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Infectious Disease 3 > Viral Diseases > Flashcards

Viral Diseases Flashcards

1
Q

submicroscopic obligate intracellular parasites are______.

A

Viruses

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2
Q

What is a virus particle known as? What are its components?

A
  • a virus particle=virion.

- virion is a nucleic acid (DNA/RNA) enclosed in a protein shell/coat.

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3
Q

Where a dbl stranded DNA virus replicate? Single-stranded RNA viruses?

A
  • Dbl: must enter host cell nucleus before they can replicate?
  • Single strand RNA virus replicate in the host cell cytoplasm.
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4
Q

What is a viral capsid?

A

-the protein coat that envelopes viral genetic material, may be polyhedral(icosahedral), rod, or complex.

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5
Q

How does virus infect cells?

A
  • adsorption- virus binds to host cell
  • penetration- virus injects its genome into host cell
  • viral genome replication- viral genome replicates using the host cellular machinery
  • assembly- viral components and enzymes are produced and begin to assemble
  • maturaton- viral components assemble and viruses fully develop
  • release: newly produced viruses are expelled from host cell.
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6
Q

How do we classify viruses?

A
  • type of symmetry of the virus capsid (helical vs icosahedral)
  • presence or absence of lipid envelope
  • Type and structure of the viral nucleic acid and the strategy used in its replication.
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7
Q

virus classification

  • Class 1
  • Class 2
  • Class 3
  • Class 4
  • Class 5
  • Class 6
  • Class 7
A

1: Dbl stranded DNA:
- Papovavirus (warts, cervical cancer)
- Adenovirus (respiratory disease)
- Herpesvirus (cold sores, genital herpes, chicken pox, mono)
- Poxvirus(small pox, cow pox)

2: Single Stranded DNA:
- Parvovirus

3: Dbl stranded RNA:
- Coronavirus
- Picornavirus (poli, common cold)
- Togavirus (rubella, yellow fever)
- Hep C virus

4: + single stranded RNA itself as mRNA:
- Rhabdovirus (rabies)
- Paramyxovirus (measles, mumps)
- Orthomyxovirus (influenza)
- Bunyavirus (Korean Hemorrhagic fever)
- Arenaviruses

5: - single strand RNA used as template for mRNA:
- reovirus (diarrhea)

6: + single strand RNA w/ DNA intermediate in replication:
- Retrovirus (leukemia, AIDS)

  1. ) double stranded DNA with RNA intermediate in replication:
    - Hep B virus
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8
Q

What are the viral exanthematous diseases?

A
  • checkenpox/herpes zoster
  • infectious mono
  • roseola infantum (6th disease or erythema subitum)
  • Fifths disease (Erythema infectiosum)
  • Measles
  • Rubella
  • Enteroviral exanthems
  • -coxsackievirus
  • -echovirus
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9
Q

What disease processes are associated with each of the Herpes simplex viruses?

  • HHV1
  • HHV2
  • HHV3
  • HHV4
  • HHV5
  • HHV6
  • HHV7
  • HHV8
A

1: Herpes Simplex 1
2: Herpes SImplex 2
3: varicella-zoster
4: EBV
5: CMV
6: Roseola (6th disease)
7: T-lymphotrophic virus
8: Virus associated with Kaposi’s sarcoma

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10
Q

Herpes Simplex:

  • how does the virus get into our body?
  • Where do latent infections harbor?
A

-virus infects through mucosal membranes or abraded skin

  • Latent infections harbored in neuronal cells
  • -trigeminal ganglia
  • -pre-sacral ganglia
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11
Q

Herpes Simplex 1 & 2 Clinical Presentation

A

-Dew drop on rose petal***?

  • Oral/facial lesions
  • -gingivostomatitis (canker sores/inflamm of gums&lips) and pharyngitis

-fever, malaise, myalgias, inability to eat, irritability and cervical adenopathy lasts 3-14days

  • Urogenital lesions (HSV-1 or 2)
  • -systemic: HA, fever, malaise, and myalgia
  • -local: vesicular lesions(moist»crust 1-2weeks) of the external genitalia with pain, itching, dysuria, vagina, and urethral discharge, tender inguinal lymph adenopathy
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12
Q

Characteristics of HSV recurrences?

