Viral infections of the Skin Flashcards
2 conditions caused by Varicella Zoster Virus
Chicken pox and shingles
Complications of chicken pox?
secondary bacterial pneumonitis haemorrhagic scarring, absent or minor encephalitis
How could you reduce severity neonatal VZV in a woman susceptible to chicken pox who is pregnant?
Varicella Zoster Immune Globulin
Can you get shingles in a child?
Yes
e.g. if you had chicken pox in utero or if you become immunocompromised
Ramsay Hunt Syndrome
Vesicles and pain in auditory canal and throat Facial palsy (7th nerve palsy) Poorer prognosis than Bell’s palsy Irritation of the 8th cranial nerve Deafness Vertigo Tinnitus Also known as geniculate or otic herpes zoster
Symptoms of Ramsay Hunt
A rash or blisters in or around the ear, scalp or hair line. The blisters may also appear inside the mouth.
The rash/blisters are often painful with a generalised sensation of burning over the affected area.
Weakness on the affected side of your face which causes the facial muscles to droop.
Difficulty closing the eye or blinking on the affected side.
Altered taste on the affected half of the tongue.
Loss of facial expression on the affected side.
Difficulty eating, drinking and speaking as a result of weakness in the lip and cheek on the affected side.
Ear, face or head pain.
Hearing loss on the affected side
Dizziness/vertigo
Tinnitis (ringing in the ear) on the affected side.
What type of vaccine is the chicken pox vaccine and who do you give it to?
Live attenuated vaccine is available for chickenpox
Widely used around the world but not routine for UK children
Used in susceptible health care workers
How long does herpes simplex virus/primary gingivostomatitis last?
Lasts around a week
Blistering rash around vermillion border?
Herpes simplex virus
Herpetic whitlow?
Extremely painful infection of the fingers and thumb
-Caused by herpes simplex virus
(herpes on your fingers)
HSV-1
main cause of oral lesions
causes half of genital herpes
causes encephalitis
HSV-2
rare cause of oral lesions
causes half of genital lesions
encephalitis / disseminated infection (particularly in neonates)
Aciclovir is an analogue of what?
Aciclovir is an analogue of guanosine
Lab confirmation test you could do if viral site is inaccessible for swab?
Antibody tests
yellow top vacutainer
where virus infected site is inaccessible or as adjunct to swab
Lab confirmation viral test preferred for viral skin infection?
Take a swab!
Swab with viral transport medium
Red cap
This is preferred for viral skin infections
Infections which could cause erythema mutiforme?
Herpes simplex virus and mycoplasma pneumonia bacteria
Molluscum Contagiosum
Fleshy, firm, umbilicated, pearlescent nodules
1 to 2 mm diameter
Self limiting but take months to disappear
Common in children
Can also be sexually transmitted
Treatment for molluscum contagiosum?
Liquid nitrogen
HPV 6 and 11
Warts
HPV 16 and 18
Cervical cancer
Herpangina
Mouth blisters (caused by enterovirus, NOT herpes simplex virus)
- coxsackie virus
- echovirus
Enteroviruses that can cause herpangina?
Coxsackie virus
Echovirus
Herpangina
Blistering rash of back of mouth Caused by enterovirus not herpes virus coxsackie virus echovirus Self-limiting Swab of lesion, sample of stool for enterovirus PCR
Herpangina clinical presentation?
Often in children, viral infection
Ulcers and sores in the mouth, sore throat and fever
Type of virus that causes hand, foot and mouth virus?
Enterovirus
ESPECIALLY COXSACKIE VIRUS
Hand, foot and mouth disease?
Typically children
Family outbreaks
A viral cause of rash and acute arthritis?
Erythema infectiosum
also known as “slapped cheek disease”
-Caused by parvovirus B19
-as the rash on the face fades, a lacy macular rash on the rest of the body appears
-acute arthritis commonly seen in the WRISTS
What does parvovirus B19 cause?
Parvovirus B19 causes “slapped cheek” disease
Another name for “slapped cheek disease”
Erythema infectiosum
Complications of parvovirus?
Spontaneous abortion Aplastic crisis (sudden drop in haemoglobin, e.g. in sickle cell anemia) Chronic anaemia (in immunocompromised patients)
Diagnosis of erthyema infectiosum?
By antibody testing rather than skin swabs
parvovirus B19 IgM test
Is Rubella a notifiable disease?
Yes, rubella is a notifiable disease n the UK
A rash that begins behind the ears and on the face
- Spread to trunk and extremities
- Petechia on the soft palate may be present?
Rubella
- the rash usually develops 7-14 days after exposure to the virus
- low grade fever, headache, anorexia
- joint pain
ORF
Virus of sheep “scabby mouth” Firm, fleshy nodule on hands of farmers Constitutional symptoms rare Self limiting Clinical diagnosis, lab confirmation not used
Treponema pallidum causes what?
Syphilis
Painless ulcers?
Syphilis
Primary infection Chancre Painless ulcers at site of entry Secondary phase of infection Red rash over body Prominent on soles of feet and palms of hands Tertiary CNS, cardiovascular etc etc Due to infection with Treponema pallidum
Secondary syphilis in the mouth?
Pseudomembranous lesions and erosions of the tongue, soft palate, hard palate and tonsils
Typically caused by Coxsackie A16 virus?
Hand, foot and mouth disease
Generally patient feels unwell first and then sore throat and spots that develop in the mouth. These usually progress to small ulcers . In ¾ cases, spots also develop on the skin
Hand, foot and mouth disease
Is scarring from shingles common?
No
Blistering rash at vermillion border?
Herpes simplex virus
- Main cause of oral lesions
- causes half of genital herpes
- causes encephalitis
HSV type 1
Rarely causes oral lesions
Causes half of genital lesions
Encephalitis/disseminated infection (particularly in neonates)
HSV type 2
Diagnosis of herpangina?
Swab of lesion, sample of stool for enterovirus PCR
Virus which causes hand, foot and mouth?
Enterovirus (especially cocksackie virus)
What usually follows an episode of erythema infectiosum (slapped cheek)?
Acute arthritis
especially wrists
Complications of parvovirus B19?
- Spontaneous abortion
- Aplastic crises
- Chronic anaemia
Lab confirmation of erythema infectiosum?
By antibody testing rather than skin swabs
parvovirus B19 IgM test
Fever, sore throat, rash, generally unwell
Diffuse erythema
Fever and rash may subside and then give rise to sore oral cavity and PETECHIAL HAEMORRHAGE
Rubella
Virus of sheep “scabby mouth” Firm, fleshy nodule on hands of farmers Constitutional symptoms rare Self limiting Clinical diagnosis, lab confirmation not used
Orf
Primary syphilis
Painless ulcers
Secondary syphilis
Red rash over body
(prominent on soles of feet and palms of hands)
-pseudomembranous lesions and erosions of the tongue, the hard and soft palate and tonsils
Tertiary syphilis
CNS, cardiovascular etc
