Viral Infections Flashcards
1
Q
General notes on viruses
Dx tests/Tx
A
not always required
2
Q
General notes on viruses
Prognosis
A
usually benign and self-limited
3
Q
General notes on viruses
need for consultations
A
unlikely with typical presentations
4
Q
Herpes Simplex Virus
where does the virus lie dormant?
A
in neurons
can have asx viral shedding
5
Q
Herpes Simplex Virus
when does the virus reactivate
A
- follows minor infection, trauma, stress, sun exposure, menstruation
6
Q
Herpes Simplex Virus
Consideration in pregnancy
A
risk of transmission during delivery
7
Q
Herpes Simplex Virus
what to do during genital flare up during birth?
A
deliver via c-section to not spread to baby
8
Q
Herpes Simplex Virus
HSV 1 epi
A
- common for oral and genital ulcers in young females
- positive serology common
9
Q
Herpes Simplex Virus
HSV 2 epi
A
- most common cause of genital ulcers in developed world
- many unaware they are infected
10
Q
Herpes Simplex Virus
describe lesions
4 things
A
- skin or mucous membrane
- vesicle changing to painful ulcer over several days
- prodrome of pain
- regional tender lymphadenopathy
11
Q
Herpes Simplex Virus
what does suppressive tx do?
A
reduces transmission and sx
12
Q
Herpes Simplex Virus
ophthalmicus heals well when limited to?
A
epithelium
13
Q
Herpes Simplex Virus
ophthalmicus when involves the stroma can lead to?
3
A
- uveitis
- scarring
- blindness
14
Q
Herpes Simplex Virus
Complications
A
- meningitis
- disseminated infection
- bell palsy
- esophagitis/proctitis
- erythema multiforme minor
- stevens-johnson syndrome
15
Q
Herpes Simplex Virus
Dx for meningitis
A
- CSF for HSV DNA PCR
- CSF for HSV antibodies later in disease
16
Q
Herpes Simplex Virus
Dx for oxular disease
A
- branching ulcers that stain with fluorescent
17
Q
Herpes Simplex Virus
Dx GI disease
A
- biopsy with HSV PCR and culture
18
Q
Herpes Simplex Virus
Dx pneumonia
A
- diagnosed by clinical, pathologic, and radiographic findings
19
Q
Herpes Simplex Virus
Tx
A
- treat to inhibit replication for both hsv-1 and hsv-2
- Aycylovir- dosage varies based on goal of tx
- Trifluridine- for eye infection
20
Q
Herpes Simplex Virus
Acyclovir- 3 categories for tx
A
- mild-moderate disease
- severe disease/immunocompromised
- suppression
21
Q
Herpes Simplex Virus
Acyclovir- mild/moderate tx
dosage/duration/freq
A
400-800mg PO, Q8 hrs, 10 days
22
Q
Herpes Simplex Virus
Acyclovir- severe disease/immunocomp
dosage, duration, freq
A
5-10mg/kg IV, Q8 hrs
23
Q
Herpes Simplex Virus
Acyclovir- suppression
dosage, frequency, duration
A
400-800mg PO, Q12 hrs
24
Q
Varicella
AKA
A
chicken pox
25
# Varicella
incubation period
10-20 days
26
# Varicella
mode of transmission
respiratory droplets
contact with lesions
27
# Varicella
most typically presents in:
children
28
# Varicella
varicella zoster virus aka
human herpesvirus-3
| and this = varicella/chicken pox
29
# Varicella
herpes zoster aka
shingles
30
# Varicella
sx & signs
* fever
* malaise
* headache
* abd pain
* rash
31
# Varicella
describe rash
* contagious from 1-2 days before rash until all lesions crusted
* successive crops, lesions in dif stages development
crust 4-7 days after onet
* maculopapular rash that quickly transforms to vesicles that become pustular and then crusts
32
# Varicella
distribution of rash
* starts on face/scalp/trunk
* spreads to extremities later
33
# Varicella
change in incidence due to vax
79% decrease
34
# Varicella
dx
clinical
35
# Varicella
treatment
* usually self-limiting in children, treat symptomatic
* Acyclovir 20mg/kg PO, Q24 hrs, 7 days
* initiate treatment w/in 24 hrs of dx
36
# Varicella
max dose of acyclovir daily
800 mg
37
# Varicella
pt's at highest risk of complications
| 4 groups
unvax children/adults
pregnant women
immunocomp
38
# Varicella
complications
| 4 things
1. skin infection
2. pneumonia
3. encephalitis
4. death
39
# Varicella
what do we give for PEP?
