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Nelson - Exam 3 (IDS) > Viral infections > Flashcards

Viral infections Flashcards

1
Q

Single-stranded RNA virus

A

Measles, Mumps, Rubella, Enteroviruses

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2
Q

2 most important structural proteins of measles virus important for induction of immunity

A

H protein and F protein (hemagglutinin and fusion)

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3
Q

Portal of entry of measles virus

A

Respiratory tract or conjunctiva

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4
Q

Patients with measles are infectious when

A

3 days before up to 4-6 days after onset of rash

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5
Q

Pathognomonic of measles

A

Warthin-Finkeldey multinucleated giant cells resulting from fusion of infected cells

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6
Q

4 phases of measles

A

Incubation, prodrome, exanthematous phase, recovery

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7
Q

Primary viremia spreads the measles virus to what organ system

A

Reticuloendothelial

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8
Q

Secondary viremia spreads measles virus to what organ system

A

Body surfaces

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9
Q

Pathognomonic sign of measles

A

Koplik spots

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10
Q

Koplik spots appear when

A

1-4 days prior to the onset of the rash

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11
Q

Rash of measles fades over how many days

A

~7 days

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12
Q

Of the major symptoms of measles, ___ lasts the longest`

A

Cough, up to 10 days

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13
Q

T/F Persons with inapparent or subclinical measles do not shed measles virus and do not transmit infection to household contacts

A

T

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14
Q

What is atypical measles

A

More severe form of measles seen in children who had received the original formalin-inactivated measles vaccine (1963-1967)

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15
Q

Symptoms of atypical measles

A

1) High fever, cough, and abdominal pain 2) Maculopapular, petechial, vesicular or urticarial rash begins on the limbs and spreads centripetally 3) Swelling/edema of the hands and feet4) Pneumonia may persist for 3 months or more

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16
Q

Measles IgM appears when

A

1-2 days after onset of rash

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17
Q

Measles IgM remains detectable for how long

A

1 month

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18
Q

Serologic confirmation of measles infection

A

(+) IgM and fourfold rise in IgG antibbodies in acute and convalescent specimens collected 2-4 weeks later

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19
Q

Complications of measles are largely attributable to pathogenic effects of the virus on which organ systems

A

1) Respiratory tract 2) Immune system

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20
Q

Morbidity and mortality from measles are greatest in what population of patients

A

<5 years (especially <1 y/o) and > 20 years

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21
Q

MCC of death in measles

A

Pneumonia

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22
Q

MC complication of measles

A

OM

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23
Q

Virus associated with giant cell pneumonia

A

Measles virus

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24
Q

MC bacterial pathogens that complicate measles pneumonia

A

S. pneumoniae, H. influenzae, and S. aureus

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25
Q

Final common pathway to a fatal outcome following severe measles pneumonia

A

Bronchiolitis obliterans

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26
Q

T/F Measles encephalitis is due to a direct effect of the measles virus

A

F, immunologically-mediated process

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27
Q

Severe form of measles that manifests as a hemorrhagic skin eruption and is often fatal

A

Black measles or hemorrhagic measles

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28
Q

T/F Antiviral therapy is NOT effective in treatment of measles in otherwise normal patients

A

T

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29
Q

Vit A Treatment in Measles: Indications

A

1) 6m-2y hospitalized with complications (croup, pneumonia, diarrhea) 2) >6m not already receiving vit A supplementation and have risk factors - immunodef, clinical evidence of vit A def, impaired intestinal abbsorption, mod to severe malnut, recent immigration from areas with high mort rates attributable to measles

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30
Q

Vit A Treatment in Measles: Regimen

A

50,000 IU PO single dose for infants <6m; 100,000 IU PO single dose for children 6m-1y; 200,000 IU PO single dose for children ≥1y; REpeat the next day and 4 weeks later for children with ophthalmologic evidence of vitamin A deficiency

