SM_267a: Viral Infections / Exanthems Flashcards
Herpes simplex virus is a ____ with ____
Herpes simplex virus is a herpesvirus with dsDNA
HSV presents as ____
HSV presents as cluster of grouped vesicles on an erythematous base
HSV can remain ____ and ____ periodically
HSV can remain dormant in local nerve ganglia and reactivate periodically
Describe clinical diagnosis of HSV
HSV
- Grouped (clustered) vesicles on erythematous base: can be painful
- Tingling, itching, burning on the skin (before visible vesicles) -> red papules (1 day later) -> vesicles -> crusted lesions (lasts 1-2 weeks, may be recurrent in nature)
- UVB radiation is common trigger of orolabial HSV
____ is common trigger of orolabial HSV
UVB radiation is common trigger of orolabial HSV
____ are found on Tzanck smear of HSV
Multinucleated giant cells are found on Tzanck smear of HSV
(abnormal cell division in cells caused by HSV)
Eczema herpeticum is ____
Eczema herpeticum is disseminated HSV lesions in patient with widespread eczema (atopic dermatitis)
(sudden onset of widespread small umbilicated vesicles that turn into small round erosions in a patient with active atopic dermatitis)
____ caused by ____ is sudden onset of widespread small umbilicated vesicles that turn into small round erosions in a patient with active atopic dermatitis
Eczema herpeticum caused by HSV is sudden onset of widespread small umbilicated vesicles that turn into small round erosions in a patient with active atopic dermatitis
Varicella zoster virus belongs to the ____ family
Varicella zoster virus belongs to the herpes family
(dsDNA)
____ infection of VZV leads to clinical presentation known as chicken pox
Primary infection of VZV leads to clinical presentation known as chicken pox
Varicella zoster virus is transmitted by ____ or ____
Varicella zoster virus is transmitted by respiratory droplet or direct contact
Varicella zoster virus is contagious beginning _____ and lasting _____
Varicella zoster virus is contagious beginning 24 hours before eruption appears on skin and lasting until lesions have crusted
Describe clinical presentation of chicken pox
Chicken pox clinical presentation
- Multiple lesions on skin at various stages: faint red macules -> vesicle -> crusted papule
- Vesicle on an erythematous base: “dewdrop on a rose petal”
- Multinucleated giant cells with Tzanck smear
- Systemic complications of pneumonia and encephalitis
“Dewdrop on rose petal” refers to ____ caused by ____
“Dewdrop on rose petal” refers to chicken pox caused by Varicella Zoster Virus
(vesicle on erythematous base)
____ are found on Tzanck smear of chicken pox (Varicella Zoster Virus)
Multinucleated giant cells are found on Tzanck smear of chicken pox (Varicella Zoster Virus)
Chicken pox vaccine is ____
Chicken pox vaccine is live attenuated
(2 doses)
Describe effect of chicken pox on special populations
Chicken pox (VZV) in special populations
- Pregnant women and neonates: maternal infection during first 20 weeks may result in syndrome of congenital malformation to fetus or spontaneous abortion
- Immunocompromised patient: can be fatal in patients with cell-mediated immunity, varicella pneumonia / hepatitis / encephalitis
Shingles is _____
Shingles is reactivation of dormant Varicella Zoster Virus from sensory dorsal root ganglion
Shingles has ____ distribution of crop of vesicles and pustules on an erythematous base
Shingles has dermatomal distribution of crop of vesicles and pustules on an erythematous base
(unilateral)
(if disseminated look for immunosuppression - check HIV status)
____ are found on Tzanck smear of shingles (Varicella Zoster Virus)
Multinucleated giant cells are found on Tzanck smear of shingles (Varicella Zoster Virus)
Describe clinical clues for shingles
Shingles clinical clues
- Preceded by one to several days of numbness, tingling, or pain in affected area prior to onset of rash
- Papules -> vesicles -> pustules in a background of erythema in a dermatomal distribution
Describe complications of shingles
Shingles complications
- Post-herpetic neuralgia: burning or deep aching pain or shooting pain that may persist for weeks after the skin lesions have healed
