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MSII Micro Unit 2 > Viral Infections of Skin > Flashcards

Viral Infections of Skin Flashcards

1
Q

skin rash decision tree

A
  • infectious or not?
  • if non-infectious-allergy, cancer, injury, AI?
  • if infectious- bacterial, fungal, protozoan, viral?
  • if viral-treatable or not?
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2
Q

viruses that cause skin manifestations

A 
-from most to least common:
herpes- HSV1,2; VZV, EBV, CMV, HHV6,HHV7, KSH/HHSV8
coxsackie
papilloma
pox-molluscum, monkey, variola, vaccinia
measles
rubella
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3
Q

sources of viral skin infections- exogenous

A
  • from without
  • infection at site of lesion
  • breaks in skin integrity, cuts, insect bites, pimples
  • mucous membranes
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4
Q

sources of viral skin infections- endogenous

A
  • from within
  • disseminated infection
  • viremia- spread through blood/lymph
  • reactivation from latency
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5
Q

dermatitis

A
  • inflammation of skin

- non-infectious

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6
Q

exanthem

A
  • eruptive disease

- infectious rash

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7
Q

macular/macule

A

-flat, discolored patch

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8
Q

papular, papule

A

-raised, doscolored patch

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9
Q

vesicular/vesicle

A

-raised, fluid filled blister

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10
Q

petechial

A

=tiny dark spots due to localized hemorrhage

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11
Q

pustular/pustule

A

-vesicle filled with pus

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12
Q

umbilicated

A

pustule with dimple in center

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13
Q

herpesvirus infections

A
  • large, enveloped DNA viruses
  • 8 different species
  • most people infected with >3 kinds
  • primary and recurrent infections
  • a naive person is exposed and gets the disease through transmission
  • secretions contain infectious viruses in primary or recurrent infections
  • can also have asymptomatic shedding of virus
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14
Q

primary HSV 1

A
  • usually occurs in childhood
  • stomatitis
  • spread by close contact with active lesions or asymptomatic shedding
  • lesions on mouth, face, nose, eyes
  • latency in dorsal root ganglia
  • usually above waist, can be genital
  • trt with oral acyclovir or derivatives
  • 50-80% of pop is seropositive
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15
Q

recurrent HSV1

A
  • herpes labialis
  • cold sores
  • 20% of seropositive people have recurrent lesions on lips, eyes, or inside mouth
  • triggered by fever, UV exposure, hormones, stress, physical trauma
  • trt with acyclovir, zovirax, valtrex, famvir
  • use as needed for outbreaks or prophylactically to prevent recurrences
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16
Q

HSV keratitis and corneal scarring

A
  • primary infection of the eye often occurs at birth from vaginal mucosa
  • caused by recurrence of HSV1 or 2
  • chronic keratitis can cause corneal scarring and vision loss
  • disease is mediated by infiltration of T cells that destroy cornea
  • trt- antivirals to prevent corneal damage, corneal transplant may be needed
17
Q

herpetic whitlow

A
  • primary HSV1 or 2 of non-mucosal sites, acquired by direct contact
  • putting bare hands into others mouths is a risk factor
  • dentists, hospital workers, and wrestlers are susceptible
  • recurrences at unusual sites: hands, legs, back
  • trt- acyclovir and derivatives
  • prevention- gloves
18
Q

HSV2 primary

A
  • genital herpes
  • extensive vesicular, pustular or erythematous lesions on penis, labia, anus, oral and ocular possible
  • other sx- pain, itching, fever, malaise, headache
  • HSV2 usually but not always below the waist
  • antiviral trt is important to shorten acute infection, prevent spread to brain
  • double infections with HSV1/2 common
  • highest risk for congenital infections from mother to fetus
19
Q

HSV2 recurrent

A
  • recurrent genital herpes
  • prodrome-itching, tingling at lesion site a day before outbreak
  • vesicular lesions appear on labia, penis, anus, mouth
  • lesions are contagious, shedding and transmission can also occur without sx, especially female to male
  • freq of recurrences is highly individual, ranges from never to monthly
  • prophylactic antiviral treatment can reduce recurrences and thus transmission
  • infection is also emotionally painful, heavy stigma associated with HSV2
  • moderate risk for perinatal infection
20
Q

Varicella-zoster virus primary

A
  • chicken pox
  • aerosol transmission, highly contagious
  • 1-2 week incubation period: contagiousness, fever, malaise precede and accompany rash
  • latency in dorsal root ganglia neurons
  • distinctive rash- dew drops on rose petals; few to hundreds on face and trunk
  • lesions are itchy, vesicular, form scabs that may scar
  • trt and prevention-vaccine, acyclovir, foscarnet
  • complications: visceral infections, dissemination to brain, bacterial infection of lesions
  • severity increases with age
21
Q

VZV secondary

A
  • herpes zoster/shingles
  • prodrome-burning, itching, tingling
  • outbreak occurs along a single dermatome
  • vesicular lesions are extremely painful, pruritic
  • more common in elderly and immunocompromised
  • trt with acyclovir and derivatives
  • complications include keratitis, retinitis, bell’s palsy, postherpetic neuralgia
  • contagious to naive persons- can transmit virus and babies will get chicken pox
22
Q

herpes zoster ophthalmicus

A
  • approx 30% of zoster outbreaks affect the face
  • zoster in the eye can destroy the retina, rapidly leading to blindness
  • all tissues of the eye can be infected and damaged
  • long lasting pain is common
  • treat aggressively
23
Q

VZV vaccines

A
  • live attenuated virus
  • varivax for varicella- ages 1-60, 80-90% effective
  • zostavax for zoster, ages >50; 50% effective
  • zostavax is 14 times higher dose than varivax
  • ACIP recommends both
24
Q

