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1
Q

distinguish those numbered diseases…

A

first = measles
second = scarlet fever = strep. pyogenes
third = rubella
fourth = ?SSSS
fifth = parvo = erythema infectiosum
sixth = roseola infantum = HHV6

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2
Q

specific rashes
- parvo
- measles
- rubella
- congenital rubella
- measles

A

parvo = slapped cheek, rash worse with sun/heat, and LACY rash!
rubella = pinpoint petechiae on soft palate
congenital rubella= blueberry muffin rash
measles = koplik spots, maculopapular cephalocaudal rash

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3
Q

which viruses can be reactivated with a transplant

A

hhv6 (latency in monocytes and macrophages)
EBV
CMV
HSV
VZV
adenovirus

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4
Q

parvovirus: when infectious

A

days prior to rash/arthropathy - those are immune mediated in response to infection

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5
Q

parvovirus: main complications

A
  1. transient aplastic crisis - goes to bone marrow and affects erythroid progenitor&raquo_space; chronic haemolytic anaemia
  2. arthropathy
  3. hydrops fetalis
  4. neurological e.g. GBS
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6
Q

HHV6: higher rate of what??

A

1/3 feb covulsion
complex seizures inc. post ictal paralysis

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7
Q

HHV8 causes what??

A

Kaposi sarcoma = multifocal angiogenic lesions in skin/mucous membranes

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8
Q

rubella vaccinations

A

Given at 12 months (MMR) and 18 months (MMR-V)
- Not given to immunocompromised patients

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9
Q

complications of rubella (non-congenital)

A

arthralgia
encephalitis ** RARE, but severe
thrombocytopaenia

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10
Q

measles: main complications

A

it suppresses the immune system for up to 6 weeks so can get:
1) OM (most common)
2) pneumonia
3) encephalitis
4) a decade later: subacute sclerosing panencephalitis

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11
Q

Warthin Finkeldey giant cells = what disease???

A

measles

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12
Q

public health things about measles

A

vaccinate contacts within 72h of exposure
- exclude school for 14 days if vax declined
90% household contacts will get it
2 vax - 12mo and 18mo

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13
Q

classic lymphadenopathy pattern rubella

A

post-auricular and suboccipital lymphadenopathy.

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14
Q

measles vax vs flu vax can be given to which people?

A

measles can given with egg allergy!

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15
Q

mumps: main complications

A
  1. parotitis
  2. SNHL
  3. orchitis/EO
  4. meningitis
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16
Q

features of congenital varicella

A
  • Cicatricial skin scarring
  • Limb hypoplasia
  • neuro stuff e.g microcephaly, seizures
  • Eyes – chorioretinitis, microphthalmia, cataracts
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17
Q

shingles - explain

A

herpes zoster = shingles:
varicella dormant in dorsal root ganglia
if IC/aging
reactivates > travels to dermatome
post-herpetic neuralgia = pain in dermatoma which can last up to 3 months

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18
Q

why is aspirin CI in VZV / influenza

A

Reye syndrome = rapidly progressive encephalopathy with hepatic dysfunction esp a/w VZV/influenza

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19
Q

exposure during the foetal/neonatal period for varicella - what to do?

A

For mum:
past infection / immunisation - no action
If seronegative:
i. Exposure <= 96 hours earlier = ZIG
ii. Exposure >= 96h = no ZIG, consider oral aciclovir PEP

For foetus:
<28/40 = VZIG
>28/40 = VZIG if no maternal Ab

<1 week old = VZIG if from mum. If not from mum, VZIG if no maternal Ab

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20
Q

what is ramsay hunt syndrome?

A

herpes zoster oticus:
reactivation of VZV in geniculate ganglion > facial nerve palsy, deafness and vertigo with vesicles and pain in the auditory canal

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21
Q

HSV1 vs HSV2

A

HSV 1
- oral infection, can cause genital
- decreased risk of recurrent infection

HSV2
- Genital infection, can cause oral
- Increased risk of recurrent infection

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22
Q

where does HSV lie latent?

A

trigeminal or sacral ganglia

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23
Q

clinical manifestations possible with HSV (outside of neonates)

A
  1. gingivostomatittis
  2. encephalitis
  3. eyes: keratoconjunctivitis, branching dendritic lesion on cornea
  4. skin: herpes labialis (cold sores), herpes whitlow
  5. genital herpes
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24
Q

PCR vs serology: what is the more useful test in detecting CMV acute infection, and why?

A

PCR:
- MOST of the population is IgG positive
- IgM only develops after 4-16 weeks
- Avidity of IgG is typically LOW for the first 4-5 months following infection