immune globin varizig IM
40
# Varicella
who do we give PEP to?
those at higher risk of complications
41
# Congenital Varicella
what can happen if preg women becomes ill?
| 6 things
* spontaneous abortion
* chorioretinitis
* catarats
* limb atrophy
* cerebral cortical atrophy
* neurological disability
42
# Congenital Varicella
Rate of spontaneous abortion if infection is during first trimester?
3-8%
43
# Congenital Varicella
varizig rec to who?
| 4 groups
1. newborns with significant exposure to VZV
2. neonates whose mom's have s/s within 5 days before or 2 days after delivery
3. hosp preterm infants born > 28 wks whose mom's aren't immune (no vax hx, or neg serology)
4. hosp permature infants born < 28 wks or wt < 1000g
44
# Herpes Zoster
describe rash
* tingling
* pain
* eruption of vesicles in a dermatomal distribution
* evolving to pustules followed by crusting
45
# Herpes Zoster
how do people become ill with this?
VZV remains latent in root ganglia after varicella infection.
46
# Herpes Zoster
Primary infection= ?
Secondary infection= ?
1. chicken pox
2. shingles
47
# Herpes Zoster
vax series?
2 dose vax rec at age 50
48
# Infectious Mononucleosis
most common virus
epstein barr virus (EBV)
49
# Infectious Mononucleosis
EBV AKA
human herpesvirus-4 (HHV4)
50
# Infectious Mononucleosis
who is most affected?
| age/gender/race
young adults (15-25)
gender/races equally
51
# Infectious Mononucleosis
how long is saliva infectious?
up to 6 mo after sx onset
52
# Infectious Mononucleosis
incubation period
30-50 days
53
# Infectious Mononucleosis
what can insufficient cellular immune responses result in?
EBV induced malignancy
54
# Infectious Mononucleosis
signs & sx
| 5 categories, 10ish things
1. abrupt onset severe sore throat/pharyngitis with posterior cervical lymphadenopathy
2. gradual onset low-grade fever, malaise, arthralgia, myalgia
3. splenomegaly
4. abd pain/discomfort
5. hepatomegaly (meh, elevated ALT/AST)
55
# Infectious Mononucleosis
how many pts have mono rash?
15%
56
# Infectious Mononucleosis
describe mono rash
* faint and not pruritic
* first on trunk and upper arms
* extends to face and forearms
57
# Infectious Mononucleosis
what makes the mono rash more intensive or extensive?
abx use!
seen 2-10 days after cessation of tx
58
# Infectious Mononucleosis
complications
| 6 things
1. severe upper airway obstruction
2. splenic rupture
3. fulminant hepatitis
4. encephalitis
5. severe thrombocytopenia
6. hemolytic anemia
59
# Infectious Mononucleosis
Dx
* Lymphocytosis
* Heterophile antibodies
60
# Infectious Mononucleosis
what do we see in mono with heterophile antibodies?
1. pos 2-9 wks after infection
2. can be pos for > 1 yr
3. not everyone develops these after infection
61
# Infectious Mononucleosis
what test for heterophile antibodies?
heterophile agglutination test (monospot)
62
# Infectious Mononucleosis
Tx
* supportive care
* hydration
* antipyretics
* analgesics
* avoid contact sports for at least 4 wks to reduce risk of splenic rupture
63
# Cytomegalovirus (CMV)
sx in general population?
similar to what in immunocompromised pts?
