Viral exanthems and other dermatologic infections/inflammations - Stillwell Flashcards
1
Q
exanthema
A
-widespread rash - caused by toxins, drugs, infection, autoimmune
2
Q
enanthem
A
-rash on mucous membrane (ex. mouth, nose)
3
Q
macule
A
- flat lesion on the surface of skin (not raised)
- <2cm; patch if >2cm diameter
- ex. freckle
4
Q
papule
A
- small lesion raised above the skin
- <0.5 cm; nodule (0.5-5cm); tumor >5cm
5
Q
plaque
A
- large, flat topped raised lesion
- > 1cm
- ex. psoriasis or eczematous dermatitis
6
Q
pustule (pimple)
A
- small collection of pus in epidermis/dermis
- may form to papule –> collection of inflammatory cells
- small abscess
7
Q
vesicle
A
- small fluid filled lesion above the skin (translucent)
- <0.5 cm
- may be grouped
- ex. HSV-1 - fever blister on lip
8
Q
bulla
A
- fluid filled lesion above the skin (translucent)
- > 0.5 cm
- ex. 2nd degree burn or pressure blister
9
Q
morbilliform rash
A
- diffuse rash sometimes showing circular or elliptical lesions
- ex. measles, drug/allergic rxns, syphilis
10
Q
viral exanthems/enanthems
A
- viral syndrome includes fevers, chills, myalgias, arthralgias, fatigue (may or may not have a rash)**
- rash may be from virus itself or immune response
- low WBCs, platelets, sometimes anemia
- ESR, CRP, procalcitonin usually normal
11
Q
alpha herpes viruses**
A
HHV-1 (Herpes simplex virus-1/HSV-1) (oral>genital herpes)
HHV-2 (Herpes simplex virus-2/HSV-2) (genital>oral herpes)
HHV-3 (Varicella zoster virus- VZV) (chickenpox/shingles)
HHV-B (Herpes simiae virus- Herpes B virus) (rash/meningoencephalitis/lymphadenitis)
12
Q
gamma herpes viruses**
A
HHV-4 (Epstein-Barr virus- EBV) (infectious mononucleosis)
HHV-8 (Kaposi’s sarcoma herpesvirus- KSHV) (Kaposi’s sarcoma)
13
Q
beta herpes viruses**
A
HHV-5 (Cytomegalovirus- CMV) (infectious mononucleosis)
HHV-6 (Roseolovirus) (roseola)
HHV-7 (Roseolovirus) (roseola)
14
Q
herpes group viruses
A
- DNA viruses - DNA in capsid wrapped within a tegument with with the virion as the envelop
- latently infect cells (LAT genes) - can reactivate
- may live the rest of someone life
- may or may not be symptomatic
15
Q
HSV-1
A
- most people carry it latently
- can reactivate and spread when there are no symptomatic lesions** (reactivate less frequently than HSV-2)
- usually oral** - ex. fever blisters on the lip
- 80-90% usually orolabial, 10-20% genital
- can occur on skin (herpes gladitorium - no dermatome)** and around fingertips (herpetic whitlow) and perianally**
- begins with preherpetic neuralgia** (pain and tingling) –> progress to ulcers
- primary infection worse than recurrences** –> febrile illness, lesions, ulcerative stomatitis**
- no longer contagious once the scab crusts
- prophylaxis can abort virus
16
Q
HSV-2
A
- less people carry virus latently; more common in women
- can reactive and spread when there are no symptomatic lesions** (reactivates more frequently than HSV-1)**
- 80-90% genital, 10-20% orolabial**
- primary infection more severe than recurrences –> febrile, lesions, vaginitis, urethritis, urinary retention, inguinal lymphadenitis**
- begin with preherpetic neuralgia –> vesicles –> ulcers
17
Q
HSV-1,2
A
- treatment: acy/penci/famci/valacyclovir**
- prophylaxis: condoms, oral meds –> lowers reactivation risk and makes it less severe
- diagnosis: usually clinical, antibodies ineffective bc would cross react
- Tzanck smear from ulcer –> multinucleated giant cells*
