Resp Exam 1 Flashcards
Pseudomonas
lab tests
The suiters of pseudo Mona
gram (-) bacillus
obligate Aerobe
oxidase (+)
catalase (+)
Blue green pigment when plated (from Pyocyanin and pyoverdin, may even turn wounds blue)
Encapsulated
Pseudomonas
signs and symptoms
The suiters of pseudo Mona
* Thrives in aquatic environments (HOT TUB FOLLICULITIS)
- ⬆ risk if pt has Chronic Granulomatous Disease
- Fruity grape like odor
- May turn wounds blue (from Pyocyanin and pyoverdin)
- Most common gram (-) Nosocomial Pneumonia
- Osteomyelitis in IV drug users and diabetics
- UTI’s (catheters!)
- Burn patients are especially susceptile
- Ecthyma gangrenosum
- Otitis Externa (Swimmers ear)
Pseudomonas
Respiratory failure in who?
The suiters of pseudo Mona
Respiratory failure in CF patients.
Most common gram (-) Nosocomial Pneumonia.
(CL- channels dysfunctional in CF)
Pseudomonas
MOA
The suiters of pseudo Mona
Exotoxin A
Ribosolation of EF2** → inhibition of protein synthesis and cell death
Pseudomonas
Treatment
The suiters of pseudo Mona
Piperacillin (penicillin)
amingoglycosides
and Fluoroquinolones
Aspergillus fumigatus
lab tests
Asparagus Farm
Catalase (+) *
Acute branching (< 45º) with septations (Aspergillus)
(ddx Mucor which has 90º branching and is nonseptate)
* Candida also catalase (+). Catalase (+) ↑ risk of Chronic Granulomatous Disease (CGD)
Aspergillus fumigatus
source
Asparagus Farm
Aspergillus fumigatus is found nearly everywhere in soil and decaying plants (like compost heaps), and generally won’t infect healthy people.
They are condiospores with fruiting bodies that get inhaled by human.
Aspergillus fumigatus
3 types of infection
Asparagus Farm
- Allergic bronchopulmonary aspergillus (ABPA)
- Aspergillosis causing aspergillomas
- Angioinvasive aspergillosis
Aspergillus fumigatus
3 types of infection
1. Allergic bronchopulmonary aspergillus (ABPA)
Asparagus Farm
Causes asthma, wheezing, fever, and a migratory pulmonary infiltrate.
Type 1 hypersensitivity, IgE response.
Aspergillus fumigatus
3 types of infection
2. Aspergillosis causing aspergillomas
Asparagus Farm
Associated with TB (susceptibility ↑ with TB cavities)
Aspergillomas are gravity dependent so fungus balls will be at the bottom of the cavity
Aspergillus fumigatus
3 types of infection
3. Angioinvasive aspergillosis
Asparagus Farm
Seen in pt with neutropenia from leukemia or lymphoma.
Aspergillus invades blood vessels and the surrounding tissues.
Leads to kidney failure, endocarditis, ring enhancing lesions in the brain.
Invades nasal sinus (causing Angioinvasive aspergillosis) leading to hemoptysis (coughing up blood) or blood stained mucos.
Aspergillus flavus
Aspergillus flavus key facts
(NOT Aspergillus fumigatus!)
Asparagus Farm
Aflatoxin associated with peanuts or grain!
Can lead to Hepatocellular carcinoma (HCC)
Aspergillus fumigatus
treatment
Asparagus Farm
_For less serious infection_s: Voriconazole
For angioinvasive disease: AMP B
Candida albicans
lab tests
Candid Canadians
Dimorphic (but not mold in cold!!!)
- Budding yeast at 20º with pseudohyphae.
- Mold form with true hyphae germ tubes at 37º
catalase (+)*
AIDS defining illness at CD4 < 100
White patches in mouth can be scraped off for KOH prep. (vs. leukoplakia where patches CANT be scraped off)
* Aspergillus also catalase (+). Catalase (+) ↑ risk of Chronic Granulomatous Disease (CGD).
