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MOUTH nonNF path Flashcards

1
Q

Mumps virus

A

paramyxovirus: env. -ssRNA–>syncyteal formation

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2
Q

mumps epi

A

summer/fall, kids 5-15, POE-RT, asymp. inf. carriers

adults: subclin/resp. only symps, kids 2–>9: classic disease

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3
Q

mumps path

A

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.)

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4
Q

mumps immuno

A

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

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5
Q

mumps s/s/prodrome

A

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

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6
Q

why vaccinate for mumps

A

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

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7
Q

mumps may cause epididymo-orchitis

A

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

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8
Q

mumps may cause oophoritis +/- mastitis

A

uncommon,

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9
Q

mumps may also cause..

A

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

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10
Q

mumps dx

A

s/s
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

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11
Q

mumps tx

A

NO ASA, hot/cold packs on cheeks over parotids

ppx: vaccination (15-18 mos)

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12
Q

Herpesvirus

A

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

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13
Q

HHV class.

A

1–>8, 3 groups

*humans are sole host/resevoir

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14
Q

hallmark of HHV

A

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

site varies

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15
Q

HSV1 vs HSV2

A

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.)

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16
Q

HSV1 site

A

oral/oropharyngeal lesions in children–>adults

milder than 2

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17
Q

HSV2 site

A

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

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18
Q

ww distr. HSV

A

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

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19
Q

HSV transmission

A

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)

20
Q

HSV patho

A

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

21
Q

HSV latent infection

A

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

22
Q

HSV primary inf (varies w. age)

A

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

23
Q

recurrent classic lesions

A

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

24
Q

Herpetic (ves, ulc) gingivostomatitis in children

A

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

25
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.
26
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: w.in 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
27
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)
28
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
29
herpes ppx/prev
no FDA approved vaccine! avoid direct contact w/ lesions counsel on autoinoculation protective barriers/hand washing
30
enteroviruses are a group in the..
picornaviruses: sm. RNA viruses, non-env acid stable (pass thru stom unharmed) *Rhinovirus, enterovirus, Hep A (human hosts)
31
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)
32
enterovirus is one of most common/imp viral pathogens
(nonsp.) respons. for 1/2 febrile illness in infants/y. kids during summer/early fall
33
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
34
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)
35
enterovirus inf. occur
during sum/fall, males most commonly manifest | highest attack rate rt in kids
36
diseases caused by enteroviruses
``` herpangina hand, foot, mouth (HFMD) conjunctivitis (acute epid hem conjunct) CNS : meningitis, encephalitis epidemic pleurodynia non-sp febrile illness in kids/adults, abrupt onset ```
37
non sp. febrile illness from enterovirus
fever, ha, malaise/fatigue +/-: V/D, maculopapular rash, pharyngitis
38
Herpangina org
Coxsackie virus (Group A serotypes: 2,4,10,21,24) **NOT Herpes virus
39
Herpangina incidence
sum/fall (also yr round), kids 3-10, RT or fec/oral route
40
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!*
41
Hand foot mouth disease org
Coxsackie Virus: Group A serotypes (A16) and Enterovirus 71
42
HFMD incidence
summer/fall w/ yr round inc., 1-5 yo, POE-RT
43
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)
44
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
45
HFMD complications
meningitis, encephalitis, transverse myelitis
46
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)
47
HFMD tx and ppx
symptomatic, supportive | education to prev. transmiss, toilet hygiene

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