Viral Skin Infection - Diebel

Question 1

What units is the capsid made of in the virion?

Answer 1

Capsomers

Question 2

Describe the 3 classes of DNA viruses in the Baltimore classification system:

Answer 2

Class 1 - dsDNA, Classic semi-conservative
Class 2 - ssDNA, Semiconservative, discard the (-) strand
Class 7 - dsDNA, transcription followed by reverse transcription

Question 3

Describe the 4 classes of RNA viruses in the Baltimore Classification System:

Answer 3

Class 3 - dsRNA, transcibe (-) strand
Class 4 - ssRNA(+), used directly as mRNA
Class 5 - ssRNA(-), makes ssRNA(+)
Class 6 - ssRNA(+), makes ssRNA(+) by reverse transcription and a double stranded intermediate

Question 4

Basic description of HPV:

Answer 4

Human Papilloma Virus
Site: epithelial cells/mucous membranes (Warts on genitalia and hands) can lead to cancer

non-enveloped, circular genome, dsDNA

Viral proteins block Rb and p53

HPV vaccine

Question 5

Basic description of poxviruses:

Answer 5

various rashes - severe ones include multiple organs
bar-bell shaped

Molluscan contagiosum
-autoinoculation (one lesion spreads to other parts of the body via scratching)
-limited to the epidermis, no dormant state (trunk and anogenital regions)
often seen in AIDS patients
-Presentation: pearly skin papules and nodules forms craters

Smallpox

• rash (macules—vesicles).
• Pathology: (1) Inhalation: upper respiratory epithelium, enters the bloodstream establishing primary viremia. Infects organs, back into blood (secondary) (2) Skin infection and replication within epidermis, macules on head spread to extremities, macules become vesicles, crusts form -detection = serology Treatment = vaccination

Orf Virus

• presentation: exanthemous disease causing denuded lesions.
• Pathology: Zoonotic, direct contact with infected sheep or fomites carrying virus.
• Local, purulent-appearing papule.
• Diagnosis: history/clinical presentation.
• Treatment: topical cidofovir

Question 6

What are the important herperviruses we need to know?

Answer 6

Varicalle zoster
Herpes Simplex Virus 1
Herpes Simplex Virus 2
Roseolovirus
Epstein Barr Virus

Question 7

Basic Description of Varicella Zoster:

Answer 7

varicella Zoster (chickenpox) or 
Herpes Zoster (shingles). 

• Pathology: Contracted from respiratory secretions or contact with ruptured vesicles
• 2 week incubation.
• Flu-like symptoms
• “dew on a rose petal”
• resolves within 2 weeks
• Latent infection of the dorsal root ganglion. Stress or immunocompromised individuals can lead to viral reactivation
• rash appears over the sensory dermatome
• Treatment: supportive, acyclovir (severe), live-attenuated VZV vaccine

Question 8

Basic Description of Herpes Simplex Virus 1:

Answer 8

• sporadic encephalitis (adults).
• Clinical presentation: Gingivostomatitis, -keratoconjunctivitis, cold sores (labialis). -Pathology: Humans are the only reservoir for this virus, transmitted via saliva—mucous membranes. -The primary infection resolves after 2-3 weeks.

The virus enters sensory ganglion cell bodies to establish latent infection.
Treatment: acyclovir

Question 9

Basic Description of Herpes Simplex Virus 2:

Answer 9

• Clinical presentation: genital herpes or neonatal herpes.
• Pathology: Human reservoir, transmission via sexual contact. Mucous membranes, asymptomatic, vesicular lesions in the genital area. -Possible transmission to unborn child.

Diagnosis: detection of virus (PCR), Tzanck. Treatment: acyclovir.
Prevention: cesarean section in infected mothers.

Question 10

Basic Description of Roseolovirus:

Answer 10

Clinical presentation: exanthema subitum, sudden high fever. reactivation can occur in organ transplant patients leading to enchepalitis, bone marrow suppression.