Candida albicans
source
Candid Canadians
Normal flora of the GI tract and Oral cavity.
Commonly contaminates sputum cultures.
Candida albicans
signs and symptoms
Candid Canadians
- Severe diaper rash (when exposed to heat and humidity)
- Oral candidiasis (in immunocompromised or from inhaled steroids)
- White patches in mouth (CAN be scraped for KOH prep)
- Esophagitis and white pseudo membranes
- Vaginal candidiasis
- Endocarditis
Candida albicans
AIDS defining illness
Candid Canadians
AIDS defining illness at CD4 < 100
Candida albicans
predisposing factors
Candid Canadians
- AIDS (CD4 < 100)
- Diabetics
- Birth control pills
- Antibiotics (due to lowering the pH).
* Candida infections occur at a pH < 4 vs. gardenella at a pH > 4.5
- IV drug users (Candida found in some heroine) infecting tricuspid valve.
Candida albicans
Treatment
Candid Canadians
For minor infections: Azoles
For major infections: AMP B
For oral or esophageal candiasis: Nystatin
For resistant candida: Capsofungin
Corynebacterium diphtheria
lab tests
Corazon de la Corrida (Heart of the bullfight)
gram (+) bacilli
C. diphtheria is club shaped and y or v shaped
Non-spore forming
Metachromatic granules that stain (Red) with aniline dyes (rest of cell stains blue)
Plate on Tellurite and Loeflers media
Eleks test: in-vitro assay w/ antitoxin onit to determine if toxic or non-toxic strain
Corynebacterium diphtheria
MOA
Corazon de la Corrida (Heart of the bullfight)
Found in throat and tonsil, transmitted by respiratory droplets.
2 subunits A and B (A is active and B is binding)
Toxin causes ribosylation of EF2 (elongation factor) → inhibits ribosome function → inhibits protein synthesis → cell death
Leads to pseudomembranous exudate in oral pharynx
Will damage myelin of nerve fibers → neuropathy
Corynebacterium diphtheria
signs and symptoms
Corazon de la Corrida (Heart of the bullfight)
* Immigrants most likely to get C. diphtheria
Can cause airway obstruction and lymphopathy → * bulls neck (thickening of the neck)
Myocarditis like arrhythmias and heart block (lethal effect).
Neuropathy from damaged myelin.
Corynebacterium diphtheria
Vaccines
Corazon de la Corrida (Heart of the bullfight)
DTaP vaccine
Given with tetanus and pertussis
It is a Toxoid vaccine
Actinomyces israaelii
lab tests
Israeli Soldier
gram (+) Filamentous bacilli
Obligate Anaerobe (vs. aerobe for Nocardia)
Yellow sulfur granules in thick yellow pus
Actinomyces israaelii
signs and symptoms
Israeli Soldier
“Cervical facies actinomyces infection”
* Associated with jaw trauma or recent dental work
(due to being normal flora of oral cavity)
Jaw trauma or dental work → Non-tender lumps → abcess → sinus tracts → drains infection site through the skin → think yellow pus filled with sulfur granules
Actinomyces israaelii
Treatment
Israeli Soldier
penicillin
POS sense RNA
shared replication MOA
POS sense RNA replication MOA
- Viral RNA structured like hosts mRNA
- POS sense RNA uses the hosts transcription factors! (since it’s the SAME SENSE as the host cell)
- It only needs hosts RNA polymerase (vs. NEG sense that brings its own RNA polymerase)
- ALL RNA POS (and most RNA NEG) replicate in the cytoplasm (where host cell RNA polymerase is located! makes sense!)
Picornavirus Family
lab tests
The Peak-orna Animal Nursery
POS sense SS RNA
Naked virus (No envelope!)
