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Clinical Medicine II > Viral Infections Part I > Flashcards

Viral Infections Part I Flashcards

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1
Q

What are some alpha herpes viruses that stay latent in neurons?

A 
HHV1 = HSV - 1 
HHV2 = HSV - 2
HHV3 = VZV
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2
Q

What does latency allow viruses to do?

A
  • Life-long infection
  • Intermittent reactivation
  • Lifelong shedding
  • Long term infection
    (Can lead to cancer)
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3
Q

What are some beta herpes viruses that stay latent in T Cells?

A

HHV5 = Cytomegalo CMV

HHV6 =
HHV7 =

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4
Q

What is the Gamma herpes virus that stays latent in B Cells?

A

HHV8 = KSV

Karposi Sarcoma Associated Herpes Virus

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5
Q

What gamma virus is HHV4 ?

A
  • Epstein Barr Virus (EBV)
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6
Q

What are the two gamma herpes viruses?

A
  • HHV4 = (EBV)

- HHV8 = (KSV)

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7
Q

What is the most common primary herpatic infection?

A
  • HSV-1

- Acute Gingivostomatitis

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8
Q

What are some S&S of HSV-1 ?

A
  • Pain
  • Bleeding of the gums
  • Ulcers with necrotic bases
  • Adenopathy
  • Fever
  • Self limited disease
  • Lasts around 14 days
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9
Q

What is herpes labialis?

A
  • Cold Sore
  • Re-occurrence of Oral HSV (Primary infection)
  • Reactivation
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10
Q

What are some prodrome signs of HSV-1?

A
  • Tingling
  • Warmth
  • Itching
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11
Q

After the prodrome signs of HSV-1, what occurs next?

A
  • 12 hours later
  • Redness
  • Papules
  • Vesicles
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12
Q

What are some associated diseases or complications with HSV-1 ?

A
  • Herpetic Whitlow (Distal fingers)
  • Encephalitis
  • Ocular herpes
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13
Q

What are some characteristics of HSV 2?

A
  • Vesicular Lesions (Clean base)
  • Pustular
  • Ulcerative
  • Involves the penis, vagina, cervix, Anus
  • Painful
  • Tender adenopathy
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14
Q

T of F

Primary infection worse than reactivation secondary infection?

A
  • True

- Primary infection typically worse than reactivation

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15
Q

What is the best test (Highest Sensitivity) for active skin lesions of HSV?

A
  • PCR > 90% sens
    Most Sensitive
  • Ag Detection 70% sens
  • Cx 30-80% sens
  • Tzanck Smear 40% sens
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16
Q

What is the best test (Highest Sensitivity) for Dx HSV encephalitis ?

A
  • PCR with CSF Fluid
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17
Q

T of F

HSV 1 and HSV 2 are the easiest viruses to cultivate?

A
  • True

- 1 to 5 days results available

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18
Q

Why is serology not useful in Dx HSV in acute phases ?

A
  • Takes 1-2 weeks before antibodies appear
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19
Q

When can you use serology to Dx a pt with HSV?

A
  • Only use IgG if you need to Dx a pt with a latent infection without skin lesions
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20
Q

What are the main reasons to treat HSV?

A
  • Primary infection is severe
  • Dissemination
  • Vision threatened
  • HSV encephalitis
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21
Q

Drug of choice to treat HSV currently?

A
  • Valacyclovir (New #1)
  • Acyclovir (Was #1)
  • Famciclovir
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22
Q

HSV perinantal infections occur during?

A
  • 1st trimester = Miscarriage

- 2nd & 3rd trimester = Premature labor

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23
Q

Can the infant contract HSV during birth?

T of F

A
  • True
  • Even in the absence of vesicles
  • Viral shedding 30 days after resolution of lesion)
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24
Q

Treatment of neonatal HSV infections consist of ?

