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
for boards** - not on test
1. First disease- Measles (Rubeola)
2. Second disease- Scarlet fever/Scarletina (secondary to Group A Strep producing an exotoxin)
3. Third disease- German measles (Rubella)
4. Fourth disease- Staphylococcal Scalded Skin Syndrome (Ritter’s disease caused by exfoliative exotoxin producing Staphylococcus aureus)
5. Fifth disease- Erythema infectiosum (Parvovirus B 19/Slapped Cheek Syndrome)
6. Sixth disease- Exanthem subitum (Roseola)
26
Parvovirus B19 (Fifth disease/Erythema Infectiosum/Slapped Cheek Syndrome)*****
1. 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
2. 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
3. treat: none
4. prophylaxis: no vaccine
5. diagnosis: clinically, parvovirus IgM antibody, or PCR
27
measles - rubeola aka red measles
1. epidemiology: highly contagious, spread through airborne, respiratory droplets, secretions
- many deaths even though there is vaccine
- seen less over time with increasing vaccination
2. 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
3. complications: subacute sclerosing panencephalitis (SSPE)** --> brain inflammation, neurologic problems, personality changes, occurs years after measles**
- also pregnancy, vit. A deficient, malnutrition
4. atypical measles**: patients immunized with killed vaccine b/w 1963-1967 (no full protection) --> high fevers, headaches, rash, pneumonia, hepatitis, vasculitis
5. treat: sometimes vit. A supplementation
6. prophylaxis: live attenuated vaccine, give 2 doses, MMR/MMRV
7. diagnosis: clinic, serology for IgM antibodies, or PCR
8. path/histo: F protein causes cell to cell fusion forming giant cell syncytium***
28
Mumps - mumps virus
1. epidemiology: spread airborne or saliva
2. 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
3. treat: none
4. prophylaxis: live attenuated vaccine, 2 doses, 3 if needed
5. diagnosis: clinic, IgM serology
29
rubella (German measles)
1. epidemiology: virus in humans and non-human primates, spreads through respiratory droplets
- was problem before MMR vaccine
2. 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
3. clinical illness in teen/adult: more severe, harsher prodrome
- arthralgias and polyarthritis**
- exanthem similar to children**
4. congenital rubella infection (CRI): intrauterine infection --> stillbirth, miscarriage
5. congenital rubella syndrome (CRS): fetal infection and many birth defects along with ischemia in organs
6. treat: none
7. prophylaxis: rubella vaccine, MMR/MMRV
8. diagnosis: clinic, rubella IgM antibody
30
acute HIV***
1. epidemiology: CD4 count becomes low soon after you acquire it
2. clinic: primary HIV infection days/weeks after exposure
- mono-like syndrome** with fever, lymphadenopathy, pharyngitis, malaise, myalgia
- enanthem (oral or vaginal) and exanthem
3. treat: HAART immediately
4. prophylaxis: safe sex, avoid needles, no vaccine
5. diagnosis: combo test for HIV1/2 and HIV RNA PCR
31
difference between mono and acute HIV??**
- 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
HPV - human papilloma virus
1. epidemiology: most common STI*
- precancerous lesions or warts
- most cervical and oropharyngeal cancers due to HPV16,18***
2. 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
3. treat: topical therapy, surgical removal
4. prophylaxis: safe sex and vaccines; Gardasil 9 in US
33
smallpox (variola virus)
1. epidemiology: spread by respiratory droplets and oral secretions
2. clinic: fever/headache/myalgia --> enanthem --> rash
- macules/papules/vesicles on palms/soles unlike chickenpox***
- one crop of lesions***
3. treat: Tecovirimat/Tpoxx
4. prophylaxis: initially cowpox vaccine, now vaccinia vaccine
34
cowpox (cowpox virus)
1. epidemiology: skin contact with animals (cattle, rodents, cats)
- "milk maids hands"***
2. clinic: macules --> papules --> vesicles --> ulcers
- black eschar that falls off***
3. treat: none
4. prophylaxis: use gloves
5. diagnose: clinic or biopsy
35
monkeypox (monkeypox virus)
1. epidemiology: contact with macaque monkeys ("bush meat"), prairie dogs, squirrels, rats
2. clinic: viral prodrome --> rash on trunk (can spread to extremities)
3. treat: none
4. prophylaxis: smallpox vaccine
5. diagnosis: clinic or biopsy
36
orf (orf virus) aka Thistle disease, Ecthyma contagiosum
1. epidemiology: poxvirus that is zoonotic and get from sheep, goats, and fomites***
- animals get lesions on muzzle, mouth/eyes --> clear it better than humans
2. clinic: non healing lesions on face, hands, arms
3. treat: none
4. prophylaxis: wear gloves, vaccine for animals
5. diagnosis: clinic and PCR
37
Molluscum Contagiosum/Water Warts (Molluscum Contagiosum virus
1. epidemiology: direct/sexual contact, auto inoculation, and fomites
2. clinic: papules that umbilicate in center (very superficial, only epidermis)
- everywhere in children
- face/genitals in adults
3. treat: topicals, cryosurgery, laser
4. prophylaxis: avoid contact with lesions and fomites
5. diagnosis: clinic or biopsy
38
zika fever (zika virus)
1. epidemiology: Flavivirus spread via Aedes mosquito bites, transfusions and sexual contact
2. clinic: usually no symptoms**
- if symptoms --> conjuctivitis**, myalgia, headache, rash
- petechial enanthem
- microcephaly in fetus and Guillain-Barre syndrome**
3. treat: none
4. prophylaxis: safe sex, avoid mosquitos
5. diagnosis: blood or amniotic fluid for IgM or PCR
39
Dengue Fever (Dengue fever virus infection/ Breakbone fever)
1. epidemiology: bites from aedes mosquitos, transfusions
2. 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)
3. treat: none
4. prophylaxis: avoid mosquitos, vaccine not in US
5. diagnosis: serology IgM or PCR
40
Chikungunya Fever (Chikungunya virus)
1. epidemiology: aedes mosquitos and transfusions
2. clinic: high/biphasic fever, joint pain, rash, headache GI, conjunctivitis
- polyarthritis
- hyperpigmented rash with mouth ulcers
3. treat: none
4. prophylaxis: avoid mosquitos
5. diagnosis: serology IgM, PCR
