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Flashcards in Common Viral Diseases Deck (116):
1

What part of viruses are the complete infective particle and do not grow?

virons

2

WHat are small circular RNA molecules with a rod like secondary structure that possess no capsid or envelope?

Viroids

3

A virus particle, also known as a virion, is made of what?
2

nucleic acid (DNA or RNA) enclosed in a protein shell or coat.

4

How big are viruses?

15 - 25 nanometers in diameter

5

The type of genetic material found in a particular virus depends on the nature and function of the specific virus.
For example, double-stranded DNA viruses typically must enter the host cell's what before it can replicate?

Where does RNA viruses replicate?

nucleus

host cell's cytoplasm

6

What is a capsomere?


Whats the funciton of a capsid?

protein units that compose the capsid of a virus

Function to protect the viral genetic material from damage.

7

In addition to the protein coat, some viruses have specialized structures. What is special about the flu virus?

The flu virus has a membrane-like envelope around it’s capsid.
The envelope has both host cell and viral components and assists the virus in infecting its host

8

The basic process of viral infection and virus replication occurs in 6 main steps. What are these steps?

1. Adsorption - virus binds to the host cell.


2. Penetration - virus injects its genome into host cell.


3. Viral Genome Replication - viral genome replicates using the host's cellular machinery.


4. Assembly - viral components and enzymes are produced and begin to assemble.


5. Maturation - viral components assemble and viruses fully develop.


6. Release - newly produced viruses are expelled from the host cell.

9

The key components of current classification systems are?
3

1. Type of symmetry of the virus capsid (helical versus icosahedral)

2. Presence or absence of a lipid envelope

3. Type and structure of the viral nucleic acid and the strategy used in its replication

10

Why does the HA and NA make the flu virus so virulent?

These protein subunits can swap back and forth and become resistant to the vaccine that has been made

11

Class I viruses are what kind of viruses?

What are the viruses in this class?
4

- double stranded DNA

1. Papovavirus
2. Adenovirus
3. Herpesvirus
4. Poxvirus

12

What are 2 examples of papovaviruses?

Examples of adenoviruses?

Examples of the herpesvirus?4

Examples of the poxvirus?

1. warts, cervical cancer
2. respiratory diseases
3. (cold sores, genital herpes, chicken pox, mononucleosis)
4. (smallpox, cowpox)

13

Class II viruses are what kind of viruses?
What is the virus in this class?

single stranded DNA

Parvovirus
-easy to recognize by the body because we dont have them

14

Class III virsuses are what kind of viruses?

What are the viruses in this class? 4

- double stranded RNA
Coronavirus
Picornavirus
Togavirus
Hepatitis C virus

15

WHat are examples of picornavirus? 2
What are exampes of a togavirus? 2

1. (polio, common cold)
2. (rubella, yellow fever)

16

Class IV viruses are what kind of viruses and what viruses are in this class?5

- positive single stranded RNA itself acting as mRNA

1. Rhabdovirus
2. Paramyxovirus
3. Orthomyxovirus
4. Bunyavirus
5. Arenaviruses

17

GIve an example of a rabdovirus?

Give an example of a paramyxovirus? 2

Give an example of an orthomyxovirus?

Give an example of a bunyavirus?

(rabies)

(measles, mumps)

(influenza viruses)

(Korean hemorrhagic fever)

18

WHat kind of virus is a class V virus.

What kind of virus is in this category and what does it cause?

- negative single stranded RNA used as a template for mRNA synthesis

Reovirus (diarrhea)

19

What kind of viruses are class VI viruses and what virus is in this class?

GIve two examples?


What kind of viruses are class VII viruses and what virus is in this category?

- positive single stranded RNA with a DNA intermediate in replication

Retrovirus (leukemia, AIDS)


- double stranded DNA with an RNA intermediate in replication.