* asx in general pop
* mono like in immunocomp group
64
# Cytomegalovirus (CMV)
mode of transmission
| 5 components
* close contact
* sexual
* blood transfusion/transplant
* occupational
* perinatal
65
# Cytomegalovirus (CMV)
Complications
| 4
* retinitis
* GI/hepatobiliary
* pneumonitis
* neurologic syndromes
66
# Congenital CMV
Neurodevelopmental Complications
| 5 things
1. sensorineural hearing loss
2. cerebral palsy
3. intellectual disability
4. vision impairment
5. seizures
67
# Congenital CMV
Dx and Tx
* Dx: test urine or saliva
* Tx: ganciclovir or valganciclovir
68
# Cytomegalovirus (CMV)
Dx
PCR test
69
# Cytomegalovirus (CMV)
Tx
| general pop vs immunocompro
* general: supportive care only
* immunocomp: ganciclovir IV or valganciclovir PO
70
# Rotavirus
most common in children of what ages?
6 mo to 2 yrs
71
# Rotavirus
3 factors that play a role in pathogenesis of diarrhea
1. loss of brush border enzymes
2. direct effect of rotavirus enterotoxin NSP4
3. activation of enteric nervous system
72
# Rotavirus
Sx
| 3 big ones
* vomiting
* watery, nonbloody diarrhea
* fever
73
# Rotavirus
Sx/Complications of severe cases
1. dehydration
2. seizures
3. death
74
# Influenza
Seasonality?
fall/winter
75
# Influenza
Types
| 3
1. Influenza A
2. Influenza B
3. Influenza C
76
# Influenza
which are most common?
which rarely results in illness?
1. A & B
2. C
77
# Influenza
Who is at highest risk?
| 6 categories
1. children
2. elders
3. immunocompromised
4. pregnant
5. co-morbid conditions
6. morbid obesity
78
# Influenza
Incubation period
1-4 days
79
# Influenza
80
# Influenza
Clinical presentation
1. fever/chills/sweats
2. myalgia
3. headache
4. malaise/fatigue
5. anorexia
81
# Influenza
Dx
* rapid molecular assays (NP swab)
* PCR testing (rec for hosp patients)
* viral culture (only in unusual cases)
82
# Influenza
Tx
* Supportive care (rest/fluids/antipyretics/analgesics/anti-tussives)
* Oseltamivir
* Zanamivir
83
# Influenza
dosage/duration/freq of oseltamivir
| adults only
75mg PO, Q12 hrs, 5 days
84
# Influenza
admin route of zanamivir
inhaled or IV
only used if resistance to oseltamivir
85
# Influenza
admin route of paramivir
IV- use if they cannot tolerate Tamiflu
86
# Influenza
Who to treat?
adults/children who meet the following criteria:
* hospitalization
* severe or progressive illness
* high risk patients
* children < 2 yrs or > 65 yrs
* pregnant women and those within 2 wks of being postpartum
87
# Influenza
consider treating
* outpatients with illness onset < 48 hrs before presentation
* patients who have high risk contacts at home
* sx health care providers
88
# Influenza
Decision to Admit
admit if severe illness/progressing illness in pregnant women, children < 5 y/o, adults > 65 y/o
89
# Influenza
Decision to admit to ICU
1. rapidly declining respiratory function/hypoxia
2. bilateral diffuse pneumonia
3. hemodynamic instability
90
# Influenza
Risks of influenza illness during pregnancy?
* increased risk for hospitalization but not mortality
* increased risk for pre-term birth or SGA infants
91
# Influenza
when to vax pregnant women
any trimester
92
# SARS-COV-2 (COVID)
incubation period
< 14 days
93
# SARS-COV-2 (COVID)
typical sx
| general
URI
fever
cough
94
# SARS-COV-2 (COVID)
Complications
* respiratory failure
* cardiovascular
* thromboembolic complications
* neurologic complications
* inflammatory complications
95
# SARS-COV-2 (COVID)
Tx
Nirmatrelvir-ritonavir (paxlovid)
96
# SARS-COV-2 (COVID)
Timeframe for initiating paxlovid
within 5 days of sx onset
97
# SARS-COV-2 (COVID)
Vaccination
* can wait 3 mo from infection
* reduces risk of multisystem inflammatory syndrome
* safe during pregnancy
98
# Viral Encephalitis (Rabies)
mode of transmission
infected saliva that enters the body by an animal bite or open wound
99
# Viral Encephalitis (Rabies)
Incubation period
typically 3-7 wks but could be yrs
100
# Viral Encephalitis (Rabies)
what does incubation period depend on?
distance of wound from CNS
101
# Viral Encephalitis (Rabies)
pathophys
virus travels in nerves to brain, multiplies in brain, then migrates along efferent nerves to salivary glands
102
# Viral Encephalitis (Rabies)
Signs & sx in non-specific prodrome
* pain at infection site
* fever/malaise/headache/n/v
* aerophobia (skin temp change sensitivity)
* percussion myoedema
* abnormal sexual behavior
103
# Viral Encephalitis (Rabies)
When does CNS stage begin?
