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Unit 3 Microbio > L21: Viral skin infections > Flashcards

L21: Viral skin infections Flashcards

(90 cards)

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1
Q

Rubeola aka

A

Measles

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2
Q

Who gets severe measles?

A

Malnourished

Vitamin A deficiency

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3
Q

4 Stages of the measles

A
  1. Incubation
  2. Prodrome
  3. Rash
  4. Resolution
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4
Q

Incubation of the measles

A

10-14 days
Multiplies in respiratory epithelium and lymph nodes
Monocytes disseminate to other tissues=viremia

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5
Q

Prodrome of the measles

A

1-12 days post infection
High fever
3 C’s, Koplik’s spots

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6
Q

3 C’s of the measles

A

Prodrome
Coryza (rhinitis)
Cough
Conjunctivitis

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7
Q

Koplik’s spots

A

Buccal mucosa
Diagnostic of measles
Prodrome (precede rash)

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8
Q

Measles rash

A

appears 3-4 days after prodrome starts
Highest fever
Begins below ears, spread extensively, lesions may merge

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9
Q

Measles resolution

A

Viremia ends
Rise in Ab titers
Rash fades in same order it appears

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10
Q

Complication that causes the most measles deaths

A

Pneumonia
Greatest risk: malnourished, older
Bacterial superinfection common

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11
Q

Measles CNS involvement

A

Acute symptomatic encephalitis
High fatality
Subacute sclerosing panecephalitis (very rare)

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12
Q

Measles hosts

A

Humans and monkeys

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13
Q

Who is measles rare in?

A

<6 months (maternal immunity)

>10 years, as most are exposed by this age

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14
Q

How is measles transmitted?

A

HIGHLY CONTAGIOUS

Respiratory droplets

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15
Q

Diagnose the measles:

A

Rash, koplik’s spots
Serology
Fluorescent antibody: Multinucleated giant cells

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16
Q

Multinucleated giant cells

A

Measles

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17
Q

MMR vaccine schedule

A

15 months

4-6 years

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18
Q

If you think a kid younger than 15 months has been exposed to the measles

A

Vaccinate with monovalent measles vaccine

Revaccinate with MMR at 15 months

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19
Q

When to give a 3rd measles booster

A

recent outbreaks

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20
Q

Measles vaccine in the US

A

MMR II

Live attenuated, uses Jeryl Lynn mumps virus strain

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21
Q

Why isn’t the original MMR used?

A

Had a side effect of meningitis which resolves

Cheaper to make

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22
Q

BayGam

A

measles immune globulin for exposed non-immune subjects (6 days)

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23
Q

What was wrong with the 1st measles vaccines tested before MMR/MMR II?

A

Patients were sensitized but not immune, causing atypical measles which appeared like Rocky mountain spotted fever (hemorrhagic petechiae)

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24
Q

What percent of the population must be vaccinated to halt measles persistence?