- best is PCR test of swab of lesion* - immunity: cell mediated immunity** - not much problem if antibodies are low, but problem with low T cells (immunosuppressed people)
18
Q
varicella zoster - HHV-3
A
- epidemiology: acquire through inhalation
- will normally get it if not immune (vaccinated)
- primary infection (chickenpox aka varicella) –> lead to pneumonia and meningitis/encephalitis**; secondary bacterial infections in child
- remains dormant in CN5 and dorsal root ganglia and reactivates into shingles (herpes zoster) - risk increases with age - clinic: vesiculated lesions that come in crops*
- reactivation to shingles follows single dermatome
- reactivation can develop postherpetic neuralgia (chronic pain) with shingles**
- if reactivated in trigeminal nerve –> cornea is at risk** - treat: acy/famci/valacyclovir or VZV Igs
- prophylaxis:
- viravax (live) for children
- zostavax (live) given to adults –> decreases risk of reactivation and post herpetic neuralgia
- shingrix (recombinant) given to elderly –> go to treatment - diagnosis: clinic or PCR
19
Q
chickenpox vs smallpox**
A
- chickenpox - lesions are crops over time, easily crusts, mild illness before rash, spares palms/soles**
- smallpox - lesions all at once, takes days to crust, sever illness before rash, affects palms/soles**
20
Q
HHV-6, HHV-7 (roseola) aka exanthem subitum
A
- epidemiology: spread through saliva or mother to baby, frequent in children
- clinic: high fevers and febrile seizures, rash starts on trunk and moves peripherally
- similar to measles, but does not look as sick in roseola - treat: supportive
- prophylaxis: no vaccine
21
Q
HHV-8 (kaposi’s sarcoma)
A
- epidemiology: seroprevalence increases with age/sex partners
- pass from mother to child, body fluids (sexual contact) - clinic: associated with kaposi’s sarcoma tumor in immunocompromised (ex. AIDS - low CD4)**
- associated with multicentric Castleman’s disease
- purplish-violet lesions on MOUTH and NOSE** - treat: boost immune system with HAART
- prophylaxis: safe sex; no vaccine
22
Q
Herpes B virus (Herpes simiae)
A
- epidemiology: virus in macaque/rhesus monkeys**
- acquire from bite or secretions - clinic: lesions similar to HSV (gladiatorum)
- also pharyngitis, lymphadenitis, meningoencephalitis –> death - treat: acyclovir immediately
- prophylaxis: no vaccine
23
Q
hand, foot, and mouth disease (coxsackie virus A16 - sometimes enterovirus-17)**
A
- epidemiology: highly contagious
- transmitted by nasopharyngeal, fecal-oral, air droplets, direct contact
- usually in children under 10
- polio like illness in adults - clinic: papules, vesicles, ulcers on hands, feet, mouth
- nonpruritic rash involving the palms/soles**
- grey-white lesions with ulcers in the back of mouth - treat: none
- prophylaxis: no vaccine in US, is vaccine in China
24
Q
herpangina (coxsackie virus A and B, enterovirus 71, sometimes echovirus)**
A
- epidemiology: spread in summer in respiratory droplets or fecal-oral, children under 10
- clinic: within couple days, grayish lumps develop into vesicle in the in mouth and pharynx (often soft palate and tonsils) and get bigger
- looks like herpes stomatitis or hand-foot-mouth disease - treat: none
- prophylaxis: no vaccine
25
Q
for boards** - not on test
A
- First disease- Measles (Rubeola)
- Second disease- Scarlet fever/Scarletina (secondary to Group A Strep producing an exotoxin)
- Third disease- German measles (Rubella)
- Fourth disease- Staphylococcal Scalded Skin Syndrome (Ritter’s disease caused by exfoliative exotoxin producing Staphylococcus aureus)