A
  • involve few lesions
  • tend to be labial
  • heal faster
  • induced by stress, fever, infection, sunlight, chemo, pregancy
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13
Q

HSV may lead to more serious disease, what are these?

A
  • ocular disease (herpetic keratitis)
  • neonatal congenital infections
  • bells palsy
  • Bells palsy
  • encephalitis and recurrent meningitis
  • Disseminated herpes (think AIDS)
  • herpetic whitlow
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14
Q

What is the most common cause of encephalitis in the US?

What is the number one cause of corneal blindness?

A
  • herpes

- herpetic keratitis

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15
Q

Herpes Simplex Diagnostics for Dx

A
  • dx is clinically made
  • -should be confirmed with lab testing, viral culture, PCR, direct fluorescence aby, Tzanck preparation, and type specific serologic tests.

*will see giant cell with multiple nuclei on smear.

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16
Q

Important things to remember:

What does TORCHHS stand for?

A

TORCHHS is a group of blood tests that check for several different infections in a newborn & screen in pregnant mom

  • Toxoplasmosis
  • Reubella
  • CMV
  • Herpes simplex
  • HIV
  • Syphiliis?
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17
Q

PCR is particularily useful for the detection of what?

A

asymptomatic shedding in HSV

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18
Q

What is a Tzanck smear?

What do the inclusions respresent?

A
  • performed on lesion scrapping from patients with active genital lesions. Low sensitivity and specificity, only helpful if positive.
  • inclusion bodies are the virus replicating
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19
Q

Tx of Herpes Simplex Virus

A

-acyclovir for acute and suppressive therapy

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20
Q

What is herpetic whitlow?

A

-herpes on the hand

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21
Q

Varicella-Zoster Virus

  • what are the types?
  • when are people infectious?
  • incubation period
A
  • Primary infections: chickenpox
  • Recurrent infections: herpes zoster
  • 48hrs before onset of vesicular rash, throughout vesicle formation (4-5days), and until all vesicles are crusted.
  • incubation: 10-21days (usually 14-17)
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22
Q

Clinical Presentation of Varicella Zoster Virus

A
  • Primary Infection : chickenpox
  • -rash, fever (100-103), lasting 3-5days, malaise, skin lesions are hallmark of disease (maculopapule vesicles, scabs in varying stages of development”crops”, erythematous base of 5-10mm)
  • Reinfection: Herpes Zoster or Shingles:
  • -unilateral vesicular eruptions which develop within a single dermatome (T3-L3 most common)
  • -severe pain
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23
Q

Site the difference between chicken pox and small pox exanthems?

A
  • Chickenpox:
  • -crops (they are all at diff stages)
  • -superficial
  • -rash start trunk/face
  • -never palms/soles
  • -common on trunnk/face
  • -all same stage
  • -shallow umbillicated
  • -centrifugal (trunk to extremities)
  • -back=abdomen
  • uniloculated vesicles
  • Small pox:
  • -all at same stage
  • -rash starts face
  • -deeply umbilliccated
  • -hard lesions
  • -often palms/soles
  • -more common on extremities and face
  • -Back> Abdomen
  • -multiloculated vesicles (many small cavities or cells)
24
Q

Diagnostics of Varicella-Zoster virus for dx

A
  • dx usually clinical
  • test include:
  • -complement fixation and virus neutralization in cell culture
  • -fluorescent aby test of smear of lesions
25
Q

Varicella Zoster virus Tx

A
  • Primary infection prevention: vaccination
  • Primary disease: prevent secondary infections, wait it out.
  • Reccurent infection: Zoster
  • -antivirals (acyclovir, famcyclovir)
  • -analgesics
  • -can give immune globulin
26
Q

EBV

  • incubation period
  • virus infects what cells?
  • how is this transmitted?
  • peak ages of incidence
  • how long does EBV shed?
A
  • 4-8weeks incubation
  • B cells
  • transmitted in the saliva

-Girls 14-16
Boys 16-18

-EBV shed from oropharynx for up to 18mo post infection.

27
Q

EBV may cause what type of cancer?

