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Case 13: FASD > Virology: Childhood Infections > Flashcards

Virology: Childhood Infections Flashcards

1
Q

What type of infection is measles

A

RTI

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2
Q

When is measles highly infectious

A

4 days pre & 5 days post rash

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3
Q

What is the pathogenesis of measles

A
  1. Virus infects respiratory mucosa/conjunctiva & local replication & lymphatic tissue spread
  2. Dissemination through blood circulation occurs resulting in the 1st viraemia
  3. Mild rash & Koplik’s spots present
  4. Typical rash appear & Koplik’s spots disappear & symptoms worsen
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4
Q

What is the 4 symptoms of measles

A

Cough
Fever
Rash
Conjunctivitis

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5
Q

What is the 2 types of diagnosis for measles

A

IgM or PCR
Urine, blood or respiratory swab

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6
Q

What is the 4 complications of measles

A
  1. Secondary infections like bacterial pneumonia, croup & otitis media
  2. Giant cell pneumonia (immunocompromised)
  3. Meningitis (AMPE, MIBE & SSPE)
  4. Atypical measles (previous ineffective vaccine)
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7
Q

What is the 4 management stragies for measles

A
  1. Isolation
  2. Notification to control spread & vaccination campaign
  3. Symptomatic support
  4. Antibiotics for secondary bacterial pneumonia
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8
Q

What is the 2 prevention strategies for measles

A
  1. Vaccine (part of EPI)
  2. Eradication & notification
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9
Q

What is AMPI

A

Acute measles post infectious encephalitis due to auto immune reaction against basic myelin proteins causing demyelination of
neurons

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10
Q

What is the 5 symptoms of AMPI

A

Fever, headaches, seizures, ataxia & coma

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11
Q

When does AMPI occur

A

Rash still present & within 8 days of onset

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12
Q

What is SPPE

A

Subacute sclerosing panencephalitis that is rare, progressive & fatal

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13
Q

When does SPPE start

A

Starts 6-8 years after initial infection (can take 20-30 years) with higher risk if had measles before age of 2

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14
Q

What is 5 complications of SPPE

A

Decrease in intellectual functioning
Psychological problems misdiagnosed
Visual & speech disturbance
Myoclonic jerks & convulsions
EEG changes

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15
Q

Who is at greater risk for SPPE

A

Males

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16
Q

What is used for diagnosis of SPPE

A

High CSF IgG levels

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17
Q

What is the virological factors of SPPE

A

Deficient or mutated virus causing infection

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18
Q

What is the immunological factors of SPPE

A

Antibodies found in CSF inhibit certain viral function

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19
Q

What is MIBE

A

Measles inclusion body encephalitis

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20
Q

What is similarity & difference between MIBE & SPPE

A

Both are defective disease
MIBE is in immunocompromised

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21
Q

Who is at greater risk for MIBE

A

Children receiving radiation for leukemia

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22
Q

What is the 10 clinical presentations of MIBE

A

Gradual decline in intellectual abilities
Behavioral alterations
Progressive myoclonus
Muscle spasticity
Hemiplegia
Seizures
Dementia
Autonomic dysfunction
Ataxia
Blindness

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23
Q

What is the time for clinical presentation in MIBE

A

Progressive, slow onset & always fatal

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24
Q

What worsens MIBE mortality

A

HIV

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25
Q

What type of infection is mumps

A

RTI

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26
Q

What is the pathogenesis of mumps

A
  1. Enters & replicate at mucosa of URT & eye
  2. Spreads to local lymphoid tissue
  3. Primary viraemia (salivary glands, pancreas, testes, ovaries & CNS)
  4. Secondary viraemia (further spread)
  5. Excreted in urine (diagnosis)
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27
Q

What is the 6 symptoms related to mumps

A

Fever
Malaise
Headache
Myalgias
Anorexia
Infective glands

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28
Q

What glands does mumps infect

A

Salivary glands: parotitis (uni-/bilateral, 7-8days)
Testes/ovaries
Pancreas (pancreatitis)

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29
Q

What is the 3 complications of mumps

A

CNS disease: meningitis (aseptic) encephalitis & deafness
Pancreatitis: resulting in DM1
Testes: orchitis leading to sterility in post-puberty men