Hepatitis B virus

20

Viral exanthematous diseases?
7

1. Chickenpox/Herpes zoster
2. Infectious mononucleosis
3. Roseola infantum (Sixth Disease or Erythema subitum)
4. Fifth disease (Erythema infectiosum)
5. Measles
6. Rubella
7. Enteroviral exanthems

21

Enteroviral exanthems examples? 2

Coxsackievirus
Echovirus

22

DDx of exanthematous eruptions?
7

1. Rickettsial infections
2. Mycoplasma pneumoniae
3. Syphilis- palms and soles
4. Typhoid fever-
5. Bacterial toxins- staph - toxin shock syndrome
6. Drug eruptions
7. Live-virus vaccinations

23

What are the Human herpes viruses in order?
8

1. HHV-1: Herpes Simplex Virus 1 (HSV1)
2. HHV-2: Herpes Simplex Virus 2 (HSV2)
3. HHV-3: Varicella-Zoster Virus (VZV)
4. HHV-4: Epstein-Barr Virus (EBV)
5. HHV-5: Cytomegalovirus (CMV)
6. HHV-6: Exanthema (or Roseola) subitum (Roseola infantum or Sixth Disease)
7. HHV-7: T-lymphotropic virus (could cause cancer)
8. HHV-8: Virus associated with Kaposi’s sarcoma

24

What viruses have the blistering rash look?

HSV 1and 2 and chicken pox

25

How does herpes simplex infect infect the body?
2

1. through mucosal membranes or abraded skin
2. Latent infections harbored in neuronal cells
--Trigeminal ganglia
--Pre-sacral ganglia

26

How is the rash described for HSV?

What are the clinical manifestations for the oral facial lesions for the primary infection of HSV? 2

What demographic is it commonly seen in?

What are the other symtpoms? 6
How long does it last?

What does it reoccur as?

Dew-drop on rose petal

Gingivostomatitis (canker sores on gum) and pharyngitis most frequent


Commonly seen in children and young adults

1. Fever,
2. malaise,
3. myalgias,
4. inability to eat,
5. irritability and
6. cervical adenopathy lasts 3-14 days

Herpes labialis (“Cold Sores”)

27

HSV urogential lesion systemic symtpoms? 4

Local symtpoms?6



What will the pt experience in the prodromal phase?

1. Headache,
2. fever,
3. malaise and
4. myalgia

Vesicular lesions of external genitalia with
1. pain,
2. itching,
3. dysuria (horrible pain peeing),
4. vagina and urethral discharge,
5. tender inguinal lymph adenopathy


patient will usually present early. makes area sore and tender first then you get the lesions

28

Moist ulcers will form in how many days with HSV?
How long will they last untreated?

What are recurrent infections of HSV caused by? 5

Vesicles form moist ulcers after several days and crust over in 1-2 weeks of left unaddressed

Are induced by stress, fever, infection, sunlight, chemo.

29

Complications of HSV?
4

1. Ocular disease- herpetic kerokitis
2. Neonatal and Congenital infections
3. Bells Palsy (facial nerve paralysis)
4. Encephalitis and recurrent Meningitis- you can treat it with your cyclovirs IV

30

If we see diseminated herpes what should we think about?

What is the most common cause of viral encepholopathy?

AIDS or some other kind of immunosuppression

Herpes

31

How do we diagnose HSV?

5

Usually clinically made

Lab tests:
1. viral culture (only if its blistering)
2. PCR
3. Direct flouroscence antibody
4. Tzanck prepartion
5. Types specific serologic tests

32

What have emerged as a more sensitive method to confirm HSV infection in clinical specimens obtained from genital ulcers, mucocutaneous sites, and cerebrospinal fluid?


What test is particularly useful for the detection of asymptomatic HSV shedding?

real-time HSV PCR assays

PCR

33

What test is used to detect HSV in clinical specimens?This test is specific and reproducible.


Direct fluorescent antibody

34

What test helps us identify the cytopathic effect of the virus (multinucleate giant cells) and can be performed on lesions scrapings?

Why dont we use it more?


What test is the only test that can determine whether an infection is HSV1 or 2?

Tzanck smear

low sensitivity and specificity and is only helpful if positive.


viral culture

35

What are inclusion cells in HSV?

inclusion cells are the virus replicating in the cell

36

What is the management for Herpes simplex acute infections?

Antiviral agents only shorten duration of symptoms by 1-2 days
-Acyclovir

Cant do suppressive therapy too. Daily

37

Where does herpatic whitelow occur?

finger and nails
Occassionally toes

38

Two distinct clinical presentations for herpes zoster. What are they?

