viral exanthemata childhoos.txt

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viral exanthemata childhoos.txt
2011-02-21 19:52:22
child rash

child rash
Show Answers:

  1. What is an exanthem?
    SKIN rash/eruption or disease in which skin rashes/eruptions are prominent
  2. What is an enanthem?
    An eruption on a MUCOSAL surface
  3. What is a macule?
    Discoloured area on the skin NOT ELEVATED above the surface
  4. What is a papule?
    SMALL, circumscribed, superficial, solid ELEVATION of skin
  5. What is a vesicle?
    SMALL, circumscribed EPIDERMAL ELEVATION, less than 5mm usually containing clear fluid
  6. What is spread of measles?
    Airborne and direct contact with respiratory secretions eg kiss
  7. Who is the attack rate of measles high in?
    Unimmunised (people who haven’t had MMR)
  8. What is the mortality of measles in UK?
    Low as developed
  9. What are the 3 C’s of measles?
    • Coryza
    • Cough
    • Conjunctivitis
  10. What are clinical features of measles?
    Prodromal features 3-5 days: cough, coryza, malaise, fever, conjunctivitis
  11. What is a characteristic feature in the prodrome of measles?
    Koplik’s spots in bucclal mucosa inside cheek and mouth. White, opposite molar usually. Like grains of salt
  12. What appears 4-5 days after onset of symptoms?
    Maculopapular rash: starts on face and spreads downwards
  13. How infectious is measles and what is timing of infectivity?
    • Highly infectious – up to 90% of contacts are infected
    • Infectious period: 4 days before and after rash onset
  14. What are the 2 main categories of complications of measles? And give eg of the actual complications. Concentrate on immunocomptent patient
    • Respiratory: opportunistic secondary infections of epithelial surfaces (as this is destroyed by virus so strep and staph can get in) eg respiratory tract, pneumonia, otitis media, bronchitis
    • CNS: acute measles post infectious encephalitis, decades after primary infection can get SSPE – subacute sclerosing panencephalitis
  15. How does SSPE present?
    In puberty with decline in mental function and seizures
  16. What are 2 major comlpications of measles specifically in immunoCOMPROMISED?
    • Resp: measles giant cell pneumonia (virus fuses cells and get syncytium)
    • CNS: subacute measles encephalitis
  17. How is diagnosis of measles made?
    • Detect measles specific ANTIBODIES: IgM or IgG seroconversion
    • Detect measles NUCLEIC ACID in acute serum, oral fluid (saliva) or urine.
  18. What is treatment of measles?
    • No specific treatment – warn if get signs of complications then come back
    • Give antibiotics for secondary bacterial infections: otitis media or pneumonia
    • Paracetamol to reduce fever
  19. How is measles prevented?
    MMR vaccine. Live attenuated. Need 2 doses for a good response (1st at 13-15months, 2nd at 3-4 years)
  20. If there are susceptible contacts (pregnant, HCW, immunocomp) who are non immune, how is measles prevented?
    Human normal Ig
  21. If you see a case of measles what do you have to do?
    • Notifiable disease
    • Report to CCDC
  22. What is the other name for rubella?
    German measles
  23. How is rubella different from measles
    • It is MILD
    • But can cause severe fetal congenital abnormalities early in pregnancy (1st trimester)
  24. When do we worry about rubella?
  25. How is rubella spread?
    Droplet and direct contact with resp secretions
  26. What are 3 main symptoms of rubella
    • 1. Mild fever
    • 2. Macular rash – fine
    • 3. Lymphadenopathy: suboccipital, post auricular, cervical nodes
  27. Name 3 major complications of rubella?
    • 1. Joint involvement – esp adult women
    • 2. Thrombocytopenic purpura – low platelets
    • 3. Fetal damage (congenital rubella syndrome)
    • What is the congenital rubella triad?
    • Cardiac
    • Ophthalmic
    • Auditory
  28. How is rubella diagnosed?
    • Detect rubella specific antibodies: IgM or IgG seroconversion (if post natal will only have IgM)
    • Detect rubella nucleic acid ONLY for prenatal diagnosis of fetal infections
  29. What is treatment of rubella?
    No specific management
  30. How is rubella prevented?
    MMR vaccine
  31. Give 3 other names for human parvovirus B19 disease
    • 1. Fifth disease
    • 2. Erythema infectiosum
    • 3. Slapped cheek disease
    • How does parvo B19 spread?
    • Contact with respiratory secretions
  32. Where do you get outbreaks of parvo B19?
    Primary schools
  33. How many phases are there to parvo B19 infection? Describe them
    • Biphasic
    • First phase: non-specific symptoms for 2-3 days: fever, myalgia, chills, malaise, or subclinical
    • 7 days symptom free
    • Then exanthematous phase: red rash on cheeks (slapped cheek), circumORAL pallor
    • Then the erythematous maculopapular rash spreads to trunk and limbs
