Viral Infections

Question 1

What are the viral causes of meningitis?

Answer 1

Enteroviruses, EBV, adenovirus, measles, mumps

Question 2

What are the viral causes of encephalitis?

Answer 2

Direct invasion (HSV), post infectious (VZV) or slow virus (HIV or subacute sclerosing panencephalitis). Also enteroviruses, RSV and arbovirus

Question 3

What are the viral causes of a maculopapular rash?

Answer 3

HHV6 or 7 if under 2, enteroviral, parvovirus if school age

Question 4

What are the viral causes of a vesicular/bullous/pustular rash?

Answer 4

VZV, HSV, coxsackie

Question 5

What are the viral causes of petechial/purpuric rash?

Answer 5

Enterovirus et al

Question 6

What causes erythema multiforme?

Answer 6

HSV

Question 7

What is the most common form of primary HSV illness in children?

Answer 7

Gingivostomatitis. Occurs 10mo-3yrs. High fever and lesions

Question 8

What are notable HSV manifestations?

Answer 8

Eczema herpeticum, herpetic whitlows, eye disease including corneal scarring, CNS in neonates

Question 9

What are the notable serious complications of VZV?

Answer 9

Secondary bacterial infection (fever settles then returns), encephalitis, purpura fulminans (autoimmune inactivation of protein S)

Question 10

Who is given VZV immunoglobulin?

Answer 10

Immunocompromised with deficient T cell function after contact or neonate if maternal chickenpox around delivery

Question 11

Who gets recurrent shingles in childhood?

Answer 11

T cell immune defectives, eg HIV

Question 12

What is the presentation of HHV6 and 7?

Answer 12

Roseola infantum with high fever which settles as a macular rash appears

Question 13

What is the presentation of parvovirus B19?

Answer 13

Slapped cheek syndrome which follows a week of fever/malaise and progresses to a “lace” rash on the trunk. Can cause aplastic crisis in SCD/thalassaemia and immunodeficient

Question 14

What is the effect of Parvovirus B19 on the foetus?

Answer 14

Hyrdops and anaemia; most recover

Question 15

Where do vesicles arise in coxsackie disease?

Answer 15

Hands, feet, mouth, tongue and buttocks. Subside after a few days.

Question 16

What is herpangina?

Answer 16

Vesicular and ulcerated lesions on the soft palate and uvula

Question 17

What is Bornholm disease?

Answer 17

Acute fever, pleuritic chest pain and muscle tenderness. Resolves after a few days. Caused by enteroviruses

Question 18

What are the key features of measles?

Answer 18

Fever, rash (spreads down from ears), Koplik’s spots, conjunctivitis and coryza, cough. Symptomatic treatment

Question 19

What are the complications of measles?

Answer 19

Pneumonia, secondary bacterial infections, febrile convulsions, encephalitis, SSPE, diarrhoea, hepatitis, myocarditis

Question 20

What are the key features of mumps?

Answer 20

Incubation period of 15-24 days. Fever, malaise and parotitis. Pancreas may be involved. Orchitis can occur

Question 21

What are the key features of rubella?

Answer 21

Incubation period of 15-20 days, mild fever, maculopapular rash for 3-5 days, suboccipital and postauricular lymphadenopathy

Question 22

What does a HIV test show in the child of a HIV positive mother?

Answer 22

Positive due to transplacental maternal IgG until 18mo. Do 2 PCRs within first 3mo of life

Question 23

Which children should be tested for HIV?

Answer 23

Persistent lymphadenopathy, hepatosplenomegaly, recurrent fever, parotid swelling, htrmobocytopaenia, SPUR infections