10 days after prodrome
104
# Viral Encephalitis (Rabies)
two categories of CNS stage & % of people impacted by each
1. Encephalitic (80%)
2. Paralytic (20%)
105
# Viral Encephalitis (Rabies)
Describe Encepahlitic CNS stage
* delirium alternating w/ periods of calm
* severe laryngeal or diaphragmatic spasms
* sensation of choking
* hypersalivation, lacrimation, sweating, dilated pupils
106
# Viral Encephalitis (Rabies)
Describe paralytic CNS stage
* paralysis ascends
* onset of dense paraplegia w/ loss of sphincter tone
* paralysis of swallowing & resp muscles
107
# Viral Encephalitis (Rabies)
what is after CNS stage?
| x x
coma, ANS dysfunction, death
108
# Viral Encephalitis (Rabies)
Dx in domesticated animals
1. animals (dogs/cats) should be quarantined and observed for 10 days after bite
2. if animal dies in 10 day period, test animal for rabies
109
# Viral Encephalitis (Rabies)
Dx in wild animals
1. capture and kill animal
2. send brain to lab for examination
if animal can't be captured, assume pos
110
# Viral Encephalitis (Rabies)
rabies tx (at time of bite)
1. cleanse, debride, flush wound
2. PEP when indicated (pos animal or wild animal that wasn't captured)
111
# Viral Encephalitis (Rabies)
tx once sx
* palliative care
* rabies isn't really survivable
112
# Poliomyelitis
mode of transmission
fecal oral
113
# Poliomyelitis
what are vaccine-associated paralytic polio or vaccine-derived polio viruses?
consequence of the oral polio vaccine that has mutated and reverted to the neuro variant
(only inactivated vax given now)
114
# Poliomyelitis
describe abortive poliomyelitis
* non-specific & mild sx over 2-3 days
* fever, headache, vomiting, diarrhea, constipation, sore throat
115
# Poliomyelitis
Describe non-paralytic polio
* non-specific symptoms
* muscle spasms without paralysis
* signs of meningeal irritation (neck stiffness, irritability, PE findings)
116
# Poliomyelitis
Paralytic Polio
* flaccid asymmetric paralysis, mostly proximal MM of LE
* sensory loss (rare)
117
# Poliomyelitis
2 types of paralytic polio
1. spinal polio (spinal nerves)
2. bulbar polio (cranial nerves, resp, vasomotor centers)
118
# Poliomyelitis
post-polio syndrome
* progressive muscle limb paresis
* MM atrophy
* fasciculations/fibrillations (during rest activity)
* restless leg syndrome
119
# Poliomyelitis
Dx
* PCR of throat washings (early)
* PCR of stool (later)
* rarely present in spinal fluid
120
# Poliomyelitis
Tx
* supportive
* hospitalize when paralytic polio
* physiotherapy
121
# Poliomyelitis
prognosis
| 3 PPP
* course of disease is worse in adults/pregnant women vs children
* bulbar polio has mortality rate 75%
* postpolio muscular atrophy occurs in 30-40% of paralyzed limbs 20-30 years later
122
# Ebola Viral Disease (EVD)
mode of transmission
| 2 types
* zoonotic (contact w/ reservoir species)
* P2P (via infected bodily fluids)
123
# Ebola Viral Disease (EVD)
incubation period
2-21 days
124
# Ebola Viral Disease (EVD)
stages of sx
1. non-specific febrile illness
2. 3-5 days into sx
125
# Ebola Viral Disease (EVD)
signs/sx of non-specific febrile illness phase
1. fever
2. headache
3. dizziness
4. weakness
5. fatigue
6. myalgias
7. arthalgias
126
# Ebola Viral Disease (EVD)
signs/sx within 3-5 days of onset
1. abd pain, n/v/d
2. beginning of neurologic sx (confusion, slowed cognition, agitation, occasional seizures)