  34. What happens to the rash as it clears?
    • Central clearing of the rash follows
    • Giving a lacy reticular appearance
  35. Which complication of B19 happens to women?
    Joint involvement
  36. What is complication in pregnancy?
    • Fetal loss
    • Hydrops fetalis: heart failure due to anaemia
  37. What is complication of B19 in patients with chronic haemolytic anaemia?
    Aplastic crisis
  38. What happens if immunocompromised get B19?
    • Persistent anaemia
    • Need iv Ig
  39. What 2 ways can you diagnose parvo B19?
    • Detect B19 nucleic acid in fetus or immunocompromised
    • Detect B19-specific antibodies: IgM or IgG seroconversion
  40. What is the treatment of B19?
    • No antiviral drug
    • ivIg for persistent anaemia
  41. how many kids get HHV6/7?
    • Most children get it
    • Hhv6 up to 2 years
    • Hhv7 up to 5 years
  42. What is mode of spread of hhv6/7?
  43. What does primary infection of HHV6 give?
    • Exanthem subitum aka roseola infantum
    • Fever for 3-5 days (often with fits) – common cause of status epilepticus in children 1-2 years old
    • Followed by rose pink macular rash
    • What is HHV6 rash easily confused with?
    • Measles or rubella rash
  44. Which childhood virus causes febrile fits?
  45. How is HHV6/7 diagnosed?
    • Detect specific Ab IgM/IgG seroconversion
    • HHV6/7: nucleic acid in acute serum
  46. What is treatment of HHV6
    No antiviral drug
  47. What type of rash do you get with herpes SIMPLEX virus?
    • Widespread
    • Vesicular rash
    • Due to disseminated herpes simplex virus infections
    • In perinatal, immunocompromsed, eczema herpeticum
  48. Which 2 viruses can cause a vesicular rash?
    • HSV
    • VZV
  49. What age and class to people get EBV?
    • 15-25
    • Upper SEC
  50. Where does EBV infect and replicate?
  51. Which cells are the primary cell type infected by EBV? And what happens to them?
    B cells they stimulate vigorous T cell response which controls PROLIFERATION of infected B cells
  52. What happens to some of the B cells infected with EBV
    They are latently infected with EBV for life
  53. How does IM begin – symptoms?
    • Abruptly, sore throat (cant swallow), swelling of neck
    • Fever
  54. What are the 2 types of rashes you get in IM?
    • 1. Faint morbilliform rash
    • 2. Maculopapular rash in any patient receiving amoxicillin/ampicillin
  55. What else can happen in the abdomen in IM?
    • Splenic enlargement
    • Mild hepatomegaly or jaundice
  56. Name 5 complications of IM
    • 1. Thrombocytopenia
    • 2. Splenic rupture
    • 3. Guillain-barre syndrome
    • 4. Meningitis
    • 5. Encephalitis
    • What are 4 differnetials of EBV IM?
    • 1. CMV mononucleosis
    • 2. Toxoplasmosis
    • 3. Lymphoma/leukaemia
    • 4. HIV seroconversion
    • How is a lab diagnosis of IM EBV made?
    • 1. Lymphocytosis with high WBC (15-20) >50% are T cells, many are large or atypical
    • 2. Heterophile Ab are reactive to Ags present on sheep and horse RBCs and can be used to diagnose a primary EBV infection = the Paul Bunnell or Monospot test
    • 3. EBV antibody tests
  57. What is the monospot test?
    • Heterophile means it reacts with proteins across species lines
    • The antibodies in the patients serum will agglutinate with horse RBC and then the test is +ve
  58. Which rashes can enteroviruses case?
    • Hand foot and mouth disease: ulcers on buccal mucosa and painful vesicular lesions on hand and feet
    • Rubelliform rashes: fine maculopapular rash is a feature of some enterovirus infections
  59. Which rashes can you get with HIV?
    • 1. Seroconverting illness: get widespread PAPULAR, erythrmatous rash
    • 2. Seborrheic dermatitis: erythematous scaling rash, typically affecting the face
  60. What is the rash in mumps like?
    • There is no rash in mumps
    • In this section as it is a childhood infection
  61. How is mumps spread?
    Direct contact with saliva – respiratory route
  62. What are the 2 main clinical featuers of a patient with mumps?
    • Fever
    • Parotitis
  63. What happens after 2 days of mumps?
    Facial swelling due to parotid swelling that is painful
  64. Why is there a recent increase in mumps?
    Only received one dose of vaccine in childhood
  65. Name 4 complications of mumps
    • 1. Meningitis
    • 2. Orchitis
    • 3. Pancreatitis
    • 4. Oophoritis
  66. If you see a case of mumps, what do you have to do?
    • Notifiable disease
    • Need to report to CCDC (consultant of communicable disease control)
  67. How is mumps diagnosed?
    • Clinically as parotid swelling is characteristic
    • Antibody: detect mumps-specific IgM
    • Detect virus in oral fluid – saliva or urine by VIRAL CULTURE or PCR for mumps nucleic acid
  68. How is mumps prevented?
    MMR vaccine