Viral Infections: Chickenpox, Herpes Zoster, HIV, Molluscum Contageosum, Viral Warts, Herpes Simplex Flashcards
Common Viral Infections
Chickenpox, Herpes Zoster, HIV, Molluscum Contageosum, Viral warts, Herpes Simplex
Chickenpox
- 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
Causes of Chickenpox
Varicella Zoster Virus, Herpes type 3, airborne or contact with fluid
Features of Chicken Pox
- Itchy red papules to vesicles
- Stomach, back, face, blister in mouth
- Fever, headache, D&V
Treating Chicken Pox
- Blisters clear up naturally in 1-3 weeks, but can leave scars
- IV Aciclovir
Complications of Chicken Pox
- 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
Herpes Zoster aka Shingles
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
Risk factors for Herpes Zoster
Adults, elderly, poor immunity
Triggers of Herpes Zoster
- Nerve Pressure
- Radiotherapy at level of nerve root
- Spinal Surgery
- Infection
Features of Herpes Zoster
- 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
Treatment for Herpes Zoster
Antiviral: Aciclovir
Recovery is 2-4 weeks
Rest and pain relief, vaseline
Complications of Herpes Zoster
- 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
Herpes Simplex
‘Cold Sores’ or ‘Fever blisters’
Causes of Herpes Simplex
- 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
Features of Type 1 Herpes Simplex
-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
Features of Type 2 Herpes Simplex
- 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
Treatments for HSV
Antiviral drugs
Complications of HSV
Eye infection, throat infection, eczema herpeticum, erythema multiforme ( symmetrical plaques on hands, forearms, feet and lower legs), disseminated/widespread infection
Acute HIV Infection Syndrome
Occurs in those infected with HIV during the first few weeks following exposure
Symptoms of HIV Infection Syndrome
Fever & lymphadenopathy, sore muscles/joints, malaise, loss of appetite, GI symptoms, erythematous maculopapular rash, mucocutaneous ulceration, symmetrical rash on face, palms and soles
Pruritic Papular Eruption of HIV
Most common rash seen in HIV
Form of prurigo
Itchy, red bumps, symmetrical, diffuse, extremities and trunk affected, no mucosal, palmar or webbing involvement
Treatment of Pruritic Papular Eruption
Topical Steroids, emollients, antihistamines then phototherapy
Viral skin conditions associated with HIV
HSV, VZV, Molluscum Contagiosum, Human papillomavirus, oral hairy leukoplasia due to EBV
Fungal skin conditions associated with HIV
Tinea, Candidiasis, Cryptococcosis, pityrosporum, pityriasis versicolor, Pneumocystosis
Bacterial skin conditions associated with HIV
Cellulitis, ecthyma impetigo, folliculitis (strep), syphillis, atypical mycobacteria
Infestations of the skin associated with HIV
Leishmaniasis
Scabies
Inflammatory skin conditions associated with HIV
Seborrhoeic dermatitis, psoriasis, eczema, Pruritic papular eruption, granuloma annulare
Malignant skin conditions associated with HIV
Kaposi’s Syndrome, B & T cell lymphoma, Melanoma, SCC, BCC
Viral warts
common non-cancerous growths
Risk factors for viral warts
School aged children, Eczema, immunosuppressed individuals
Causes of viral warts
- 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
Features of Viral Warts
Hard surface with black dot in the middle of each scale - thrombosed capillary blood vessel
Features of Common Warts
Papules with hyperkeratotic, rough surface, back of fingers or toes, around nails and knees, butcher’s warts- cauliflower like
Features of Plantar warts (Veruccas)
Tender, inward growing ‘mymecia’ with clusters of mosaic warts
Features of Plane Warts
flat, hands, face and shins. Spread by shaving/scratch
Features of Filiform Warts
Long thread/stalk. Common on face
Mucosal Wart
Lips and inside cheeks
Treatments of Warts
- Topical: salicylic acid, removes dead surface cells
- Cryotherapy: freezing wart, success after 3-4 months
- Electrosurgery: curettage and cautery for large warts
Molluscum Contagiosum
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
Risk factors for Molluscum Contagiosum
Children under 10, warmer climates, wet conditions, overcrowded environments, atopic eczema, immunocompromised
Causes of Molluscum
Molluscum Contagion Virus part of the Poxvirus
Spreads: skin-to-skin, Indirect e.g. towels, auto-inoculation i.e. shaving or scratching, sexual transmission
Features of Molluscum
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
How to reduce spread of molluscum
Washing hands Avoid scratching/shaving Cover visible lesions with clothes/plasters Do not share towels Adults practise safe sex
Treating Molluscum
Picking out white core Cryotherapy Laser ablation Antiseptic e.g. hydrogen peroxide Wart paint e.g. salicylic acid
Complications of Molluscum
Secondary bacterial infection (impetigo)
Secondary eczema
Conjunctivitis if eyelid becomes infected
Large and numerous mollusca in immunocompromised
