Viral Infections Flashcards
1
Q
Herpes
What leads to flare ups?
A
Flare ups May follow minor infections, trauma, stress, or sun exposure.
2
Q
HSV 1
A
In US alone, HSV 1 is more common for oral and genital ulcers in young females
positive serology very common
3
Q
HSV 2
A
Most common cause of genital ulcers in developed world
Most in US unaware infected
4
Q
HSV
Where do lessons form? And what’s their patho?
A
Skin or mucous membrane
vesicle changing to painful ulcer over several days
may have prodrome of pain
Suppressive tx reduces transmission and Sx
5
Q
HSV
What is Herpes simplex ophthalmicus? Epithelial vs stomal?
A
HSV infection in the eye
Lesions limited to epithelium should heal well
Stromal involvement can cause uveitis, scarring, and blindness
6
Q
HSV
What are complications of infection? (4)
A
- Meningitis
- Ocular disease (herpes keratitis)
- GI disease
- Pneumonia
7
Q
what is Ocular disease (herpes keratitis)?
A
Branching (dendritic) ulcers that stain with fluorescein in the iris
8
Q
HSV
How do we treat?
A
Acyclovir 400-800mg 3x a day for 10 days
Trifluridine for eye infection
9
Q
what are signs and symptoms of VZV?
A
(chicken pox) fever, malaise, abd pain 1-2 days before rash
rash successive crops, lesions in different stages, crusted 4-7 after onset
contagious until all lesions pop and are crusted over
pitted scars are frequent
10
Q
VZV
Varicella-zoster virus (VZV) aka human herpesvirus (HHV)-3 may manifest as
A
varicella (chickenpox) or herpes zoster (shingles)
11
Q
Varicella
How do you describe the rash for chicken pox
A
“dew drop on a rose petal”
12
Q
Varicella
What are complications of chicken pox? (4)
A
skin infxn, pneumonia, encephalitis, death
13
Q
Varicella
What is the Tx for chicken pox?
A
Treatment with acyclovir 20mg/kg (Max 800mg) orally for 7 days within 24 hours of dx if Age > 12 years, Secondary household contacts (tends to be more severe), chronic cutaneous and cardiopulm disease, children using long term salicylates (risk for Reye’s syndrome-neurologic condition)
Immunocompromised patients
14
Q
Varicella
Congenital varicella risks for fetus
A
when mother is infected while pregnant
Spontaneous abortion, chorioretinitis, cataracts, limb atrophy, cerebral cortical atrophy, neurological disability
15
Q
Varicella
What is the mortality rate of neonatal varicella?
A
30% mortality
16
Q
Herpes zoster
Shingles Rash
A
tingling, pain, eruption of vesicles in a dermatomal distribution, evolving to pustules and then crusting
17
Q
epstein barr
how long does someone remain infectious?
A
up to 6 months after symptom onset
18
Q
Epstein barr
how long is incubation
A
30-50 days
19
Q
epstein barr
pathophys
A
(heterophile antibodies)
Primary EBV infection of B lymphocytes induces circulating antibodies directed against viral antigens
20
Q
EBV
Lifelong infection
A
can have latency with periodic reactivation with oral shedding (often w/o shedding)
21
Q
EBV
Malignancy Complications
A
Insufficient cellular immune responses may result in EBV-induced malignancy (Hodgkin lymphoma, Burkitt lymphoma)
22
Q
EBV
Signs and symptoms
A
- Abrupt onset severe sore throat/pharyngitis withposterior cervicallymphadenopathy
- Gradual onset low-grade fever,malaise,arthralgia, andmyalgia
- Splenomegaly in 2nd and 3rd weeks
- Abdominal pain/discomfort
- Hepatomegaly rarely clinicallypalpable
- Elevation of liver transaminases common
- Hoagland sign (transient upper lid edema)
23
Q
EBV
Mono rash
A
Morbilliform rash
affects <15% of pts
More intense and extensiverash in up to 90% of patients 2–10 days afterantibiotics- happens when Dr thinks they have strep, then pt thinks they’re allergic to penicillin
24
Q
EBV
what are life threatening complications? 6
A
Rare but potentially life-threatening complications:
severe upper airway obstruction
splenic rupture
fulminant hepatitis
encephalitis
severe thrombocytopenia
hemolytic anemia
25
# CMV
Cytomegalovirus what disease? Transmission?
very common, also causes mono.
by age 5 30% are infected
transmitted by close contact, sexual, occupational, perinatal (in utero, during birth, breast milk)
26
# CMV
Complications
Retinitis, GI/hepatobiliary, pneumonitis, neurologic syndromes
27
# CMV
Congenital CMV complications, Dx, Tx?
long-term neurodevelopmental disabilities: sensorineural hearing loss, cerebral palsy, intellectual disability, vision impairment, seizures
Test urine or saliva
Treat with ganciclovir/valganciclovir
28
# Rotavirus
causes what disease? What age group?
viral gastroenteritis, particularly in children between 2-6y
29
# rotavirus
3 factors that play a role in rota diarrhea
1. loss of brush border enzymes
2. the direct effect of the rotavirus enterotoxin NSP4
3. activation of the enteric nervous system
30
# rotavirus
signs and symptoms
N/V/watery nonbloody diarrhea and fever
31
# rotavirus
severe signs and symptoms of rotavirus? Tx?
dehydration, seizures, and death can occur.