Primary infection: Chickenpox
Recurrent infections: Herpes zoster

39

Primary infection by Varicella Zoster is transmitted how?

Recurrent infection?

respiratory

VZV probably infects dorsal root ganglia during primary infection. Certain sitations will trigger it to come out

40

Incubation period of varicella zoster?

Infected persons are infectious for how long?

10-21 days (usually 14-17)


48 h before onset of vesicular rash, throughout vesicle formation (~4-5 d), and until all vesicles are crusted.

41

Clinical Presentation
Primary infection: Chickenpox?
3

1. Rash, fever (100-103F) lasting 3-5 days, malaise
2. Skin lesions are hallmark of disease:
Maculopapules, vesicles, and scabs in varying stages of development (“crops” of lesions) on an erythematous base of 5-10 mm
3. Distribution centripetal
(much more common on trunk)

42

Clinical presentation for varicella zoster recurrent infection or shingles?2

What are the most common dermatomes? 2

1. Unilateral vesicular eruptions which develop within a single dermatome (T3 to L3 most common)
2. Often associated with severe pain

43

Diagnostics for varicella zoster?
2

Usually clinically made

Tests can include
1. Specialized complement fixation and virus neutralization in cell culture
2. Fluorescent antibody test of smear of lesions

1. Cell culture
2. Flourescent antibody stain

44

Management of varicella zoster:

Primary infeciton prevention?
Primary disease?
Recurrent infection? 2

1. Primary infection prevention: Vaccination

2. Primary disease: Prevent secondary infections

3. Recurrent infection: Zoster

A. Antivirals (high dose)
--Acyclovir
--Famcyclorvir
B. Analgesics

45

HOw is EBV transmitted and what does it infect in the body?

Incubation period?

Peak incidence occurrence?
(ages?)

How long can it be contagious/symtpomatic for?

B-cell lymphotropic virus primarily transmitted in saliva

4-8 weeks incubation period

Peak incidence occurrence
Ages 14-16 for girls
Ages 16-18 for boys

EBV shed from oropharynx for up to 18 months post-infection

46

Clinical presentation for EBV:
Childhood?
Adolescence/adult? 2

Subclinical or mild when infected during childhood

Infectious mononucleosis defined by transient appearance of heterophil Ab and clinical triad
1. Fever/chills
2. Lymphadenopathy
3. Severe pharyngitis with exudates

47

How long is the fever for in EBV?

How long is the lymphadenpathy and what nodes is it?

How long does pharyngitis last?

1. Fever/chills: 7-14 days duration (may be prodromal)
2. Lymphadenopathy rarely exceed 3 weeks duration (Posterior chain)
3. Severe pharyngitis with exudates which is maximal for 5-7 days and resolved over following 7-10 days

48

Why are the lymph nodes enlarged in EBV?

The B cells are replicating in them

49

Clinical Presentation
Other common signs/symptoms of primary infection?
4


What else is a risk factor in the furture if you've had EBV?
2

1, Headache, malaise, anorexia
2. Soft palatal petechiae
3. Maculopapular rash (especially with administration of amoxicillin/PCN)
4. Splenomegaly and mild hepatic tenderness in up to 50%

Neoplasms
1. Nasopharyngeal carcinoma
2. B-cell lymphomas (Burkitt’s lymphoma)


50

Laboratory findings for EBV?
5

1. Throat culture ( to check for B-Hemolytic strep)
2. Monospot
3. Heterophil antibodies

4. Atypical lymphocytosis in about 75%
5. EBV-specific immune response

51

When do we become positive for heterophil antibodies after we have been infected with EBV?

What are the specific antigens that are tested for EBV?
2

What do we need to make sure to do for mono on physical exam?