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31
Q

Patients shed measles virus when

A

7 days after exposure to 4-6 days after onset of rash

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32
Q

Measles vaccine: what

A

Live attenuated, available as monovalent or with mumps, rubella, varicella

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33
Q

Measles vaccine: when

A

6m during outbreaks, 1st dose at 9m, 2nd dose as MMR at 12m, 3rd dose as MMR (2nd dose MMR) at 4-6y but may be given earlier with min 4 weeks interval

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34
Q

Measles vaccine: how

A

SC; MMR may be given as an alternative to monovalent measles vaccine; MMRV may be given as an alternative to MMR and Varicella vaccines

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35
Q

Minimum interval between MMRV doses

A

3 months

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36
Q

MMRV must be given at a minimum age of ___ and a maximum age of

A

12 months, 12 years

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37
Q

Measles vaccine is effective in prevention or modification of measles if given within

A

72 hours of exposure

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38
Q

Measles post exposure prophylaxis

A

1) Vaccine within 72h 2) Ig within 6 days

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39
Q

Indications for measles Ig

A

Susceptible household contacts especially infants <6m, pregnant women, and immunocompromised persons

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40
Q

SSPE results from

A

Persistent infection with an altered measles virus harbored intracellularly in the CNS

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41
Q

SSPE: After ____ years, virus apparently regains virulence and attacks cells in the CNS that offered it protection

A

7-10

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42
Q

Clinical manifestations of SSPE begin insidiously when

A

7-13 yrs after primary measles infection

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43
Q

Hallmark of 2nd stage of SSPE

A

Massive myoclonus

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44
Q

Massive myoclonus in the 2nd stage of SSPE coincides with extension of inflamm process to

A

Deeper structures in the brain including the basal ganglia

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45
Q

Stage of SSPE: Massive myoclonus

A

2

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46
Q

Stage of SSPE: Involuntary movements disappear

A

3

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47
Q

Stage of SSPE: Lead pipe rigidity

A

3

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48
Q

Stage of SSPE: Choreoathetosis

A

3

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49
Q

Stage of SSPE: Loss of critical centers that support vital signs

A

4

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50
Q

Criteria for diagnosis of SSPE

A

1) Compatible clinical course 2) At least 1 of the following: Measles Ab in CSF, characteristic EEG, typical histo findings in and/or isolation of virus or viral Ag from brain tissue obtained by biopsy or postmortem exam

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51
Q

CSF analysis in SSPE

A

Normal cells with elevated IgG and IgM Ab titers in dilutions of 1:8

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52
Q

EEG findings in SSPE

A

St 1 - normal; Suppression-burst episodes in the myoclonic phase (characteristic but not pathognomonic)

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53
Q

SSPE prognosis

A

Most die within 1-3 yrs of onset fr infection or loss of autonomic control mechanisms

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54
Q

T/F Rubella is typically more severe and associated with more complications in adults

A

T

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55
Q

Major clinical significance of Rubella

A

CRS

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56
Q

Rubella, family

A

Togaviridae

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57
Q

Rubeola, family

A

Paramyxoviridae

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58
Q

3-day measles

A

Rubella

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59
Q

Rubella virus replicates where

A

Respiratory epithelium

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60
Q

Rubella: Viremia ensues and is most intense when

A

10-17 days after infection

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61
Q

Rubella: Viral shedding from the nasopharynx

A

~10 days after infection and detected up to 2 weeks after onset of rash

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62
Q

Rubella: Period of highest communicability

A

5 days before to 6 days after appearance of rash

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63
Q

Rubella: Most important RF for severe congenital defects

A

Stage of gestation of infection

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64
Q

Rubella: Results in the most severe and widespread defect

A

Maternal infection during 1st 8 weeks of gestation

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65
Q

Most distinctive feature of congenital rubella

A

Chronicity

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66
Q

Rubella: Incubation period

A

14-21 days

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67
Q

In children, 1st manifestation of rubella is usually

A

Rash

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68
Q

Forchheimer spots

A

Rose-colored or petechial hemorrhages on the soft palate of patients with rubella seen at about the time of onset of the rash