Treatment: supportive care
32
# Flu
what are the most common groups?
A and B
C rarely results in illness
33
# Flu
Complications
DM, Heart failure, pulm disease, chronic disease – renal, hepatic, hematologic, or neurologic
more severe in obese pts
34
# flu
incubation period
1-4 days
35
# flu
clinical presentation
Fever, chills, diaphoresis
Fever less common in children and elderly
Myalgia
Headache
Malaise and fatigue
Anorexia
Rhinorrhea and nasal congestion
hacking nonproductive cough
Sometimes GI symptoms (N/V/D) in kids, rarely in adults
Tachycardia
If fever or dehydrated
Cervical adenopathy (posterior)
Lungs are typically clear.
Sore throat, non-exudative
36
# Flu
Dx (2)
1.Rapid molecular assays with nasal swab
2.PCR testing
37
# Flu
Tx
supportive care
if caught w/in 2 days
oseltamivir, zanamivir, peramivir
38
# Flu
who do we Tx with antivirals?
Children <2 years and adults ≥65 years
Pregnant women and within 2 weeks postpartum
immunocompromised
39
# Flu
when to admit? ICU?
Admit if severe illness/moderate illness w declining function:
Pregnant women, Children <5 & Adults ≥65
ICU admission if:
Rapidly declining respiratory function/hypoxia
Bilateral diffuse pneumonia
hemodynamic instability
40
# Flu
Pregnancy- special population risks? When can can you vax?
Increased risk for hospitalization but not mortality
Increased risk for pre-term birth or sGA(small for gestational age) infants
VACCINATE during any trimester
If suspected or confirmed case, treat
Consider post-exposure chemoprophylaxis
within 48 hours of exposure
41
# COVID
COVID incubation
<14 day incubation
40% asymptomatic
42
# COVID
complications 5
Respiratory failure
Cardiovascular
Thromboembolic complications
Neurologic complications
Inflammatory complications
43
# Covid
treatment
Nirmatrelvir-ritonavir (paxlovid) must be given w/in 5 days of symptoms
44
# Rabies
Rhabdovirus encephalitis
Transmission? Incubation?
spread through saliva
incubation 3-7 weeks depending on distance of wound from CNS, may be years!
45
# Rabies
pathophys
virus travels in nerves to brain, multiplies in brain, then migrates along efferent nerves to salivary glands
46
# rabies
non-specific prodrome
Pain at infection site
Fever, malaise, Headache, Nausea/vomiting
Aerophobia (skin temperature change sensitivity)
Abnormal sexual behavior
Males-frequent ejaculation, Priapism
Females-hypersexuality
47
# Rabies
CNS stage- incubation, Sx
begins 10 days after prodrome
Encephalitic (80%) “furious”
Classic rabies symptoms
Delirium alternating with periods of calm
severe laryngeal or diaphragmatic spasms and sensation of choking (hydrophobia)
hypersalivation, lacrimation, sweating, dilated pupils
Paralytic (20%) “dumb”
paralysis ascends, onset of dense paraplegia with loss of sphincter tone; paralysis of swallowing and respiratory muscles, leading to death.
48
# rabies
treatment
Rabies vaccine four iM injections in deltoid (anterolateral thigh muscles in children) on days 0, 3, 7, and 14 after exposure)
notify public health
49
Poliomyelitis- how many types, where is it endemic?
