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Flashcards in MOUTH nonNF path Deck (47):

Mumps virus

paramyxovirus: env. -ssRNA-->syncyteal formation


mumps epi

summer/fall, kids 5-15, POE-RT, asymp. inf. carriers
adults: subclin/resp. only symps, kids 2-->9: classic disease


mumps path

RT, long incub. period (18d ave, 12-->29d)
replicates in nasal passages/URT/local LNs-->primary viremia-->spreads (circ) to all maj. organs but targets gland. tiss and CNS
infects epi cells and kidneys-->viruria occurs (det. 14 days)-->sec. viremia
viral rep-->syncytia formation-->necrosis of host cells-->mononuclear infiltrate/edema
virus shed from salivary gland in droplet nucl. (2 wks, 1 wk pre symps-->1 wk after sal gld swell) in urine up to 2 wks
*1/3 inf. are asymptomatic (but still inf.)


mumps immuno

lifelong immunity
Abs neutralize virus (appear during convalescent or after imm (IgM, then IgG)
CMI likely involved


mumps s/s/prodrome

flu-like: low/mod fever, ha, malaise, loss of app for 2 days
swelling w/ pain of 1/both parotid glands near jaw w. pain w. chew/swall/eating acid food


why vaccinate for mumps

CNS inf.: rare, -->meningitis (10-50%), encephalitis, CSF pleocytosis (50-60%)
(other complications, flip further)


mumps may cause epididymo-orchitis

most common 10-40%
often unilat, painful, testicular inflamm
postpub adoles. >=13, rarely results in sterility, but may if testic. necrosis


mumps may cause oophoritis +/- mastitis



mumps may also cause..

pancreatitis (abd. pn, vom)
spontaneous abortion
deafness (perm. nerv damage, not unusual)
myocard. inf
neurological cond (facial palsy, Guillain-Barre synd)


mumps dx

det. of virus from saliva/urine (viral cx or RT-PCR)
enzyme immunoassay (det. IgM, IgG Abs against virus) IgM rises during prodromal phase, pks 7 days
blood: low WBC, high serum protein amylase


mumps tx

NO ASA, hot/cold packs on cheeks over parotids
ppx: vaccination (15-18 mos)



env. ds DNA (fried egg on EM) encodes own thymidine kinase* or sim. enz.-->activates herpes antivir. agent in hum. cell-->termination of DNA chain rep. in inf. cell


HHV class.

1-->8, 3 groups
*humans are sole host/resevoir


hallmark of HHV

latency, life-long (that shit sticks with you)
site varies


HSV1 vs HSV2

both have sim Ag. but env. glycoprotein B (gB) is Ag distinct and blood test can differentiate inf. btw 2 types (gB1 and gB2, resp.)


HSV1 site

oral/oropharyngeal lesions in children-->adults
milder than 2


HSV2 site

genital (60-85% HSV2) (dist. is blurred)


ww distr. HSV

60-90% seropositive! 85-95% primary/initial oral inf. are asymp.


HSV transmission

inoculation of virus in secretions onto muc. surfaces or skin cracks
or contact btw lesions and muc. surf/cracks
fomites (secondary)
in utero, during parturition, post partum(HSV2)
via autoinoculation (mouth-active lesions, fingers (herp. Whitlow))
*can occur in absence of lesions (asymp. ind)


HSV patho

virus induced cytolysis of epidermis
lytic virus rep. in nuc-->intranuc inclusion (periphery) in host cell-->syncytia formation (mult. nuc giant cell) via men. fusion of inf./neighboring cells-->cellular necrosis-->inflammation @ site


HSV latent infection

site: dorsal or sacral root ganglia
recurrent disease in 20-40% pop
decreasing episodes/severity w/ age


HSV primary inf (varies w. age)

in utero (1) or perinatal (2) can be devastating
SEM (skin, eye, mouth) in neonates-->disseminated (all organs), encephalitis
herpetic gingivostomatitis in kids
vesicular ulcerative pharyngitis in adolescents
urogen/anorect herpes in adolescents/y. adults


recurrent classic lesions

reactivated lesions (skin, genital, CNS):
classic oral (cold sore, fever blister)
encephalitis in adult (HSV1)
Aseptic(Mollaret's) recur. menintitis in y. adults-->elderly (HSV2)
acute peripheral facial palsy/idiopathic (Bell's) (HSV1 or VZV)


Herpetic (ves, ulc) gingivostomatitis in children

mostly HSV1, some HSV2, 1-3 yo
prodrome: mod-high fever, malaise, irrt, ha, oral pain, syst. symps-->viral dissem, mot viral mening.
eruptive phase: 3-5d, lesions on gingiva, buccal muc, tong, palate (enanthem), lips (exanthem) (first look like papules-->coalescing vesicles on eryth. edem oral mucosa ("dewdrop on a rose petal")-->pustule-->ulcerate-->scabs over, bilat, painful cerv/submand lymphaden.
complications: dehydration, maln. from oral pain