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69
Q

T/F Rash of rubella usually fades without desquamation

A

T

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70
Q

MC diagnostic test for rubella

A

IgM

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71
Q

Most serious complication of postnatal rubella

A

Encephalitis

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72
Q

Extremely rare complication of either acquired or CRS

A

PRP (progressive rubella panencephalitis)

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73
Q

T/F Onset and course of PRP is similar to that of SSPE

A

T

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74
Q

CRS: Single most common finding

A

Nerve deafness

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75
Q

CRS: MC occular abnormality

A

Salt-and-pepper retinopathy

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76
Q

CRS: Most serious eye finding

A

Unilateral or bilateral cataracts

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77
Q

CRS: Late-onset manifestations

A

DM, thyroid dysfunction, glaucoma and visual abnormalities associated with the retinopathy

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78
Q

Rubella: Treatment

A

Supportive

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79
Q

Rubella: Patients with postnatal infection should be isolated from susceptible individuals for how long

A

7 days after onset of rash

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80
Q

T/F Routine Ig for susceptible pregnant women exposed to rubella is recommended

A

F, considered only if termination of pregnancy is not an option because of maternal preferences

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81
Q

Bilateral or unilateral parotid swelling

A

Mumps

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82
Q

Mumps, family

A

Paramyxoviridae

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83
Q

Mumps: Appears in the saliva

A

7 days before to as long as 7 days after onset of parotid swelling

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84
Q

Mumps: Period of maximum infectiousness

A

1-2 days before to 5 days after onset of parotid swelling

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85
Q

Mumps: Incubation period

A

12-25 days, usually 16-18 days

86
Q

Mumps: Prodrome

A

1-2 days, constitutional

87
Q

Mumps: Parotitis becomes bilateral in ___%

A

70

88
Q

Mumps: Peak of parotid swelling

A

~3 days then gradually subsides over 7 days

89
Q

Mumps: Confirmation of presence of parotitis

A

Elevated serum amylase

90
Q

Mumps: Virus can be isolated from what specimens during acute illness

A

Upper respiratory tract secretions, CSF, urine

91
Q

Mumps: Establishes diagnosis

A

Significant increase in serum mumps IgG between acute and convalescent specimens

92
Q

Mumps: Close ddx

A

Purulent parotitis

93
Q

Purulent parotitis: Caused by

A

S. aureus

94
Q

Purulent parotitis: Characteristics

A

Unilateral, extremely tender, elevated WBC, purulent drainage from Stensen duct

95
Q

Mumps: MC complications

A

Meningitis w/ or w/o encephalitis and gonadal involvement

96
Q

Mumps: T/F Maternal infection results in increased fetal wastage

A

T

97
Q

Mumps: Thought to enter the CNS via

A

Choroid plexus

98
Q

Mumps: T/F CSF pleocytosis can be found in mumps parotitis even without CNS symptoms

A

T, in 40-60%

99
Q

Mumps: Meningoencephalitis commonly manifests when

A

5 days after parotitis

100
Q

Mumps: 2nd MC finding to parotitis

A

Orchitis

101
Q

Mumps: T/F Majority of orchitis is bilateral

A

F, ≤30% only

102
Q

Mumps: T/F Sterility is rare in cases of orchitis, even with bilateral involvement

A

T

103
Q

Mumps: T/F Pancreatitis may occur with or without parotitis

A

T

104
Q

Mumps: Management should be aimed at

A

Reducing pain and maintaining adequate hydration

105
Q

Mumps: Acceptable presumptive evidence of immunity to mumps

A

1) Documentation of adequate vaccination 2) Lab evidence of immunity 3) Birth before 1957 4) Documentation of physician-diagnosed mumps