CSF findings of viral (aseptic) meningitis: Normal glucose, nothing (aseptic) when plated, and ↑ protein
Picornavirus Family
Viruses in the Picorna family
The Peak-orna Animal Nursery
- Hep A
- Enteroviruses (Polio, Cocksackie A & B, Echovirus)
- Rhinovirus*
All picornavirus are transmitted fecal-orally (acid-stable) except Rhinovirus which is transmitted respiratorily (acid-labile)
Picornavirus Family
Picornavirus RNA transmitted into
The Peak-orna Animal Nursery
Picornavirus RNA is tansmitted into:
A long protein product that contains viral proteases to cleave it into active viral subunits.
Rhinovirus (a picornavirus)
MOA
(on top of the POS sense replication MOA)
Rhino Petting Zoo (common cold*)
- Transmitted via inhalation (acid labile) or through fomites (like hands!!!).
- Attaches to I-CAM1 to enter host cells
- Needs to keep cool → grows best at 33°c → upper respiratory tract cooler due to movement of fresh air.
- 113 serotypes! So no vaccine!
*Rhinovirus and Coronavirus are the 2 major causes** of common **cold.
Coronavirus Family
lab tests
Kingdom of SARS
Encapsulated** helical _POS_ sense _S_S RNA**
Test for antibodies to SARS (or other strain) or PCR to confirm. (-) finding if absence of antibodies after 28 days.
Coronavirus Family
signs and symptoms
Kingdom of SARS
- Cause of common cold! (along with Rhinovirus!)
- Severe Acute Respiratory Syndrome (SARS)
- Middle East Respiratory Syndrome (MERS)
- Acute bronchitis → can lead to Acute Respiratory Distress Syndrom (ARDS, wet lung)
Adenovirus
lab tests
A Den-O lions
DS DNA
Naked virus (No envelope!)
Adenovirus
Source
A Den-O lions
- Transmitted by respiratory droplets and fecal-orally.
- Most at risk are little children**, **military recruits, and public pools.
Adenovirus
signs and symptoms
A Den-O lions
3 major disease processes:
- Tonsillitis (most common cause of infection in adenoids and tonsils).
- Hemorrhagic cystitis*
- Viral conjuctivitis aka “Pink Eye“ (common cause)
* DDX BK Virus (a Polyomavirus) which also has hemorrhagic cystitis, but is more common in immunocompromised (transplant pts, or pts with AIDS)
Adenovirus
Vaccine
A Den-O lions
Military** recuits get a **live vaccine
Paramyxovirus Family
lab tests
Paranormal Mixer
NEG** sense _S_S RNA**
Enveloped non-segmented virus
Anti-measles antibodies in the CSF (SSPE from Measles) or Warthin–Finkeldey cells in lymphoid tissue (for Measles/Rubeola)
Syncytia (cells merged together from RSV)
Steeple radiographic sign on xray (for Parainfluenza)
Paramyxovirus Family
Viruses in the Paramyxo family
Paranormal Mixer
*** Respiratory droplet transmission! ***
- Measles (Rubeola) AKA 1st disease
- Mumps
- Respiratory Syncytial Virus (RSV)
- Parainfluenza
Measles (a Paramyxovirus)
signs and symptoms
Initial infection
AKA: Rubeola, 1st disease
Paranormal Mixer
- Prodromal (early) symptoms (4 C’s!!!): include Cough, Conjunctivitis, Koplic signs (blue spots on red near molars on bucal mucosa), Coryza (runny/stuffy nose)
- Fever of 104º F (40º C)
- 1-2 days later, after Koplic spots, a late maculopapular rash starts on head and works down (like rubella), but is a confluence rash (vs. rubella which does not coalesce)
- Complications including viral or bacterial pneumonia
Measles (a Paramyxovirus)
signs and symptoms
Persistent infection
AKA: Rubeola, 1st disease
Paranormal Mixer
Subacute sclerosing panencephalitis (SSPE)
AKA Dawson disease
- Rare and chronic form of progressive brain inflammation
- 1-15 years after initial Measles (Rubeola) infection
- Symptoms include personality changes, seizures, myoclonus, ataxia, coma, and possibly death.