Herpes: ulcerative pharyngitis

mostly HSV1, some HSV2, y. kids, adolescents
(enanthem) posterior ves, ulc. pharyngitis +/- tonsillitis, tiny vesicles and ulc. appear on pharyngeal wall, tonsils, soft palate (rarely lesions in ant. mouth/lips)
syst. signs: fever, malaise, myalgia, ha, throat/oral pain
ant. cerv. lymphaden.


herpes: recurrent classic oral lesions (cold sore, fever blisters)

HSV1, 2, kids-->adults
painful, transmissible, mucocutaneous ulc. inf.
prodrome: pain, tingling @ site (orolabial) (6 hr duration)
exanthem: 48 hrs: 3-->5 painful herp. vesicles form at vermilion border of lips-->coalesce-->(4d) papule-->vesicle-->ulcer-->hard crust (pain 3-5 days)
healing in 10-14 d, resolves w.out scarring
recurrences up to 10/year (1st year) dec. w/ time


herpes ddx

clinical pres.
stained (Wright's Giemsa or Papnicolaou, Tzanck) specimens: look for multi.nuc giant cells and/or intranuclear inclusions
DFA (det. Ags)


herpes tx

topical or oral antivirals (Acyclovir: guanin nuc. analog, *prodrug):
-postactivation by herpes-encoded thymidine kinase, inhibitor of HSV DNA polymerase-->DNA chain term, aborting viral genome sun
-tx and ppx of symp. inf.: affects actively replicating virus* -->shortens lesion's duration*
(some pts use during prodrom. phase, claims prev. outbreaks of cold sores)
**not a cure!! cannot affect latent virus
symp. tx: drying of lesion


herpes ppx/prev

no FDA approved vaccine!
avoid direct contact w/ lesions
counsel on autoinoculation
protective barriers/hand washing


enteroviruses are a group in the..

picornaviruses: sm. RNA viruses, non-env
acid stable (pass thru stom unharmed)
*Rhinovirus, enterovirus, Hep A (human hosts)


enteroviruses consist of

polio viruses (3 serotypes)
non-polio enteroviruses:
-coxsackie A (23 serotps) and B viruses (6 st's), -echo (enteric cytophatic human orphan) viruses (40st's)
-enteroviruses (68-71)


enterovirus is one of most common/imp viral pathogens

(nonsp.) respons. for 1/2 febrile illness in infants/y. kids during summer/early fall


called enterovirus bc

replicate in sm int, virus is in feces, passes fecal-oral route (transmission lasts 4w-mos, post-resolution), less resp.
-inf in lymphoid tiss in pharynx occurs 1st w/ high titers and transmission occurs by resp. route (about wk)-->inf. of Peyer's patches (LP) in intestines occurs later w/ lower titers


enterovirus transmission

fecal-oral is most common (water is vehicle)
inh. of aerosols
in utero (ECHO, Coxsackie)
(humans are host, hum and environ can be reservoir)


enterovirus inf. occur

during sum/fall, males most commonly manifest
highest attack rate rt in kids


diseases caused by enteroviruses

hand, foot, mouth (HFMD)
conjunctivitis (acute epid hem conjunct)
CNS : meningitis, encephalitis
epidemic pleurodynia
non-sp febrile illness in kids/adults, abrupt onset


non sp. febrile illness from enterovirus

fever, ha, malaise/fatigue +/-: V/D, maculopapular rash, pharyngitis


Herpangina org

Coxsackie virus (Group A serotypes: 2,4,10,21,24) **NOT Herpes virus


Herpangina incidence

sum/fall (also yr round), kids 3-10, RT or fec/oral route


herpangina s/s

syst. signs: fev, V, ha, myalgia, sore throat and painful swallowing (pre and during enanthem)
enanthem: ves, ulc pharyngitis: 1st red macules/papules-->sm vesicles-->painful shallow ulcers that do not crust and appear on soft palate, uvula, tongue, pharynx and and pillars of tonsils of 1-4d duration
virus is in the lesion (ulcers)- contagious!*


Hand foot mouth disease org

Coxsackie Virus: Group A serotypes (A16) and Enterovirus 71


HFMD incidence

summer/fall w/ yr round inc., 1-5 yo, POE-RT


HFMD s/s

syst.: low grade fever, poor app, vague malaise, sore throat 2d then ves ulc pharyngitis: enanthem (like herpangina, but milder)
*BOTH enanthem and exanthem
disease lasts 10-15 d
virus is in the lesion (contagious)


HFMD enanthem/exanthem

enanthem: mouth (ant buccal mucosa, tongue, hard palate, lips) not pharynx tonsils (few)
exanthem: hands, feet, butt (lat, dorsal surfs) also knees, elbows, genital


HFMD complications

meningitis, encephalitis, transverse myelitis


HFMD ddx

streptococcal/adenovirus/other virus pharyngitis (PIV, RSV, CMV, primary HIV, influenza virus)
inf. mono, pharyngeal gonorrhea, oropharyngeal syphilis, acute ulc pharyngitis (HSV, enteroviruses)


HFMD tx and ppx

symptomatic, supportive
education to prev. transmiss, toilet hygiene

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