S13C148 - Disseminate viral infections

Question 1

HSV encephalitis

Answer 1

• acute onset fever and neurologic Sx
• hemiparesis, CN abnormality, ataxia, focal seizures, AMS
• prefers temporal lobes
• CSF: lymphocytic pleocytosis
• Dx: PCR
• high mortality and high neurologic sequelae
• Tx: acylcovir, valacyclovir, famciclover x10d

Question 2

HSV meningitis

Answer 2

-bening course and uusally recover uneventfully, some may develop recurrent lymphocytic meningitis

Question 3

VZV infection

Answer 3

• spreads from respiratory secretions or direct contact with vescile fluid
• vesicular rash, fever, h/a, malaise, lesions at varying stages of healing, more on torso and face
• contagious until all lesions are crusted over
• remains latent and then comes back as shingles along the dermatomes
• complications: baterial superinfection, may involve lung, liver, brain, ataxia, mningitis, mingoencephlaiits, vasculopathy
• Dx: clinical, viral culture, antigen testing, PCR of vesical fluid
• tx if sever: acyclovir (valacyclovir not approved in VZV but ok for zoster)

Question 4

EBV: associated cancer

Answer 4

• b cell lympoma
• hodgkin dz
• burkitt lymphoma
• nasopharyngeal carcinoma

Question 5

EBV

Answer 5

• kissing dz, transmitted by saliva, infiltrates b cells causing enlarged lymph tissue
• signs: (teenagers) tonsillar exudate, fever, lymphadenopathy, splenomegally in 50%, severe fatiguemost recover uneventrgully
• if treated with amox for presumed strep throat they will get a morvilliform rash if they have EBV
• complications: hepatitis, myocarditis, encephalitis, meningitis, Guillain-barre
• dx: monospot, may be neg early in course
• tx: supportive, no contact sports x4w b/c of risk for splenic injury

Question 6

CMV

Answer 6

• not highly contageous, spread by sexual contact, saliva, breastfeeding, transplantation, and transplacentally
• teratogenic
• usually asymptomatic, but can cause fever, myalgias, lymphocytosis but no exudative pharyngitis, hepatitis, colitis, GBS, encephlaitis, hemolytic anemia
• infant CMV: HSM, jaundice, microcephaly, petechiae, growth reatrdation
• HIV pts: retinitis and blindness (painless), polyradiculopathy
• transplant pts: Pneumonia, hepatitis, CNS involvement, B symptoms

Question 7

Arboviral infection

Answer 7

-spread by bugs
-japanese encephalitis, west nile, eastern equine encephliits, dengue, chikungunya, rift valley fever, yellow fever
-if severe: fever, myalgia, arthritis, rash, encephalitis, hemorrhagic fever
-Dx:
Ct/MRI if encephalitis
CSF: lymphocytic pleocytosis
serology, IgM will appear w/in a few days
-tx: supportive