EBV primary

A
  • infectious mono
  • EBV infects B cells and epithelia of oropharynx
  • restricted to humans, 90% of population is infected by adulthood
  • older teens have mono often
  • 170,000 cases of infectious mono per year, 15 % hospitalized
25
Q

EBV recurrences

A
  • EBV is latent in a small fraction of B cells, most people are asymptomatic
  • immune surveillance suppresses EBV
  • recurrences linked to B cell cancers, esp in immunocompromised
26
Q

oral hairy leukoplakia

A
  • epithelial overgrowth caused by EBV
  • non painful hairy/feathery lesions on tongue or buccal mucosa
  • associated with HIV infections, transplants, chemo
27
Q

CMV primary

A
  • usually asymptomatic and acquired in childhood
  • when sx do occur, similar to EBV
  • lack of sore throat and presence of petechial rash and jaundice differentiate from EBV
28
Q

roseola

A
  • exanthem subitum
  • caused by HHV6b and HHV7
  • infect CD4 cells, also the site of latency
  • transmitted by saliva
  • by age 2, >90% of kids have had roseola tiwce
  • 3 day illness- high fever followed by faint rash on trunk
  • many infants are mistakenly given antibiotics for a suspected infection, then rash is attributed to drug allergy
29
Q

kaposis sarcoma virus

A
  • KSHV/HHV8
  • primary infection has no known disease
  • KSHV is prevalent in African, Mediterranean, and homosexual pops
  • evidence for sexual transmission
  • KSHV is found in B cells and endo cells, probable site of latency
  • recurrences linked to cancers- kaposi’s sarcoma, body cavity based lymphomas, castlemans diseasehyperplastic lymphadenopathy
30
Q

coxsackie virus

A
  • small naked ssRNA virus, enterovirus (with polio and others)
  • herpangina-throat infection with red ringed blisters and ulcers on tongue/soft palate
  • hemorrhagic conjunctivitis-begins as pain, then red, watery eyes with swelling, light sensitivity, and blurred vision
31
Q

hand/foot/mouth disease

A
  • painful blisters of the throat, tongue, gums, hard palate, inside of cheeks, and palms and soles
  • common in pre school children and their parents
  • highly contagious, spread on hands and surfaces contaminated with saliva and deces
  • aerosol spread from sneezes/coughs
  • no trt, prevent with hand washing
32
Q

HPV

A
  • small, naked DNA virus
  • infects skin, genitals, cervix, anus,, mucosa
  • spread by direct contact
  • trt with chemical or surgical removal
  • gardasil, vaccine for young women, now recommended for boys at age 11
  • differentiate from lesions caused by molluscum contagiousum
33
Q

molluscum contagiousum

A
  • named after pearly appearance of vesicles, lack of IF
  • poxvirus-large, enveloped DNA virus
  • lesions are pearly, flesh colored, raised, imbilicated
  • occur anywhere on body in kids
  • anogenital area in sexually active adults
  • occasionally, a single nodule may occur
  • lesions rarely appear on palms, soles, mucosa, face or eyes
  • transmission by skin-skin contact or fomites- tattooing, wrestling, towels
  • disease incidence is 2-8%, most common in school aged kids
  • higher incidence in HIV pop-5-20%
  • trt-surgery, cryoptherapy, chemicals
  • topical trt with cidofovir is promising
34
Q

monkey pox

A
  • indistinguishable from smallpox
  • fatality rate 10-15%
  • endemic to west and central africa
  • squirrels are the natural host, disease occurs in monkeys and humans
  • transmission via direct contact, aerosol, ingestion, needles, or person to person
  • smallpox vaccine is cross protective
  • # of human to human transmissions are increasing
35
Q

variola virus

A
  • smallpox
  • historical cause of massive, lethal epidemics
  • fever, severe aching pains, and prostration
  • 2-3 days later, an umbilicated papular rash over face and extremities
  • rash stages: papular, vesicular, then pustular, scabs leave pitted scars
  • death usually occurs in the second week from overwhelming infections
  • trt-supportive care and vaccination
  • eradicated from the world in 1979 following vaccination
36
Q

smallpox vaccine

A
  • variola virus blended with other pox viruses to make vaccinia
  • adverse reactions: live vaccine
  • auto inoculation from arm to eye
  • generalized vaccinia-virus disseminates in body
  • eczema vaccinatum- not for people with eczema!
  • progressive vaccinia- vaccinia necrosum or gangreosum- in immunocompromised patients
  • trt is cidofovir and vaccinia immune globulin (VIG)
  • still given to military, lab personnel, others who need protection
37
Q

measles

A
  • paramyxovirus, enveloped, negative strand RNA
  • contagious during incubation process
  • sx-cough, conjunctivitis, fever, rash
  • spread through respiratory droplets
  • kopliks spots- small red spots with bluish centers on buccal mucosa
  • outbreaks in UK, Asia, Africa
  • 122,000 deaths in 2013
  • ~500,000 cases annually worldwide
38
Q

rubella

A
  • togavirus, enveloped pos strand RNA
  • respiratory virus, aerosol spread
  • maculopapular rash, lyphadenopathy, arthralgia
  • congenital infections are severe
  • no trt
  • prevention-MMR vaccine- no association with autism, herd immunity is crucial to prevent outbreaks
39
Q

other viruses

A
  • many can cause rashes
  • 5th disease (parvo), dengue, west nile, yellow fever
  • many rashes look alike
  • most viral exanthems look are never diagnoses
  • offer supportive care, isolation if contagious

MSII Micro Unit 2 (7 decks)

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