A
  • Acyclovir
  • Systemic and Localized
  • Systemic high mortality
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25
Varicella Zoster Virus characteristics?
- Primary infection 4 - 10 y/o - Highly communicable - Attack rate of 90% seronegative pt's close contact - Secondary attack rate 70-90% in siblings
26
When are you contagious with Varicella Zoster Virus?
- 48 hrs prior to vescicles - Contagious until all lesions crust over
27
When was the VZV vaccine introduced?
- Vaccine available since 1995
28
What is the point of entry of VZV?
- Respiratory tract | - Spread into lymphoid system
29
What is the main target of the VZV ?
- The skin | - Take 14 days (2 weeks) from date of inoculation
30
Where does the VZV remain latent following the primary infection?
- Cerebral or Posterior root ganglia
31
The primary VZV rash | starts where and then spread where ?
- Face | - Spreads to the trunk and Extremities
32
Herpes Varicella Virus?
- Children | - Dew drops on a rose petal
33
Herpes Zoster Virus?
- Adults and Elderly | - Reactivation of Varicella = Shingles
34
How many dermatomes does herpes zoster usually affect?
- Single dermatome | - Wont cross mid-line
35
Where does the latent VZV reactivate?
- Sensory ganglion and tracks down the nerve to the skin innervation
36
What is postherpetic neuralgia?
- Vesicles in the dermatome often accompanied by intense pain - Last for months
37
Complications of Herpes Zoster Shingles?
- Encephalitis | - Disseminated Zoster
38
Management of Varicella ?
- Self limited | - Clinically DX, labs rarely used
39
Management of Varicella in immunocompromised or with serious complications (Pneumonia & Encephalitis) ?
- Acyclovir / Valacyclovir | - Promptly
40
Treatment of Varicella eye complications?
- Ganciclovir
41
Management of Zoster?
- Manage post herpetic neurological (Pain) - Antiviral offered to all pt's > 50 y/o (Acyclovir, Valacyclovir or Famciclovir) - Vaccination
42
Varicella Zoster Virus Perinatal Infections early in pregnancy can cause?
- Miscarriage - Congenital infection with growth restriction - Microcephaly - Hepatosplenomegaly leading to Neurological disabilities
43
Varicella Zoster Virus Perinatal Infections late in pregnancy (3 to 5 days before delivery) can cause?
- Disseminated infections at days 5-10 after birth | - High mortality 30%
44
Treatment of mother is symptomatic unless pneumonia develops?
- Acyclovir | - Isolation
45
S&S of the prodrome phase of VZV?
- Fever - HA - Malaise - Followed by a pruritic vesicular rash
46
What is another name for HHV4 ?
- Epstein Barr Virus
47
How is EBV transmitted?
- Via saliva | - Long kissing events
48
What is the most notable EBV disease?
- Mononucleosis
49
What other diseases is EBV associated with?
- Burkitt Lymphoma - Nasopharyngeal carcinoma - Pediatric Leiomyomas - Lymphoma in immunosuppressed - Oral leukoplakia in AIDS patients - Chronic interstitial pneumonitis in AIDS
50
What are the two peaks of infection in developed countries?
- Preschool 1-6 y/o | - Adolescents / young adults 14-20 y/o
51
What percentage of the population is currently infected?
- 90%
52
In developing countries the EBV infection occurs earlier, by what age?
- 90% of 2 y/o | - Seropositive & Asymptomatic
53
EBV is associated with what type of cell?
- B Cell
54
What are some S&S of EBV?
- Fever (Cytokine release due to B- Cell invasion) - Pharyngitis (B- Cell infected lymphocytes in Oropharynx) - Lymphocytosis (Proliferation of EBV infected B cells)
55
What does EBV do to B-Cells?
- Immortalize B-lymphocytes | - Continue in circulation
56
Incubation period of EBV?
- 30 to 50 days
57
