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Clinical Medicine II > Viral Infections Part I > Flashcards

Viral Infections Part I Flashcards

1
Q

What are some alpha herpes viruses that stay latent in neurons?

A 
HHV1 = HSV - 1 
HHV2 = HSV - 2
HHV3 = VZV
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2
Q

What does latency allow viruses to do?

A
  • Life-long infection
  • Intermittent reactivation
  • Lifelong shedding
  • Long term infection
    (Can lead to cancer)
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3
Q

What are some beta herpes viruses that stay latent in T Cells?

A

HHV5 = Cytomegalo CMV

HHV6 =
HHV7 =

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4
Q

What is the Gamma herpes virus that stays latent in B Cells?

A

HHV8 = KSV

Karposi Sarcoma Associated Herpes Virus

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5
Q

What gamma virus is HHV4 ?

A
  • Epstein Barr Virus (EBV)
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6
Q

What are the two gamma herpes viruses?

A
  • HHV4 = (EBV)

- HHV8 = (KSV)

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7
Q

What is the most common primary herpatic infection?

A
  • HSV-1

- Acute Gingivostomatitis

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8
Q

What are some S&S of HSV-1 ?

A
  • Pain
  • Bleeding of the gums
  • Ulcers with necrotic bases
  • Adenopathy
  • Fever
  • Self limited disease
  • Lasts around 14 days
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9
Q

What is herpes labialis?

A
  • Cold Sore
  • Re-occurrence of Oral HSV (Primary infection)
  • Reactivation
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10
Q

What are some prodrome signs of HSV-1?

A
  • Tingling
  • Warmth
  • Itching
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11
Q

After the prodrome signs of HSV-1, what occurs next?

A
  • 12 hours later
  • Redness
  • Papules
  • Vesicles
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12
Q

What are some associated diseases or complications with HSV-1 ?

A
  • Herpetic Whitlow (Distal fingers)
  • Encephalitis
  • Ocular herpes
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13
Q

What are some characteristics of HSV 2?

A
  • Vesicular Lesions (Clean base)
  • Pustular
  • Ulcerative
  • Involves the penis, vagina, cervix, Anus
  • Painful
  • Tender adenopathy
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14
Q

T of F

Primary infection worse than reactivation secondary infection?

A
  • True

- Primary infection typically worse than reactivation

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15
Q

What is the best test (Highest Sensitivity) for active skin lesions of HSV?

A
  • PCR > 90% sens
    Most Sensitive
  • Ag Detection 70% sens
  • Cx 30-80% sens
  • Tzanck Smear 40% sens
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16
Q

What is the best test (Highest Sensitivity) for Dx HSV encephalitis ?

A
  • PCR with CSF Fluid
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17
Q

T of F

HSV 1 and HSV 2 are the easiest viruses to cultivate?

A
  • True

- 1 to 5 days results available

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18
Q

Why is serology not useful in Dx HSV in acute phases ?

A
  • Takes 1-2 weeks before antibodies appear
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19
Q

When can you use serology to Dx a pt with HSV?

A
  • Only use IgG if you need to Dx a pt with a latent infection without skin lesions
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20
Q

What are the main reasons to treat HSV?

A
  • Primary infection is severe
  • Dissemination
  • Vision threatened
  • HSV encephalitis
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21
Q

Drug of choice to treat HSV currently?

A
  • Valacyclovir (New #1)
  • Acyclovir (Was #1)
  • Famciclovir
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22
Q

HSV perinantal infections occur during?

A
  • 1st trimester = Miscarriage

- 2nd & 3rd trimester = Premature labor

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23
Q

Can the infant contract HSV during birth?

T of F

A
  • True
  • Even in the absence of vesicles
  • Viral shedding 30 days after resolution of lesion)
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24
Q

Treatment of neonatal HSV infections consist of ?

A
  • Acyclovir
  • Systemic and Localized
  • Systemic high mortality
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25
Q

Varicella Zoster Virus characteristics?

A
  • Primary infection 4 - 10 y/o
  • Highly communicable
  • Attack rate of 90% seronegative pt’s close contact
  • Secondary attack rate 70-90% in siblings
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26
Q

When are you contagious with Varicella Zoster Virus?

A
  • 48 hrs prior to vescicles
  • Contagious
    until all lesions crust over
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27
Q

When was the VZV vaccine introduced?

