Viral infections of skin

Question 1

Exogenous: means what?

Endogenous means what?

Answer 1

1. From without: infection at site of lesion, breaks in skin integrity: cuts, insect bites, pimples; mucous membranes
2. From within: viremia (spread through blood), reactivation from latency (think neurons and lymphocytes)

Question 2

Exanthem is

Answer 2

an eruptive disease, infectious rash

Question 3

Macular/macule is

Answer 3

flat, discolored patch

Question 4

Papular/papule is

Answer 4

raised, discolored patch

Question 5

Vesicle is

Answer 5

raised, fluid-filled blister

Question 6

Erythema is

Answer 6

redness

Question 7

Petechial/petechiae is

Answer 7

tiny, dark spots due to localized hemorrhage

Question 8

Pustular/pustule is

Answer 8

vesicle filled with pus

Question 9

Umbilicated is

Answer 9

pustule with dimple (umbilicus) in center

Question 10

Herpesvirus is

Answer 10

a large enveloped icosahedral DNA virus, primary infection (first exposure and THEN DISEASE), latency in neurons or lymphocytes , then potential recurrence with or without symptoms

Question 11

____ person that is ____ to an individual infected with ____ is at risk for acquiring what?

Answer 11

Naive; exposed; herpesvirus; infection

Question 12

____ and _____ contain what when?

Answer 12

Secretion (saliva, breastmilk) and mucous membranes (oral, genital); infectious herpesviruses when infected individual has primary infection or recurrence of latent one

Question 13

When doe most people acquire a primary infection?

Answer 13

Childhood, but naive adults also susceptible

Question 14

What can occur at any time and be transmitted to naive people?

Answer 14

Asymptomatic shedding!!!

Question 15

Primary Herpes Simplex virus: who, spread, lesion types/location, latency, treat

Answer 15

Who: Childhood
Spread: close contact with active lesions or asymp shedding (kissing, sex)
Lesion types/location: mouth, face, nose eyes; usually ABOVE waist, can be genital
Latency: look in dorsal root ganglia neurons or trigem
Treat: oral acyclovir or derivatives

Question 16

Recurrent HSV-1: herpes labialis (cold sores): lesion types, trigger, lesion characteristics, treat?

Answer 16

Lesion types: recurrence on lips, eyes, or inside mouth (vesicular); cold sores, “canker sores,” fever blisters
Triggers: fever, UV, hormones, stress, physical trauma
Lesion characteristic: secretions can spread virus without symptoms; contagious
Treat: acyclovir, zovirax, valtrex, famvir (prophylactic)

Question 17

HSV keratitis and corneal scarring: infection type, cause, sequelae, disease mediated, treat?

Answer 17

Infection type: primary in eye occurring at birth from vaginal canal
Cause: HSV-1 or -2 recurrence
Sequelae: chronic can cause corneal scarring and vision loss
Disease: T cell infiltration destroys cornea
Treat: antivirals; might need corneal transplant!!!

Question 18

Herpetic Whitlow: Acquiring, cause, who, what sites, treat, prevention

Answer 18

Acquire: direct contact (primary HSV-1 or -2 of non-mucosal sites)
Cause: bare hands into others’ mouths
Who: Dentists, hospital workers, wrestlers
Sites of recurrence: hands, legs, back
Treat: acyclovir and derivatives
Prevention: gloves

Question 19

HSV-2: Primary genital herpes: lesion types and location, symptoms, treatment, other infections, highest risk?

Answer 19

LT and L: Vesicular, pustular, erythematous lesions on penis, labia, anus (usually below waist)
Symptoms: pain, itching, fever, headache, malaise
Treat: antiviral to shorten acute infection and prevent spread to brain
Other infections: HSV-1 and -2 coinfection common
Highest risk: congenital infection (highest risk to fetus)

Question 20

HSV-2: Recurrent genital herpes: prodrome, lesions and locations, lesion characteristics, recurrence, antivirals,

Answer 20

Prodrome: itching, tingling at lesion site a day before outbreak
Lesions and location: vesicular, labia, penis, anus, mouth
Lesion chara: contagious, but shedding and transmission can occur without symptoms!!
Recurrence: frequency highly individual
Antivirals: prophylactic antiviral can reduce recurrence and transmission

Question 21

Primary VZV: Varicella: transmission, incubation, latency, distinct, lesion chara, treat

Answer 21

Transmission: aerosol, highly contagious
Incubation: 1-2 week incubation period with contagiousness, fever, and malaise preceding and accompanying rash
Latency: dorsal root ganglion neurons
Distinct: rash “dew drops on rose petals”
Lesion chara: itchy, vesicular, scabs that could scar
Treat and prevention: vaccine (Varivax), acyclovir, Foscarnet

Question 22

VZV REcurrence: Herpes zoster: prodrome, outbreak, lesion chara, seen in whoe, treatment, complications

Answer 22

Prodrome: burning, itching, tingling
Outbreak: single dermatome
Lesion chara: vesicular, extremely painful, pruritic
Who: elderly, immunocomp
Treat: acyclovir and derivatives
Comp: keratitis, retinitis, Bell’s, postherpetic neuralgia

Question 23

HZO: herpes zoster ophthalmicus: affects where, what can happen, how to treat?

