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CMT-uno > Viral Infections > Flashcards

Viral Infections Flashcards

1
Q

Herpes

What leads to flare ups?

A

Flare ups May follow minor infections, trauma, stress, or sun exposure.

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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

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3
Q

HSV 2

A

Most common cause of genital ulcers in developed world
Most in US unaware infected

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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

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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

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6
Q

HSV

What are complications of infection? (4)

A
  1. Meningitis
  2. Ocular disease (herpes keratitis)
  3. GI disease
  4. Pneumonia
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7
Q

what is Ocular disease (herpes keratitis)?

A

Branching (dendritic) ulcers that stain with fluorescein in the iris

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8
Q

HSV

How do we treat?

A

Acyclovir 400-800mg 3x a day for 10 days

Trifluridine for eye infection

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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

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10
Q

VZV

Varicella-zoster virus (VZV) aka human herpesvirus (HHV)-3 may manifest as

A

varicella (chickenpox) or herpes zoster (shingles)

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11
Q

Varicella

How do you describe the rash for chicken pox

A

“dew drop on a rose petal”

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12
Q

Varicella

What are complications of chicken pox? (4)

A

skin infxn, pneumonia, encephalitis, death

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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

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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

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15
Q

Varicella

What is the mortality rate of neonatal varicella?

A

30% mortality

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16
Q

Herpes zoster

Shingles Rash

A

tingling, pain, eruption of vesicles in a dermatomal distribution, evolving to pustules and then crusting

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17
Q

epstein barr

how long does someone remain infectious?

A

up to 6 months after symptom onset

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18
Q

Epstein barr

how long is incubation

A

30-50 days

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19
Q

epstein barr

pathophys

A

(heterophile antibodies)
Primary EBV infection of B lymphocytes induces circulating antibodies directed against viral antigens

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20
Q

EBV

Lifelong infection

A

can have latency with periodic reactivation with oral shedding (often w/o shedding)

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21
Q

EBV

Malignancy Complications

A

Insufficient cellular immune responses may result in EBV-induced malignancy (Hodgkin lymphoma, Burkitt lymphoma)

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22
Q

EBV

Signs and symptoms

A
  1. Abrupt onset severe sore throat/pharyngitis withposterior cervicallymphadenopathy
  2. Gradual onset low-grade fever,malaise,arthralgia, andmyalgia
  3. Splenomegaly in 2nd and 3rd weeks
  4. Abdominal pain/discomfort
  5. Hepatomegaly rarely clinicallypalpable
  6. Elevation of liver transaminases common
  7. Hoagland sign (transient upper lid edema)
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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

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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

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25
Q

CMV

Cytomegalovirus what disease? Transmission?

A

very common, also causes mono.
by age 5 30% are infected
transmitted by close contact, sexual, occupational, perinatal (in utero, during birth, breast milk)

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26
Q

CMV

Complications

A

Retinitis, GI/hepatobiliary, pneumonitis, neurologic syndromes

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27
Q

CMV

Congenital CMV complications, Dx, Tx?

A

long-term neurodevelopmental disabilities: sensorineural hearing loss, cerebral palsy, intellectual disability, vision impairment, seizures
Test urine or saliva
Treat with ganciclovir/valganciclovir

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28
Q

Rotavirus

causes what disease? What age group?

A

viral gastroenteritis, particularly in children between 2-6y

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29
Q

rotavirus

3 factors that play a role in rota diarrhea

A
  1. loss of brush border enzymes
  2. the direct effect of the rotavirus enterotoxin NSP4
  3. activation of the enteric nervous system
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30
Q

rotavirus

signs and symptoms

A

N/V/watery nonbloody diarrhea and fever

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31
Q

rotavirus

severe signs and symptoms of rotavirus? Tx?

A

dehydration, seizures, and death can occur.
Treatment: supportive care

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32
Q

Flu

what are the most common groups?

A

A and B

C rarely results in illness

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33
Q

Flu

Complications

A

DM, Heart failure, pulm disease, chronic disease – renal, hepatic, hematologic, or neurologic

more severe in obese pts

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34
Q

flu

incubation period

A

1-4 days

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35
Q

flu

clinical presentation

A

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

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36
Q

Flu

Dx (2)

A

1.Rapid molecular assays with nasal swab
2.PCR testing

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37
Q

Flu

Tx

A

supportive care

if caught w/in 2 days
oseltamivir, zanamivir, peramivir

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38
Q

Flu

who do we Tx with antivirals?

A

Children <2 years and adults ≥65 years
Pregnant women and within 2 weeks postpartum
immunocompromised

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39
Q

Flu

when to admit? ICU?