Become positive within 4 weeks after onset of symptoms

EBV antibody titers directed at several antigens
1. EB virus capsid antigen - (VCA)
2. Antibodies to EBV nuclear antigen – (EBNA)

Palpapate the spleen

52

Complications (many but infrequent)?
4

1. Bacterial Strep pharyngitis
2. Hematologic
3. Splenic rupture
4. Neurologic

53

Neurologic symtpoms for EBV?
3

Hematologic symtpoms are EBV? 2

1. CN palsies (Bell’s palsy)
2. Guillain-Barre syndrome
3. encephalitis

1. thrombocytopenia,
2. neutropenia

54

Infectious Mononucleosis
Epstein-Barr Virus management?
5

1. most cases requiring only supportive therapy
2. Acetaminophen or NSAIDS
3. Warm salt water gargles
4. Adequate rest (return to school/work based upon Sx)
5. Avoid contact sports for 6-8 weeks from onset

55

When will the fever in EBV disappear?

When will the EBV Lymphadenopathy and splenomegaly disappear?

10 days


4 weeks

56

How does CMV spread?
2

1. Prolonged close contacts (family, day-care centers, etc)
2. Blood/body fluids: transfusion (containing viable leukocytes), maternal-fetal transmission, STD

57

Congenital CMV occurs almost exclusively when?

almost exclusively when pregnant women acquires primary infection (vs. reactivation)

58

When does perinatal CMV occur?

when infant is infected at time of delivery through an infected birth canal or postnatal contact with maternal milk or other secretions

59

What are the biggest risks for developing CMV?
3

HIV, Pregnancy, Organ transplants

60

Clinical presentation for congenital CMV?
8

Ranges from
1. inapparent infection (most) to
2. severe/disseminated (~5%)
3. Petechiae,
4. hepatosplenomegaly,
5. jaundice common (60-80%)
6. Microcephaly,
7. growth retardation,
8. prematurity (30-50%)

61

Perinatal CMV clinical presenation?
6

1. poor weight gain,
2. adenopathy,
3. rash,
4. hepatitis,
5. anemia and
6. atypical lymphocytosis

62

CMV mononucleosis
clinical presentation?
5

1. Heterophil Ab negative mononucleosis syndrome
2. Prolonged high fevers, profound fatigue and malaise
3. Myalgias, headache & splenomegaly are frequent
4. Exudative phayngitis and cervical adenopathy are rare
5. Occasional rubelliform rash

63

CMV laboratory tests?
4


What's the important test?

1. viral culture
2. PCR
3. Antigen assays
4. Tissue confirmation with AIDS related CMV

64

What part of the body can CMV be cultured from?
7

1. Blood,
2. urine,
3. saliva,
4. cervicovaginal secretions, 5. cerebrospinal fluid (CSF), 6. bronchoalveolar lavage fluid, and
7. tissues

65

Three things to look for in CMV?

1. SIGNIFICANT hepatomegaly or splenomegaly
2. microcephaly
3. blueberry muffin rash

66

Etiologic agent for Fifth's disease?

What is the route of transmission?

Human Parvovirus B19

Respiratory tract is probably route of transmission

67

Clinical Presentation
fifth's disease (Erythema infectiosum)?
10

1. Mild febrile exanthematous disease with little or no prodrome
2. Low-grade fever,
3. varying degrees of conjunctivitis,
4. upper respiratory complaints,
5. cough, myalgia, itching,
6. nausea and diarrhea
7. Slapped face lesions (fiery cheeks)
8. Circumoral pallor
9. Bilateral symmetric eruptions (maculopapular slightly raised blotchy areas with reticular or lacy pattern)
10. Rash that lasts about a week

are initial signs and symptoms

68

What does the rash look like in Fifth's disease?

How would we treat it?

reticular- not raised

treat with NSAIDS and tylenol

69

How is the diagnosis for 5th disease made?2

Usually made clinically in kids

Labs:
1. Elevated titer of IgM anti-parvovirus antibodies
2. PCR in serum

70

Roseola (infantum)-Sixth Disease is a benign disease in children of what ages?

What cell do they target?

What is Roseola the major cause of?

In older children/adults, associated with several illnesses. What are they?
3

infants 6 months months to 4 y/o (most commonly seen in children

HHV6 – b-cell lymphotropic virus

Major cause of infantile febrile seizures!!

In older children/adults, associated with several illnesses: hepatitis, Immunocompromised states, chronic fatigue syndrome, others

71

What will the progression of the disease look like?
3

1. high high fever (up to 105) and causes child to sieze.
2. have to do workup for menigitis and encephalopathy
3. Rash and low grade fever- this will happen after the high fever

72

When do first manifestations occur in Roseola pts?