3 wild serotypes. eliminated from 99% of world. endemuc in Nigeria, Pakistan, Afghanistan
50
Abortive Polio
Nonspecific & mild over 2-3 days
Fever, ha, vomiting, diarrhea/constipation, and sore throat
51
Nonparalytic poliomyelitis
Nonspecific symptoms as above
Signs of meningeal irritation (neck stiffness, irritability, PE findings)
muscle spasms without paralysis
52
# polio
paralytic poliomyelitis
Flaccid asymmetric paralysis, mostly proximal mm of LE
Sensory loss is rare
2 types
Spinal poliomyelitis (spinal nerves)
Bulbar poliomyelitis (cranial nerves, respiratory and vasomotor centers)
53
# polio
Post-poliomyelitis syndrome symptoms
Progressive muscle limb paresis, mm (muscle mass) atrophy, fasciculations and fibrillations during rest activity
Restless leg syndrome
54
# Ebola
mortality/pregnancy, transmission and incubation
Zoonotic transmission to humans occurs via contact with the reservoir or infected primate
Fruit bat possible reservoir
2-21 days, RNA peaks 7 days into illness
Mortality rate 70% in endemic areas
pregnant female mortality 86%
55
# Ebola
Signs and Symptoms of nonspecific febrile illness
Up to 1 week
Fever, HA, dizziness, weakness, fatigue, myalgias, and arthralgias
56
# Ebola
Signs and symptoms 3-5 days in
Abdominal pain, severe n/v, and diarrhea
for an additional week
During this period, neurologic symptoms begin
Confusion, slowed cognition, agitation, occasional seizures
Hypovolemic shock
1-5% hemorrhagic issues
GI bleeding, diffuse mucosal bleeding, conjunctival bleeding
57
# Ebola
Dx
IGM or PCR test
58
# ebola
Treatment
Supportive
Iv fluids may decrease mortality rate to <50%
No approved meds
59
# Arbovirus
include which visuses and how are they transmitted
Togavirus
flaviviruses-west nile, dengue, zika
orthobunyaviruses
alphaviruses
mosquito and ticks
60
# arboviruses
West Nile Virus
Incubation
Time
Is it reportable?
leading cause of domestically acquired arboviral disease in US
must report
Mid July to sept
incubation is 2-14 days, only 10% develop symptoms
61
# West nile virus
Neuroinvasive Symptoms signs and mortality rate
10% progress to neuroinvasive disease
Meningitis, encephalitis, asymmetric acute flaccid paralysis (like polio)
3-15% mortality rate
Fever, AMS (altered mental status), seizures, tremors, cranial nerve palsies
Nonpruritic maculopapular rash (not required)
62
# West Nile Virus
Complications of infection (3)
Bronchial pneumonia
Retinopathy (24%)
Renal infection
Virus may show in urine for up to 6 years
Risk to develop chronic renal disease
63
# West Nile Virus
Diagnostic testing
IgM for West nile virus in serum or csf typically + once symptomatic
Igm in csf = neuroinvasive disease
OR
4x increase in baseline igg titer
64
# West Nile Virus
treatment
no specific antiviral therapy
supportive care
avoid mosquitos
65
# Dengue fever
transmission and incubation
via mosquito
7-10 days
66
# dengue
Febrile Phase
high fever, facial flushing, malaise, retroorbital eye pain, arthralgias, sore throat
Maculopapular rash
Most patients recover and fevers resolve by day 8
67
Severe dengue
Plasma leakage
Increased liver size, vomiting, severe abdominal pain
Hemorrhage
Ecchymosis, GI bleeding, epistaxis
organ involvement
Hepatitis, encephalitis, myocarditis
68
# dengue
Shock
Decreased level of consciousness, hypothermia, hypoperfusion leading to metabolic acidosis, organ impairment, DIC, AKI
69
# Dengue
Dx
IGM and IGG ELISA after febrile phase
70
# Dengue
Immunization who is eligible
only for children 9-16yo with prior hx of infection living in endemic area
71
Tx for polio
Supportive
Paralytic polio should be hospitalized w physiotherapy
72
# fifth disease
Nonspecific Prodrome Sx
low grade fever, coryza, headache, nausea, diarrhea
Low grade fever = above 98.6° F (37° C) but below 100.4° F (38° C)
73
# fifth disease
Sx
Classic **“slapped cheek”** rash [erythematous malar rash with relative circumoral pallor] 2-5 days after prodrome; followed several days later by reticular rash on trunk and extremities
74
# fifth disease
incubation
14 days
can be contagious before rash is visible
75
# fifth disease
when are school epidemics likely
late winter/early spring
76
# fifth disease
pathogen
Erythema infectiosum
Parvovirus B19
77
# fifth disease
Phase 1
"slapped cheek" appearance – abrupt onset
fades in 2-4 days
78
# fifth disease
Phase 2
Erythematous macules
~1-4 days
fades to Reticular ~5-9 days
79
# Fifth disease
phase 3
Clearing and recurrences of rash over weeks/months due to: exercise, stress, overheating, bathing in hot water
80
# fifth disease
Tx
Usually reassurance and symptomatic treatment
Immunocompromised patients (HIV): maybe IV IG
81
# fifth disease
effects on congenital
30 - 40% of pregnant women are seronegative for B19V and susceptible to infection
Fetal effects include spontaneous abortion, anemia, intrauterine fetal death