106
Q

Enteroviruses: Family

A

Picornaviridae

107
Q

T/F Humans are the only known reservoir for human enteroviruses

A

T

108
Q

Enteroviruses: Incubation period

A

3-6 days

109
Q

MC symptomatic manifestations of enterovirus infection especially in infants and young children

A

Nonspecific febrile illness

110
Q

Hand-foot-and-mouth disease

A

Coxsackievirus A16

111
Q

Sudden onset fever, sore throat, dysphagia, and lesions in the posterior pharynx

A

Herpangina

112
Q

Paroxysmal thoracic pain due to myositis involving chest and abdominal wall muscles

A

Pleurodynia (Bornholm disease)

113
Q

Pleurodynia

A

Coxsackie B and Echoviruses

114
Q

Acute hemorrhagic conjunctivitis

A

Enterovirus 70 and Coxsackievirus A24/A24

115
Q

Account for ~25-35% of myocarditis and pericarditis with proven cause

A

Enteroviruses

116
Q

2nd to mumps as MC cause of orchitis

A

Coxsackie B

117
Q

MCC of viral meningitis

A

Mumps

118
Q

MCC of viral meningitis in mumps-immunized populations

A

Enteroviruses

119
Q

Account for up to 90% or more of viral men cases in which a cause is identified

A

Enteroviruses

120
Q

Responsible for ≥10-20% of enceph cases with an identified cause

A

Enteroviruses

121
Q

Mainstay of treatment of enterovirus infection

A

Supportive care

122
Q

Erythema infectiosum or fifth disease: Caused by

A

Parvovirus B19

123
Q

Single stranded DNA virus

A

Parvovirus B19

124
Q

Parvovirus B19: T/F benign viral exanthem in healthy children

A

T

125
Q

Affinity to RBC progenitor cells

A

Parvovirus B19

126
Q

Aplastic crisis in patients with hemolytic anemias

A

Parvovirus B19

127
Q

Double-stranded DNA virus

A

HSV, VZV

128
Q

Leading cause of sporadic, fatal enceph in children and adults

A

HSV

129
Q

Fever blisters or cold sores

A

HSV

130
Q

Fetal anemia and hydrops fetalis

A

Parvovirus B19

131
Q

Cell receptor for parvovirus B19

A

Erythrocyte P antigen

132
Q

Replicates in actively dividing erythroid stem cells

A

Parvovirus B19

133
Q

Parvovirus B19: Mode of transmission

A

Respiratory secretions and blood product transfusions

134
Q

Parvovirus B19: Incubation period

A

4-14 days, rarely 21 days

135
Q

Parvovirus B19: 3 stages of rash

A

1) Slapped cheek with circumoral pallor 2) Symmetric maculopapular truncal rash 1-4 days later3) Central clearing of preceding rash, now lacy and reticulated, lasting 2-40 days, may be pruritic, DOES NOT DESQUAMATE, and may recur with exercise, bathing, rubbing, or stress

136
Q

Parvovirus B19: T/F Transient neutropenia and thrombocytopenia also commonly occur

A

T

137
Q

Parvovirus B19: Treatment

A

No specific therapy

138
Q

Parvovirus B19: Prognosis

A

Excellent

139
Q

Parvovirus B19: T/F teratogenic

A

F

140
Q

Parvovirus B19: Population at greatest risk and from whom

A

Pregnant women from infected children 5-7 y/o in the household, at daycare, and in schools

141
Q

Parvovirus B19: T/F Exclusion of affected children from school is recommended

A

F, children are generally not infectious by the time the rash is present

142
Q

Occurs in individuals previously infected with 1 type of HSV who have become infected for the 1st time with the other HSV type

A

Nonprimary 1st infection

143
Q

During primary and nonprimary initial infections, HSV establishes latent infection where