Describe the onset

How long does the rash last?

First manifestations occur after 5-15 days incubation period

Abrupt onset irritability and fever lasting 3-5 days

Lasts a few hours or up to 1-2 days

73

Management of roseola?
3

1. still get a head CT to rule out menigitis if they have seizures
2. nice warm baths will bring down the core temp. 3. Tylenol

74

How is measles transmitted?
3

1. Transmitted through nasopharyngeal secretions (directly or airborne droplets) to
2. respiratory mucous membranes or
3. conjunctivae of susceptible persons

75

How long is measles contagious for?

Highly contagious: infectious from 5 days after exposure to 5 days after skin lesions appear

76

Clinical presenation of measles?
8

Whats the prodromal period?

1. Acute febrile eruption following 9-11 days incubation (2 weeks until rash eruption)
Prodromal (lasts 1-8 days; average 3-4d):
1. malaise, irritability, fever (up to 105F),
2. conjunctivitis with increased lacrimation,
3. edema of eyelids,
4. photophobia,
5. hacking cough,
6. rhinorrhea

7. KOPLICK SPOTS (blue white centers)
8. Brick red irregular maculopapular rash that starts on top and goes down

77

Diagnostic Labs for Measles?
2


Treatment of Measles?
4

Labs:
1. Neutropenia
2. Detection for IgM antibodies with enzyme-linked imumosorbent assay (ELIZA)- when there was outbreak this is what they used

1. Isolation of patient
2. Bedrest
3. Antipyuretics
4. Fluids


78

Rubella is transmitted how?

Whats it caused by?

Why is it dangerous for babies?

1. Nasopharyngeal secretions transmit virus

2. Caused by Togavirus

3. Transplacental transmission results in congenital rubella syndrome

79

Clinical presentation of rubella?
5

1. Viral exanthemous primary disease is generally milder than rubeola (measles)
2. No prodromal in children
3. Adults - Prodromal illness precedes rash by 1-8 days and consists of malaise, headache, fever
4. lymphadenopathy
5. Splenomegaly

80

When does the rash appear in rubella?

Whats the difference in appareance of rash in rubella and rubeola?
3

14-21 days after exposure and follows same pattern as rubeola

1. Lesions have lighter hue than measles
2. Lesions usually remain discrete versus coalescent form and last 1-5 days (most commonly 3 days)
3. Small red lesions (Forchheimer’s spots) may appear on soft palate (not pathognomonic)

81

What nodes are most affected by rubella?
2

post-auricular and suboccipital nodes

82

Clinical Presentation
Congenital rubella syndrome
8

1. Heart malformations
2. Eye lesions
3. Microcephaly
4. Mental retardation
5. Deafness
6. Thrombocytopenic purpura
7. Heptosplenomegaly
8. Intrauterine growth retardation

83

What are the heart malformations that could occur with congenital rubella?3

1. patent ductus arteriosus, 2. interventricular septal defect,
3. pulmonic stenosis

84

What are the eye lesions that could occur with congenital rubella?
4

Management?

1. corneal clouding,
2. cataracts,
3. chorioretinitis,
4. microphthalmia

Prevention!!! Attenuated virus can be detected up to 4 weeks after immunization

85

Diagnostic tests for Rubella?

2 and 2



Treatment?

1. Leukopenia
2. Virus isolation and serologic tests of immunity
--Fluorescent antibody tests
--IgM antibodies to Togavirus

Acetominophen

86

Complications of Rubella? 2

Congenital rubella complications?
4

1. Exposure during PG
2.Post infectious encephalopathy


-Heart defects,
-cataracts,
-glaucoma
-Psychomotor retardation

87

What kind of virus is mumps?

How is it spread and how contagious is it compared to measles or chicken pox?

Etiologic agent: A paramyxovirus

Spread by respiratory route but less “contagious” than measles or chickenpox

88

Clinical presentaiton of mumps:

Incubation period?

What percent of infections are subclinical?

12-25 days incubation period

At least 25% of infections are subclinical

89

What is the first indication of mumps and usually occurs very suddenly?

What else is a common clinical presentation in men?

