Herpes Flashcards

Question

VZV clinical symptoms

Answer 1

Incubation period 10-21 d Prodrome: fever (100-103 F), malate, pharyngitis Followed by generalized rash in 24 hours Rash begins on chest back and face, spreads rapidly and lasts 3 - 5 days Rash starts out maculopapular and then small fluid filled vesicles with central dimple (umbilication) on a red base; rash is itchy All stages of rash present at any given moment- avg 300 lesions Highly contagious at 1-2 days befor rash onset to 4 - 5 d after rash onset

Answer 2

Chickenpox generally self-limited Bacterial superinfection of skin (Cellulitis) - renders of skin beginning near a lesion and spreading (staph or strep caused) Encephalitis: VZV spread to cerebellum and cause unsteady gait (ataxia) PNEUMONIA: majority of morbidity and mortality in teens and adults Hepatitis Congenital and perinatal infections (if fetus infected when mother develops chickenpox--> damage to infants Brian or infants born to mother with active chickenpox and can be life threatening) Immunocompromised: everything more severe, life threatening pneumonia, encephalitis, progressive-disseminated varicella

Answer 3

Unilateral vesicular rash that follows a dermatome distribution following reaction of VZV in a single dorsal root ganglion Rarely crosses midline Rash involves thoracic and lumbar distribution; ophthalmic distribution can lead to serious eye infection Post herpetic neuralgia: persistence of pain > 90 days after healing of rash in 20% of patients

Answer 4

Age is most important risk factor although anyone with prior primary VZV can get shingles Incidence increases with age, dramatic increase after 50 Immunocompromised and underlying disorders are other risk factors Zoster vaccine recommended in adults > 60 yo; reduces zoster by 50% and post herpetic neuralgia by 67%

Answer 5

Infx common and usually asymptomatic in healthy children and adults Most adults infected Large owls eye inclusions, giant cells with intranuclear owls eye inclusion Clinical link CMV to congenital infections and immunocompromised individuals

Answer 6

Infects humans of all ages Seroprevalence increases with age, 50% by 30, 60-80% by 60 Prevalence peaks 2 - 5 (day care or school) and young adults (sexual) Crowded living is risk factor Routes of infection - oral 30-70% infection rates in daycare - sexual transmission - blood transfusions (now blood depleted of WBC) - organ transplantation - CMV-negative recipients at greatest risk for disease

Answer 7

C in torch Leading infectious cause of birth defects Primary: maternal infection poses much greater risk to fetus than reactivation Infection in early pregnancy (first 12 - 16 weeks) poses highest risk to developing fetus Infx in mother almost always asymptomatic, no warning the fetus is at risk CMV infection detected in 1% of newborns and is most common identified infectious cause of birth defects Risk of CMV transmission to fetus and rate of symptomatic fetal infection are much Ghiberti with primary maternal infection In primary infection 90% of babies become infected and of those, many have congenital abnormalities

Answer 8

Petechial rash - blueberry muffin baby CMV retinitis ``` Brain malformations - periventricular calcification - enlarged ventricles - microcephalic Leads to seizures cognitive deficits ``` Jaundice with hepatosplenomegaly Hearing loss - can occur at birth if symptomatic CMV, can occur over first several years if infx asymptomatic Even if no symptoms at birth can develop sensorineural hearing loss, visual impairment, psychomotor and or intellectual disabilities later in life

Answer 9

HIV: reactivation with CD4 < 50 less common with HAART Tranpslants Any other immunosuppressed Can get bad viral pneumonia, retinitis Esophagitis with round solitary ulcer

Answer 10

Mononucleosis like syndrome 79% EBV, 21% CMV Frequent manifestation of priamry CMV infx in young adult Syndrome: fever 2 - 4 weeks, fatigue, mild h epatitis, lymphocytosis and small % of atypical lymphocytes in blood - exudative pharyngitis frequently absent - lymphadenopathy less common ``` Heterophile antibody negative - IgM class antibody that agglutinate RBC from certain species like sheep ```

Answer 11

Infects and transforms B lymphocytes - binds to cd21 on B cells, some become latently infected - also infects epithelial cells in oral cavity

Answer 12

Mono Cancer: burkitts lymphoma, Hodgkin lymphoma, nasopharyngeal carcinoma (B cells affected) Lymphoproliferative disorders (psottransplant lymphoproliferative disease, oral hairy leukoplakia) Seroprevalence 50% by age 5, 90 by age 20 Spread by oral secretions - the kissing disease Often asymptomatic can be shed for years

Answer 13

Classic triad - lymphadenopathy - splenomegaly - avoid contact sports - exudative pharyngitis Fever malaise and rash can appear if mistakenly treated with ampicillin War b/w infected B cells and the T cell response - pharyngitis due to respond to infected epithelial cells - fatigue due to energy needed to power robust T cell response so you are tired al the time

Answer 14

Symptoms Peripheral blood smear: see atypical lymphocytes (Activated T cells, called Downey cells) CBC; activated T cells, can comprise up to 80% of total WBC Serology: heterophile AB positive (monospot test) - Ab that cause sheep red cells to clumb EBV: heterophile + mono CMV: heterophile - mono

Answer 15

Burkett lymphoma - jaw tumor of African children, EBV--> chromosomal translocation leading to activation of cmyc oncogene Other lymphomas- Hodgkin, T cell head and neck, CNS (in HIV infected) Nasopharyngeal carcinoma - cancer of epithelial cells common in males of Chinese origin Post-transplant lymphoproliferative disorder (PTLD) - occurs in setting of immunosuppression associated with transplantation, can range from B cell expansion to lymphomas Oral hairy leukoplakia**: excessive wart like growth of papillae on tongue, in advanced HIVi and othe rimmunosuppressed - one of most common virally induced oral diseases in HIV patients - cant be scrapped off like oral thrush

Answer 16

Most common cause of roseola infantry - rose red rash of children (sudden rash - exanthum subitum), virtually all children infected by 4 yo - HHV causes ~10% roseola Undifferentiated febrile illness without rash - HHV6 accounts for 5 - 25% of ED visits for fever in infants HIGH FEVER febrile seizures common with roseola - responsible or 1/3 febrile seizures in children up to 2 years old Lymphotropic virus (infects CD4+ T cells in particular); causes transient immunosuppresion and can exacerbate disease with other viruses

Answer 17

Abrupt onset of high fever (104) that persists 2 to 5 d Child is normally fussy and irritable Rash develops coincidental with abatement of fever - rash first appears on neck, behind ears and on back - it blossoms - spread to trunk and abdomen - some rash on face and arms and legs - maculopapular in appearance, not itchy or uncomfortable - no treatment no vaccine

Answer 18

Cell tropism for CD19+ B cells, macrophages, endothelial cells Painless purplish macules, nodules or plaques Tumors mostly on skin, but can involve any organ Pathology shows spindle shaped tumors with red cells

Answer 19

No point of care ot true rapid tests For HSV1/2 and VZV molecular is recommended Serology still primary method for otherwise healthy populations for EBV For CMV and HSV1/2 serology is limited to pregnant women with fetal abnormalities requiring TORCH investigation or for donor/recipient screening prior to transplant ``` Old fashioned: culture Tzanck test (look for multinucleated cells in skin vessels) ```

Herpes Flashcards

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