Viral ID

Question 1

• s/s:
  
  • “scratchy” throat
  • rhinorrea
  • sneezing
  • coughing
  • edematous nasal turbinates
  • symtoms > signs
  • absent/low fever (<100.4)
  • 1-2wks

Answer 1

Common Cold

• Tx:
  
  • acetaminophen
  • oxymetazoline (Afrin)- spray adrenergic
  • pseudoephredrin/phenylefrin- oral adrenergic: *monitor HTN
  • chlorpheniramine- oral antihistamine
  • ipratropium spray- anticholinergic

Question 2

• S/s:
  
  • “mono-like” symtoms (tired, fever, aching, splenomegaly)
  • NO sore tonsils/exudate
  • may reactivate later in life
  • “itis’” in immunocompromised (retinitis/slow vision loss in HIV)
  • STD

Answer 2

Cytomegalovirus

• Dx:
  
  • blood nucleis acid PCR testing
  • IgM/IgG Ab titers
  • lymphocytosis on CBC
• Tx:
  
  • usually self-limited, tx severe and immunocompromised only
  • Ganciclovir IV (possibly carcinogenic)
  • Valganciclovir oral
  • Foscarnet IV
  • freq prophylaxis 3-6mo prior to transplant
• Pearls:
  
  • suspect in healthy teens with non-specific “mono-like” illness and negative mono spot
  • prolonged fatigue
  • suspect in immunnocompromised with progressive vision loss over wks/mos (HIV)

Question 3

• highest rates in 15-24y/o
• infection of epithelium of oropharynex and salivary glands, B-lyphocytes spread infection into circulatory system
• S/s:
  
  • pronounced fever (101-104), fatigue, myalgia, pharyngitis
  • lymphadenopathy of POSTERIOR nodes
  • splenomegaly (LUQ) & hepatomegaly (RUQ)
  • tonsillitis (“ugly throat”)

Answer 3

Epstein-Barr Virus / Mono

• Test:
  
  • rapid mono test
  • blood test for heterophile Ab or IgM Ab against EBV capisid antigen
  • CBC: lymphocytosis, leukocytosis
• Tx:
  
  • avoid Abx (supportive care)
    
    • **if penicillin prescribed pt will develop macual & pruritic rash
  • AVOID physical activity for 4wks - risk of splenic rupture
  • corticosteroid taper ONLY if hypertrophy of tonsils
• Other:
  
  • neurologic manifestations can appear w/in 2wks: meningitis/encephalitis
  • secondary streptococcal pharyngitis: if pt retruns w/ persistant sore throat TEST FOR STREP
  • immunocompromised:
    
    • can develop EBV related cancers
    • Oral hairy leukoplakia in HIV

Question 4

• macular rash appears at hairline and spreads cepalocaudally over 3 days which blanch and progress to papules
• Fever
• Cough
• Coryza (sever runny nose)
• Conjunctivitis (pink eye)
• Koplik Spots - small white spots on buccal mucosa “grains of salt with reddish background”

Answer 4

Rubeola (American Measles)

• infectious 4 days before symtoms until 4 days after rash appears
• Tests:
  
  • IgM may not be sensitive in first 3 days of rash
  • viral culture of blood or throat
• COMPLICATIONS:
  
  • diarrhea - can be significant and increase mortality
  • pneumonia - results in majority of deaths
  • fetal demise in 1st trimester
  • Keratoconjunctivits - can cause blindness
• Tx:
  
  • viral=supportive: fluids, acetaminophen, Abx only if secondary infection
  • Vitamin A for children
  • Ribavirin in severe cases only
  • if exposed:
    
    • vaccinate w/in 72hrs if susceptible
    • Ig between days 3 and 6 after exposure

Question 5

• low-grade fever
• coryza (inflammation in nose)
• occipital lymphadenopathy
• conjunctivitis
• Forchheimer spots (red petechiae on palate)

Answer 5

Rubella (German measles)

• Tests:
  
  • IgM Ab
  • ALL pregnant women test for rubella IgG during pregnancy
• Tx:
  
  • viral=supportive care

Question 6

• predominantly before age 2
• S/s:
  
  • high fever 3-5 days then rash appears within 48hrs of fever resolving
  • rash begins a neck and spreads to extremeties
  • no pruritis - faint pink color that blanches when palpated
  • cervial lymphandenopathy
  • Nagayama spots (red papules on soft palate/uvula)
  • less common: seizures, cough, diarrhea, meningitis/ecepahalitis, pneumonia, hepatitis

Answer 6

• Dx:
  
  • presentation alone
• Tx:
  
  • acetaminophen/ibuprophen for fever
  • symtoms resolve within a week
  • complications addressed separately

Question 7

• commonly in ages 5-9 but can occur in older as well
• highly infectious!
• S/s:
  
  • PAROTITIS (parotid or other salivary gland) - worsens over 7 days then resolves
  • high fever, neck pain, fatigue, headache, anorexia

Answer 7

Mumps

• Dx:
  
  • presentation
  • mumps IgM or reverse transcriptase PCR
• Tx:
  
  • viral=supportive
  • acetaminophen for fever
  • hospitcalization if complications:
    
    • encephalitis: seizures, delirium, other neuro
    • epididymo-orchitis
    • pancreatitis
    • thyroiditis
    • increased spontaneous abx in women

Question 8

• S/s (primary):
  
  • fever then distinctive rash 2 days later
  • starts on head then spreads to trunk: papules->pustules->crust
  • “dew drops on a rose petal”
• S/s (secondary):
  
  • pt feels rash before it appears - pain/burning/tingling prior
  • rash following dermatome NOT crossing midline
  • not contageous after crusting

Answer 8

Varicella-Zoster

• Primary (chicken pox) Tx:
  
  • acetaminphen for fever - NO ASA: Reye syndrome - neurologic complications in children with virus
  • oatmeal baths
  • immunocomprimised, chronic lung/skin, newborns v-z complications:
    
    • Valacyclovir (Valtre)
• Secondary/latent (shingles) Tx - CRUCIAL:
  
  • acute localized: Valacyclovir / Famciclovir / Acyclovir
  • extensive lesions: Acyclovir
  • acyclovir resistant: Foscarnet

Question 9

• Hutchinson’s Sign: vesicles on nose
• corneal inflammation (keratitis) and vision loss
• post-herpetic neuralgia (PHN) - pain after rash resolved
• cellulitis
• meningitis

Answer 9

Complications of Herpes Zoster

• Corticosteroids + antivirals
  
  • Prenisone taper
• Opioids for pain
  
  • Hydrocodone/Oxycodone
• PHN:
  
  • Gabapentin (Neurontin)
  • Pregabalin (Lyrica)

Question 10

• mild “flu-like” symtoms”
• SLAPPED CHEEK APPEARANCE
• erythema infectiosum (fifth disease)

Answer 10

Parvovirus B19

• Tx:
  
  • no vaccine or tx
• Complications:
  
  • middle-aged women: arthropathy similar to RA and “slapped cheek” resolving over several weeks
  • miscarriage or hydrops fetalis during pregnancy
  • aplastic crisis (bone marrow failure)