82
# fifth disease
immunocompromised complications
Parvovirus B 19 infection in immunosuppressed patients can result in chronic red cell aplasia/anemia
83
# Rubeola
what disease does it cause
Measles
84
# Rubeola- measles
transmission and incubation
by direct contact with infectious droplets or by airborne spread
1-2weeks
85
# Rubeola- measles
Prodrome
3 C's
7-18 days after exposure fever,** coryza, cough, conjunctivitis,** malaise, irritability, photophobia, Koplik spots (small irregular, and red with whitish center on the mucous membrane)
86
# rubeola- measles
Rash
brick red, maculopapular; appears 3–4 days after onset of prodrome; begins on face and proceeds “downward and outward,” affecting palms and soles last
Pinhead size papules → coalesce to a brick red, irregular, blotch maculopapular rash → spreads to trunk and extremities, including palms and soles
Rash lasts for 3-7 days
Fades in order of appearance
87
# Rubeola- measles
when is pt infectious
highly infectious 4-5 days before and after rash shows up
88
# rubeola - measles
Dx
Classic presentation, clinical diagnosis
Serum for measles IgM antibody
throat/nasopharyngeal swab or urine for viral culture
Diagnosis unlikely if patient vaccinated and does not have typical symptoms
Public Health reporting
89
# Rubeola - measles
Tx
Supportive care
Infants <1 year should have IM immunoglobulin
Isolation for 4 days from onset of rash
90
# Rubeola - measles
congenital Sx
Not known to be teratogenic, but associated with spontaneous abortion, premature labor, low birth weight
91
# Mumps
Transmission, incubation
resp droplets, 1/3 are aSx
12-25
92
# mumps
Sx
Painful, swollen parotid glands overlying facial edema
Frequent involvement of testes, pancreas, and meninges in unvaccinated individuals
93
# mump
Dx
Clinical diagnosis usually sufficient
Serum IgM for mumps
94
# mumps
Tx
supportive, usually brief illness
Topical compresses
isolation
95
# Mumps
congenital disease
unlikely
96
# Rubella
what is Rubella
Rubella is a systemic disease caused by togavirus transmitted by inhalation of infective droplets
97
# Rubella
incubation
14–21days
98
# Rubella
Promdrome
No prodrome in children
mild prodrome in adults (fever, malaise, coryza)
99
# Rubella
Sx
symptoms coincide with rash or precede rash by up to 5 days
Posterior cervical and postauricular lymphadenopathy 5–10 days before rash
Fine pink maculopapular rash of 3 days duration; face to trunk to extremities over 2-3 days
100
# Rubella
Dx and Tx
Cannot make dx based on single igm isolation (cross reactivity with other viral infx)
supportive
101
# rubella
congenital infection
Congenital rubella infection: hearing loss, developmental delay, growth retardation, cardiac and ophthalmic defects.
2015: WHO announced Americas region is world’s first to eliminate rubella and congenital rubella syndrome.
102
# Roseola infantum
incubation & Sx
9-10 days after exposure
3-5 days of high fever (may exceed 40°C [104°F]) that resolves abruptly, followed by rash
103
# roseola
rash
Morbilliform rash, starting on the neck and trunk and spreading to the face and extremities (cephalad and centrifugal spread)
Mostly children under age 2, usually benign and self-limited
104
# hand foot mouth
incubation & transmission
3-5 days
direct contact with skin, nasal/oral secretions of infected individuals, or fecal contamination.
blisters infective until they have dried up, usu. few days.
stools infective for up to a month.
105
# hand foot mouth
typical infection
Flat pink patches on dorsal and palmar surfaces of hands and feet; progression to small, elongated greyish blisters; within a week, blisters peel off leaving no scars.
Small vesicles and ulcers in and around mouth, palate, pharynx. sometimes painful, so child eats is fretful and eats poorly. (inside oral cavity – enanthem)
Red macules and papules on buttocks and sometimes arms, genitalia.
106
# hand foot mouth
atypical Sx
Widespread red, crusted papules; no blisters or very large ones; subsequent skin peeling and/or nail shedding; unusual sites such as ear
In children with atopic dermatitis, lesions may select skin affected by eczema (eczema coxsackium).
107
# Hand foot mouth
complications
Dehydration
Fingernail/toenail changes (2 months after infection)
Transverse lines
Nail shedding (onychomadesis)
Eventually nails return to normal.
Serious infection:
Enteritis
Myocarditis
Meningoencephalitis
Pneumonia
108
# hand foot mouth
pregnancy comlications
Pregnancy: spontaneous abortion or fetal growth restriction
109
# Monkeypox
incubation,
reportable?
13 days
yes
110
# monkeypox
Signs and Sx
Lad
Fever
Rash
Well circumscribed lesions all in same stage of development
111
# monkeypox
Dx and Tx
Elisa, PCR, viral culture
No standardized treatment regimen
Cidofovir (vistide)
