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Multisystem 1st Half > Viral Diseases of Childhood > Flashcards

Viral Diseases of Childhood Flashcards

1
Q

the 5 common childhood viral xanthemas (rashes)

A 
measles
scarlet fever
german measles
filatov dukes
erythema infectiosum
roseola infantum
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2
Q

scarlet fever

organism?
symptoms?

A

group A strep = strep pyogenes)

sore throat, fever and red rash

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3
Q

german measles

organism?

A

rubella virus

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4
Q

erythema infectiosum

organism and presentations

A

parvovirus B19

slapped cheek syndrome

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5
Q

roseola infantum

org?

A

HSV 6 and 7

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6
Q

paramyxoviruses

A

large, enveloped negative-stranded RNA (-RNA) viruses with a single-stranded non-segmented RNA genome and their own RNA-dependent RNA polymerase

cause common diseases like respiratory tract infections, measles, mumps and neurological disease

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7
Q

route of transmssion for paramyxoviruses is

A

respiratory

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8
Q

Paramyxoviruses and the childhood viral infections they cause:

1-respirovirus?
2-morbillivirus?
3-rubulavirus?
4-pneumovirus?
5-metapneumovirus?
A

1 - parainfluenza virus (PIV types 1 and 3)
2 - measles
3 - mumps and parainfluenza types 2 and 4
4 - RSV (respiratory syncytial virus)
5 - hMPV (human metapneumovirus)

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9
Q

paramyxoviruses have their own what?

A

RNA dependent RNA polymerase!

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10
Q

paramyxovirus replication

A

virus is a -RNA
transcription by viral RNA dep RNA polymerase
–transcription complex = L(large)-polymerase protein + NP (nucleoprotein) + P (phosphoprotein)

this creates +RNA template and mRNAs
–mRNAs are translated into proteins and the +RNA template makes more -RNA genomes

proteins and RNA genomes are assembled into new viruses

virus particles undergo “budding” from infected cell

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11
Q

paramyxovirus replication is detected by three ways:

A

1 - hemadsorption cell fusion (syncytia or giant cells)
2 - immunofluorescence
3 - reverse transcriptase PCR (RT-PCR)

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12
Q

paramyxovirus-specific neutralizing antibodies are reactive to what structures of the virus?

A

reactive to the F glycoproteins and the attachment glycoproteins (H, HN, and G) on the outer envelope

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13
Q

parainfluenza viruses cause what type of infections?

6 syndromes due to parainfluenza virus?

A

–> local infections of the respiratory tract

1 - inapparent infection
2 - minor respiratory infection
3 - croup (laryngo-tracheitis)
4 - bronchitis
5 - bronchiolitis (lower airway inflammation)
6 - bronchopneumonia (pneumonia localized to smaller bronchial tubes)

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14
Q

upper resp. infection with barking cough

A

croup

inflammation and infection of the voice box

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15
Q

are vaccines available for parainfluenza virus?

A

no
Problems: how to induce long-lasting immunity when natural infection does not, viruses cause disease in early infancy, vaccines must be effective in the presence of maternal antibody

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16
Q

parainfluenza virus types 1/2 vs 3 vs 4

major syndrome?
age?
when?

A

1/2 –> croup, 6mo to 5 yr, in the autumn
3 –> bronchiolitis/pneumonia, 0-6months, endemic
4 –> URI, kids, endemic

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17
Q

RSV

major syndrome?
age?
when?

A

bronchiolitis/pneumonia
0-6months
winter epidemic

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18
Q

in immunocompromised patients, parainfluenza viruses and RSV have…

A

prolonged and severe infection (30% mortality in bone marrow recipients)

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19
Q

RSV

A

a Pneumovirus (no HA or NA activities)

Has a F (fusion) glycoprotein

The MOST important cause of lower respiratory tract disease in young children. Will infect virtually all infants by age 2.

Symptoms resemble the common cold.
In premature infants or those with chronic lung disease, RSV can cause severe to life-threatening illness.

Restricted to the respiratory epithelium.

Immunity is not long-lived.

There is a prophylactic therapy (passive antibody therapies: (palivizumab (Synagis™).

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20
Q

palivizumab

A

monoclonal Ab prophylaxis against RSV in infants

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21
Q

what will infect almost all infants by 2?

A

RSV

22
Q

mumps

A

a paramyxovirus systemic infection
–viremia that spreads to parotid glands (parotitis) and other epithelium (testes/ovaries, meninges, thyroid, bladder, kidney, and pancreas)

presents 2-3 weeks after exposure

23
Q

complications of mumps?

A

meningitis, orchitis (unilateral), encephalitis

24
Q

how to acquire mumps immunity?

A

usually acquired in childhood
infection gives lifelong immunity since there is only one serotype and infection is systemic

or MMR vaccine

25
Q

who is most at risk for mumps?

A

post pubertal boys

26
Q

mumps vaccine

A

a live-attenuated vaccine (part of MMR with measles and rubella)

27
Q

measles

A

paramyxovirus systemic infection
VERY contagious - if child is non-immune = will contract virus

2 week incubation period
infects via respiratory tract –> local replication –> spreads to lymphoid tissue via viremia –> infects skin and organs

symptoms = kopliks spots, fever, cough, conjunctivitis, and rash; photophobia

28
Q

measles rash depends on…

patients with low CMI….

