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Dermatology Pathology > Viral Infections of the Skin > Flashcards

Viral Infections of the Skin Flashcards

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1
Q

What are the two types of Herpes Simplex (HSV) and where are they typically found?
• what percentage of adults have abs to these?

A

HSV-1
• Perioral, Lips, Oral Cavity
• 85% of adults have antibodies to this virus

HSV-2
• Genital
• 20-25% of adults have abs to this

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2
Q

HSV
• How is it spread? when do you realize you got it?
• Where does it go?
• When can you get infected?

A

Spread via SKIN to SKIN contact and symptoms appear 3 to 7 days after exposure. It spreads most often via sensory nerves to Ganglia where the infection can be latent.

Infection can happen during Recurrences and during Asymptomatic Viral Shedding

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3
Q

What type of genome does HSV have?

A

HSV has a dsDNA genome

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4
Q

How does a primary Herpes Simplex infection feel?
• compare a recurrent infection to this.

A

Primary Infection:
• Pain, Burning, Tingling, Fever, Mailase, LAD

Recurrent Infection:
• Milder

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5
Q

What are some Triggers of HSV?

A
  • Fever
  • Sun exposure (cold sores)
  • Stress
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6
Q

**What are some key features that you need to look for in Herpes Simplex Infections?

A
  • Monomorphous Vesicles with an ERYTHEMATOUS BASE (very important for differentiating it from other conditions)
  • punched out (cookie cutter si

milarity) erosions and crusted papules

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7
Q

What key feature is seen here?
• what is this?

A

Erythematous Background to cookie cutter pustules

This is Herpes Simplex I most likely

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8
Q

What type of herpes is this?

A

Genital Herpes = HSV-2

HSV-1 shown below on lips (crusty)

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9
Q

Somone presents with this lesion. What do you do to confirm the diagnosis?
• what are you looking for?

A
  • Open a fresh vesicle to do a Tzanck Smear and you’re looking for **multinucleated giant cells to confirm the dx
  • You can also do aViral Culture or PCR**
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10
Q

You need to culture HSV to confirm the Dx. Until cultures come back what else could be in your differential?

A 
Impetigo (top) 
Aphthous Stomatitis (middle) 
Syphilitic Chancre (bottom)
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11
Q

A person got a Tzank smear that showed this?
• significance?

A

They have Herpes

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12
Q

How do you treat HSV?
• Mild?
• Severe?

A

Mild HSV:
• Topical Antiviral

Moderate to Severe HSV:
• Systemic Antiviral (oral or IV)

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13
Q

Herpes Zoster (VZV)
• what is it?
• What are the chances of getting this?
• Who is at the greatest risk of getting this?

A

Herpes Zoster = Shingle => Reactivated VZV

Risk of Reactivation is 20-30%:
• People over 60 and the Immunosuppressed are at extremely high risk

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14
Q

Where does Varicella (herpes) Zoster Virus hide?
• what is the genome like for this virus?
• what are some triggers?

A

VZV sits latent in the dorsal root ganglion its a dsDNA virus

Triggers:
• Trauma
• Stress
• Fever
• Radiation
• Immunosuppression

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15
Q

How does someone typically present with a Herpes Zoster reactivation?

A

Often they have pain, itching, and burning before the lesions appear (may in their back etc.)aka PRODROME. When lesions do appear they are dermatomal (b/c this virus lives in nerves). Most often this occurs on the TRUNK.

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16
Q

What location can VZV reactivate in that is particularly dangerous?
• what are some associated complications?
• How often does this happen?

A

Trigeminal Nerve Reactivation -> Happens in 10-15% of cases
V1 Opthalmic Distribution Reactivation:
• Nasociliary Branch
• BLINDNESS

V2 and V3:
• Facial Palsy
• Tinnitus, Vertigo, Deafness

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17
Q

Why should you be worried when someone has Shingles and you see vesicles at the tip of their nose?

A

This is Hutchinson’s Sign. It indicates that the reactivation is in the V1 branch of trigeminal and blindness could be a complication.

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18
Q

How long does it take Shingles to Resolve?
• are there any long-term consequences?

A

Takes 3-5 weeks to resolve typically

Postherpetic Neuralgia occurs 5-20% of the time (mostly in people over 40)

19
Q

What characteristics let you know that this is Herpes Zoster (shingles)?

A

Single Dermatome affected

See below for opthalmic nerve reactivation of VZV

20
Q

What is a key way to differentiate Herpes Simplex from Herpes Zoster?

A

Herpes Zoster STAYS in a DERMATOME, Simplex does not stay in a dermatome. Simplex is also less painful.

21
Q

How would you confirm the diagnosis of Herpes Zoster?