3. hypovolemic shock
4. hemorrhagic issues in 1-5% of cases
127
# Ebola Viral Disease (EVD)
Dx- testing early on in infection
* antigen elisa test
* IGM elisa or RT-PCR
if negative, but EVD is still suspected you should retest later
128
# Ebola Viral Disease (EVD)
Dx- testing later on in infection
* IgM and IgG serologic testing
(IgM raises first, followed by IgG)
129
# Ebola Viral Disease (EVD)
expected abnormalities on blood work
* thrombocytopenia
* elevated LFTs
* coagulopathy
* elevated creatinine
* electrolyte abnormalities
130
# Ebola Viral Disease (EVD)
Tx
* supportive care
* IV fluid can decrease mortality rate to < 50%
* no approved meds
* native abs persist for at least 10 yrs in survivors
131
# Ebola Viral Disease (EVD)
mortality
| in endemic areas & in pregnancy
1. 70%
2. 86%
132
# Ebola Viral Disease (EVD)
prevention
* minimize animal contact
* isolation/contact tracing/IP precautions
* vax used in endemic areas
133
# Arboviruses
come from what vector?
mosquitos
134
# Arboviruses
4 categories
1. togaviruses
2. flavivurses
3. orthobunyaviruses
4. alphaviruses
135
# Arboviruses
examples of togaviruses
| mosquitos
western/eastern/venezuelan equine encephalitis
136
# Arboviruses
examples of flaviviruses
| mosquitos
* west nile virus
* dengue
* zika
137
# Arboviruses
examples of orthobunyaviruses
| mosquitos
california serogroup of viruses
138
# Arboviruses
examples of alphaviruses
| mosquitos
* chikungunya
* mayaro virus
139
140
# Tick Borne Pathogens
examples of flavivirus
* powassan encephalitis
* tick-born encephalitis virus
* colorado tick fever retrovirus
141
142
# West Nile Virus
seasonality
* outbreaks most often occur mid July to early sept
* increases with higher temps and rainfall
* circulates between birds and mosquitos
143
# West Nile Virus
mode of transmission
P2P only from blood transfusions/organ transplants
vector (mosquitoes)
144
# West Nile Virus
incubation period
2-14 days
145
# West Nile Virus
how many are symptomatic?
what % of those progress to neuroinvasive disease?
1. 10% symptomatic
2. 10% of those progress to neuroinvasive disease
146
# West Nile Virus
sx of neuroinvasive disease
* meningitis
* encephalitis
* asymmetric acute flaccid paralysis
147
# West Nile Virus
mortality of neuroinvasive disease
3-15%
148
# West Nile Virus
Typical presentation
* fever
* altered mental status
* seizures
* tremors
* cranial nerve palsies
* nonpruritic rash (not always)
149
# West Nile Virus
complications
* bronchial pneumonia
* retinopathy (24%)
* renal infection
150
# West Nile Virus
Issues by age/group:
* young
* middle age
* older adults
* immunocompromised
* young: acute febrile illness, mild neurologic sx
* middle age: aseptic meningitis, polio like sx
* older: frank encephalopathy
* immunocomp: more severe, higher mortality
151
# West Nile Virus
Dx
1. IgM for WNV in Serum or CSF (if IgM is in CSF = neuroinvasive)
**or**
2. 4x increase from baseline IgG titer
WBC is typically normal
152
# West Nile Virus
Tx
* supportive care, no specific antivirals
153
# West Nile Virus
Prognosis
mostly good
most fatalities with neuroinvasive disease & sx may persist for at least 6 mo
154
# West Nile Virus
prevention
mosquito avoidance
155
# Dengue
where are bulk of cases?
what do pt's with dengue usually report?