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25
treatment of varicella contacts
1mo-1yo: if complications, VZIG. >1yo: VZV vax within 5 days (prevents and modifies disease)
26
acute EBV illness i.e. mono: clinical signs/symptoms
1. Fever 1-2 weeks 2. pharyngitis / tonsillitis 3. Lymphadenopathy (particularly epitrochlear + posterior cervical LN) 4. fatigue 5. Hepato-splenomegaly 6. Eyelid edema (MCQ) 7. palatal petechiae
27
complications of EBV infection
1. splenic rupture 2. lymphoproliferative disorders: HLH, PTLD 3. malignancy: burkitt's, hodgkin's, leiomyosarcoma, nasopharyngeal 4. in immunocompromised: Oral hairy leukoplakia and Lymphoid interstitial pneumonitis
28
lab test for EBV
MONOSPOT – tests for Heterophile antibody (made by infected B cell), usually +ve after 2-9 weeks after infection younger kids: EBV specific Abs (EBNA = latent infection, IgM VCA)
29
two common reasons for false negative monospot
1. too early (25% neg in first week) 2. too young (<4yo, B cell won't make the heterophile Ab)
30
what is the only respiratory virus with a mAb to treat? when to treat?
RSV and palivizumab (monthly injections); 1. CLD 2. Congenital heart disease if < 2 3. Extremely premature < 28 weeks
31
RSV most often co-infects with what virus
human metapneumovirus
32
unlike influenza, what can RSV not do?
no antigenic shift!
33
most common cause of a common cold in a child?
rhinovirus!
34
major clinical manifestations of adenovirus to know about
1. resp - bronch, pneumonia 2. eyes - conjunctivitis (pink eye) 3. GI - diarrhoea 4. haemorrhagic cystitis 5. disseminated
35
what are the 4 enteroviruses?
PEEC: polio echo entero coxackie
36
the major clinical manifesatations of enteroviruses, and which ones are implicated
1. non-specific viral 2. HFM = coxsackie A16 (+ enterovirus 71) 3. herpangina = Coxsackie A and enterovirus 71 4. Acute haemorrhagic conjunctivitis = enterovirus 70 + coxsackie virus A25 5. Myocarditis/ pericarditis = coxsackie B 6. meningitis = enterovirus 71, coxsackie B 7. polio = coxsackie A7, poliovirus, enterovirus 71
37
coxsackie A vs B generally affect what?
coxsackie A = skin stuff (HFM, conjunctivitis) coxsackie B = internal stuff (pericarditis, myocarditis, gastro, encephalitis, aseptic meningitis)
38
enterovirus 71 causes what important things
HFM herpangina aseptic meningitis paralytic poliomyelitis
39
most common viral cause of viral meningitis
enterovirus - most coxackie B / echo
40
incidence of paralysis with polio infection
1/1000
41
prognosis of polio virus infection
dependent on type a. Abortive polio + aseptic meningitis = usually benign b. Severe bulbar poliomyelitis = mortality rates up to 60%
42
which polio vax causes vaccine derived polio virus?
OPV i.e. Sabin (therefore we prefer Salk)
43
antigenic shift vs antigenic drift
antigenic shift = point mutation = variant "shift = seasonal" antigenic drift = sudden new HA subtype +/- NA = no recognition by immune response = PANDEMIC (e.g. H1N1) - only happens with flu A
44
what are the surface proteins we care about for influenza
1. haemagluttinin 2. neuraminidase = releases virus from cells 3. membrane channel protein M2
45
oseltamivir MOA
neuraminidase inhibitor
46
human metapneumovirus vs paraflu - more bronch or croup?
human metapneumo: bronch > croup paraflu: croup > bronch
47
rotavirus vax - major rare side effect
intussusception - in first 3 weeks post vax. Risk increases if doses are delayed
48
hpv cause what cancers, and which types cause what manifestations
- Genital warts and laryngeal papillomatosis (types 6, 11) - Cervical cancer (types 16, 18); vulval and vaginal cancer
49
how can HIV be transmitted
1. vertical (intra-uterine, intra-partum, post-partum breastfeeding is not common in industrialised nations) 2. blood transfusion 3. sexual transmission
50
rotavirus vaccine efficacy
85% only
51
how does HIV infect?
-targets CD4 T cells -binds to the T cell using gp120. needs to bind to the T cell co-receptors (CXCR4 or CCR5) for entry -RNA reverse transcribes > DNA moves into host nucleus and integrates into host DNA
52
natural history of HIV
1. primary infection with seroconversion: like mono 2. clinical latency by 12 weeks - but virus replicating and T cells reducing 3. 200-500 cell count: constitutional symptoms, candidiasis, leukoplakia, lymphadenopathy 4. <200 adults; <1500 in <1yo: AIDS
53
what is wasting syndrome?
- Persistent weight loss >10% of baseline OR downward crossing of 2 or more major centile lines - an AIDS defining condition
54
when to treat HIV positive children
treat at any CD4 count all <1yo all infants also need PJP prophylaxis
55
Meds for HIV - the 4 MOA
1. prevent viral entrance - gp41 binder = enfuvirtide - CCR4 receptor blocker = maraviroc 2. reverse transcriptase inhibitor - NRTI - NNRTI 3. protease inhibitor 4. inhibit integration of virus into human DNA
56
classic side effects of NRTIs
lactic acidosis + hepatic steatosis (zidovudine also causes lipodystrophy)
57
how do you manage BK induced transplant nephropathy
reduce immunosuppression
58
human t lymphotrophic virus
i. Myelopathy ii. Arthropathy iii. Uveitis iv. (adult) T cell leukaemia/ lymphoma v. Hairy cell leukaemia
59
exams: rabies = ?? symptoms
aerophobia hydrophobia
60
compare the 5 maculopapular rashes of childhood
1. VZV: itchy AF. 1-3d prodrome fever. vesicles. 2. roseola: not itchy, but high as fuck fever 3. measles: not itchy, but got them 3C's and koplick spots with cephalocaudal rash. 4. rubella: itchy. starts on face. can get blueberry muffin. 5. parvo: usually not itchy. fever 3 days prior to rash. slapped cheek. aplastic crisis/fetal hydrops.

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