- Buzzwords: “Measles as a child” or “Immigrants”
Measles (a Paramyxovirus)
VF
AKA: Rubeola, 1st disease
Paranormal Mixer
- Hemagglutinin (HA): causes RBC to stick together
- Fusion proteins: Causes multinucleated giant cells and red (eosinophilic) inclusion bodies → found in lymphoid tissue (AKA Warthin–Finkeldey cell)
*** NO Neuraminidase (NA)!!! ***
Paramyxovirus Family
VF for each Paramyxovirus
(HA, NA, or Fusion proteins)
Paranormal Mixer
- Measles (Rubeola): HA & Fusion (no NA)
- Mumps: HA, NA, & Fusion
- Respiratory Syncytial Virus (RSV): Fusion (only)
- Parainfluenza: HA, NA, & Fusion
Measles (a Paramyxovirus)
To reduce mortality and complications you can give what vitamin?
AKA: Rubeola, 1st disease
Paranormal Mixer
Vitamin A
can reduce mortality and complications
Measles & Mumps (Paramyxovirus family)
Vaccine
Measles AKA: Rubeola, 1st disease
Paranormal Mixer
- MMR vaccine!
- Live attenuated vaccine to induce humoral and cell mediated immunity.
- Do NOT give to pregnant women.
- HIV pt should only get the vaccine if CD4 count is > 200.
Mumps (a Paramyxovirus)
signs and symptoms
Paranormal Mixer
- Fever, muscle pain, headache, and feeling tired.
- Usually followed by painful swelling of one or both parotid* salivary glands.
- Orchitis* (inflammation of testicle tissue) unilaterally (more rarely bilaterally) → can lead to impaired fertility and testicular atrophy.
- Meningitis*
* (Mumps replicates in the parotid glands, testes, and CNS)
Mumps (a Paramyxovirus)
VF
Paranormal Mixer
- Hemagglutinin (HA)
- Fusion proteins
- Neuraminidase (NA)
Respiratory Syncytial Virus (RSV) (a Paramyxovirus)
signs and symptoms
Paranormal Mixer
- Attaches to G protein to infect respiratory epithelial cells
- Bronchiolitis and Pneumonia (most common cause of these in infants!!!)
- Rhinitis and Pharyngitis
Respiratory Syncytial Virus (RSV) (a Paramyxovirus)
VF
Paranormal Mixer
- Fusion proteins (NO HA or NA for RSV)
Fusion proteins on the surface of the virus cause the cell membranes on nearby giant multinucleated cells to merge and stick together, forming syncytia.
Respiratory Syncytial Virus (RSV) (a Paramyxovirus)
Treatment
Paranormal Mixer
- Ribavirion for adults.*
* (Not children or pregnant women!!!)
- Palivisumab, a monoclonal antibody (IgG**) against the F protein of RSV, is used for high risk children and premies.
Parainfluenza (a Paramyxovirus)
signs and symptoms
Paranormal Mixer
Croup!
- AKA seal bark cough, inspiratory strider, or Laryngotracheobronchitis.
- characterized by a “barking” cough, stridor(harsh or grating sound), hoarseness, and difficulty breathing which usually worsens at night.
- Steeple radiographic sign on xray due to narrowing of the subglottic region from swelling.
Parainfluenza (a Paramyxovirus)
VF
Paranormal Mixer
Mainly affects children!!!
(Adults usually get a severe “cold”)
- Hemagglutinin (HA)
- Fusion proteins
- Neuraminidase (NA)
Mucormycoses
lab tests
Mu Car Auto Shop
Biopsy is needed for diagnosis.