A

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

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40
Q

Flu

Pregnancy- special population risks? When can can you vax?

A

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

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41
Q

COVID

COVID incubation

A

<14 day incubation
40% asymptomatic

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42
Q

COVID

complications 5

A

Respiratory failure
Cardiovascular
Thromboembolic complications
Neurologic complications
Inflammatory complications

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43
Q

Covid

treatment

A

Nirmatrelvir-ritonavir (paxlovid) must be given w/in 5 days of symptoms

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44
Q

Rabies

Rhabdovirus encephalitis
Transmission? Incubation?

A

spread through saliva
incubation 3-7 weeks depending on distance of wound from CNS, may be years!

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45
Q

Rabies

pathophys

A

virus travels in nerves to brain, multiplies in brain, then migrates along efferent nerves to salivary glands

46
Q

rabies

non-specific prodrome

A

Pain at infection site
Fever, malaise, Headache, Nausea/vomiting
Aerophobia (skin temperature change sensitivity)
Abnormal sexual behavior
Males-frequent ejaculation, Priapism
Females-hypersexuality

47
Q

Rabies

CNS stage- incubation, Sx

A

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
Q

rabies

treatment

A

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
Q

Poliomyelitis- how many types, where is it endemic?

A

3 wild serotypes. eliminated from 99% of world. endemuc in Nigeria, Pakistan, Afghanistan

50
Q

Abortive Polio

A

Nonspecific & mild over 2-3 days
Fever, ha, vomiting, diarrhea/constipation, and sore throat

51
Q

Nonparalytic poliomyelitis

A

Nonspecific symptoms as above
Signs of meningeal irritation (neck stiffness, irritability, PE findings)
muscle spasms without paralysis

52
Q

polio

paralytic poliomyelitis

A

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
Q

polio

Post-poliomyelitis syndrome symptoms

A

Progressive muscle limb paresis, mm (muscle mass) atrophy, fasciculations and fibrillations during rest activity
Restless leg syndrome

54
Q

Ebola

mortality/pregnancy, transmission and incubation

A

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
Q

Ebola

Signs and Symptoms of nonspecific febrile illness

A

Up to 1 week
Fever, HA, dizziness, weakness, fatigue, myalgias, and arthralgias

56
Q

Ebola

Signs and symptoms 3-5 days in

A

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
Q

Ebola

Dx

A

IGM or PCR test

58
Q

ebola

Treatment

A

Supportive
Iv fluids may decrease mortality rate to <50%
No approved meds

59
Q

Arbovirus

include which visuses and how are they transmitted

A

Togavirus
flaviviruses-west nile, dengue, zika
orthobunyaviruses
alphaviruses

mosquito and ticks

60
Q

arboviruses

West Nile Virus

Incubation

Time

Is it reportable?

A

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
Q

West nile virus

Neuroinvasive Symptoms signs and mortality rate

A

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
Q

West Nile Virus

Complications of infection (3)

A

Bronchial pneumonia
Retinopathy (24%)
Renal infection
Virus may show in urine for up to 6 years
Risk to develop chronic renal disease

63
Q

West Nile Virus

Diagnostic testing

A

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
Q

West Nile Virus

treatment

A

no specific antiviral therapy
supportive care
avoid mosquitos

65
Q

Dengue fever

transmission and incubation

A

via mosquito
7-10 days

66
Q

dengue

Febrile Phase

A

high fever, facial flushing, malaise, retroorbital eye pain, arthralgias, sore throat
Maculopapular rash
Most patients recover and fevers resolve by day 8

67
Q

Severe dengue

A

Plasma leakage
Increased liver size, vomiting, severe abdominal pain
Hemorrhage
Ecchymosis, GI bleeding, epistaxis
organ involvement
Hepatitis, encephalitis, myocarditis

68
Q

dengue

Shock

A

Decreased level of consciousness, hypothermia, hypoperfusion leading to metabolic acidosis, organ impairment, DIC, AKI

69
Q

Dengue

Dx

A

IGM and IGG ELISA after febrile phase

70
Q

Dengue

Immunization who is eligible

A

only for children 9-16yo with prior hx of infection living in endemic area

71
Q

Tx for polio

A

Supportive

Paralytic polio should be hospitalized w physiotherapy

72
Q

fifth disease

Nonspecific Prodrome Sx

A

low grade fever, coryza, headache, nausea, diarrhea

Low grade fever = above 98.6° F (37° C) but below 100.4° F (38° C)