A

Berketts lymphoma

28
Q

Clinical Presentaion of EBV

A

-subclinical or mild when infected in childhood

  • Clinical Triad*
  • -fever/chills (7-14days)
  • -Lymphadenopathy (rarely exceeds 3weeks)
  • -severe pharyngitis w/ exudates (5-7days resolving over following 7-10days)
  • other sx include:
  • -HA, malaise, anorexia
  • -soft palate petechiae
  • -maculopapular rash (especially w/ amoxicillin/PCN)
  • -splenomegaly and mild hepatic tenderness
  • -neoplasms; once it transforms it can cause other things such as….. nasopharyngeal carcinoma and B-cell lymphomas (Burkitts lymphoma)
29
Q

Do viruses cause exudates?

A

-No, they usually dont, EBV is the exception. In EBV you will see pharyngitis with exudates.

30
Q

EBV Lab findings?

A
  • throat culture (check for B-hemolytic strep)
  • monospot
  • Heterophil Abys (name of aby in mon) (become + within 4weeks after onset of sx)
  • atypical lymphocytosis in about 75%
  • EBV-specific immune response
  • -EBV aby titers directed at several ags (EB virus capsid ag VCA, abys to EBV nuclear antigen EBNA)
31
Q

Complications of EBV?

A
  • bacterial strep pharyngitis
  • hematologic: thrombocytopenia, neutropenia
  • splenic rupture
  • Neurologic: CN palsies (bells palsy); Guillian Barre Syndrome, encephalitis
32
Q

EBV Tx

A
  • 95% pts have self-limited disease in most cases requiring only supportive therapy.
  • acetaminphen or NSAIDS
  • warm salt water gargles
  • adequate rest
  • avoid contact sports for 6-8weks from onset
  • fever disappears in 10days
  • Lymphadenopathy and splenomegaly in 4weeks
33
Q

CMV

  • hows it spread?
  • who does this affect?
  • how long until resolvation?
A
  • spread via:
  • -prolonged close contacts (family, day-care)
  • -blood/bodily fluids (transfussion, maternal/fetal/vertical), STI
  • -AIDS pts, transplant patients, pregos.

-NEVER, its a life-long infection.

34
Q

CMV Clnical Presentation

A
  • Congential CMV; may be asymptomatic or severe/disseminated.
  • -petechia, hepatosplenomegaly, jaundice, microcephaly, growth retardation, prematurity, blueberry muffin rash
  • Perinatal CMV:
  • -poor weight gain
  • -adenopathy
  • rash
  • hepatitis
  • anemia
  • atypical lymphocytosis

CMV mononucleosis-like syndrome:

  • heterophil Ab negative mononucleosis syndrome
  • prolonged high fevers, profound fatigue and malaise
  • myalgias, HA, & splenomegaly
  • exudative pharyngitis and cervical adenopathy are rare
  • occasional rubelliform rash
35
Q

CMV Diagnostics and Tx

A

-viral culture (most important study)** (culture may be from any body fluid or organ system)

  • PCR
  • Ab assays
  • Tissue confirmation w/ AIDS related CMV
  • -CMV GI or nuero disease
  • -CMV pneumonitis

*OWL eye cells

Tx: Ganciclovir

36
Q

Blueberry muffin rash found in what disease?

A

-CMV and Rubella

37
Q

Fifths Disease

  • what type of virus?
  • transmission
  • clinical presenation
A
  • Human Parvovirus B19, NOT HERPES.
  • respiratory tract
  • Presentation:
  • mild febrile exanthematous disease with little or no prodrome.
  • Low grade fever, conjunctivitis, cough, myalgia, itching, nausea, diarrhea, SLAP CHEEK**
38
Q

What is slap cheek?

A
  • lesion that presents with 5th disease
  • indurated, confluent erythema of cheeks
  • fiery red
  • circumoral pallor
  • bil. symmetric eruptions (maculopapular slightly raised blotchy areas w/ lacey pattern on arms, legs, and trunk 1 day later)
  • rash last 1wk, may disappear and reappear in same area a few hours later.
39
Q

Dx and Tx of 5th disease

A

Dx: clinical in kids

Tx: NSAIDS!! Thats all folks.