Hyphae have right angle branching (90º) and are non-septate
(ddx Aspergillus which have acute branching < 45º and have septations “Aspergillus”)
Broad, irregular, and ribbon-like.
Mucormycoses
source
Mu Car Auto Shop
Mucormycoses is found nearly everywhere in soil and decaying plants (like compost heaps), and generally won’t infect healthy people.
Transmitted via spore inhalation.
Mucormycoses
signs and symptoms
Mu Car Auto Shop
Invade through cribriform plate in the skull → cause necrosis of tissues and frontal cortex abscesses.
- Presents as a black eschar and necrosis of nasal cavity and eyes, causing neuro deficits and death (Rhinocerebral mucormycosis)
Mucormycoses
predisposing factors
Mu Car Auto Shop
- Immunocompromised (leukemia, neutropenia, etc)
- Diabetes patients
- Diabetic Ketone acidosis (DKA) is the most common predisposing factor.
(Mucormycoses likes to proliferate in blood vessel walls, especially where there is ↑ glucose and ↑ keytones)
Mucormycoses
Rhizopus
Mu Car Auto Shop
Most common cause of Mucormycosis.
Rhizopus is a bread mold.
Mucormycoses
Treatment
Mu Car Auto Shop
- Debridement first: Surgically remove dead tissue.
- AMP B
Epstein-Barr Virus (aka HHV4)
lab tests
Ye Olde Epstein Bar
- DS DNA
- Enveloped virus
- Cytotoxic (CD8+) T-cell reactive* lymphocytes
* (Downy cells** AKA **atypical cells; Very large, lots of cytoplasm, have oval, indented, or folded nucleus)
- Monospot Ig* test to diagnose during acute infections → activates B cells to secrete heterophile sheep antibodies that agglutinate sheep or horse RBC’s.
* (IgM for current or recent infection, IgG for prior infections)
Epstein-Barr Virus (aka HHV4)
MOA
Ye Olde Epstein Bar
- EBV envelope (glycoprotein) binds to CD21 receptor (Complement receptor type 2 aka CR2; on the surface of B cells) to infect B cells.
- T-cells proliferate → causing splenomegaly*
- Most are reactive cytotoxic CD8+ T cells (reactive lymphocytosis) aka downy cells or atypical cells but can also be NK cells.
* (Must avoid contact sports due to risk of splenic rupture)
Epstein-Barr Virus (aka HHV4)
signs and symptoms
Ye Olde Epstein Bar
- Triad of symptoms:
- fever
- pharyngitis (mono pharyngitis often in teens and adults, vs. strep pharyngitis more often in children)
- lymphadenopathy (often tender lymphadenopathy in posterior cervical region)
- Can also see Splenomegaly**
Epstein-Barr Virus (aka HHV4)
EBV ↑ the risk factor for 3 cancers!
Ye Olde Epstein Bar
- Hodgkin’s lymphoma (HL); mixed cellularity
- Non-Hodgkin’s lymphoma (NHL); Burkett lymphoma
- Nasopharyngeal carcinoma (NPC)
- Also ↑ risk of Oral Hairy leukoplakia (but its NOT a precancerous lesion)
Epstein-Barr Virus (aka HHV4)
Adverse RXN if treated w/ a penicillin!
Ye Olde Epstein Bar
- Intense itchy maculopapular or morbilliform rash.
- Appears on extensor surfaces and pressure points 7 to 10 _days after treatmen_t with beta-lactam antibiotics (such as ampicillin, amoxicillin and cephalosporins).
- This rash indicates a ‘hypersensitivity reaction’ to the antibiotic.
- It is not a true allergy and does not occur if the antibiotic is given later on in the absence of EBV infection.
Epstein-Barr Virus (aka HHV4)
Source
Ye Olde Epstein Bar
- Spread through mouth secretions
- “KISSING DISEASE!!!”