Pathology: Children: 3mo-3yrs, aerosol transmission
Diagnosis: clinical presentation.
Treatment: Ganciclovir

Question 11

Basic Description of Epstein Barr Virus:

Answer 11

-patients with infectious mononucleosis are at risk for splenic rupture.
Clinical presentation: “kissing disease”. Pathology: transmitted by saliva and respiratory secretions. Infects the oropharynx epithelium. Infects B cells—transformed and multiply—lymph nodes and spleen enlarged due to immune response.
Diagnosis: monospot test- heterophil antibody, anti-EBV IgM (acute), IgG (past)

Question 12

Viruses are sometimes boring… Can you think of anything exciting about the parvovirus?

Answer 12

in immunodeficiency patients parvovirus infection can lead to chronic severe anemia

Clinical presentation: erythema infectiosum (5th Disease)
5th disease is pretty exciting! Right?

Question 13

Referring to herpes viruses again, what do the alpha beta and gamma mean?

Answer 13

Herpes viruses infect you for life and often hide in areas until a reactivation event

Alpha – in nerve cells
Beta - Bone marrow
Gamma – in b cells

Question 14

What are two important examples of flaviviruses?

Answer 14

Dengue Fever

West Nile

Question 15

Describe Dengue fever - real simple-like:

Answer 15

“tropical”
Clinical presentation- “breakbone fever” (flu-like with severe joint and muscle pain).
Pathology: mosquito bite

First - Infects macrophages causing acute inflammation pyrogens and pain mediators released
Second - antibodies from 1st increase and cross-react to form immune complexes and a type III hypersensitivity reaction→ hemorrhage and shock.

Treatment: prevention against mosquito bites

Question 16

West Nile Virus, what is it’s deal?

Answer 16

• most infections asymptomatic
• Can have fever, fatigue, headache, myalgia, anorexia, eye pain, nausea, vomiting, diarrhea, rash.
• West Nile encephalitis- neuroinvasive disease causing encephalitis (elderly) or meningitis (children). May progress to coma or death.

Pathology: Mosquito - Spreads to human host and replicates in the skin Langerhans cells → regional lymph nodes -→viremia and infects multiple organs (CNS).

Treatment: prevention/ supportive.

Question 17

Let’s say you have a young patient that didn’t get vaccinated because the child’s parents love Jenny McCarthy….

The child has had flu symptoms for a couple days along with some small white pustular lesions on the buccal mucosa inside her mouth

The parents bring her in today because she has a red maculopapular rash.

What is your diagnosis?

Answer 17

Measles!

Tell the parents they need to get her an MMR and help them realize they could have infected a lot of people for being so inconsiderate of their child and others.

Question 18

How would you know if a child has Rubella?

Answer 18

Clinical presentation: fever followed by descending rash.

Pathology: aerosol transmission, infects nasopharynx,replicates in lymph nodes.

Antibody mediated reaction leads to maculopapular rash

no MMR? that’s a good clue

Question 19

Basic description of Coxsackievirus A&B?

Answer 19

Hand-foot-mouth disease: vesicles in young children.
Clinical presentation:
A: herpangia-HFM = an infection of the throat which causes red-ringed blisters and ulcers on the tonsils and soft palate, the fleshy back portion of the roof of the mouth.

B: pleurodynia, myocarditis, A&B aseptic meningitis, paralysis, upper respiratory tract infection.

Pathology: summer/fall, aerosols or fecal-oral route. Travels in the GI tract and infects mucosal epithelial cells. Viremia, lyse skin and mucosal epithelium. (B: travels to heart)

Treatment: anti-inflammatory agents. No antivirals/vaccines available

Question 20

Tell me about the ECHO virus:

Answer 20

Clincal presentation: acute febrile illness often in male children.
Pathology: fecal-oral route, infection in neonates can be fatal. Myocaditis complication in adult infections.
Typically nonspecific infection with fever (rash face down to neck).
Diagnosis: Serology
Treatment: new antiviral