Viruses & Sepsis Flashcards
What is the pathognomonic signs of measles?
Warthin-finkeldey giant cells = multinucleated cells
Kopliks spots
What is the period of communicability in measles virus?
3 days before up to 4-6 days after the onset of rash
What aer the 4 phases of measles infetion?
Incubation (8-12days)
Prodrome
Exanthema
Recovery
What are the significant clinical presentaion during prodrome phase of measles infection?
Cough, Coryza, Conjunctivitis
What are significant skin lesions seen in measles?
Confluence rash = map-like, coalescing rash
Fades in order of appearance
Hyperpigmented before diapperance -> brawny desquamation
What are important complications to take note of in px with measles?
Blindness - children with VIt A def & corneal aberrations
Severe diarrhea & dehdyration
Acute otitis media = most common
Severe respiratory infections (Pneumonia)
Encephalitis
Immune amnesia
Subacute Sclerosing Panencephalitis = chronic
When can you suspect that measles has a bacterial complication/
Persistence of fever after the 4th day of rash OR
Rash on the soles of the feet
How many doses of MMR vaccine should be taken?
2 doses
What is the vax sched for filipino infants for MMR?
1st dose = early as 6 months to 9 months
2nd dose = 15 months (“true first dose”)
3rd dose = 4-6 years old (“true 2nd dose”)
In patients who have active immunization with live, attenuated mesales vaccine, when should post-exposure prophylaxis be given?
Within 3 days of exposure
CIs: Malignancies, immunodeficiencies, chronic corticosteroid tx
In px with passive immunization with Igs, when should post-exposure prophylaxis be given?
Within 6 days of exposure
What are the clinical feature of Rubella?
Incubatio = 14-21 days post exposure
Prodrome: headache, malaise, anorexia, low grade fever, sore throat, red eyes (w or wo pain), lymphadenopathy
During Prodrome stage of Rubella, what is a pathognomonic sign for rubella?
Lymphadenopathy
Druing Enanthem in Rubella, what are petechial hemorrgages in soft palate with tiny rose-colored lesions, Koplik’s spots?
Forchheimer spots
What are the type of rashes seen in Exanthem of Rubella?
Rash = does not desquamate & Pruritic, 3 days
What are the complications of Rubella?
Thrombocytopenia
Arthralgia/arthritis
Encephalitis
Hemorrhagic Manifestations
Orchitis & or neuritis
What is the most seriou complication of Rubella?
Encephalitis
What are the classical triad of Congenital Rubella Syndrome?
Bulag
Bingi
Butas
Ocular abnormalities= catact, infantile glaucoma, pigmented retinopathy
Sensorineural hearing loss = most common
Congenital heart disease = patent ducctus arteriosys
What is the gold standard in Rubella dx?
Isolation of rubella virus (urine/nasopharync)
Can wpmen of childbearing age who intend to become pregnant within 4 weeks receive Rubella vaccine (MMR)?
No, they should not
What is the common childhood disease that is caused by HHV-6 aka Sixth Disease?
Roseola/Exanthem Subitum/Baby measles
What are the clinical presentation of sixth disease?
9-12 mons old
Febrile seizure
Fussiness
Acute high grade fever up to 40C
After 3 days rapid defervesncence (fever disappears) occurs & morbiliform rash appears
What is a pathognomic sign of sixth disease in infants from asian countries?
Nagayama spots
- ulcers at uvulopalatoglossal junction
What is the first manifestation of Varicella in children?
Exanthem = generalized vesicular rash with few systemic effects, classic exanthem is a vesicular tear-drop shaped lesion
When is the most contagious period of VZV?
1-2 days before and shortly after onset of rash
What is the hallmark of Varicella rash?
Vesicular lesions
Macules > Maculopapular > Vesicular > Crusting > Scab formation
When should u administre VZ Ig?
Within 96 hrs but rarely found in PH
Chemoprophylaxis
What should be prescribed as post-exposure prophylaxis to VZV 7-10 days after exposure?
Acyclovir (4x a day for 7 days)
Max dose = 800mg 4x a day
What is the routine vax of VZ in children?
12-15 months
What causes erythema infectious/fifth diseas?
Parvovirus or B19 infection
- low grade fever
When is the highest viral load of SARS COV2?
Onset & up to 3 days after symptoms onset
What is the diff betw antigenic shift and antigenic draft?
Antigenic drift - minor change (epidemic)
Antigenic shift = major change (pandemic)
What are the clinical presentations of Chikungunya?
Night time biting (A aegypti) or daytime biting mosquitos
Polyarthralgia
Backache
Headache
What is the diff betw Chikungunya & Dengue?
Polyarthralgia, Arthritis = chikungunya
Dengue - none of these
Out of the 4 dengue serotypes, what are the most common in PH?
DEN-1 & DEN-2
What is the vector that causes dengue?
Aedes aegypti
What serotype is dengue hermorhagic fever more likely to develop?
DEN-2
Why is protein malnutrition a protective factor in reducing risk of DHF/DSS?
Suppresses cellular immune response
How do you classify probable dengue case?
Lives in or traveled to dengue endemic area
Fever and 2 of the ff
- nausea
- vimiting
- rashes
- aches 7 pain
- (+) tourniquet test
- leukopenia
- any warning sign
What are the diff warning signs of dengue?
Requires strict observation & medical itnervention
Abdominal pain or tenderness
Persistent vomiting
Clinical fluid accumulation
Lethargy or restlessness
Liver enlargement >2cm
INC in HCT concurrent with rapid dec in plt ct
What are parameters to say that there is severe organ involvement?
AST or ALT > 1000
Impaired consciouness
Heart and other organs
What are the 3 phases of dengue?
Febrile phase = mild hemorrhagic manifestations
Critical phase = defervescence & improvement fter defervescence or deterioration
Recovery phase = 48-72 hrs
What virus affects children <5 yo and characterized by erythematous-based macules which ulcerate centrally creating an ERYTHEMATOUS HALO?
Hand,foot, & mouth disease
What are the diff Enteroviruses causing HFMD?
Coxsackievirus A16 = mild, self-limiting
Enterovirus-71 = serious: meningitis, encephalitis
What is a pathognomonic sign of HFMD?
Oral lesions: Herpangina (transmissible by saliva)
Rash: papulovesicular affecting the palms & soles of the feet
What is the leading cause of death in pedia px worldwide?
Sepsis
What characterizes SIRS?
> 2 of the ff criteria:
- abnormal core temp (<36C or >38.5C)
- abnormal HR (>2 standard deviations above normal for age, or <10th percentile for ag if child is <1yr)
- INC RR (>2 SD above normal for age, or mechanical ventilation for acute lung disease)
- abnormal WBC ct (> or < normal ange or >10% immature WBC)
What characterizes severe sepsis?
- > or equal to 2 age based SIRS criteria
- Confirmed or suspected invasive infeciton
- Cardiovascular dysfunction, acute respiratory distress syndrome, or >2 non-cardiovascular organ system dysfunctions
What is the most useful diagnosis and monitoring of sepsis and septic shock?
Serum procalcitonin
What are the 2 key points in the tx of sepsis?
- Timely recognition & institution of therapy (<1hr) = most crucial
- Early & aggressive source control (drainage, debridement, surgical intervention)