A
  • *Tzanck Smear** (mutinucleated giant cells)
  • *Viral Culture** (not practicle for VZV)
  • *PCR**
22
Q

What is the treatment for Shingles?
• What can you do to prevent it? how effective is this?

A

Shingles
• Treat withing 72 hours with Oral Antiviral
• Pain Meds needed

Prevention:
• Vaccine for all people 60 years and older
• Decreases risk by 1/2 and neuralgia by 2/3

23
Q

Molluscum Conatgiosum
• genomic structure
• Transmission
• duration of infection

A

Molluscum Contagiosum = POX VIRUS
• Large dsDNA virus with CYTOPLASMIC inclusions

Transmission:
• Skin to Skin or autoinoculations/fomites

Duration:
• Infection may resolve completely in Months to Years

24
Q

What does Molluscum Contagiosum look like?
• common locations?

A

Key Features of MC:
• Pink to Skin colored 2-10mm DOME-SHAPED WAXY PAPULES
• ± central umbilication (important feature but not always present)

Commonly found on:
• Chest, Face, Extremities

25
Q

What key features are seen here?
• disease?
• what’s in your differential?

A

Molluscum Contagiosum from Pox dsDNA complex structured virus

Important notes:
• Waxy dome-shaped papules without central umbilication in this case

Differential:
• Acne
• Folliculitis

26
Q

What is shown here?
• Infection?

A

Molluscum Contagiosum: Waxy Papules WITH central umbilication

• NOTE this is NOT a superimposed bacterial infection, instead it suggests that the immune system is responding to the infection and it may soon resolve

27
Q

How do you rule Acne and Folliculitis out of the DDx for Molluscum Contagiosum?

A

Acne:
• has comedones that LACK umbilication

Folliculitis:
• Papules or Pustules, no umbilication

NOTE ALSO that BOTH OF THESE CONDITIONS MUCH OCCUR AT A HAIR FOLLICLE, Molluscum contagiosum does not.

28
Q

What is the preferred Treatment for Molluscum Contagiosum?
• what is it?

A

Cantharidin
• Chemical Vesicant - may cause minor pain and erthema but is pretty effective and typically painless

29
Q

What Virus is responsible for Warts?
• Genome?
• How is it transmitted?

A

HPV causes warts small circular dsDNA virus in an icosahedral capsid

Transmission:
Can occur directly via Hetero or Autoinoculation OR indirectly via Fomites may get on warm, moist surfaces like towels and get on you like that

30
Q

What stains of HPV are known to be oncogenic?
• does gardasil cover these?

A

16, 18, 31, 33 are oncogenic genotypes but only 16 and 18 are covered by gardasil which covers (6, 11, 16, and 18)

31
Q

How does the Transmission of HPV occur?
• how long before you are symptomatic?
• is it lifelong? If not how do we combat it?

A

HPV is transferred from fomite or directly into TRAUMATIZED skin (so that it can infect the stratum basal). It then incubates for 1 to 6 months and after 2 years about 67% of these resolve as a result of cell mediated immunity (CTLs).

32
Q

What are the 4 types of Warts caused by HPV?

A
  • Verrucae Vulgaris (common warts)
  • Verrucae Plantaris (plantar warts)
  • Verrucae Plana (flat warts)
  • Condylomata Acuminata (angogenital warts)
33
Q

How do common warts (HPV) present?
• Key clues to Dx?

A

Most common these are on the hands (either periungula or subungual, but could be on ANY mucosal surface) and may be single or multiple skin-colored hyperkeratotic papules and/or plaques that are Dome shaped, Exophytic, or on a filiform stock.

Clues to Dx:
• Black Dots (seeds) from thrombosed capillaries on paring the surface
• Disruption of normal skin lines

34
Q

What type of wart is shown here?

A

Common wart -> Filiform Variant (typically found on the face)

35
Q

What is shown here?
• key features?

A

These are FLAT WARTS

Keys:
• Smooth Skin-colored to slightly tan/pink flat-topped thin paules and/or plaques

36
Q

What should you advise your patient with these NOT to do?

A

Don’t Shave over the Flat Warts b/c that just facillitates the spread

Note how the patient here has scratched to facillitate spread in a linear fashion by damaging the tissue and allowing viral entry

37
Q

Plantar Warts
• Typical location?
• Symptoms?
• Wart characteristics?

A
38
Q

What is this?

A

Plantar Warts

Close-up below

39
Q

What is this?

A

Corn - NOT a plantar wart (no thrombosed capillaries)

40
Q

What is this?

A

Talon Noir - just hemmorhaged blood at pressure points

41
Q

What are the mechanisms of transmission for Antogenital Warts?

A
42
Q

How do anogenital warts typically appear?

A
43
Q

Anogenital Warts

A
44
Q

What is the treatment for Anogenital warts?

A

Dermatology Pathology (10 decks)

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