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MSK/Derm > Cutaneous Manifestations of Viral Infections > Flashcards

Cutaneous Manifestations of Viral Infections Flashcards

1
Q

What are the general patterns of viral infection of the skin?

A

acute infection followed by viral clearance

acute infection followed by latent infection

chronic infection

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2
Q

Name the major DNA viruses.

A

Herpes virus

Hepadna virus (Hep B)

Adenovirus

Pox virus (small pox, molluscum)

Papovavirus (HPV)

Parvovirus (ssDNA)

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3
Q

Name the important RNA viruses.

A

Flavivirus (Hep C)

Picornavicus (Xoxsackie, echo, enterovirus)

Arboviruses

Retroviruses (HIV)

Togavirus (Rubella)

Paramyxovirus (measles)

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4
Q

Herpes Simplex Virus (HSV)

A

dsDNA, linear, envelope

HSV remains dormant in the local nerve ganglia

HSV-1 is orolabial herpes, common

HSV-2 is genital herpes, sexually transmitted

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5
Q

What is the clinical presentation of HSV?

A

grouped vesicles on erythematous base

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6
Q

What is the diagnosis of HSV?

A

in-office confirmation with Tzanck Smear - multinucleated giant cells

DFA (Direct Flourescent Antibody)

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7
Q

What is the treatment for HSV?

A

oral antivirals

IV antivirals (immunocompromised)

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8
Q

What is eczema herpeticum?

A

most common viral complication of patients wiith atopic dermatitis

disseminated HSV lesions in eczematous skin

eruption spreads over 7-10 days and may be associated with fever, malaise, and lymphadenopathy

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9
Q

What is the treatment for eczema herpeticum?

A

treat with oral antivirals

intravenous antivirals if widespread, fever, clinically ill, or immunocompromised

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10
Q

exanthem

A

general term for a more widespread rash on the skin

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11
Q

enanthem

A

general term for rash involving the mucous membrane

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12
Q

What is erythema multiforme (EM)?

A

cutaneous reaction pattern with classic targetoid lesions

palms and soles, mucous membranes, centrally pale with a red ring, and then develop a blister (which can look dusky in the center)

may have associated fever, myalgia, arthralgias, and headaches

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13
Q

What are the causes of erythema multiforme (EM)?

A

infections - HSV (most common), mycoplasma

drugs - sulfa, anticonvulsants, barbituates, pcn, NSAIDs

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14
Q

What family of viruses is Varicella Zoster/Chicken Pox (VZV)?

A

herpes virus family

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15
Q

How is Varicella Zoster/Chicken Pox (VZV) transmitted?

A

via respiratory droplet or direct contact

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16
Q

What is the incubation period of Varicella Zoster/Chicken Pox (VZV)?

A

10-20 days

contagion begins 24 hours before eruption appears and lasts until lesions have crusted

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17
Q

What is the pattern of the skin manifestation of Varicella Zoster/Chicken Pox (VZV)?

A

centrifugal eruption (trunk > extremities)

“dewdrop on rose petal” - palms and soles are spared

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18
Q

How is Varicella Zoster/Chicken Pox (VZV) diagnosed?

A

in-office confirmation with Tzanck Smea - multinucleated giant cells

systemic complications are pneumonia and encephalitis

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19
Q

What are the prominent features of Herpez Zoster/Shingles (VZV)

A

reactivation of dormant VZV

dermatomal distribution of crop vesicles to vesculopustules on an erythematous plauqe

if disseminated - look for immunosuppression and check HIV status

20
Q

How is Herpez Zoster/Shingles (VZV) diagnosed and treated?

A

diagnosis is through in-office confirmation with Tzanck Smear - multinucleated giant cells

treat with oral antivirals

21
Q

What are common complications of Herpez Zoster/Shingles (VZV)?

A

post herpetic neuralgia

Ransay-Hunt syndrome

22
Q

Ransay Hunt Syndrome

A

VZV infection of the geniculate ganglion (CN VII - facial nerve)

involvement of external ear and/or tympanic membrane

facial paralysis - ipsilateral

tinnitus or other auditory symptoms

may need IV anti-virals and possibly steroids

23
Q

shingles vaccine

A

live vaccine (weakened VZV)

a single dose for people 60+, even if they’ve already had a bout of shingles

shingles vaccine reduces the risk of developing shingles by about 50%

24
Q

What is pityriasis rosea?