Triad of most common symptoms in an EBV infection ?
- Fever - Lymphadenopathy - Sore Throat
58
Sore throat in an EBV infection can consist of ?
- Pharyngitis - Tonsilitis - Gingivitis - Soft palate petechiae
59
Other S&S of EBV infection?
- Malaise | - Muscle aches
60
T of F High risk of Splenomegaly with EBV?
- True 50% of cases - Pt must not play contact sports - High risk of Splenetic rupture
61
PE findings with EBV ?
- Dramatic appearing pharyngitis or tonsillitis | - Tender enlarged posterior cervical nodes
62
Pt develops a maculopapular rash with EBV?
- Pt was accidentally treated with Amoxicillin with caused the rash
63
Serious Complications of EBV?
- Bacterial pharyngitis - Splenetic rupture - Pericarditis - Meningitis - Encephalitis
64
Less common complications of EBV?
- Hepatitis - Mono-neuropathy - Aseptic meningitis - Myositis - Renal failure
65
Differential Dx for EBV in a pt with Fever, Pharyngitis & Lymphadenopathy ?
- Streptococcal infection - Cytomegalovirus - Acute HVI - Toxoplasma infection - RARE
66
Dx of EBV includes?
- Increase in granulocytes - Followed by lymphocytic leukocytosis - Atypical lymphocytes - Hemolytic anemia and thrombocytopenia - Mono spot positive in 4 weeks - Increase in LFTs and Total bilirubin
67
Treatment of EBV?
- 95% self limited without therapy - NO ANTIBIOTICS - Corticosteriods only for certain cases - Antivirals only for certain cases - NSAIDS for Pain and Fever - No contact sports
68
When are corticosteriods used when treating EBV?
- Pts with mononucleosis EBV - and 1) Airway obstruction 2) Severe Thrombocytopenia or 3) Severe hemolytic anemia
69
When are antivirals used to treat EBV?
- Acyclovir or Ganciclovir in Transplant patients - Not for treatment of simple mononucleosis
70
What is mumps?
- Highly contagious - Preventable by vaccination - Belongs to the genus Rubula virus
71
When is the peak incidence of mumps?
- Late winter to Early spring
72
Who is at high risk of mumps?
- Most commonly infected school-aged children and young adults
73
T of F Maternal antibodies protect infants from mumps?
- True
74
Mumps S&S include?
- Fever - Headache - Myalgia - Fatigue - Followed by Parotitis
75
Most common symptom of mumps?
- Swollen Parotid gland (Parotitis)
76
Most common complication of Mumps?
- Orchitis (Swollen testicle or both Inflammation)
77
Other complications of mumps?
- Meningitis - Encephalitis - Deafness
78
How do you test for mumps?
- Buccal swab with PCR (preferred) or - Serum mumps immunoglobulin (Ig)M antibody
79
What is the treatment for mumps?
- Supportive care | - Self limited
80
What is measles?
- Measles is a respiratory disease - Very contagious - Preventable with vaccination
81
Number of measles cases reported in 2014, 2018 and so far as of March 2019?
- 2014 = 667 - 2018 = 372 - 2019 = 387
82
Measles hallmark sign?
- Koplik Spots Pathognomonic for measles
83
Symptoms of measles included?
- Fever - Cough - Runny nose - Red watery eyes - Tiny white spots in mouth (Koplik Spots) - Rash from head to toe - 3-5 days after symptoms, rash breaks out
84
Complications of Measles?
- Diarrhea - Otitis media - Pneumonia - Encephalitis - Blindness - Subacute Sclerosing Panencephalitis (Progressive Neurological disorder)
85
How do you test for Measles?
- IgM AB serum assay standard | - May also do viral culture / PCR
86
Treatment of Measles includes?
- Symptomatic | - Children & infants, high dose Vitamin A
87
When can you give a prophylaxis treatment for suspected measles post exposure?
- Given within 72 hours of exposure in unvaccinated pt's

Clinical Medicine II (9 decks)

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