* 75% of cases occur in Asia
* travel to endemic area in previous 14 days
156
# Dengue
incubation period
7-10 days
157
# Dengue
Febrile Phase sx
* high fever
* facial flushing
* sore throat
* eye pain
* malaise
* arthralgias
* maculopapular rash
most pts recover and fever resolves by day 8
158
# Dengue
Severe Dengue signs & sx
| 3
* plasma leakage
* hemorrhage
* organ involvement
159
# Dengue
components of plasma leakage w/ severe dengue
| 3
* increased liver size
* vomiting
* abd pain
160
# Dengue
components of hemorrhage with severe dengue
| 3 things
* ecchymosis
* GI bleeding
* epistaxis
161
# Dengue
components of organ involvement in severe dengue
* hepatitis
* encephalitis
* myocarditis
162
# Dengue
Sx of shock
| 7 things
* LOC
* hypothermia
* hypoperfusion
* metabolic acidosis
* organ impairment
* DIC
* AKI
163
# Dengue
Dx
* IgM and IgG Elise after febrile phase
* IHC for antigen detection from tissue/dried blood
164
# Dengue
Complications
* neurologic complications
* maternal infection = risk of hemorrhage
* many!
165
# Dengue
Tx
no known tx
166
# Dengue
Prevention
| 3 things
1. mosquito control
2. screen blood transfusions in endemic areas
3. vax approved for endemic areas
167
# Erythema Infectiosum (Fifth Disease)
Signs & sx
* often asymptomatic
* non-specific prodrome sx: low grade fever, coryza, headache, nausea, diarrhea
* "slapped cheek rash"
168
# Erythema Infectiosum (Fifth Disease)
Describe slapped cheek rash
* erythematous malar rash
* relative circumoral pallor
169
# Erythema Infectiosum (Fifth Disease)
when does slapped cheek rash begin? how long does it last?
2-5 days after prodrome
fades in 2-4 days
170
# Erythema Infectiosum (Fifth Disease)
what does the slapped cheek rash develop into?
reticular rash on trunk/extremities
171
# Erythema Infectiosum (Fifth Disease)
incubation period
14 days
172
# Erythema Infectiosum (Fifth Disease)
seasonality
winter/spring
173
# Erythema Infectiosum (Fifth Disease)
caused by what?
parvovirus B19
174
# Erythema Infectiosum (Fifth Disease)
Three phases of infectiousness
1. Slapped Cheeck Rash
2. Erythematous Macules which fade to reticular
3. Clearing/waning of rash over weeks/months
175
# Erythema Infectiosum (Fifth Disease)
Tx
* symptomatic tx
* immunocomp (HIV): IV IG?
176
# Erythema Infectiosum (Fifth Disease)
Notable for Pregnancy
| 3 things
1. congenital disease
2. 30-40% of women are seronegative for B19V and susceptible to infection
3. Can cause spontaneous abortion, anemia, intrauterine fetal death
177
# Erythema Infectiosum (Fifth Disease)
Notable for immunocomp people
can result in chronic red cell aplasia or anemia
178
# Rubeola (Measles)
mode of transmission
resp droplets
airborne
179
# Rubeola (Measles)
incubation period
7-18 days
180
# Rubeola (Measles)
When is someone first infectious?
4-5 days before & after rash appears
181
# Rubeola (Measles)
3 major sx
| the 3 C's
1. cough
2. Coryza
3. Monjunctivitis
182
# Rubeola (Measles)
signs & sx
| 5
* fever
* malaise
* irritability
* photophobia
* koplik spots
183
# Rubeola (Measles)
Describe Koplik Spots
small, irregular, red with whiteish center on mucous membrane
184
# Rubeola (Measles)
Describe rash
| visually, distribution, onset
maculopapular
begins on face then travels downward & outward
onset 3-4 days after prodrome (marks beginning of exanthem)
185
# Rubeola (Measles)
Stages
| 2
1. prodrome
2. Exanthem
186
# Rubeola (Measles)
Dx
* classic presentation, clinical dx
* Serum for mealses IgM ab
* Throat/NP swab, urine for viral culture
187
# Rubeola (Measles)
who is this dx unlikely in?
vaccinated individuals
188
188
189
# Rubeola (Measles)
Tx
* supportive case
* isolation for 4 days from onset of rash
* Infants < 1 y/o receive IM immunoglobin
190
# Rubeola (Measles)
Concerns for infection in pregnancy
* not a known teratogenic
* Associated with spontaneous abortion, premature labor, low birth weight
191
# Rubeola (Measles)
Prevention
vax
192
# Mumps
mode of transmission
* paroxysmal disease
* respiratory droplets
193
# Mumps
incubation period
12-25 days
194
# Mumps
which age group has worse sx?
which age group is more often infected?