A

Regional sensory ganglion neurons

144
Q

HSV: Targets for antiviral drugs

A

DNA polymerase and thymidine kinase

145
Q

HSV: Targets for humoral immunity

A

Glycoproteins

146
Q

T/F Neonatal herpes is uncommon but potentially FATAL infection of the fetus or newborn

A

T

147
Q

HSV: T/F Viremia or hematogenous spread of the virus does not appear to play an important role in HSV infections in the IMMUNOCOMPETENT HOST

A

T

148
Q

Hallmarks of common HSV infections

A

Skin vesicles and shallow ulcers

149
Q

Acute oropharyngeal infections caused by HSV resolves in 7-14 days UNTREATED

A

T, although lymphadenopathy may persist for several weeks

150
Q

HSV: Presentation in older children and adults rather than gingivostomatitis

A

Pharyngitis and tonsillitis

151
Q

MC manifestation of recurrent HSV-1 infections

A

Fever blisters and cold sores

152
Q

HSV: Herpes gladiatorum is associated with what sport

A

Wrestling

153
Q

HSV: Scrumpox is associated with what sport

A

Rugby

154
Q

Term generally applied to HSV infection of fingers or toes

A

Herpes whitlow

155
Q

___% of individuals with genital HSV infection are unaware that they are infected

A

90%

156
Q

Course of classic primary genital herpes from onset to complete healing is

A

2-3 weeks

157
Q

T/F Conjunctivitis or keratoconjunctivitis caused by HSV is usually unilateral

A

T

158
Q

Conjunctivitis or keratoconjunctivitis with preauricular lymphadenopathy

A

HSV

159
Q

Leading cause of sporadic, nonepidemic enceph in children and adults in the US

A

HSV

160
Q

HSV enceph is an acute necrotizing infection generally involving the ___

A

Frontal and/or temporal cortex and limbic system

161
Q

Beyond the neonatal period, HSV enceph is almost always caused by

A

HSV-1

162
Q

MCC of recurrent aseptic meningitis

A

HSV

163
Q

Mollaret meningitis

A

HSV

164
Q

3 patterns of neonatal HSV infection

A

1) Localized to skin eyes or mouth (SEM) 2) Enceph with or without SEM 3) Multiple organs

165
Q

Infants with HSV enceph typically present on ___

A

8-17 days of life

166
Q

HSV present with clinical findings suggestive of

A

Bacterial meningitis

167
Q

Test of choice in examining CSF of infants suspected to have HSV encephalitis

A

PCR for detection of HSV DNA

168
Q

3 antiviral drugs available for the mgt of HSV infections

A

Acyclovir, Valacyclovir, Famciclovir

169
Q

HSV Mx: Gingivostomatitis

A

Acyclovir 15mkdose 5x a day PO for 7 days (max 1g/day) started within 72 hrs of onset

170
Q

HSV Mx: Herpes labialis

A

Oral treatment superior to topical

171
Q

T/F Suspected first-episode genital herpes should be treated with antiviral therapy

A

T

172
Q

3 strategic options re mgt of recurrent HSV infections

A

1) No therapy 2) Episodic therapy 3) Long-term suppressive therapy

173
Q

HSV Mx: Herpes encephalitis

A

IV acyclovir 10mkdose q8 as 1 hour infusion for 14-21 days EXCEPT FOR NEONATES

174
Q

HSV Mx: Infants with proven or suspected neonatal HSV infection

A

High-dose IV acyclovir 60mkday q8

175
Q

HSV Mx: Infants with HSV limited to SEM, duration of treatment

A

14 days

176
Q

HSV Mx: Infants with disseminated HSV or CNS disease, duration of treatment

A

21 days

177
Q

HSV Mx: Pregnant women with active genital herpes at time of delivery

A

Vertical transmission can be reduced but not eliminated by cesarean section within 4-6hr of rupture of membranes