40
Q

Roseola (infantum)

  • aka
  • incubation period
  • who does this occur in
  • what type of virus?
  • major cause of what?
  • Presentation
  • Tx
A
  • 6th disease
  • 5-15days
  • benign disease of infants 6mo to 4yo
  • HHV6, b-cell lymphotropic virus
  • major cause of infantile febrile seizures*******

-Presentation: abrupt onset, irritability, fever, rash.
Rash- appears several hours after drop in temp. faint small macules over neck and trunk, thighs, and butt.. May last 1-2day

-Tx: symptomatic only, warm bath, tylenol/NSAIDS

41
Q

Measles (Rubeola)

  • transmission
  • infectivity?
  • Presentation
  • Tx
  • Dx
A
  • transmitted through nasopharyngeal secretions, (direct or airborne droplets) to respiratory mucous membrane or conjunctivae of susceptible persons
  • Highly contagious, infectious from 5days after exposure to 5 days after skin lesions appear
  • Presentaion: acute febrile eruption following 9-11 days incubation
  • -malaise, irritability, fever (105), conjunctivitis, photophobia, koplik spots**, brick red irregular maculopapular rash*

Tx: Isolation of pt, bedrest, antipyretic, fluids

Dx: clinical

42
Q

What are koplik spots?

Describe Brick Red irregular rash found in Measles?

A

-Koplik spots: small red irregular lesions with blue/white centers on oral mucosa 1-2 day before rash.

  • Rash:
  • -moves head to toe
  • -spreads outward and downward
  • -may affect palms and soles last
  • -lesions disappear in same order of appearance.
43
Q

Rubella

  • aka
  • caused by what virus
  • transmission
  • presentation
  • Tx
  • Complications
A
  • German measles, 3day measles
  • Togavirus
  • transmitted by nasopharyngeal secretions and transplacental
  • presentation:
  • viral exanthem
  • prodrome in adults only (malaise, HA, fever)
  • lymphadenopathy (post-auricular, sub occipital)
  • splenomegaly
  • rash: small red lesions(Forchheimers spots**) (same pattern as rubeola)
  • —–These are how you differentiate it from Rubeola——-
  • Congenital rubella syndrome
  • -heart malformations
  • -eye lesions
  • -microcephaly
  • -mental retardation
  • -deafness
  • -TTP
  • -Intrauterine growth retardation

-Tx: Prevention!!…and acetominophen provides symptomatic relief.

  • Complications:
  • exposure during pregnancy
  • congenital rubella
  • post infectious encephalopathy.
44
Q

Mumps

  • what type of virus
  • transmission
  • incubation period
  • clinical presentation
  • Tx
A
  • paramyxovirus
  • transmission: frequently in the spring, spread by respiratory
  • incubation period is 12-25days
  • Presentation:
  • -Epididymoorchitis, unilateral, swollen tender cord
  • -*parotitis: usually the 1st indication of disease
  • -prodrome of malaise, anorexia, fever, pharyngitis
  • -may have pain, tenderness
  • -enlargement of glands
  • 25% infections are subclinical

-Tx: no specific tx

45
Q

What are the common cold viruses?

A
  • rhinovirus
  • coronavirus
  • adenovirus
46
Q

What virus cause influenza-like illnesses?

A

-Influenza A and B

47
Q

What causes Bronchiolitis?? Croup?

A
  • Bronch: Respiratory Syncytial Virus (RSV)

- Croup: Parainfluenza virus

48
Q

Influenza

  • what type of virus
  • what are the types of influenza?
  • what are the types based off of?
  • Which type undergoes further surface AG classification?
A
  • orthomyxoviridae
  • Types A, B, and C
  • Types are based on antigenic characteristics of nucleoprotein and matrix protein Ags.
  • Type A viruses undergo further surface Ag classification: Hemagglutinin (H) (H1-2) & Neuraminidase (N) (N1-2)
49
Q

What is antigenic shift? drift?

A

Antigenic drift refers to changes to the flu virus that happen slowly over time, mutations within the genes. This causes the changes to the seasonal flu that require us to get vaccinated against the flu each year. Antigenic shift results when two different flu strains combine and infect the same cell.

50
Q

Complications and Presentation of Influenza?

A
  • Complications:
  • -pneumonia (most commonly staph pneumo)
  • -Reyes syndrome (affects brain, liver, kindey, from aspirin)
  • -Myositis,rhabdomyolysis, myoglobinuria
  • -myocarditis and pericarditis
51
Q

Diagnostics for Tx and Treatment for Influenza?