1. adults
2. children
195
# Mumps
signs & sx
* painful, swollen parotid glands
* facial edema
196
# Mumps
what other body parts are impacted in unvax pts?
| 3 things
1. testes
2. pancreas
3. meninges
197
# Mumps
Dx
1. clinical diagnosis
2. Serum IgM
198
# Mumps
Tx
1. supportive- usually illness is brief
2. topical compresses
3. isolation
199
# Rubella
caused by which virus?
togavirus
200
# Rubella
incubation period
14-21 days
201
# Rubella
who has a prodrome phase?
adults- children do not!
202
# Rubella
Sx of prodrome in adults
1. fever
2. malaise
3. coryza
203
# Rubella
Timing of rash relative to prodrome
sx coincide with rash or precede it by up to 5 days
204
# Rubella
signs & sx 5 days after initial onset
posterior cervical & postauricular lymphadenopathy
205
# Rubella
describe rash
| visually, duration, onset
* fine, pink, maculopapular
* 3 days duration
* spreads face to trunk to extremities over course of 2-3 days
206
# Rubella
Dx
* Rubella IgM antibodies elevated/4-fold increase in IgG
* cannot make dx based on single IgM isolation
207
# Rubella
Tx
supportive
208
# Rubella
Concerns of Congenital Rubella Infection
* hearing loss
* developmental delay
* growth retardation
* cardiac/opthalmic defects
209
# Roseola
incubation period
9-10 days
210
# Roseola
who is most likely to be infected?
children under 2
211
# Roseola
Signs & sx
1. 3-5 days of high fever that abruptly resolves
2. Onset of rash after fever resolution
212
# Roseola
describe rash
| visually, onset, spread
1. morbilliform rash
2. begins once fever resolves
3. spreads from neck/trunk to the face/extremities
213
# Roseola
Dx
clinical
214
# Roseola
Tx
supportive care
215
# HFM Disease
incubation period
3-5 days
216
# HFM Disease
caused by what virus?
enterovirus
217
# HFM Disease
where are blisters?
hands, feet, mouth hehe
218
# HFM Disease
who is usually infected by this? rarely infected? risk of more severe disease?
1. children under age of 10
2. rarely adults
3. elderly, immunocomp, pregnant women
219
# HFM Disease
Transmission
direct contact w/ skin, nasal, oral secretions
fecal contamination
220
# HFM Disease
how long is someone infectious?
1. blisters: until dried up
2. stool: up to a month
221
# HFM Disease
seasonality
summer/fall
222
# HFM Disease
describe rash
flat pink patches on dorsal and palmar surfaces of hands & feel which progress to small, gray blisters
223
# HFM Disease
describe ulcers in mouth
small vesicles
sometimes painful leading to anorexia
224
# HFM Disease
describe atypical disease
widespread red, crusted papules
no blisters
skin peeling, nail shedding
225
# HFM Disease
where are lesions in kids wtih atopic dermatitis?
in skin affected by eczema
226
# HFM Disease
Dx
* clinical dx
* labs: elevated WBCs, elevated CRP, atypical lymphs
* can do skin biopsy of blister or serology from stool
227
# HFM Disease
tx
* supportive
* do not rupture blisters
* fluids
* antiseptic mouthwash
* topical analgesics
228
# HFM Disease
Complications
1. dehydration
2. finger/toe nail changes
3. serious infection
229
# HFM Disease
complications in pregnancy
1. spontaneous abortion
2. fetal growth restriction
230
# Mpox
incubation period
13 days
231
# Mpox
mode of transmission
contact with sores
limited P2P
232
# Mpox
signs & sx
1. lymphadenopathy
2. fever
3. rash
233
# Mpox
dx
* ELISA
* PCR
* Viral culture of blisters
234
# Mpox
describe rash
* well circumscribed lesions
* all lesions in same stage of development
235
# Mpox
tx
no standardized regimen
Cidofovir