A

post-infectious skin manifestation, exanthem

an atypical variant may be drug induced

herald patch followed by papulosquamous papules in “Christmas tree” distribution on the trunk

atypical presentations in intertriginous areas or on extremities only

differential diagnosis - secondary syphilis

25
Q

What is the treatment of pityriasis rosea?

A

treat the symptoms

otherwise, will resolve spontaneously without necessary treatment

26
Q

What is smallpox/variola?

A

dsDNA virus - envelop, linear virus

three stages of disese - incubation, prodormal, and eruptive

rish is most dense on the face, arm/hands, legs/feet

the lesions are all in the same stage

27
Q

What are the characteristics of the stages of smallpox/variola?

A

incubation - asymptomatic (12 days)

prodromal - nonspecific febrile illness, flu-like (3 days)

eruptive - characteristic rash (same stage, head and extremities, more pustular)

28
Q

What type of virus is Molluscum Contagiosum?

A

poxvirus - dsDNA

envelope

linear (largest DNA virus)

29
Q

Who gets Molluscum Contagiosum?

A

humans are the only host

affects mainly children, sexually active adults, and individuals with impaired cellular immunity

30
Q

What are the types of Molluscum Contagiosum?

A

MCV I - most prevalent type found in kids

MCV II - more prevalent in HIV

31
Q

What is the mode of transmission for Molluscum Contagiosum?

A

skin-skin transmission

autoinoculation

incubation period is one week to several months

32
Q

What is the clinical presentation of Molluscum Contagiosum?

A

small, firm umbilicated papules with smooth, waxy, or pearly surface

base may or may not be erythematous

size is 1 mm - 1 cm

33
Q

What are the clinical manifestations of MCV in immunocompromised hosts?

A

widespread giant eruptions on the face, particularly those with HIV - very treatment-resistant

34
Q

What is molluscum dermatitis?

A

an eczematous reaction occurring around a molluscum lesion signifying host immune response to viral antigen

35
Q

What is the treatment for MCV?

A

can resolve spontaneously

curettage

cryosurgery

medications - cantharidin, tretinoin, imiquimod, oral cimetidine

36
Q

What type of virus is verruca vulgaris (HPV)?

A

human papilloma virus (HPV)

no envelop

double-stranded circular virus

37
Q

What is the clinical presentation of verruca vulgaris (HPV)?

A

scaly, rough papules can occur on any skin surface

commonly on the hands and fingers

38
Q

What is verruca plana?

A

flat warts

2-4 mm, slightly elevated flat topped papules that have minimal scale

face, hands, lower legs

often show koebnerization

HPV 3, 10, 28, 49

39
Q

What is condyloma acuminata?

A

anogenital warts

may extend into the vagina, urethra, and perirectal epithelium

40
Q

What viruses cause condyloma acuminata?

A

HPV 6 and 11 - low risk (responsible for 90% of genital warts)

HPV 16 and 18 - high risk (70% of HPV induced cervical cancer), also 31, 33

41
Q

What is the Gardasil vaccine for?

A

vaccinates against HPV types 6, 11, 16, 18

given as 3 injections over 6 months

the FDA recommends vaccination before adolescence and potential sexual activity

42
Q

What type of virus is parvovirus B19? What kind of disease does it cause?

A

single stranded linear (smallest DNA virus)

no envelope

causes erythema infectiosum aka Fifth disease

43
Q

What is the clinical presentation of Fifth disease?

A

lacy reticulate eruption on trunk and extremities

purpuric stocking and glove eruption in young adults

44
Q

What are some serious complications of erythema infectiosum?

A

arthritis (adults)

aplastic crisis (sicle cell disease)

hydrops fetalis (RBC destruction in fetus)

45
Q

What viruses cause Hand, Foot, Mouth disease?

A

Coxackie virus A-16

Etnerovirus 71

both are RNA viruses

46
Q

What is Hand, Foot, Mouth disease?

A

common viral illness of infants and children

fever, ulcerovesicular stomatitis, acral erythematous vesicles, buttock lesions

47
Q

What are the major viral exanthems?

A

Hand, Foot, and Mouth

Fifth Disease

Pityriasis Rosea

Erythema Multiformae

MSK/Derm (54 decks)

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