Week 2 - E(2) - Microbiology - Herpes/Shingles, Ramsay Hunt, H.P.V, Molluscum, Herpaingina/H.F.M, Slapped-cheek, Syphilis Flashcards
What viruses causes both chicken pox and shingles?
Both caused by varicella zoster virus - human herpes virus 3
Chicken pox is also known as varicella
Shingles is also known as zoster
State the common names which you know for the different human herpes viruses
HHV1 - herpes simplex virus 1
HHV2 - herpes simplex virus 2
HHV3 - varicella zoster virus
HHV4 - epstein barr virus
HHV5 - cytomegalovrus
HHV8 - kaposi’s sarcoma
What age does chicken pox generally present and what is the progression of the presentation? What is its site of latency?
Chicken pox generally presents in childhood with a generalized rash, itch and fever -
usually the rash begins as macules–>papules–>vesicles with a red surround
The virus establishes latency usually in the sensory nerve roots
Describe a macule, papule and vesicle?
Macule - flat lesion with less than 1cm width (>1cm - patch)
Papule - raised skin lesion less than 0.5cm height
Vesicle - small blister - lesion less than 0.5cm in diameter
Chicken pox usually is a clinical diagnosis How can it be diagnosed if uncertain?
Taking a swab in a viral medium and sending to he microbiologists for PCR
What is the latent reactivation of chicken pox known as and what is the presentation?
Latent reactivation of chicken pox is shingles - aka zoster aka herpes zoster
Results in a dermatomal vesicular rash which can begin to crust - tingling pain initially to erythema to vesicles to crusts
What is the word used to describe the type of pain experienced in shingles? What is this pain known as when it lasts longer than 4 weeks? - who does this usually occur in
Shingles pain is described as a neuralgic pain in character
Long term complication of the nerve damage due to VZV is prolonged pain (beyond 4 weeks) and this is known as post-herpetic neuralgia It is more common in elderly patients and those with trigeminal distribution zoster
Is scarring of the skin common in shingles? What is the treatment of shingles or severe chicken pox?
Scarring of the skin due to shingles is not common
Treatment of shingles or severe chicken pox is acyclovir
What is chicken pox in a neonate known as? What can cause this? What is the syndrome this can cause?
Neonatal varicella voster virus - occurs secondary due to mother contracting chicken pox in late pregnancy
Can cause foetal varicella syndrome
What can you prescribe to woman who are exposed to somebody with chicken pox whilst late in pregnancy?
Varicella Zoster Immune Globulin or acyclovir can be given to the mother
Give the baby zoster immunoglobulin
What is it known as when shingles affects the ophthalmic division of the trigeminal nerve? What division is the ophthalmic? What it is the sign known as where it has affected the tip of the nose? - why is this important?
Shingles affecting the ophthalmic division is known as ophthalmic zoster (CN V1)
Hutchinson’s sign is when there is nose tip involvement - this means involvement of the nasociliary branch of CN V1 which also supplies the globe and therefore makes it likely that the eye will be infected
Where should patients with ophthalmic zoster be referred to and why? What is the treatment?
Refer to ophthalmology to exclude inflammation and ulceration of the cornea of the eye
Treat with acicylovir + lubricating eye drops if near eyelid
Is there a vaccine for chickenpox? If so, what type of vaccine is it and who is it used in?
There is a live attenuated vaccine available for chicken pox - it is only used in susceptible health care workers in the UK
Not used in children in UK
How is the live attenuated vaccine used in chickenpox used to vaccinate against shingles and when is it given?
The live attenuated VZV used in chickenpox vaccine can be used in a high titre preparation in the elderly - to both reduce the incidence of shingles and reduce incidence of post-herpetic neuralgia
Routinely given to patients aged 70 years old
What is often the initial presentation of herpes simplex known as primary gingivostomatitis?
Primary gingivostomatitis is often a presentation of herpes simplex virus - causing extensive ulceration in and around the corner of the mouth - lasts around 1 week
Is HSV type 1 or 2 the main cause of oral lesions? Which causes genital lesions?
HSV type 1 is the main cause of oral lesions, causes half of genital lesions can lead to encephalitis
HSV type 2 - rarely causes oral lesions, causes half of genital lesions, can lead to encephalitis
What is acyclovir an analogue of? How does it inhibit replication of a viral pathogen? Does it elimate latent virus?
Acyclovir is an anlogue of the nucleoside guanosine
It is incorporated into the viral DNA inhibiting DNA replication It does not eliminate latent virus
What is it known as when the herpes simplex virus causes a lesion on the finger or thumb? What does it look like? What is it known as when herpes simplx virus affects an area of eczema?
HSV in finger or thumb - herpetic whitlow - vesicles/rash on the digit
HSV affecting an area of previous eczema - eczema herpeticum (may be confused with impetigo however eczema herpteicum usually child will also feel unwell/fever which is unusal in impetigo)
peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear or in the mouth What is this? What causes it? What is it called if it is just the peripheral facial palsy with no rash?