- Fifth disease- Erythema infectiosum (Parvovirus B 19/Slapped Cheek Syndrome)
- Sixth disease- Exanthem subitum (Roseola)
26
Q
Parvovirus B19 (Fifth disease/Erythema Infectiosum/Slapped Cheek Syndrome)*****
A
- epidemiology: spread through respiratory, blood, mother to child (highly contagious)
- worldwide outbreaks every 3-4 years
- only infects humans**
- usually in children, rare in adults - clinic: brief viral prodrome with fever, headache, nausea, diarrhea**
- kids: spare nasolabial folds, forehead, and mouth; rash on trunk and extremities
- adults: polyarthralgias/arthritis, bone marrow suppression
- utero: hydrops fetalis/miscarriage/stillbirth - treat: none
- prophylaxis: no vaccine
- diagnosis: clinically, parvovirus IgM antibody, or PCR
27
Q
measles - rubeola aka red measles
A
- epidemiology: highly contagious, spread through airborne, respiratory droplets, secretions
- many deaths even though there is vaccine
- seen less over time with increasing vaccination - clinic: prolonged episode (kids look SICK)
- cough, conjunctivitis, coryza** (stuffy/runny nose)
- Koplik spots*** inside cheeks next to molars or soft palate
- rash on back of ears –> head/neck –> trunk –> extremities - complications: subacute sclerosing panencephalitis (SSPE)** –> brain inflammation, neurologic problems, personality changes, occurs years after measles**
- also pregnancy, vit. A deficient, malnutrition - atypical measles**: patients immunized with killed vaccine b/w 1963-1967 (no full protection) –> high fevers, headaches, rash, pneumonia, hepatitis, vasculitis
- treat: sometimes vit. A supplementation
- prophylaxis: live attenuated vaccine, give 2 doses, MMR/MMRV
- diagnosis: clinic, serology for IgM antibodies, or PCR
- path/histo: F protein causes cell to cell fusion forming giant cell syncytium***
28
Q
Mumps - mumps virus
A
- epidemiology: spread airborne or saliva
- clinic: parotitis or aseptic meningitis* (meningitis that does not grow bacteria)
- parotid gland inflamed/enlarged
- post-pubertal males –> mumps orchitis*** (some sterile)
- females can get oophoritis (rare and not associated with sterility)
- rash may/may not be present - treat: none
- prophylaxis: live attenuated vaccine, 2 doses, 3 if needed
- diagnosis: clinic, IgM serology
29
Q
rubella (German measles)
A
- epidemiology: virus in humans and non-human primates, spreads through respiratory droplets
- was problem before MMR vaccine - clinical illness in child: mild illness** when acquired postnatally or in children
- posterior cervical/auricular and suboccipital lymphadenopathy** and a rash due to immune rxn (starts on face spreads to trunk/extremities; spreads faster than regular measles)
- enanthem and forshheimer spots*** (aka petechia) on soft palate - clinical illness in teen/adult: more severe, harsher prodrome
- arthralgias and polyarthritis**
- exanthem similar to children** - congenital rubella infection (CRI): intrauterine infection –> stillbirth, miscarriage
- congenital rubella syndrome (CRS): fetal infection and many birth defects along with ischemia in organs
- treat: none
- prophylaxis: rubella vaccine, MMR/MMRV
- diagnosis: clinic, rubella IgM antibody
30
Q
acute HIV***
A
- epidemiology: CD4 count becomes low soon after you acquire it
- clinic: primary HIV infection days/weeks after exposure
- mono-like syndrome** with fever, lymphadenopathy, pharyngitis, malaise, myalgia
- enanthem (oral or vaginal) and exanthem - treat: HAART immediately
- prophylaxis: safe sex, avoid needles, no vaccine