- Causes infectious mononucleosis (“mono”)
Epstein-Barr Virus (aka HHV4)
EBV ↑ the risk factor for 3 cancers!
1) Hodgkin’s lymphoma (HL); mixed cellularity
Ye Olde Epstein Bar
- Weakend immune systems develop B cell lymphoma.
- The cancerous B cells are an abnormal type called Reed-Sternberg cells (giant cells that resemble “owl eyes”).
- Mixed cellularity is the second most common type of HL and is seen mostly in older adults (although it can occur at any age).
- It can start in any lymph node but most often occurs in the upper half of the body.
Epstein-Barr Virus (aka HHV4)
EBV ↑ the risk factor for 3 cancers!
2) Non-Hodgkin’s lymphoma (NHL); Burkett lymphoma*
* (The fastest growing human tumor, associated with impaired immunity and is rapidly fatal if left untreated.)
Ye Olde Epstein Bar
- Burkitt lymphoma is a form of non-Hodgkin’s lymphoma in which cancer starts in B-cells.
- Especially likely to develop in people infected with HIV.
- Common translocation is t8:14
- Endemic (African) Burkitt lymphoma is common in young children who have both malaria and EBV. It usually starts as tumors of the jaw or other facial bones. It also can affect the GI tract, ovaries, and breasts and can spread to the CNS
- The types more common in the U.S. (sporadic and immunodeficiency-associated) usually start in the bowel and form a bulky tumor mass in the abdomen, often with massive involvement of the liver, spleen, and bone marrow.
Epstein-Barr Virus (aka HHV4)
EBV ↑ the risk factor for 3 cancers!
3) Nasopharyngeal carcinoma (NPC)
Ye Olde Epstein Bar
- Commonly in asian people.
- It is most common in males.
- It is a squamous cell carcinoma or an undifferentiated* type
* (Undifferentiated cells are cells that do not have their mature features or functions.)
Epstein-Barr Virus (aka HHV4)
EBV ↑ the risk factor for
Oral Hairy leukoplakia
Ye Olde Epstein Bar
- it is NOT a precancerous lesion
- Primarily affects people whose immune systems have been weakened by disease, especially HIV/AIDS.
- Thickened, white patches on gums, insides cheeks, bottom of mouth and sometimes tongue.
- These patches can’t be scraped off*.
* (ddx with candida which can be scraped off!)
Epstein-Barr Virus (aka HHV4)
Treatment
Ye Olde Epstein Bar
- No tx!
- rest and fluids
HPV
lab tests
Pilloma Bugs
DS DNA
Naked virus (No envelope!)
- Pap smear and cervical cancer screening.
- Koilocytes in squamous* cells (large, dense, wrinkled nucleus that may be binucleated).
* Detecting morphological changes; sampled from the transformation zone (where squamous eipthelium from outer ectocervix comes into contact with columnar epithelium in the inner endocervix).
HPV
know the main HPVs strains
Pilloma Bugs
100’s of HPV strains!
- HPV 1 - 4
- HPV 6 & 11**
- HPV 16 & 18**
- HPV 31 & 33
HPV
HPV 1 - 4
signs and symptoms
Pilloma Bugs
- Verruca** (wart) **vulgaris (common)
- aka “cutaneous common wart”
- transmission requires direct physical contact
- Children typically get on hands and feet
HPV
HPV 6** and **11
signs and symptoms
Pilloma Bugs
- Laryngeal Papillomatosis (Recurrent respiratory papillomatosis): Tumors (papilloma’s) develop in airways. Typically seen in children, and often obtained during vaginal birth (but not considered an STD)
- Anal genital warts (Condyloma acuminata*): seen in sexually active pts.
* ddx from secondary syphilis w/ Condylomata lata
HPV
HPV 16**, **18, 31, and 33
signs and symptoms
Sketchy Tip: Remember 16/18. add 15 to each to get 31/33
Pilloma Bugs
- most common STD
- Ano_genital_ carcinoma (Squamous Cell Carcinoma): Cervical, vulvar, vaginal, penile, anal
- Buzzwords = “bleeding after sex” or “cancer”
- In anal or penile cancer a major RF is immunosupression, especially in HIV* pts.