A

95%

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25
Measles outbreaks occur in the _____ population | Mumps outbreaks occur in the _____ population
Measles: unvaccinated, air travel to foreign locations Mumps: vaccinated, "breakthrough"
26
German measles aka
Rubella ("little red")
27
The only human togavirus
Rubella
28
How is rubella transmitted?
Close and prolonged contact | Children often escape infection...
29
Rubella presentation
Mild exanthematous disease that superficially resembles the measles
30
Congenital Rubella Syndrome (CRS)
Maternal infection leads to placental and fetal infection | Substantial Risk fo fetus
31
Congenital Rubella Syndrome Cardiac defects
Pulmonary artery stenosis | Patent ductus arteriosis
32
Congenital Rubella Syndrome Eye defects
Cataracts | Glaucoma
33
Congenital Rubella Syndrome, other defects
Profound hearing loss | CNS involvment
34
What led to the initial recognition of Congenital Rubella Syndrome?
neonatal glaucoma (cataracts?)
35
What is the biggest element in outcome of Congenital Rubella Syndrome?
Timing of maternal infection: Worst outcome in first month (50%), second and third months By 4th month risk is exceedingly low
36
Who can't get MMR?
Pregnant patients | MMR II: egg or neomycin sensitivity
37
You have documented rubella exposure of a non-immune mother in her 1st trimester....
administer IV immunoglobulin (IVIG) as prophylaxis | but it might not really help much...
38
2 unique properties of HSV
1. Capacity to invade and replicate in CNS | 2. Ability to establish latent infections
39
HSV primary infection
May be asymptomatic Resolves, goes into lifelong latency Lesions heal without scarring
40
How does HSV remain latent?
Retrograde transport of virus through sensory neurons leading to infection of dorsal root ganglia
41
How can HSV be reactivated?
Many ways: sunlight, stress, menses, nutrition
42
How is continued spread of latent HSV halted?
cell and humoral immune processes
43
Rule of thumb for HSV recrudescence
probability of recurrence is greater in individuals with larger and more extensive initial outbreaks
44
HSV reservoir
humans only
45
HSV1
common, oral | infection occurs early in life
46
HSV2
occurs later | genital, correlated with sexual activity
47
HSV spread
vesicular fluid, saliva, secretions | *asymptomatic shedding is possible*
48
Dendritic pattern
HSV recurrence in the cornea
49
Whitlow
a herpetic lesion in skin, medical and dental personnel at high risk
50
Direct samples of HSV:
``` Ballooning pathology Enlarged and fused cells on Tzanck smear FA assay for viral antigens Culture on HeLa, Hep-2 cell lines PCR Antibody tests ```
51
Do HSV antivirals prevent transmission?
No
52
Famciclovir
HSV antiviral
53
Acyclovir/Valacyclovir
HSV antivirals Guanosine analogues that lack 3' OH group inhibit thymidine kinase when it phosphorylates them, halting viral DNA replcation
54
Varicella-zoster virus (VZV) is a
Herpes virus
55
VZV presentation
asymmetrical vesicular rash that follows dermatomal pattern pruritic lesions prodrome: fever, malaise, HA, neuralgia, anorexia (absent in younger children)
56
VZV infects through
conjuctiva | respiratory tract mucosa
57
VZV replicates in ______ during primary viremia
regional lymph nodes | primary viremia occurs 4-6 days after infection
58
VZV replicates in ______ during secondary viremia
liver and spleen | secondary viremia+rash occur 10-14 days after infection
59
VZV reservoir, seasonality, age group
Humans Winter-spring 5-9 years
60
When is VZV most contagious?
1-2 days before lesions appear | 4-5 days after lesions appear
61
Don't give ____ for chicken pox
Aspirin | Reye's syndrome risk
62
Antiviral which is effective for VZV? | Immune serum?
Acyclovir | VariZig: for high risk+exposure
63
Chickenpox vaccine
Varivax No aspirin for 28 days after 2 rounds to reduce breakthrough cases
64
Congenital/neonatal VZV
Significant disease/damage
65
Shingles risk factor
AGE | 1/2 of individuals over 85 will experience an outbreak
66
Shingles presentation
PAIN which may precede rash by days to week Searing, burning, stabbing Redness to papules to vesicles in 24 hours Low grade fever, anorexia
67
Zoster means
"Belt/stripe" | unilateral dermatomal distribution with sharp limits
68
How often does ophthalmic branch of CN V become involved in shingles? Ocular involvement?
10% | 20%
69
Most common complication of shingles
Postherpetic neuralgia: pain lasts months
70
Is shingles transmissible?
NO | You have to have had the chickenpox to get it
71
Shingles vaccines
Zostavax | Shingrix
72
Zostavax
this is the same as Varivax but much higher potency | ONLY for pts >50 who have had chickenpox
73
Shingrix
adjuvanted, recombinant | recommended even if pt has had zostavax
74
Human Herpes Virus 6 (HHV-6) aka
6th disease Roseola Infantum Exanthum subitum
75
HHV-6 disease progression
very high fever (2-5 days, 39-41 C) yet well apearing | followed by rose-colored rash
76
HHV-6 diagnsosi
EIA detects antibody | PCR amplifies DNA sequence for detection
77
HHV-6 treatment and prevention
No antivirals, no isolation, no prevention
78
Parvovirus B19 aka
5th disease Erythema infectiosum Slapped cheek
79
Parvovirus B19 presentation
prodrome followed by rash: slapped cheek, circumoral pallor +/- lacy maculopapular rash of limbs and trunk resolves in 1-2 weeks
80
Parvovirus B19 prodrome
several days, mild: | fever, HA, malaise, myalgia, URI sx, N/V
81
Connective tissue manifestations of Parvovirus B19
Arthralgia and/or arthritis (after rash) | can be quick severe
82
Parvovirus B19 in adults
arthralgia and/or arthritis alone without any preceding or concurrent symptoms
83
Parvovirus B19 season? location? age?
Late winter/spring Worldwide School age children
84
Parvovirus B19 diagnosis
anti-B19 IgM antibody facial rash epidemic outbreak?
85
Parvovirus B19 + anemia
Immunoglobulin
86
Parvovirus B19 treatment
NSAIDs, supportive
87
anogenital warts
HPV 6, 11
88
cervical dysplasia and cancer
HPV 16, 18
89
Gardasil 9 protects against
HPV 6, 11, 16, 18 + 5 others
90
Gardasil 9 can be given to
anyone aged 9-45

Unit 3 Microbio (13 decks)

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