- diagnosis: combo test for HIV1/2 and HIV RNA PCR
31
Q
difference between mono and acute HIV??**
A
- acute HIV will have mono like symptoms but also a rash associated with it (mostly on upper body)**
- mono from EBV,CMV does not have a rash**
32
Q
HPV - human papilloma virus
A
- epidemiology: most common STI*
- precancerous lesions or warts
- most cervical and oropharyngeal cancers due to HPV16,18*** - clinic:
- skin warts** –> do not develop into cancer
- genital/anal warts** (Condylomata accuminatum) –> HPV6,7; usually cleared by immune system
- oral/pharyngeal papillomas** –> HPV16 (high risk of malignancy); white lesions on tongue - treat: topical therapy, surgical removal
- prophylaxis: safe sex and vaccines; Gardasil 9 in US
33
Q
smallpox (variola virus)
A
- epidemiology: spread by respiratory droplets and oral secretions
- clinic: fever/headache/myalgia –> enanthem –> rash
- macules/papules/vesicles on palms/soles unlike chickenpox*
- one crop of lesions* - treat: Tecovirimat/Tpoxx
- prophylaxis: initially cowpox vaccine, now vaccinia vaccine
34
Q
cowpox (cowpox virus)
A
- epidemiology: skin contact with animals (cattle, rodents, cats)
- “milk maids hands”*** - clinic: macules –> papules –> vesicles –> ulcers
- black eschar that falls off*** - treat: none
- prophylaxis: use gloves
- diagnose: clinic or biopsy
35
Q
monkeypox (monkeypox virus)
A
- epidemiology: contact with macaque monkeys (“bush meat”), prairie dogs, squirrels, rats
- clinic: viral prodrome –> rash on trunk (can spread to extremities)
- treat: none
- prophylaxis: smallpox vaccine
- diagnosis: clinic or biopsy
36
Q
orf (orf virus) aka Thistle disease, Ecthyma contagiosum
A
- epidemiology: poxvirus that is zoonotic and get from sheep, goats, and fomites***
- animals get lesions on muzzle, mouth/eyes –> clear it better than humans - clinic: non healing lesions on face, hands, arms
- treat: none
- prophylaxis: wear gloves, vaccine for animals
- diagnosis: clinic and PCR
37
Q
Molluscum Contagiosum/Water Warts (Molluscum Contagiosum virus
A
- epidemiology: direct/sexual contact, auto inoculation, and fomites
- clinic: papules that umbilicate in center (very superficial, only epidermis)
- everywhere in children
- face/genitals in adults - treat: topicals, cryosurgery, laser
- prophylaxis: avoid contact with lesions and fomites
- diagnosis: clinic or biopsy
38
Q
zika fever (zika virus)
A
- epidemiology: Flavivirus spread via Aedes mosquito bites, transfusions and sexual contact
- clinic: usually no symptoms**
- if symptoms –> conjuctivitis, myalgia, headache, rash
- petechial enanthem
- microcephaly in fetus and Guillain-Barre syndrome - treat: none
- prophylaxis: safe sex, avoid mosquitos
- diagnosis: blood or amniotic fluid for IgM or PCR
39
Q
Dengue Fever (Dengue fever virus infection/ Breakbone fever)
A
- epidemiology: bites from aedes mosquitos, transfusions
- clinic: retro-orbital headache, GI, sever myalgia/arthralgia (breakbone fever)*
- biphasic/saddleback fever - returns
- “islands of white in a sea of red”
- hemorrhagic fever –> dehydrates, multi-organ failure, bleeding*
- pulse-temp dissociation* (low pulse) - treat: none
- prophylaxis: avoid mosquitos, vaccine not in US
- diagnosis: serology IgM or PCR
40
Q
Chikungunya Fever (Chikungunya virus)
A
- epidemiology: aedes mosquitos and transfusions
- clinic: high/biphasic fever, joint pain, rash, headache GI, conjunctivitis
- polyarthritis
- hyperpigmented rash with mouth ulcers - treat: none
- prophylaxis: avoid mosquitos
- diagnosis: serology IgM, PCR