This is Ramsay Hunt syndrome - caused by latent varicella zoster virus reactivating in the geniculate ganglion of the 7th nerve
The condition where there is an idiopathic 7th nerve palsy with no rash is Bell’s palsy
Apart from the facial nerve palsy seen in ramsay hunt syndrome, what other symptoms are seen? What is the treatment of both Bell’s pay and Ramsay Hunt syndrome?
irritation of the 8th cranial nerve may also occur in ramsay hunt syndrome causing vertigo, deafness, tinnitus
Bell’s palsy - treat with steroids
Ramsay Hunt syndrome - treat with steroids and acicylovir
What is the skin reaction showing target lesions what may occur as an adverse reaction to drugs or some infections? Give two infection examples
Erythema multiforme can also be desribed as target lesions as they have a red erythematic circle with a central blister
Many triggers including drug reactions and Herpes simplex
Mycoplasma pneumoniae
How long does erythema multiforme tend to persist?
Erythema multiforme is usually mild and goes away in a few weeks
Which HPV is most common in warts/verucas? Which is most common in genital warts? Which is most common in cervical cancers? What is the HPV vaccine available known as and which age groups is it given to?
HPV 1-4 - most common in warts/verucas
HPV 6 and 8 - most common in genital warts
HPV 16 and 18 - most common in cervical cancers (account for about 70%)
HPV Vaccine known as Gardasil - Available
- * All females and males aged 12-13 years old
- * All MSM up to the age of 45 years old
- * 2 injections given 6 months apart
What cells in the skin does HPV infect? What is the treatment of warts/verucas? (HPV types 1-4)
HPV infects the keratinocytes in the skin
Treatment of HPV types 1-4
Often resolve spontaneously
Can use topical salicylic acid or liquid nitogen (cryotherapy)
What is the viral infection of the skin that results in small, raised, pink lesions with a dimple in the center? How would you describe them medically?
Molluscum contagiosum is a viral disease of the skin that results in small fleshy, pink firm, papules that have an umbilicated (depressed) central punctum
Who is molluscum contagiosum most common in? How is it treated?
Molloscum contagiosum is most common in chidlren however can be sexually transmitted in adults
Treatment is self limiting as they resolve spontaneously although it can take months
Can use local application of cryo treatment (liquid nitrogen)
What is herpangina and what causes it? What does it look like?
Herpangina is a common childhood illness caused usually by enteroviruses - eg coxsackie virus or echovirus
It’s characterized by small, blister-like ulcers at the back of the mouth and the throat
How is herpangina usually confirmed? What is the treatment?
Swab of lesion and a sample of stool for entorovirus PCR
It is self-limiting and does not require treatment
What is another enterovirus conditon (especially coxsackie viruses) that typically affects children and affects the hands, feet and mouth? How are the mouth symptoms different from that of herpangina?
Hand, foot and mouth disease is caused by enteroviruses (mainly coxsackie viruses) and cause vesicle/ulcers to develop on palms, soles and mouth
Differs from herpangina
Ulcers in herpangina at back of mouth
Ulcers in hand,foot and mouth disease at front of mouth
What is the erythema infectiosum better known as? What causes it? How does it present?
Erythema infectiosum aka erythrovirus aka fifth disease is better known as slapped cheek disease It is caused by erythrovirus B19 aka parvovirus B19
It presents typically in childhood with a rash on the cheeks - looking like a slap then this fades and a macular rash appears on the body/limbs
What are the complications of erythrovirus other than the red cheeks and macular rash?
Erythrovirus can cause acute arthritis - especially in adults as the rash fades
Also can lead to chronic anaemia or aplastic crisus - marrow stops making RBCs
Also linked to foetal loss if pregnant when infected
How is erythrovirus diagnosed?
Diagnosis via lab confirmation of the IgM antibody in the blood - parvovirus B19 IgM test
What is the virus of sheep causing firm fleshy nodules on the hands of eg farmers known as? How is it treated?
Orf - self limiting
What sexually transmitted infection causes syphilis? What is the primary infection symptoms? What are the secondary and tertiary stage symptoms?
Treponema pallidum causes syphilis -
Primary infection shows a chancre at the entry site - painless ulcer
Secondary stage - dissemination - red rash over body, prominent on soles of feet and palsm
Tertiary stage - neurosyphilis
What is the type of pupil that is seen in neurosyphilis?
Argyll Robertson pupil - pupil is constricted and unreactive to direct and consensual light reflexes
However the accommodation-convergence reaction remains intact
(prostitutes pupil - accomodates but doesnt react)
Why is Argyll-Robertson pupil sometimes referred to as prostitute’s pupils?
Argyll Robertson pupils are also sometimes called “prostitute’s pupils” because of their association with late neurosyphilis.
A popular mnemonic to remember Argyll Robertson pupils is that, just like prostitutes, they “accommodate but do not react”.
What is the treatment of syphilis?
Treat with IM benzylpenicillin - duration depends on stage