A
  • Vaccine available since 1995
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28
Q

What is the point of entry of VZV?

A
  • Respiratory tract

- Spread into lymphoid system

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29
Q

What is the main target of the VZV ?

A
  • The skin

- Take 14 days (2 weeks) from date of inoculation

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30
Q

Where does the VZV remain latent following the primary infection?

A
  • Cerebral or Posterior root ganglia
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31
Q

The primary VZV rash

starts where and then spread where ?

A
  • Face

- Spreads to the trunk and Extremities

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32
Q

Herpes Varicella Virus?

A
  • Children

- Dew drops on a rose petal

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33
Q

Herpes Zoster Virus?

A
  • Adults and Elderly

- Reactivation of Varicella = Shingles

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34
Q

How many dermatomes does herpes zoster usually affect?

A
  • Single dermatome

- Wont cross mid-line

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35
Q

Where does the latent VZV reactivate?

A
  • Sensory ganglion and tracks down the nerve to the skin innervation
36
Q

What is postherpetic neuralgia?

A
  • Vesicles in the dermatome often accompanied by intense pain
  • Last for months
37
Q

Complications of Herpes Zoster Shingles?

A
  • Encephalitis

- Disseminated Zoster

38
Q

Management of Varicella ?

A
  • Self limited

- Clinically DX, labs rarely used

39
Q

Management of Varicella in immunocompromised or with serious complications (Pneumonia & Encephalitis) ?

A
  • Acyclovir / Valacyclovir

- Promptly

40
Q

Treatment of Varicella eye complications?

A
  • Ganciclovir
41
Q

Management of Zoster?

A
  • Manage post herpetic neurological (Pain)
  • Antiviral offered to all pt’s > 50 y/o (Acyclovir, Valacyclovir or Famciclovir)
  • Vaccination
42
Q

Varicella Zoster Virus Perinatal Infections early in pregnancy can cause?

A
  • Miscarriage
  • Congenital infection with growth restriction
  • Microcephaly
  • Hepatosplenomegaly leading to Neurological disabilities
43
Q

Varicella Zoster Virus Perinatal Infections late in pregnancy (3 to 5 days before delivery) can cause?

A
  • Disseminated infections at days 5-10 after birth

- High mortality 30%

44
Q

Treatment of mother is symptomatic unless pneumonia develops?

A
  • Acyclovir

- Isolation

45
Q

S&S of the prodrome phase of VZV?

A
  • Fever
  • HA
  • Malaise
  • Followed by a pruritic vesicular rash
46
Q

What is another name for HHV4 ?

A
  • Epstein Barr Virus
47
Q

How is EBV transmitted?

A
  • Via saliva

- Long kissing events

48
Q

What is the most notable EBV disease?

A
  • Mononucleosis
49
Q

What other diseases is EBV associated with?

A
  • Burkitt Lymphoma
  • Nasopharyngeal carcinoma
  • Pediatric Leiomyomas
  • Lymphoma in immunosuppressed
  • Oral leukoplakia in AIDS patients
  • Chronic interstitial pneumonitis in AIDS
50
Q

What are the two peaks of infection in developed countries?

A
  • Preschool 1-6 y/o

- Adolescents / young adults 14-20 y/o

51
Q

What percentage of the population is currently infected?

A
  • 90%
52
Q

In developing countries the EBV infection occurs earlier, by what age?

A
  • 90% of 2 y/o

- Seropositive & Asymptomatic

53
Q

EBV is associated with what type of cell?

A
  • B Cell
54
Q

What are some S&S of EBV?

A
  • Fever
    (Cytokine release due to B- Cell invasion)
  • Pharyngitis
    (B- Cell infected lymphocytes in Oropharynx)
  • Lymphocytosis
    (Proliferation of EBV infected B cells)
55
Q

What does EBV do to B-Cells?

A
  • Immortalize B-lymphocytes

- Continue in circulation

56
Q

Incubation period of EBV?

A
  • 30 to 50 days
57
Q

Triad of most common symptoms in an EBV infection ?

A
  • Fever
  • Lymphadenopathy
  • Sore Throat
58
Q

Sore throat in an EBV infection can consist of ?

A
  • Pharyngitis
  • Tonsilitis
  • Gingivitis
  • Soft palate petechiae
59
Q

Other S&S of EBV infection?

