, headache 1-2 days before rash appears
Vesicular rash starts on trunk or face - papules, vesicles, pustules
Successive crops over days - croping is characteristic of chickenpox
Lesions of different stages of development

73
Q

Describe the pathogenesis of varicella

A

Day 0 - infection of conjunctivae and/or mucosa of upper resp tract
Day 2 - viral replication in regional lymph nodes
Day 4-6 - primary viraemia
Day 8-10 - viral replication in liver, spleen and possibly other organs
Day 11-12 - secondary viraemia
Day 14 - infection of skin and appearance of vesicular rash

74
Q

How is VZV diagnosed?

A

Usually clinically
Detection of VZV DNA by PCR from green topped virology swab
Assay also detects HSV1/2 as another common cause of vesicular rash
Serology for detection of VZV IgM

75
Q

How is VZV treated?

A

Acyclovir advised for patients at risk of severe disease, not routinely recommended for chickenpox in children
Acyclovir available as oral or IV formulation

76
Q

How can VZV be prevented?

A

Live attenuated vaccine pre-exposure
Hygiene
Avoidance of people with chickenpox/exposed shingles
Post exposure prophylaxis with acyclovir/VZIG (varicella zoster immunoglobulin) for immunocompromised/pregnant

77
Q

What type of virus is enterovirus?

A

Non enveloped RNA viruses
Many serotypes

78
Q

What family do enteroviruses belong to?

A

Picornaviridae

79
Q

How are enteroviruses spread?

A

Faecal/oral route and respiratory droplets

80
Q

What is the clinical presentation of enterovirus?

A

Febrile (with fever) illness often with rash
Aseptic meningitis usually in <1yo
Vesicular lesions in mouth, feet, buttocks, genitals
Herpangina - ulcers and lesions in mouth, sore throat, fever
Polio

81
Q

What type of virus is Epstein Barr virus (EBV)?

A

ds DNA virus
One of the Herpes viruses

82
Q

Describe EBV

A

Often asymptomatic in children
Mononucleosis - lymphadenopathy, malaise, fever
Splenic rupture
Often become infected in childhood and adolescence
Rash if ampicillin given
Prevention - hygeine

83
Q

How is EBV diagnosed?

A

Serology for VCA IgG, EBNA IgG and IgM by ELISA
PCR from whole lood
Heterophile Ab - Abs produced against poorly defined Ags; in adolescents, heterophile Abs have high specificity and sensitivity in diagnosis of primary EBV infection
Often negative in children

84
Q

What type of virus is cytomegalovirus (CMV)?

A

ds DNA enveloped virus
One of the Herpes viruses

85
Q

Describe infection with CMV

A

Primary infection often asymptomatic in children or similar to glandular fever
Can cause congenital infection if susceptible pregnant women infected during pregnancy - deafness, developmental delay, low birth weight

86
Q

How is CMV transmitted?

A

Via close contact with secretions

87
Q

How is CMV treated?

A

Antiviral treatment not indicated in most children
Usually self limiting
In immunocompromised children or congenital infection can use ganciclovir/vaganciclovir

88
Q

What type of virus is rotavirus?

A

ds DNA non-enveloped virus

89
Q

Describe rotavirus infection

A

Can cause viral gastroenteritis in <5yo especially diarrhoea causing dehydration, requiring intravenous fluids
High mortality

90
Q

How is rotavirus spread?

A

Faecal/oral route

91
Q

How is rotavirus diagnosed?

A

Antigen detection or PCR

92
Q

How is rotavirus prevented?

A

Hygiene
Infant vaccination Rotarix in UK routine schedule - given at 8 and 12 weeks of age

93
Q

What type of virus is adneovirus?

A

ds DNA non-enveloped virus

94
Q

What family does adenovirus belong to?

A

Arenaviridae

95
Q

How is adenovirus transmitted?

A

Respiratory and faecal/oral route

96
Q

How many serotypes of adenovirus are there?

A

88 in humans causing different illnesses - respiratory infection, conjunctivitis, gastroenteritis, severe disease in immunocompromised

97
Q

How is adenovirus diagnosed?

A

Clinically
PCR from respiratory swab or blood
No antivirals required unless immunocompromised then cidofovir
Currently no licensed vaccine

Medical Microbiology (23 decks)

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