VIII- Viral SSTI

Question 1

cutaneous warts etiology

Answer 1

from HPV
-can be common (verruca valgaris), plantar (verruca plantaris), flat (verruca plana on face)

transmit: direct contact with wart or contam surface thru an abrasion

HPV 1 oral

Question 2

cutaneous warts cytology

Answer 2

hyperkeratotic, painless, exophytic
-koilocytes may be found
-common warts will be in groups usually @hands, elbows, knees
-thickening of skin layers from proliferation induction by blocking p53 and E7

Question 3

molluscum contagiosum lesion etiology

Answer 3

molluscum contagiosum virus

transmit: direct contact with lesions, sexual, fomites

Question 4

molluscum contagiosum lesions cytology

Answer 4

painless, pearly, umbilicated (looks like has belly button) nodules
-large eosinophilic cytoplasmic inclusions aka molluscum bodies

Question 5

HPV life cycle

Answer 5

latent (dormant in ganglion)
lytic (active infection when virus replicates in epithelial tissue)
-reactivation correlated to stressors

virions form in suprabasal layer of skin

Question 6

viruses of skin ulcers

Answer 6

HSV

Question 7

viruses of purulent lesions

Answer 7

VZV

Question 8

skin disease of HSV

Answer 8

primary infection = herpetic gingivostomatitis so lesions outside mouth and in palate

reactivation = herpes labialis aka cold sores

Question 9

skin disease of varicella zoster virus

chickenpox

Answer 9

rash/lesions at trunk, face, scalp + fever
-vesicles>pustules>scabs in ‘crops of lesions’ so can see all 3 forms in one area
-can complicate to bacterial infection of lesions or pneumonia, neonatal disease

a herpes virus

Question 10

vaccination of chicken pox

Answer 10

2 doses of live attenuated
-grown in tissue culture
-to prevent primary infection so given to kids
-if can’t have live vaccine then passive immunization (prophylatic)

Question 11

vaccination of shingles

Answer 11

to protect from reactivation so for 50+
-recombinant zoster vaccine (SHINGRIX) of viral gE protein
-used to have live attenuated but no longer used

Question 12

common warts HPV

Answer 12

HPV 2, 3, 10

Question 13

plantar warts HPV

Answer 13

HPV 1, 4

Question 14

herpes stromal keratitis

Answer 14

from HSV in the eye
-primary infection = conjunctivitis
-recurrent disease = corneal opacity from scar tissue, see dendritic lesions

Question 15

herpes simplex encephalitis prez

Answer 15

altered consciousness + hallucinations + ansomia + bizarre behavior

Question 16

herpetic whitlow

Answer 16

lesions from HSV on digits so either fingers or toes (like cold sores)

Question 17

eczema herpeticum

Answer 17

people with eczema at inc risk for widespread lesions

Question 18

herpes simplex gladiatorum

Answer 18

specifically in wrestlers
-skin to skin spread during matches

Question 19

herpes antiviral mechanism

Answer 19

inhibit DNA polymerase by phosphoylating thymidine kinase
-acyclovir

Question 20

herpes zoster

shingles

Answer 20

reactivation of VZV in elderly or immunosup
-feels like paresthesia (needles/pins) > vesicular lesions unilateral + fever + malaise
-can complicate to postherpetic neuralgia: severe pain at site of lesion for months

Question 21

diagnosing VZV

Answer 21

tzanck smear will be pos in herpes virus infections
-HSV pos too

Question 22

smallpox lesions

Answer 22

@mouth and extremities (palms, soles) CENTRIFUGAL
-deeply set into skin (bb pelet)
-synchronous evolution from papule to ulcer that scabs, considered contagious until all scabs gone
-variola virus

chicken pox is centripetal

Question 23

smallpox vaccine

Answer 23

live strain of vaccinia virus (poxvirus family) NOT attenuated or variola
-routine vaccination stopped in 1972
-some adverse/fatal effects like eczema vaccinatum
-also use for postexposure prophylaxis

Question 24

roseola infantum

Answer 24

high fever for few days > maculopapular rash
-from HHV6 or 7 that reps in T/B cells and oral pharynx, latent in T cells (6)

Question 25

5th disease/erythema infectiousum

Answer 25

fever + rash starting on cheeks > lace like pattern
-slap cheek syndrome bc cheeks are red
no vaccine

from B19 parvovirus that grows within hematopoietic cells in bone marrow

Question 26

german measles

Answer 26

maculopapular rash starting at face then downward
-fainter than measles and not coalesce (more patchy)
-fever is more low grade than measles
-associated with arthralgia and arthritis

rubella virus

Question 27

measles prez

Answer 27

1. fever + 3 C’s (cough, coryza, conjuctivits) + koplik spots ‘grains of sand surrounded by red halo’
2. maculopapular rash starts at hairline downward
3. other symps like anorexia, diarrhea, lymphadenopathy

Question 28

measles prevention

Answer 28

measles resistance if: documented 2 doses live vaccine, lab evidence of immunity, physician diagnosed measles, birth before 1957

passive immunopprophylaxis if susceptible

Question 29

congenital rubella syndrome

Answer 29

infection during first trimester of preg = deafness, cataracts, glaucoma, heart dz, pigmentary retinopathy
-can show purpura, h/smegaly, jaundice

respiratory transmission

Question 30

measles virus

Answer 30

-forms syncitia (giant multinuc cells)
-very contagious bc infectious for up to 2 hours on fomites and air, respiratory spread- no direct contact needed

Question 31

complications of measles

Answer 31

diarrhea
otitis media
pneumonia
some encephalitis, seizures, death

Question 32

measles vaccine

Answer 32

2 doses of live attenuated in chick embyro fibroblasts > subcut injection
-combine with MMR or MMRV

Question 33

rubella vaccine

Answer 33

live attenuated grown in tissue culture
-in MMR/V
-major objective is to prevent congenital rubella syndrome

Question 34

other manifestations of B19 parvovirus

Answer 34

1. aplastic crisis
2. arthralgia, arthritis
3. pregnancy, hydrops fetalis, CHF, anemia