A

cell mediated immunity

people with low CMI do NOT develop rash but instead get measles giant cell pneumonia

29
Q

kopliks spots

A

clustered little white lesions in mouth near molars that appear a few days before MEASLES rash

30
Q

3 neurologic complications of measles

A

acute disseminated encephalomyelitis (ADEM) - within a month after infection

measles inclusion body encephalitis (MIBE) - 1-9 months after infections

subacute sclerosing panencephalitis (SSPE) - 3-12 years after BECAUSE virus persists in neurons (CNS inclusions) causing fatal CNS disease

31
Q

measles immunity acquired how?

A

one serotype worldwide so infection gives life immunity

CMI is required to clear the infection

MMR vaccine is a live attenuated virus
or
passive immunity with anti-measles IgG

32
Q

rubella virus

A

german measles
a togavirus = small enveloped +RNA virus with single stranded nonsegmented RNA genoma

causes congenital rubella syndrome

MMR vaccine

33
Q

properties of togaviruses

2 types?

A

(toga) = enveloped

attaches to host cells with glycoprotein spikes

entry through endocytosis (pH dependent)
viral genome is + sense –> serves as template for protein synthesis

rubella and alphavirus

34
Q

rubella infection

A

usually mild

respiratory entry –> spread to lymph nodes –> viremia –> skin and fetus (teratogenic)

symptoms: maculopapular rash (rubelliform), lymphadenopathy, low grade fever, conjunctivitis, sore throat, arthralgia
* *rash is main feature and first sign

35
Q

can rubella cross placenta?

what happens if 1st timester infection?

A

yes; teratogenic and causes congenital rubella syndrome

esp 1st trimester infection –> deafness, blindness (cataracts), heart or brain defects

baby continues to shed virus after birth for a few months

36
Q

complement fixation test for rubella?

A

known antigen is reacted with an unknown antibody in he patients serum

no lysis = prescence of antibody (positive test)
lysis = lack of specific antibody (negative)

CF titers

  • -> acute serum titer is 4
  • ->convalescent titer is 32
  • *this >4 fold increase in CF titer DOES indicate recent rubella infection

titer of 128 = protextion via pre-existing immunity

37
Q

what diseases are caused by parvovirus B19?

A

erythema infectiosum (5th disease, slapped cheek disease)
apastic crisis in people with chronic hemolytic anemia (sickle cell anemia)
hydrops fetalis (anemia and CHF)
polyarthritis

38
Q

parvovirus B19 infection mechanism

A

through respiratory droplets or contaminated blood
virus infects mitotically active erythroid precursors; establishes viremia
–can cross into placenta -> fetus

39
Q

vaccine for parvovirus B19?

A

no

40
Q

parvovirus B19 structure

A

small
icosahedral
nonenveloped
linear, nonsegmented, ssDNA

41
Q

erythema infectiosum (EI)

A

5th disease “slapped cheek disease”; caused by parvovirus B19
common in school kids
4-14 day incubation

nonspecific symptoms (infectious during this time) = myalgia/arthritis, fever, headache, malaise, chills

maculopapular rash on face occurs about 18 days after exposure (no longer infectious at this stage)

42
Q

fetal B19 infection

A

B19 can cross placenta to infect the fetus causing fetal anemia and congestive heart failure (hydrops fetalis) that lead to spontaneous abortion

43
Q

B19 infection leads to what crisis?

A

transient aplastic crisis

B19 infection results in a transient depletion of erythrocyte precursors and a reduction in erythropoiesis, which leads to reticulocytopenia and a decrease in hemoglobin level that lasts for 7-10 days.

The reticulocytopenia can be life-threatening in people with hemolytic anemia (sickle cell anemia).

44
Q

roseola

A

6th disease

caused by HHV6 and 7 (human herpes virus)

45
Q

VZV

A

chickenpox (primary vzv) and shingles (recurrent vzv)

due to HHV6 and 7

transmitted by aerosol and direct contact
viremia allows spread

46
Q

differential ddx for: lymphadenopathy, low grade fever, and maculopapular rash

A 
measles
scarlett fever
roseola (Hhv 6/7)
parvovirus b19
rashassociated enteroviruses

***to differentiate, must do lab serology or virus isolation

47
Q

which enteroviruses can also cause rash

A

coxsackie A and B and echovirus

48
Q

LIVE vaccines pros and cons

A

pros –> mimics natural immunity, humoral and cellular responses, durable immunity, and herd immunity

cons –> reversion to virulence, restricted by prior immunity, spread to contacts

49
Q

non-living vaccines pros and cons

A

pros–> not restricted by prior immunity, safe (not infectious), potency can be adjusted easily

cons –> poor CTL response, transient immunity, limited herd immunity

50
Q

all successful viral vaccines induce ____

A

neutralizing antibodies

51
Q

what viral vaccine is recomended at birth?
…yearly?
…at 1 year?
…at 11-12?

A

Hep B
influenza
MMR, varicella, HepA, IPV (polio)
HPV and tDAP

Multisystem 1st Half (23 decks)

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