Viral Infections: Chickenpox, Herpes Zoster, HIV, Molluscum Contageosum, Viral Warts, Herpes Simplex

Question 1

Common Viral Infections

Answer 1

Chickenpox, Herpes Zoster, HIV, Molluscum Contageosum, Viral warts, Herpes Simplex

Question 2

Chickenpox

Answer 2

• Contagious 1-2 days before the rash appears until blisters have scabbed over
• Can take 10-21 days after contact to develop chickenpox
• Children should stay away from school
• Immunocompromised individuals and pregnant women should stay away

Question 3

Causes of Chickenpox

Answer 3

Varicella Zoster Virus, Herpes type 3, airborne or contact with fluid

Question 4

Features of Chicken Pox

Answer 4

• Itchy red papules to vesicles
• Stomach, back, face, blister in mouth
• Fever, headache, D&V

Question 5

Treating Chicken Pox

Answer 5

• Blisters clear up naturally in 1-3 weeks, but can leave scars
• IV Aciclovir

Question 6

Complications of Chicken Pox

Answer 6

• Secondary bacterial infection caused by scratching
• Dehydration from D&V
• Viral Pneumonia
• Disseminated varicella infection
• Reye’s, Guillain-Barre, encephalitis
• Thrombocytopenia & purpura
• Viral pneumonia, premature labour
• Shingles

Question 7

Herpes Zoster aka Shingles

Answer 7

Localised, painful rash caused by reactivation of VZV. Anyone who has previously had chickenpox can get shingles. VZV remains dormant in dorsal rot ganglia for years. When reactivated, migrates to sensory nerves to skin

Question 8

Risk factors for Herpes Zoster

Answer 8

Adults, elderly, poor immunity

Question 9

Triggers of Herpes Zoster

Answer 9

• Nerve Pressure
• Radiotherapy at level of nerve root
• Spinal Surgery
• Infection

Question 10

Features of Herpes Zoster

Answer 10

• Severe pain in one sensory nerve distribution
• Fever, headache, lymphadenopathy
• After 1-3 days, blistering rash appears in same area of skin
• Red papules to blistering or pustules that crust over
• Chest, neck, forehead and lumbar/sacral regions commonly affected

Question 11

Treatment for Herpes Zoster

Answer 11

Antiviral: Aciclovir
Recovery is 2-4 weeks
Rest and pain relief, vaseline

Question 12

Complications of Herpes Zoster

Answer 12

• Several dermatomes involved
• Deep blisters with prolonged healing and scarring
• Muscle weakness e.g. facial nerve palsy- Ramsay Hunt Syndrome
• Infection of organs
• Pregnancy- fetus can be infected
• Post-herpetic neuralgia: persistent pain in the same area more than 1 month after onset

Question 13

Herpes Simplex

Answer 13

‘Cold Sores’ or ‘Fever blisters’

Question 14

Causes of Herpes Simplex

Answer 14

• Type 1: Oral and facial infections
• Type 2: genital and rectal infections
  Spread by direct or indirect contact. Remains dormant in dorsal root nerves until reactivated

Question 15

Features of Type 1 Herpes Simplex

Answer 15

-Type 1 presents as gingivostomatitis in children 1-5: fever, restlessness, excessive dribbling and bad breath, swollen gums, eating is painful, white vesicles to yellow ulcers inside mouth, lymphadenopathy

Question 16

Features of Type 2 Herpes Simplex

Answer 16

• Genital Herpes after onset of sexual activity
• Painful vesicles, ulcers, redness, swelling for 2-3 weeks
• In females: vulva and vagina. Often painful to urinate. Cervical infection may lead to severe ulcers
• Type 2 recurrence more common

Question 17

Treatments for HSV

Answer 17

Antiviral drugs

Question 18

Complications of HSV

Answer 18

Eye infection, throat infection, eczema herpeticum, erythema multiforme ( symmetrical plaques on hands, forearms, feet and lower legs), disseminated/widespread infection

Question 19

Acute HIV Infection Syndrome

Answer 19

Occurs in those infected with HIV during the first few weeks following exposure

Question 20

Symptoms of HIV Infection Syndrome

Answer 20

Fever & lymphadenopathy, sore muscles/joints, malaise, loss of appetite, GI symptoms, erythematous maculopapular rash, mucocutaneous ulceration, symmetrical rash on face, palms and soles

