Viral infectious diseases Flashcards
How does rhinovirus present?
non-specific URI symptoms: fever, malaise, sneezing, nasal congestion (WATERY), sore throat, hoarseness, cough, may have lymphadenopathy
Usually 10 days or less
What would you find on a PE of rhinovirus?
inflamed mucosal surface
What would you recommend for management of rhinovirus?
supportive care! saline wash, NSAIDs, rest, fluids, decongestants, cough suppressants for over 6
What do you NEVER GIVE to kids with a virus?
aspirin
What does giving a kid aspirin with a virus put them at risk for?
Reye syndrome = rapid liver failure
What are the different types of influenza and how do they differ?
A, B, and C
A - mammals
B&C - just humans! with C being more mild
What is the presentation of influenza?
sudden onset of fever, chills, malaise, headache, myalgias especially in the lower extremities and back. May have URI symptoms - sore throat, enlarged cervical nodes, congestion, non productive cough
May have GI symptoms
Which flu commonly has GI symptoms?
Type B
Who is at risk for serious complications of influenza?
asthmatics, nursing home residents, >65, comorbidities, pregnancies
What may you see upon PE of an influenza patient?
May have rales, rhonchi, wheezing. Be aware that consolidation = complication of pneumonia
How can you diagnose influenza?
rapid nasal tests, CBC, PCR
When should you suspect a secondary bacterial infection from influenza?
> 4 days with a productive cough and WBC>10k
How do you manage influenza?
Flu A/B: Oral oseltamivir (NO FOR RISK OF GI BLEEDING)
oral baloxavir (NO pregnancy, <5, immunocomp)
inhaled zanamivir (NO asthma, small children)
IV peramivir (NO children)
chemoprophylaxis
When is chemoprophylaxis a good option for influenza?
early on. Not really beneficial after 48 hours of onset.
REVIEW: herpes simplex virus
cold sores, genital herpes, can have neuralgia, regional lymphadenopathy, treat with anti-virals! consider recommending sunscreen and condoms!!
Does herpes simplex virus have a risk of congenital defect with birth?
YES. It is the H in TORCH and infants are at risk for complications
What are good diagnosis tools for herpes simplex (and other herpes as well)?
fluorescent antibody, viral culture, PCR, Tzanck smear
REVIEW: varicella
trunk –> outwards, “dew drop on a rose petal”, highly pruritic!!! and make sure to isolate patient, consider mitts, and symptomatic treatment!
acyclovir >12 years, calamine lotion for itching, antihistamines
Is varicella dangerous in pregnancy?
YES. Can cause congenital abnormalities
REVIEW: herpes zoster
unilateral along a dermatome of vesicular rash, prodromal tingling, numbness. If involves eyes, REFER. Antivirals!! Corticosteroids can help with lesions
How do you manage post-herpetic neuralgia?
gabapentin, lidocaine, tricyclic antidepressants, capsaicin cream
REVIEW: HPV
warts!! Can be reactivated with smoking, hormonal changes. Can cause cancer
Treat with salicylic acid, cryotherapy, imiquimod, excision, podophyllum resin for men in genital area
How does EBV present?
fever, sore throat, fatigue, malaise, anorexia, myalgia. potentially maculopapular rash similar to hives or petechiae
What happens if EBV is treated with amoxicillin?
diffuse erythematous rash develops in 80% of cases
In what age group is EBV most common?
12-19
What is EBV?
herpes virus 4
What would you see on PE of EBV?
pharynx – enlarged tonsils, exudate, petechiae
Lymphadenopathy
Uvular edema
Splenomegaly (50%), hepatomegaly (10-20%), urticarial/maculopapular (5-15%)
How can you diagnose EBV?
monospot (heterophile test), IgM antibody (IgG will persist for life)
How do you manage EBV?
NO contact sports for 4 weeks due to risk of splenic rupture
supportive - fluids, NSAIDs, rest
resolves in 2-4 weeks
What is the presentation of mumps?
prodrome of fever, malaise, body aches followed in 48 hours with parotid tenderness, facial edema (1 before another), may involve salivary glands
7-10 days after onset: post-puberty of fever, testicular pain/swelling, erythema of scrotum (men), lower abdominal pain, fever, vomiting (women)
For unvaccinated individuals of mumps, what more severe involvements can occur?
involvement of testes, pancreas, meninges
What is the leading cause of pancreatitis in children?
mumps
What is the virus of mumps?
paramyxovirus
How do you diagnose mumps?
test serum amylase (elevated), mild kidney injury, elevated IgM, swab the gland
When should you consider admission for mumps?
trismus, meningitis, encephalitis, myocarditis, severe abdominal pain, vomiting (pancreatitis), testicular pain, thrombocytopenia
How do you manage mumps?
isolate until swelling subsides (~9 days), bed rest during febrile period
symptomatic treatment, topical cool compresses, pain management
REVIEW: erythema infectiosum
5th’s disease, slapped cheek appearance, truncal symmetric rash –> extremities, distinctive lacy, reticulated rash
“Parvrovirus B19”, IgM antibody to parvrovirus supportive care, contagious only before rash
What is the greatest risk with erythema infectiosum?
miscarriage
What are adult specific erythema infectiosum symptoms?
mylagia, arthralgias/arthritis, coryza, HA, GI upset
REVIEW: roseola
high fever>40 with abrupt onset URI symptoms, congestion, cough, N/V, diarrhea, rose-colored rash, TRUNK–> extremities, infants, type 6 and 7, supportive treatment!