A
  • Malaise

- Muscle aches

60
Q

T of F

High risk of Splenomegaly with EBV?

A
  • True 50% of cases
  • Pt must not play contact sports
  • High risk of Splenetic rupture
61
Q

PE findings with EBV ?

A
  • Dramatic appearing pharyngitis or tonsillitis

- Tender enlarged posterior cervical nodes

62
Q

Pt develops a maculopapular rash with EBV?

A
  • Pt was accidentally treated with Amoxicillin with caused the rash
63
Q

Serious Complications of EBV?

A
  • Bacterial pharyngitis
  • Splenetic rupture
  • Pericarditis
  • Meningitis
  • Encephalitis
64
Q

Less common complications of EBV?

A
  • Hepatitis
  • Mono-neuropathy
  • Aseptic meningitis
  • Myositis
  • Renal failure
65
Q

Differential Dx for EBV in a pt with

Fever, Pharyngitis & Lymphadenopathy ?

A
  • Streptococcal infection
  • Cytomegalovirus
  • Acute HVI
  • Toxoplasma infection - RARE
66
Q

Dx of EBV includes?

A
  • Increase in granulocytes - Followed by lymphocytic leukocytosis
  • Atypical lymphocytes
  • Hemolytic anemia and thrombocytopenia
  • Mono spot positive in 4 weeks
  • Increase in LFTs and Total bilirubin
67
Q

Treatment of EBV?

A
  • 95% self limited without therapy
  • NO ANTIBIOTICS
  • Corticosteriods only for certain cases
  • Antivirals only for certain cases
  • NSAIDS for Pain and Fever
  • No contact sports
68
Q

When are corticosteriods used when treating EBV?

A
  • Pts with mononucleosis EBV
  • and

1) Airway obstruction
2) Severe Thrombocytopenia
or
3) Severe hemolytic anemia

69
Q

When are antivirals used to treat EBV?

A
  • Acyclovir or Ganciclovir
    in Transplant patients
  • Not for treatment of simple mononucleosis
70
Q

What is mumps?

A
  • Highly contagious
  • Preventable by vaccination
  • Belongs to the genus Rubula virus
71
Q

When is the peak incidence of mumps?

A
  • Late winter to Early spring
72
Q

Who is at high risk of mumps?

A
  • Most commonly infected school-aged children and young adults
73
Q

T of F

Maternal antibodies protect infants from mumps?

A
  • True
74
Q

Mumps S&S include?

A
  • Fever
  • Headache
  • Myalgia
  • Fatigue
  • Followed by Parotitis
75
Q

Most common symptom of mumps?

A
  • Swollen Parotid gland (Parotitis)
76
Q

Most common complication of Mumps?

A
  • Orchitis (Swollen testicle or both Inflammation)
77
Q

Other complications of mumps?

A
  • Meningitis
  • Encephalitis
  • Deafness
78
Q

How do you test for mumps?

A
  • Buccal swab with PCR (preferred)

or

  • Serum mumps immunoglobulin (Ig)M antibody
79
Q

What is the treatment for mumps?

A
  • Supportive care

- Self limited

80
Q

What is measles?

A
  • Measles is a respiratory disease
  • Very contagious
  • Preventable with vaccination
81
Q

Number of measles cases reported in 2014, 2018 and so far as of March 2019?

A
  • 2014 = 667
  • 2018 = 372
  • 2019 = 387
82
Q

Measles hallmark sign?

A
  • Koplik Spots Pathognomonic for measles
83
Q

Symptoms of measles included?

A
  • Fever
  • Cough
  • Runny nose
  • Red watery eyes
  • Tiny white spots in mouth (Koplik Spots)
  • Rash from head to toe
  • 3-5 days after symptoms, rash breaks out
84
Q

Complications of Measles?

A
  • Diarrhea
  • Otitis media
  • Pneumonia
  • Encephalitis
  • Blindness
  • Subacute Sclerosing Panencephalitis (Progressive Neurological disorder)
85
Q

How do you test for Measles?

A
  • IgM AB serum assay standard

- May also do viral culture / PCR

86
Q

Treatment of Measles includes?

A
  • Symptomatic

- Children & infants, high dose Vitamin A

87
Q

When can you give a prophylaxis treatment for suspected measles post exposure?

A
  • Given within 72 hours of exposure in unvaccinated pt’s

Clinical Medicine II (9 decks)

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