Question 21

Pruritic Papular Eruption of HIV

Answer 21

Most common rash seen in HIV
Form of prurigo
Itchy, red bumps, symmetrical, diffuse, extremities and trunk affected, no mucosal, palmar or webbing involvement

Question 22

Treatment of Pruritic Papular Eruption

Answer 22

Topical Steroids, emollients, antihistamines then phototherapy

Question 23

Viral skin conditions associated with HIV

Answer 23

HSV, VZV, Molluscum Contagiosum, Human papillomavirus, oral hairy leukoplasia due to EBV

Question 24

Fungal skin conditions associated with HIV

Answer 24

Tinea, Candidiasis, Cryptococcosis, pityrosporum, pityriasis versicolor, Pneumocystosis

Question 25

Bacterial skin conditions associated with HIV

Answer 25

Cellulitis, ecthyma impetigo, folliculitis (strep), syphillis, atypical mycobacteria

Question 26

Infestations of the skin associated with HIV

Answer 26

Leishmaniasis | Scabies

Question 27

Inflammatory skin conditions associated with HIV

Answer 27

Seborrhoeic dermatitis, psoriasis, eczema, Pruritic papular eruption, granuloma annulare

Question 28

Malignant skin conditions associated with HIV

Answer 28

Kaposi's Syndrome, B & T cell lymphoma, Melanoma, SCC, BCC

Question 29

Viral warts

Answer 29

common non-cancerous growths

Question 30

Risk factors for viral warts

Answer 30

School aged children, Eczema, immunosuppressed individuals

Question 31

Causes of viral warts

Answer 31

- Human Papilloma Virus (HPV) - Infection occurs in superficial epidermis, causing keratinocyte proliferation and hyperkeratosis - Spread by skin-to-skin contact or auto-inoculation- - Up to 12 months incubation period

Question 32

Features of Viral Warts

Answer 32

Hard surface with black dot in the middle of each scale - thrombosed capillary blood vessel

Question 33

Features of Common Warts

Answer 33

Papules with hyperkeratotic, rough surface, back of fingers or toes, around nails and knees, butcher's warts- cauliflower like

Question 34

Features of Plantar warts (Veruccas)

Answer 34

Tender, inward growing 'mymecia' with clusters of mosaic warts

Question 35

Features of Plane Warts

Answer 35

flat, hands, face and shins. Spread by shaving/scratch

Question 36

Features of Filiform Warts

Answer 36

Long thread/stalk. Common on face

Question 37

Mucosal Wart

Answer 37

Lips and inside cheeks

Question 38

Treatments of Warts

Answer 38

- Topical: salicylic acid, removes dead surface cells - Cryotherapy: freezing wart, success after 3-4 months - Electrosurgery: curettage and cautery for large warts

Question 39

Molluscum Contagiosum

Answer 39

Small, firm, raised papules on the skin with a characteristic small dimple in the middle. The spots are not painful, but can be itchy. Common in armpits, knee and groin

Question 40

Risk factors for Molluscum Contagiosum

Answer 40

Children under 10, warmer climates, wet conditions, overcrowded environments, atopic eczema, immunocompromised

Question 41

Causes of Molluscum

Answer 41

Molluscum Contagion Virus part of the Poxvirus | Spreads: skin-to-skin, Indirect e.g. towels, auto-inoculation i.e. shaving or scratching, sexual transmission

Question 42

Features of Molluscum

Answer 42

Clusters of small, round papules 1-6mm, few to hundreds White, pink or brown Often shiny with umbilicated pit Papules contain white, cheesy material Arise in warm, moist places e.g. flexures

Question 43

How to reduce spread of molluscum

Answer 43

``` Washing hands Avoid scratching/shaving Cover visible lesions with clothes/plasters Do not share towels Adults practise safe sex ```

Question 44

Treating Molluscum

Answer 44

``` Picking out white core Cryotherapy Laser ablation Antiseptic e.g. hydrogen peroxide Wart paint e.g. salicylic acid ```

Question 45

Complications of Molluscum

Answer 45

Secondary bacterial infection (impetigo) Secondary eczema Conjunctivitis if eyelid becomes infected Large and numerous mollusca in immunocompromised