Unilateral or bilateral?

Parotitis: parotid swelling (salivary adenitis) is first indication of illness and usually occurs suddenly

Epididymoorchitis


usually unilateral

90

When are the three common cold viruses that were mentioned?

Rhinovirus
Coronavirus
Adenovirus

91

What family are the influenza viruses part of?

What types are based on antigenic characteristics of the nucleoprotein (NP) and matrix (M) protein antigens?

Type A undergoes further classification. Describe this.
2

Orthomyxoviridae family of viruses


Types A, B and C


Further surface antigenic classification
1. Hemagglutinin (H) antigens (H1-3)
2. Neuraminidase (N) antigens (N1-2)

92

Major antigenic shifts occurs regularly.
Type A viruses about every how many years?
Type B viruses about every how many years?

3

5

93

Clinical Presentation for Influenza:

What will the onset be like and what will the initial symtpoms be?

These symtpoms are accompanied by respiratory symptoms. What are they? 2

Acute illness generally resolves within?

Abrupt onset of systemic symptoms:
1. headache,
2. fever (38-41 C),
3. chills,
4. myalgia,
5. malaise

1. cough,
2. pharyngitis

one week

94

What is evidence of pulmoary complications in influenza pts?
5

1. Dyspnea,
2. hyperpnea,
3. cyanosis,
4. diffuse rales or
5. signs of consolidation

95

Complications that can come from influenza?
4

1. Pneumonia (most common-staph)
2. Reye’s syndrome (especially children ages 2-16)
3. Myositis, rhabdomyolysis, myoglobinuria
4. Myocarditis and pericarditis

96

What do we not want to give kids for influenza?
Why?

Brain and liver in kids- aspirin, pepto has aspirin in it

97

What will we see in influenza in the elderly that is different?

mental status change

98

Diagnosis of Flu?
2

Symptomatic treatment of Flu (not in first 72 hours)?
4

1. Rapid flu swab (Nasal, throat)
2. Leukopenia

1. Acetaminophen
2. Rest
3. Fluids
4. Antibiotics if pneumonia is suspected

99

If we catch influenza in the first 72 hours we should treat with what?
2

What are the two alternative drugs?

Neuraminidase inhibitors
1. Oseltamivir (Tamiflu)
2. Zanamivir (Relenza)


Adamantane derivatives/M2 inhibitors (proton channel through viral envelope)
1. Amantadine
2. Rimantadine

100

Who is the flu vaccine contraindicated in?

Who do we need to make sure have the vaccination every year?
6

allergy to eggs

1. Chronic cardiac or pulmonary disease (including asthma)
2. Pregnant women
3. Residents of chronic care/nursing facilities
4. Over age 65
5. Chronic medical disorders: DM, renal disease, hemoglobinopathies, immunosuppressed
6. Individuals who care for high risk populations

101

What is a member of the Paramyxovirus genus is a major respiratory pathogen of young children?

How is it transmitted?

Incidence rates are highest in what age group?

Respiratory syncytial virus (RSV)

Transmitted primarily by close contact with contaminated fingers or fomites

1-6 months

102

Why is RSV so deadly to babies?


What is one thing you must do doing the physical exam?

1. The infection happens deep in the bronchioles and causes tons of inflammation
2. little babies can’t cough it out and they dont get any oxygen


O2 sats!

103

Clinical presentation of RSV in infants:

Commonly presents initally how?4

Severe illness presents how?5

Clinical presentation in adults?
Younger children? 3

Commonly presents as
1. rhinorrhea,
2. low-grade fever,
3. cough and wheezing,
4. mild systemic symtoms

Severe illness:
1. Tachypnea,
2. dyspnea,
3. hypoxia,
4. cyanosis even apnea may ensue
5. Diffuse wheezing, rhonchi and rales


Adults/older children - common cold presentation

Younger children/infants - bronchiolitis, tracheobronchitis and pneumonia

104

Diagnostic tests for RSV?
3


Treatment?

Supportive measures?
4

1. Rapid RSV with nasal washings using viral antigen ID using and
2. ELIZA or immunofluorescent assay
3. Culture of nasaopharyngeal secretions

Antiviral therapy: Ribavirin

1. Contact isolation
2. Respiratory therapy, oxygen, secretion removal
3. Hydration
4. Antibronchospastic agents

105

There are 4 major serotypes of croup. 3 are important. What do they cause?