What’s associated with 1/3 of febrile seizures?
roseola (6th’s disease)
REVIEW: rubeola
prodromal 3 Cs followed by brick red macular rash starting face and going down, can be confluent, Koplik spots, “paramyxovirus”, supportive treatment, Vitamin A, isolate for 4 days after rash onset
Do you report measles?
Yes. and rubella.
REVIEW: rubella
can be asymptomatic, if not, fever, malaise, LYMPHADENOPATHY, forehead down rash with rapid progression, Forchheimer spots, “Togavirus”, supportive treatment!
What is the presentation of cytomegalovirus?
mainly asymptomatic or acute fever, malaise, myalgias, arthralgias, splenomegaly, rash is common (esp with amoxicillin), ~7-8 weeks
Who are at risk for cytomegalovirus?
older age, lower socioeconomic status, employed in child-care, sexual partners/ Hx of STIs
How can cytomegalovirus be spread?
sexual contact, breastfeeding, blood products.. C IN TORCH. Congenital risk!
What can be associated with hospitalization and death in critically ill?
cytomegalovirus
How do you diagnose cytomegalovirus?
abnormal liver tests, detect with IgM, IgG… LOTS OF COMPLICATIONS
How do you treat cytomegalovirus?
supportive or for immunocompromised: PO valganciclovir or IV ganciclovir; monitor meds for kidney dysfunction risk and continued until CD4 is in range
What is the presentation of congenital cytomegalovirus?
hearing loss in more than 50% of infants, jaundice, hepatosplenomegaly, thrombocytopenia, microcephaly, mental retardation, motor disability
can spread from mom!
Where can pregnant women get cytomegalovirus?
their young other children that attend day care
How do you diagnose CMV?
any moms with high risk exposure – baseline CMV serology and repeat
Congenital is confirmed with amniotic fluid test or IgM assay, infants with PCR
How do you treat congenital CMV?
IV ganciclovir or valganciclovir for 6 months to improve hearing/developmental outcomes
anti-retroviral therapy in HIV patients
What is the presentation of rabies?
Hx of animal bite and prodrome, pain, fever, malaise, HA, N/V, sensitive to temp change, followed by 10 days after of CNS symptoms like delirium, laryngeal spasms, hyperventilation, seizures, paralysis leading to coma and death
What causes rabies?
viral encephalitis from infected saliva “rhabdovirus” from animal bite
How do you diagnose rabies?
fluorescent antibody testing of skin biopsy material of brain stem, cerebellum, saliva PCR
CALL HEALTH DEPT
How do you manage rabies?
post-exposure prophylaxis is almost 100% effected, active rabies = intensive care of airway management oxygen control…seizures, death inevitable
What is the presentation of West Nile virus?
acute fever and flu-like symptoms with risk of meningitis, encephalitis (AMS, tremor, seizure, CNP, pathologic reflexis, paralysis)
Who are at risk for West Nile virus?
very young or very old, immunocompromised, at risk for neuro disease
What causes and spreads West Nile virus?
athropod-borne arbovirus….mosquitoes
Do you report west nile virus?
yes
How do you manage west nile virus?
supportive treatment, but severe = hospitlization
How do you diagnose west nile virus?
IgM ELISA or CSF fluid test
In CSF = neuroinvasive disease
What is the presentation of Ebola virus?
hemorrhagic fever with dizziness, malaise, fatigue, myalgia, arthralgia with GI symptoms and subsequent neurologic symptoms and hypovolemic shock; can be from Africa travel
What’s the ebola virus called?
filoviridae
What helps diagnose ebola virus?
low immune system function - low plaetlets, electrolyte imbalance, hypoalbuminemia, leukopenia
RT-PCR, IgM ELISA
How do you treat ebola virus?
isolate, support with IV fluids and anticipate complications
70% mortality
What is the presentation of Zika virus?
acute onset low grade fever, pruritic rash on face, trunk, extremeties, palms, soles, athralgia, conjunctivitis, malaise, fatigue and causing SEVERE birth defects; mostly caused from travel!
What birth defects does Zika virus cause?
microcephaly, face disproportion, hypertonia, hyperreflexia, seizures, arthrogryposis, hearing loss
What virus is the Zika virus?
flavivirus
How do you diagnose the Zika virus?
Rt-PCR and Zika IgM
Infants = head US, hearing, CSF, PCR testing
Screen pregnant women if they have exposure Hx. If they do, screen for symptom Hx. If they do, TEST
How do you treat Zika virus?
prevention is key!
rest and symptomatic treatment
NSAIDs should be avoided >32 weeks of gestation