73
Q

fifth disease

Sx

A

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
Q

fifth disease

incubation

A

14 days
can be contagious before rash is visible

75
Q

fifth disease

when are school epidemics likely

A

late winter/early spring

76
Q

fifth disease

pathogen

A

Erythema infectiosum

Parvovirus B19

77
Q

fifth disease

Phase 1

A

“slapped cheek” appearance – abrupt onset
fades in 2-4 days

78
Q

fifth disease

Phase 2

A

Erythematous macules
~1-4 days

fades to Reticular ~5-9 days

79
Q

Fifth disease

phase 3

A

Clearing and recurrences of rash over weeks/months due to: exercise, stress, overheating, bathing in hot water

80
Q

fifth disease

Tx

A

Usually reassurance and symptomatic treatment
Immunocompromised patients (HIV): maybe IV IG

81
Q

fifth disease

effects on congenital

A

30 - 40% of pregnant women are seronegative for B19V and susceptible to infection
Fetal effects include spontaneous abortion, anemia, intrauterine fetal death

82
Q

fifth disease

immunocompromised complications

A

Parvovirus B 19 infection in immunosuppressed patients can result in chronic red cell aplasia/anemia

83
Q

Rubeola

what disease does it cause

A

Measles

84
Q

Rubeola- measles

transmission and incubation

A

by direct contact with infectious droplets or by airborne spread
1-2weeks

85
Q

Rubeola- measles

Prodrome

A

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
Q

rubeola- measles

Rash

A

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
Q

Rubeola- measles

when is pt infectious

A

highly infectious 4-5 days before and after rash shows up

88
Q

rubeola - measles

Dx

A

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
Q

Rubeola - measles

Tx

A

Supportive care
Infants <1 year should have IM immunoglobulin
Isolation for 4 days from onset of rash

90
Q

Rubeola - measles

congenital Sx

A

Not known to be teratogenic, but associated with spontaneous abortion, premature labor, low birth weight

91
Q

Mumps

Transmission, incubation

A

resp droplets, 1/3 are aSx
12-25

92
Q

mumps

Sx

A

Painful, swollen parotid glands overlying facial edema
Frequent involvement of testes, pancreas, and meninges in unvaccinated individuals

93
Q

mump

Dx

A

Clinical diagnosis usually sufficient
Serum IgM for mumps

94
Q

mumps

Tx

A

supportive, usually brief illness
Topical compresses
isolation

95
Q

Mumps

congenital disease

A

unlikely

96
Q

Rubella

what is Rubella

A

Rubella is a systemic disease caused by togavirus transmitted by inhalation of infective droplets

97
Q

Rubella

incubation

A

14–21days

98
Q

Rubella

Promdrome

A

No prodrome in children

mild prodrome in adults (fever, malaise, coryza)

99
Q

Rubella

Sx

A

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
Q

Rubella

Dx and Tx

A

Cannot make dx based on single igm isolation (cross reactivity with other viral infx)

supportive

101
Q

rubella

congenital infection

A

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
Q

Roseola infantum

incubation & Sx

A

9-10 days after exposure

3-5 days of high fever (may exceed 40°C [104°F]) that resolves abruptly, followed by rash

103
Q

roseola

rash

A

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
Q

hand foot mouth

incubation & transmission

A

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
Q

hand foot mouth

typical infection

A

Flat pink patchesondorsalandpalmarsurfaces of hands and feet; progression to small, elongated greyish blisters; within a week, blisters peel off leaving no scars.
Smallvesiclesandulcersin and around mouth, palate,pharynx. sometimes painful, so child eats is fretful and eats poorly. (inside oral cavity – enanthem)
Redmaculesandpapuleson buttocks and sometimes arms, genitalia.

106
Q

hand foot mouth

atypical Sx

A

Widespread red,crustedpapules; no blisters or very large ones; subsequent skin peeling and/ornailshedding; unusual sites such as ear
In children withatopicdermatitis, lesions may select skin affected byeczema(eczema coxsackium).

107
Q

Hand foot mouth

complications

A

Dehydration
Fingernail/toenail changes (2 months after infection)
Transverselines
Nail shedding (onychomadesis)
Eventuallynailsreturn to normal.
Serious infection:
Enteritis
Myocarditis
Meningoencephalitis
Pneumonia

108
Q

hand foot mouth

pregnancy comlications

A

Pregnancy: spontaneous abortion or fetal growth restriction

109
Q

Monkeypox

incubation,
reportable?

A

13 days

yes

110
Q

monkeypox

Signs and Sx

A

Lad
Fever
Rash
Well circumscribed lesions all in same stage of development

111
Q

monkeypox

Dx and Tx

A

Elisa, PCR, viral culture

No standardized treatment regimen
Cidofovir (vistide)

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