* HPV is an AIDS-defining illness)
HPV
HPV 16**, **18, 31, and 33
MOA
Sketchy Tip: Remember 16/18. add 15 to each to get 31/33
Pilloma Bugs
- HPV upsets the cells normal cycle.
- Tumor supressor proteins p53 and RB (Retinoblastoma protein) normally stop the cell cycle advancement from G1→S.
- HPV encodes E6** and E7** to promote the proteolysis of p53 (E6) and **RB (E7**) → removal of tumor supressors ↑ risk of cancer!
- AIDS-defining illness. Its thought HIV helps to enhance the E6/7 expression.
HPV
HPV Vaccine
Pilloma Bugs
- HPV vaccine is Gardasil
- Its an inactivated quadravalent vaccine
- Used for strains 6, 11, 16, and 18*
* These 4 strains cause ~70% of cervical cancers
Varicella Zoster Virus (aka HHV3)
lab tests
Varicella “Zeus” ster virus
- DS DNA
- Enveloped virus
- Replicates in nucleus (like most DNA viruses)
- Tzanc smear (older test, scrape) to look for multinucleated giant cells
Varicella Zoster Virus (aka HHV3)
Diseases from VZV
Varicella “Zeus” ster virus
- Congenital Varicella Syndrome (a TORCHeS infection!)
If infected in 1st and 2nd trimesters
- Chickenpox (Varicella)
Spread by respiratory droplets or ruptured vesicles
- Shingles (Herpes Zoster)
Reactivation of previous VZV infection
Varicella Zoster Virus (aka HHV3)
Chickenpox (Varicella) signs and symptoms
Varicella “Zeus” ster virus
- Headache and fever
- Xanthem (“widespread rash”); itchy
- Vesicular rash → Vesicular lesions w/ surrounding erythema (like HSV dew drops on rose petal)
- All rashes are at different stages of healing (vs. smallpox w/ similar looking rash but all at same stage!)
- Adults can get pneumonia (major cause of morbidity & mortality in adults w/ chicken pox)
- Encephalitis
Varicella Zoster Virus (aka HHV3)
Shingles (Herpes Zoster) signs and symptoms
- VZV remains latent in dorsal root ganglia until its reactivated in older individuals (stress or immunocompromised)
Varicella “Zeus” ster virus
- Vesicular rash on erythema base travels down dorsal root (sensory nerves! painful!) in a dermatone pattern*, rarely crossing the midline.
- Postherpetic neuralgia: pain after shingles!
- Herpes Zoster opthalmicus if VZV infects the V1 branch of trigeminal nerve → vision loss
* If rash crosses the midline it is Disseminated VCV and is a red flag of immunocompromisation! test for HIV if no Hx!!!
Varicella Zoster Virus (aka HHV3)
Congenital Varicella Syndrome signs and symptoms
(a TORCHeS infection!)
Varicella “Zeus” ster virus
- Limb hypoplasia
- Cutaneous scarring** in a **dermatomal pattern
- Blindness
Varicella Zoster Virus (aka HHV3)
Vaccine
Varicella “Zeus” ster virus
- Live attenuated Chickenpox (Varicella) vaccine
- Shingles (Zoster) vaccine*, is simply a larger-than-normal dose of the vaccine used against chickenpox.
* Shingles (Zoster) vaccine recommended for adults over 60; HIV pts can get if CD4 > 200
Varicella Zoster Virus (aka HHV3)
Treatment
Varicella “Zeus” ster virus
For chickenpox (Varicella):
Acyclovir
For shingles (Herpes Zoster):
Acyclovir or Famc_ycl_ovir or Valcyclovir