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30
Q

What is the prevention for mumps

A

Vaccine

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31
Q

What is the 4 diagnostic tests for mumps

A

Clinical
IgM
PCR of urine
PCR on CSF for meningitis

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32
Q

What type of infection is rubella

A

RTI

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33
Q

What is the pathogenesis of rubella

A
  1. Droplet spread infecting URT
  2. Spreads to lymph nodes causing primary viraemia
  3. Spread to skin, RT & joints (especially female)
  4. Post infection autoimmune encephalitis
  5. Slows down cell division in fetus
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34
Q

Why does rubella have such a significant effect on fetal development

A

Rubella does not kill the fetus but slow down cell division & lower total cell number resulting in small babies

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35
Q

What is the effect of rubella in first trimester of pregancy

A

Interference with death of cells/slow down mitotic rates interferes with organ development

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36
Q

What is the prevention strategies for rubella

A

Vaccine in EPI 6 & 12 months

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37
Q

What is the triad of symptoms in congenital rubella

A

Neurosensory deafness, cataracts & heart defects

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38
Q

What is 2 other symptoms also common with rubella

A

Microcephaly & late type 1 DM

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39
Q

When is the higher risk for abnormalities with rubella infection

A

1st trimester

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40
Q

When is the low risk for abnormalities with rubella infection

A

After 18 weeks

41
Q

What is the incubation period for rubella in children/adults

A

2-3 weeks & subclinical (unaware of spread)

42
Q

When are adults & children infectious with rubella

A

7 days before & after rash appears

43
Q

What is the 4 symptoms associated with rubella in adults & children & when does it occur

A

Day 3: maculopapular rash on face, trunk & limbs
Day 6: rash fades & generalized lymphadenopathy
Arthritis (post-pubertal female)
Encephalitis rare

44
Q

What is the 4 diagnostic test used for rubella in adults & children

A

IgM
IgG seroconversion (difficulty)
IgG avidity testing (differentiate primary & secondary infection, in pregnant)
PCR/culture (respiratory, urine or amniotic fluid)

45
Q

What is the 2 diagnostic test used for rubella in newborns

A

PCR on urine
IgM
Immediately after birth pre-rubella exposure (2-4 week

46
Q

What type of infection is varicella HHV3

A

RTI

47
Q

What is the 3 diagnostic tests used in HHV 3

A

Clinically
CSF, respiratory, vesicle fluid
IgM

48
Q

What is the incubation period for HHV3

A

21 days

49
Q

What is the clinical feature of HHV3

A

Rash on face, scalp & trunk & spreads to limbs

50
Q

What is the development of lesions in HHV3

A

3-6 days of new lesions developing
Lesions crust after 48 hours (old & new lesions at the same time)
All lesion crusted, no longer infectious

51
Q

Where is the latency of HHV3

A

Sensory ganglia

52
Q

What is 6 complications of HHV3

A

Varicella pneumonia
CNS/eye disease
Secondary bacterial pneumonia
Skin infections & scarring
Vasculitis: common cause of pediatric stroke
Hemorrhagic stroke

53
Q

When is a neonate at risk of developing varicella

A

Mother has rash 5 days before or after delivery (fetus at risk, severe & can be fatal)

54
Q

What is the prophylactic treatment for HHV3

A

VZIG & acyclovir to newborn

55
Q

When does congenital varicella occur

A

at week 20-32

56
Q

What is the 3 complications of congenital varicella

A

Skin scarring
Limb hypoplasia due to scarring
Eye abnormalities

57
Q

When does varicella zoster/shingles occr

A

Reactivation of VZV
Cellular defect: atrophy, stress, steroid or HIV

58
Q

What is the risk factor for VZV reactivation

A

Incidence increase with age

59
Q

Is varicella zoster more likely to disseminate or stay localised

A

Disseminate

60
Q

What is the diagnostic test for varicella zoster/shingles

A

Clinical

61
Q

When does disseminated zoster occur

A

Immunocompromised patients

62
Q

In what 2 things does disseminated zoster result is

A

Multiple dermatomes
Hematogenous spread with visceral involvement (lead to death due to
encephalitis, hepatitis or pneumonitis)