What kind of virus is it?

Caused by the parainfluenza viruses: 4 major serotypes

Type 1 is most frequent cause of croup (laryngotracheo-bronchitis) in children
Type 2 is similar but less severe disease
Type 3 causes bronchiolitis and pneumonia is infants

106

Clinical Presentation
of Croup?
4

1. Acute febrile illness in children (50-80%)
2. Coryza, sore throat, hoarseness and variably croupy cough
3. Breathing difficulty accompanied by a "barking" cough.
4. Croup is much worse at night

107

Management of croup? 2

ER treatment? 2

What treatment should we avoided?

What if the cough is going on for a long time?

1. Cool or moist air can bring relief.
2. Acetaminophen
ER treatment
1. Aerosolized Racemic Epinephrene
2. Predisone in ER and to go (oral)

Avoid cough medicines (supress cough, not your goal want to get rid of the information)

Dexamethasone

108

What virus causes rabies?

What are the two epidemiologic forms?

rhabdovirus

Urban
Sylvatic

109

Clinical presentation of rabies is divided into 4 stages.

Stage one description? 2

Prodrome usually persists 1-4 days
1. Fever, headache, malaise, myalgias, increased fatigability, anorexia, nausea/vomiting, pharyngitis, nonproductive cough.
2. Paresthesias and/or fasciculations around site of inoculation suggestive of rabies

110

Clinical presentation of rabies is divided into 4 stages.


Stage two description? 4

Acute encephalitis
1. Development of excessive motor activity, excitation and agitation
2. Confusion, hallucinations, combativeness, muscle spasms, meningismus, seizures and focal paralysis quickly follows
3. Hyperesthesia with excessive sensitivity to bright light, noise or touch is common
4. Fever (up to 105 F), dilated irregular pupils, increased lacrimation, salivation, perspiration, and postural hypotension occur

111

Clinical presentation of rabies is divided into 4 stages.

Stage three description? 4

Stage four description? 1

Profound brainstem dysfunction
1. Occur shortly after onset of encephalitic phase
2. Difficulty swallowing (with increased salivation) produces characteristic “foaming at the mouth”
3. Violent involuntary contractions of diaphragm and accessory respiratory, pharyngeal and laryngeal muscles
4. Coma and respiratory failure follow


Recovery (rarely)

112

Quick description of the four stages of rabies?



What is the first thing we do if we suspect rabies?

1. Prodrome: usually persists 1-4 days
2. Acute encephalitis
3. Profound brainstem dysfunction
4. Recovery (rarely)

CLEAN THE WOUND FIRST AND FOREMOST

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Laboratory Findings
for rabies?
3


Management for rabies:
Prevention pre and post exposure?

1. Isolation of virus (saliva, CSF or brain tissue)
2. Indirect serologic evidence of immune response
3. Direct antigen detection (skin or brain biopsies)

Pre-exposure vaccinations
Post-exposure prohpylaxis is the IG antibody

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What is structurely the most complex of any virus?

Small pox
Variola Major

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Differences in Variola Versus Varicella:

Rash starts where?
Lesions occur how?
Depth of lesions?
Present on palms or soles?
Rash presentation?
More rash on back or abs?
Multiloculated or Uniloculated vesicles?

Variola
Rash starts face
Lesions same stage
Deep lesions
Often palms/soles
Centrifugal rash
Back > Abdomen
Multiloculated vesicles


Varicella
Rash starts trunk
Lesions in crops
Superficial lesions
Never palms/soles
Centripetal rash
Back = Abdomen
Uniloculated vesicles

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Symtpoms on day:

(Day 0)
(Day 12-14)
(Day 14-16)
(Day 16-18)
(Day 22-26)
(Day 28-30)

10% will develop malignant disease and die 5-7 days after incubation

0- Exposure
12-14- Fever, malaise, non-productive cough, headache, backache, joint pain
14-16- Papular rash on face → extremities
16-18- Papular→vesicular→pustular
22-26-Crusted lesions
28-30-Resolving