A

-Dx: rapid flu swab (nasal, throat), leukopenia

Tx:

  • Symptomatic
  • -acetaminophen
  • -rest
  • -fluids
  • -abs if pneumo is suspect
  • Anti-influenza drugs
  • -Oseltamivir (tamiflu)
  • -Zanamivir (Relenza) (inhaled)
  • -Adamantadine and Rimantadine (only works on flu A
52
Q

Prevention of Influenza

A

-vaccination (CI egg allergy)

53
Q

Bronchiolitis

  • aka
  • what virus is this?
  • transmission
  • presentation
  • Diagnostics
  • Tx
A
  • Respiratory Synctial Virus (RSV
  • Paramyxovirus
  • Transmitted by close contact with contaminated fingers or fomite
  • Presentation:
  • -Infants: rhinorrhea, low-grade fever, cough, wheezing, tachypnea, dyspnea, hypoxia, cyanosis, apnea, rhonchi and rales

–adults/older children: common cold presentation

  • Diagnostics:
  • -Rapid RSV w/ nasal washings using viral Ag ID using Eliza or immunofluorescent assay
  • -culture of nasopharyngeal secretions
  • Tx:
  • -Antiviral therapy: Ribavirin
  • -Symtomatic relief: contact isolation, resp. therapy, o2, secretion removal, hydration, antibronchospastic agents
54
Q

Croup

  • what virus?
  • Clinical presentation
  • Tx
A

Caused by parainfluenza virus (4 types, type 1 most common cause of croup)

Presentaion:

  • acute febrile illness
  • coryza (rhinitis), sore throat, hoarseness and variably croupy cough
  • breathing diff accompanied by barking cough***
  • worse at night.

Tx:

  • symptomatic relief:
  • -cool or moist air (bring child into a steamy bathroom or outside into the cool night air)
  • -cool air vaporizer
  • -acetaminophen
  • ER treatment:
  • Aerosolized Racemic Epi (epi & bronchodiolator)
  • Prednisone in ER and to go (oral)

**DO NOT use cough medicine (it suppresses the cough, its more of an inflammatory issue so this wont do any good.)

55
Q

Rabies

  • caused by what virus
  • clinical presentation
  • Lab findings
  • Treatment
A
  • caused by rhabdovirus
  • -urban: caused by unimmunized domestic dogs/cats
  • -sylvatic: caused by skunks, foxes, raccoons, wolves, and bats.
  • Clinical presentation of each stage:
  • -Stage 1: Prodrome; 1-4days, fever, HA, malaise, myalgias, anorexia, n/v, pharyngitis, nonproductive cough, paresthesias around site of inoculation.

–Stage 2: Acute Encephalitis: excessive motor activity, excitation, and agitation, confusion, hallucinations, combativeness, muscle spasm, seizures, hyperesthesia to light noise or touch, fever (105), dilated pupils, salivation

–Stage 3 Profound brainstem dysfunction: difficulty swallowing w/ increased salivation (foam at mouth), violent involuntary contractions of diaphragm, accessory respiratory, pharyngeal, and laryngeal muscles, coma and respiratory failure follow

–Recovery (rarely)

  • Lab findings:
  • -isolation of virus (saliva, CSF, or brain tissue)
  • -indirect serologic evidence of immune response
  • -direct antigen detection (skin or brain biopses)
  • Treatment:
  • -Prevention: pre-exposure vaccination of domestic animals and those who are around animals (veterinarians, cave explorers, lab workers)

Post-expousure prophylaxis: clean out the wound, give vaccine and sometimes IVIG.

56
Q

Variola

  • aka
  • Signs/Symptoms/disease course
A

-small pox

  • Day 0; exposure
  • Day 12-14; fever, malaise, nonproductive cough, HA, backache, joint pain
  • Day14-16: papular rash on face to extremeities
  • Day16-18; papular»vesicular»pustular
  • Day 22-26; crusted lesions
  • Day 28-30; resolving

*10% will develop malignant disease and die 5-7 days after incubation

57
Q

Small pox vaccine SE

A

-red, itchy, vesicle umbilicates and evolves into pustule that scabs over and falls off by end of week 3 and scars.

Infectious Disease 3 (9 decks)

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