63
Q

What does HHV6 & 7 cause

A

Roseola infantum

64
Q

What is Roseola infantum

A

Childhood rash <1 year (resembles rubella/measles rash)

65
Q

What 4 things does HHV6 & 7 cause in immunocompromised patients

A

Encephalitis
Hepatitis
Bone marrow failure
Graft rejection

66
Q

What is the 4 symptoms of HHV6 & 7

A

Fever
Febrile convulsions
Rash on trunk & face (3-4 days post fever)
Leukopenia

67
Q

What is the 3 complications on HHV6 & 7

A

Bone marrow suppression
Encephalitis
Hepatitis

68
Q

What is the appearance of HHV6 & 7 in adults

A

Infectious mononucleosis with paralysis & encephalitis

69
Q

What type of virus is parvovirus

A

RTI

70
Q

What does parvovirus look like

A

ssDNA non enveloped

71
Q

Where does parvovirus replicate

A

In erythrocyte precursor cells (bone marrow) causing anemia

72
Q

What is the incubation period of parvovirus

A

4-20 days

73
Q

What is the pathogenesis of parvovirus

A

Replication local causing viraemia, RT & bone marrow
Immune complex causes rash & arthropathy

74
Q

When does parvovirus cause persistent infections

A

Immunocompromised

75
Q

What is the effect of parvovirus replicating in the bone marrow

A

Red cell aplasia
Mild, severe in sickle cell anemia & immunocompromised person
Severe anemia leads to heart failure

76
Q

What is the 4 symptoms of parvovirus

A

Fever
Rash (cheeks)
Arthritis
Hematological complications

77
Q

What is the diagnostic test in parvovirus

A

PCR on blood

78
Q

What does parvovirus cause in children

A

Erythema infectiosum

79
Q

What is the 4 symptoms of Erythema infectiosum

A

RT symptoms
Rash (cheek slapped appearance)
Fever
Malaise

80
Q

What does parvovirus cause in pregnant women

A

Fetal anemia causing heart failure, severe oedema& hydrops fetalis

81
Q

What does parvovirus cause in immunocompromised people

A

Chronic anemia

82
Q

What occurs in different trimester regarding parvovirus

A

1st trimester: fatal
2nd trimester: hydrops fetalis
3rd trimester: anemia (severe)

83
Q

What is the incubation period of enteroviruses

A

7-14 days

84
Q

What is the 2 clinical presentation in enteroviruses

A

Asymptomatic/subclinical
Mild, non-specific

84
Q

What is the pathogenesis of enteroviruses

A
  1. Primary replication after fecal oral transmission in oropharyngeal & intestinal mucosa
  2. Secondary replication in lymphatic system (tonsils & Peyer’s Patches)
  3. Transient viraemia (various cell types)
84
Q

What is the 5 symptoms of enteroviruses

A

Myocarditis
GIT disturbance
RTI
Rash (hand, foot & mouth)
CNS involvement (minority)

84
Q

What is 5 types of enteroviruses

A

Polio 1,2,3
Coxsackie A1-22, 24, B1-6
Echoviruses 1-33
Rhinoviruses
Enterovirus 68

85
Q

What causes hand, foot & mouth disease

A

Coxsackie A16/6 (mild) & enterovirus 71

86
Q

What is the symptoms of hand, foot & mouth disease

A

Lesions on hands, feet, mouth, buttocks & genitals

87
Q

What is the diagnostic test for hand, foot & mouth disease

A

Diagnosis: clinical, stool or vesicular fluid

88
Q

What causes herpangina

A

Coxsackie A9

89
Q

What is herpangina

A

Lesions inside the mouth

90
Q

What is 4 symptoms of herpangina

A

Sore throat
Fever
Nausea
Vomiting

91
Q

What is the 2 types of neurological disorders with enteroviruses

A
  1. Acute flaccid paralysis
  2. Aseptic meningitis
92
Q

What causes acute flaccid paralysis

A

Polio viruses 1

93
Q

What is the diagnostic test for acute flaccid paralysis

A

Stool (PCR)

94
Q

What occurs with meningitis caused by enterovirus is a less than 2 week old

A

Severe infection, permanent damage & outbreaks with long term consequences

95
Q

What is the diagnostic test for meningitis

A

PCR on CSF

Case 13: FASD (9 decks)

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