178
Q

Neurotropic virus

A

HSV, VZV

179
Q

Varicella vaccine: what

A

Live attenuated

180
Q

Varicella vaccine: when

A

1st dose minimum @ 12 mos as MMRV or Varicella monovalent, 2nd dose at 4-6 yrs but anytime with an interval of 3 mos from 1st dose; if 2nd dose is given 4 weeks from 1st dose, it is considered VALID; For children 13 yrs and above, recommended min interval between doses is 4 weeks

181
Q

Varicella vaccine: how

A

SC

182
Q

Max age for MMRV

A

12 y/o

183
Q

Recommended min interval between doses of MMRV

A

3 mos

184
Q

Zoster vaccine is recommended for

A

Adults ≥60y (reduces both frequency of herpes zoster and its most frequent complication)

185
Q

Most frequent complication of herpes zoster

A

Postherpetic neuralgia

186
Q

VZV: Incubation period

A

10-21 days

187
Q

VZV: Replicates where

A

Local lymphoid tissue > subclinical viremia > RES > mucosa of upper respiratory tract and orophayrnx

188
Q

Person with VZV is infectious

A

1-2 days before appearance of rash

189
Q

Varicella: Clouding and umbilication of the lesion begin when

A

24-48HR

190
Q

Simultaneous presence of lesions in various stages of evolution

A

Varicella

191
Q

Centripetal

A

Varicella, atypical measles

192
Q

Centrifugal

A

Smallpox

193
Q

What is breakthrough varicella

A

Varicella in a person vaccinated >42 days bbefore rash onset

194
Q

1 dose varicella vaccine is ___% effective in preventing severe varicella and ___% effective in preventing all disease after exposure to wild-type VZV

A

≥97, 85

195
Q

Breakthrough varicella is caused by

A

Wild-type VZV

196
Q

Characteristics of breakthrough varicella

A

Mild, fewer than 50 skin lesions, afebrile or low-grade fever, shorter duration of illness, rash more likely maculopapular than vesicular, less contagious in general but dependent on number of lesions

197
Q

T/F Neonatal varicella has a high mortality rate

A

T

198
Q

Infants of mothers that develop varicella during this period are at high risk for severe varicella

A

5 days before and 2 days after delivery

199
Q

1 vial VariZIG ASAP is indicated for neonates who

A

1) Are born to mothers who demonstrate Varicella 5 days before to 2 days after delivery 2) Are born at <28 weeks to a mother with active varicella even if maternal rash has been present for >1 week

200
Q

When pregnant women contract varicella early in pregnancy, experts estimate as many as ___% of fetuses may become infected

A

25

201
Q

Congenital varicella syndrome: Clnically apparent disease is uncommon

A

T

202
Q

Congenital varicella syndrome: Characteristic skin lesion

A

Cicatricial or zigzag scarring in a dermatomal distribution, often associated with atrophy of affected limb, and neurologic and eye abnormalities

203
Q

T/F Almost half of elderly with herpes zoster experience complications

A

T

204
Q

What is postherpetic neuralgia

A

A painful condition that affects the nerves despite resolution of shingles skin lesions

205
Q

Lab evaluation is not necessary for HEALTHY children with varicella or herpes zoster, but acute infection can be confirmed by

A

Fourfold or greater rise in VZV IgG

206
Q

T/F Antiviral treatment modifies course of varicella infection

A

T

207
Q

T/F Antiviral treatment modifies course of herpes zoster infection

A

T

208
Q

The only drug available for the treatment of acyclovir-resistant VZV infections

A

Foscarnet

209
Q

The only antiviral drug for Varicella that is available in liquid form and licensed for pediatric use

A

Acyclovir

210
Q

To be most effective, antiviral treatment for Varicella should be initiated ASAP, preferrably

A

Within 24hrs of onset of exanthem

211
Q

T/F Use of corticosteroids in children for treatment of herpes zoster is NOT recommended

A

T

212
Q

Primary varicella has lowest case fatality rate among what population

A

1-9 y/o

Nelson - Exam 3 (IDS) (21 decks)

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