- Ramsay Hunt syndrome: VZV infection of the geniculate ganglion (CN VII - facial nerve), involvement of external ear and/or tympanic membrane, and facial paralysis (ipsilateral)
Ramsay Hunt syndrome is ___ infection of the ___ leading to ___ and with involvement of ___
Ramsay Hunt syndrome is VZV infection of the geniculate ganglion (CN VII - facial nerve) leading to ipsilateral facial paralysis and with involvement of external ear and / or tympanic membrane
Shinges vaccine (one dose) is recommended for ___
Shinges vaccine (one dose) is recommended for peopled aged ≥ 60
(even if they had a bout of shingles)
Kaposi sarcoma occurs in setting of ____, results from ____, and presents as ____
Kaposi sarcoma occurs in setting of AIDS / other immunosuppression, results from HHV-8, and presents as brown / dark red violaceous lesions
(lesions look vascular)
Pityriasis rosea is a ____ rash that presents as ____
Pityriasis rosea is a post-viral rash that presents as a large oval patch (Herald patch) followed by oval slightly scaly patches scattered on a trunk (sometimes in Christmas tree distribution)
Christmas tree distribution refers to ____
Christmas tree distribution refers to pityriasis rosea
Pityriasis rosea differential diagnosis includes ____
Pityriasis rosea differential diagnosis includes secondary syphilis
(pityriasis rosea will self-resolve in 3-8 weeks)
Molluscum contagiosum is a ____ with ____ and an ____
Molluscum contagiosum is a poxvirus with linear double stranded DNA and an envelope
Molluscum contagiosum affects mainly ___, ___, and ___
Molluscum contagiosum affects mainly children, sexually active adults, and individuals with impaired cellular immunity
Molluscum contagiosum is transmitted _____
Molluscum contagiosum is transmitted skin-to-skin
Molluscum contagiosum presents as ____
Molluscum contagiosum presents as small, firm umbilicated papiules with smooth, waxy, or pearly surface
Verruca vulgaris is caused by ____ which has ____ and ____ envelope
Verruca vulgaris is caused by which has circular dsDNA and no envelope
Condyloma acuminata is caused by ____ which are _____
Condyloma acuminata is caused by HPV 6 and 11 which are low risk
(responsible for virtually all genital warts)
Gardasil vaccinates against ____
Gardasil vaccinates against HPV types 6, 11, 16, and 18
Describe manifestations of viral rashes that should prompt HIV testing
Manifestations of viral rashes that should prompt HIV testing
- Widespread and / or giant Molluscum lesions especially involving the face
- Disseminated herpes zoster or large ulcerated herpes zoster lesions
- Lesions suspicious of Kaposi Sarcoma
Parvovirus B19 has ____ and ____ envelope
Parvovirus B19 has linear ssDNA and no envelope
Parvovirus B19 presents as ____
Parvovirus B19 presents as sudden appearance of slapped cheek
(lacy reticulate eruption on trunk and extremities)
Hand, foot, mouth disease is a common viral illness of ____ and ____ and presents as ____, ____, ____, and ____
Hand, foot, mouth disease is a common viral illness of infants and children and presents as fever, ulcerovesicular stomatitis, acral erythematous vesicles, and buttock lesions
Hand, foot, mouth disease is caused by ____ and ____
Hand, foot, mouth disease is caused by Coxsackie Virus A-16 and Enterovirus 71
Describe progression of measles
Measles
- After 1-7 days: coalescing papules usually start around ears and quickly spread over face
- 2-3 days later: extends to trunk and extremities and then whole body is covered
- High fever, malaise, conjunctivitis, and URI
- Complications: otitis media, pneumonia, encephalitis (1%) fatal
____ are pathognomonic for measles
Koplick spots are pathognomonic for measles
(appear during prodrome, are classic features of measles, 1 mm white papules on erythematous base in buccal mucosa)
Describe diagnosis of measles
Diagnosis of measles
- High fever
- Koplick spots
- Conjunctivitis
- URI symptoms
- Rash
This is ____
This is pityriasis rosea
This is ____
This is shingles (herpes zoster)
This is ____
This is molluscum (pox virus)
(extensive molluscum should trigger HIV testing)
This is ____
This is condyloma accuminata (HPV likely 6 or 11)
This is ____
This is HSV-1
This is ____
This is HSV-2