Answer 23

Affects where: 30% can affect face
What can happen: destroy retina and lead to blindness; all tissues of eye can be infected and damaged
Treat: aggressively

Question 24

VZV vaccines: type, what can they prevent?

Answer 24

Type: live attenuated virus
Prevent: Varivax to prevent varicella (age 1-60, 80-90% effective); Zostavax to prevent zoster (>50, 50% effective)

Question 25

EBV: primary infectious mono: infects where, restricted to, who tends to get it?

Answer 25

Infects: B cells and epi of oropharynx
Restricted: humans (90% affected by adulthood)
Who: childhood infections asymp, older teens with “mono”

Question 26

EBV recurrences: who is it linked to? What is a major sequelae?

Answer 26

Who: Immunocompromised with recurrences linked to B cell cancers
Major seq: Oral hairy leukoplakia with epi overgrowth caused by EBV with hairy/feathery lesions on tongue or buccal mucosa; associated with HIV, transplant, chemo

Question 27

CMV: general, what differentiates from EBV? Treatment?

Answer 27

General: usualy asymp and acquired in childhood
Different: Lack of SORE THROAT, presence of PETECHIAL rash and JAUNDICE differentiate
Treat: Gancyclovir especially with immunocomp

Question 28

Roseola: Exanthem subitum: cause, latency, transmission, typical presentation, what not to do

Answer 28

Cause: HHV6b and HHV7
Latency: CD4 T cells are site of latency
Transmission: saliva (respiratory droplets)
Presentation: 3 days of high fever, then faint rash on trunk
What not to do: hold off on antibiotics!!!

Question 29

Kaposi’s Sarcoma: KSHV, HHV8: prevalence, evidence of, found where; recurrences

Answer 29

Prevalence: African, Mediterranean, homosexual pops
Evidence: sexual transmission
Found: B cells, endothelial cells
Recurrences: Kaposi’s, body cavity based lymphomas (BCBL), Castleman’s disease, hyperplastic lymphadenopathy

Question 30

Coxsackie Virus: family, skin manifestation, what else with transmission?

Answer 30

Family: small, naked, ssRNA viruses in enteroviridae
Skin manifestation: herpangina (throat infection causing red-ringed blisters and ulcers on tonsils and soft palate) and hemorrhagic conjunctivitis (eye pain, then red water eyes with swelling, light sens, blurred vision);
hand, foot, mouth disease (red blisters in throat, tongue, gums, hard palate, inside of cheeks, and palms of hands, soles of feet; think pre-school children and parents)
Transmission: highly contagious, spread on hands and surfaces contaminated by feces and saliva, aersol spread from sneezes or coughs
Treat with none, prevent with handwashing and sanitation

Question 31

HPV: virus type, infects where, spread, treat, prevent

Answer 31

Virus type: Small, naked DNA virus
Infects: skin, genitals, cervix, anus, mucosa
Spread: direct contact
Treat: chemical/surgical removal
Prevent: gardasil, a vaccine for young women and also boys at age 11

Question 32

Molluscum Contagiousum Virus (MCV): lesion characteristics, found where, lesions where, transmission, who do you see it, treat

Answer 32

Lesion chara: pearly, flesh-colored, raised, umbilicated
Found where: anywhere on body in kids, anogenital in sexually active adults; rarely on palms, soles, mucosa, face or eyes
Trasmit: skin-skin contact or fomites, tattos, wrestling
Who: school-age, HIV pop
Treat: surgery, CRYOTHERAPY along with Cidofovir

Question 33

Variola Virus (Smallpox): look for, rash stages, treat

Answer 33

Look for: umbilicated papular rash on face and extremities
Rash stages: papular, vesicular then pustular, scabs leaving pitted scars
Treat: supportive care, vaccination

Question 34

Vaccinia virus, what is it used for, given to who, possible vaccine reactions

Answer 34

Used for: modern vaccine strain
Given to: military personnel, lab personnel
Possible vaccine reactions: auto-inoculation from arm to eyes, generalized vaccinia (virus in body), eczema vaccinatum (contraindicated with eczema), progressive vaccina leading to vaccinia necrosum/gangrenosum (immunocomp, need Cidofovir but potentially fatal)

Question 35

Measles: virus type, contagious, symptoms, key feature

Answer 35

Virus type: paramyxovirus, enveloped, neg strand RNA
Cont: during incubation period
Symptoms: cough, conjunctivitis, fever, rash (at this point not contagious)
Feature: Koplik’s spots, or small red spots with bluish centers on buccal mucosa

Question 36

Rubella virus (German measles): virus type, spread, symptoms, treat, prevent

Answer 36

Virus type: togavirus, enveloped, pos strand RNA
Spread: aerosol spread
Symptoms: maculopapular rash, lymphadenopathy, arthralgia
Treat: none
Prevent: MMR vaccine