VIRAL DISEASES part II

1. VIRAL DISEASESpart II Andrews’ p501-525

3. Molluscum contagiosum • Poxvirus • MCV-1 to -4 and variants • MCV-2 in HIV • Worldwide • Children, sexually active adults and immunosuppressed • Direct contact

4. Lesions are smooth surfaced, firm and dome shaped pearly papules • A central umbilication is characteristic • Clinical pattern depends on the group affected • When restricted to only the genital area in a child the possibility of sexual abuse must be considered • Secondary infections may occur

7. Seen in 10-30 % of AIDS pts • Helper T-cell count of less than 100 • Giant lesion may be confused with BCC • Henderson-Patterson bodies – basophilic inclusion bodies

8. treatment • Topical tretinoin or imiquimod • Extraction • Light cryotherapy • Cantharadin • Curettage • podophyllotoxin

9. Human monkeypox • Rare • More than 90% of cases occur in children under 15 • Fatality rate of 11% • Disease is clinically similar to smallpox • Fever followed by vesiculopustular eruption • Develop following contact with wildlife sources

10. Human to human transmission may occur

11. Picornavirus group • RNA • Only coxsackieviruses, the echoviruses, and enterovirus type 71 are significant causes of skin disease

12. Enterovirus infections • Person to person transmission occurs by the intestinal-oral route and less commonly the oral route • Usually the diagnosis is by clinical characteristics

14. herpangina • Disease of children worldwide • Coxsackievirus and echovirus • Acute onset of fever, ha, sore throat, dysphagia, anorexia, and sometimes a stiff neck • Yellowish white, vesicles in the throat, surrounded by an intense areola • Most frequently on the anterior faucial pillars, tonsils, uvula, or soft palate

15. Lesions coalesce and ulcerate leaving a shallow crater • Lesions disappear in 5-10 days • Treatment is supportive • Topical anesthetics or allopurinol mouthwash

16. Hand-Foot-and-Mouth Disease • Infection begins with a fever and sore mouth • 90% have oral involvement • Lesions are small rapidly ulcerating vesicles surrounded by a red areola • Buccal mucosa, tongue, soft palate, and gingiva • Lesions on hands and feet • Red papules that quickly turn to gray vesicles • With a red halo

19. Typically lasts less than a week • Treatment is again supportive • Topical anesthetics • Coxsackievirus A-16 • Distribution and presence of skin lesions differentiates this from herpangina

20. Boston Exanthem Disease • Occurred as an epidemic in Boston • Caused by echovirus 16 • Consisted of sparsely scattered pale red macules and papules • Chiefly on the face chest and back • Now an uncommon cause of viral exanthems

21. Eruptive pseudoangiomatosis • Young children during or immediately following a viral illness develop red papules that resemble angiomas • Face trunk and extremities • Resolve spontaneously within 10 days • Echoviruses 25 and 32 have been implicated

22. PARAMYXOVIRUS GROUP • RNA viruses • Measles • Rubella

24. Measles(rubeola, morbilli) • Worldwide disease • Commonly affects children under age of 15 months • Respiratory spread with an incubation of 9-12 days • Immunizations are highly effective • Prodrome- fever, malaise, conjunctivitis and prominent upper respiratory symptoms

25. A macular or maculopapular eruption appears after 1-7 days • Anterior scalp line and behind the ears • Quickly spreads over the face and involves the entire body by day 3 • Purpura may be present • Koplik’s spots are pathognomonic, appear during the prodrome

26. Erythematous lesions of the measles exanthem

27. Pink macules with minimally elevated papules with confluence

28. Koplik’s Spots • cluster of tiny bluish white papules with an erythematous areola on buccal mucosa opposite premolar teeth

29. complications • OM • Pneumonia • Encephalitis • Thrombocytopenic purpura • Infection in pregnant patients is associated with fetal death

30. DX • Clinical- high fever, Koplik’s spots, conjunctivitis, upper respiratory symptoms, rash • course and prognosis • maximum intensity of rash reached in 3 days • rash fades 5-10 days • self limited • death 1 in 3000 • chronic complication, subacute sclerosing panencephalitis

31. RUBEOLAmanagement • Acute • Vitamin A • decreases morbidity and mortality • given to severe measles even if no nutritional deficit is suspected • vaccine • MMR given at 12-15 months, and 4-6 years

32. measles

33. Rubella • German measles, 3-day measles • benign contagious viral disease • etiology • Togavirus • transmission • inhalation of aerosolized respiratory droplets • incubation • 12-23 days • Vaccination gives lifelong immunity

34. RUBELLAclinical manifestations • Prodrome- 1-5 days • mild symptoms of malaise, headache, sore throat, eye pain, and moderate temperature elevation • Pain on lateral and upward eye movement is characteristic • precedes eruption by a few hours to a day • children are usually asymptomatic

35. RUBELLAclinical manifestations • Eruptive phase • begins on neck or face • spreads to trunk and extremities in hours • lesions are pinpoint to 1 cm, round or oval, pinkish or rosy red, macules or maculopapules (purplish lesions of measles and fine punctate yellow-red lesions of scarlet fever) • discrete, grouped or coalesced • arthritis of phalangeal joints may be seen in women

36. RUBELLA • Diagnosis • Clinical, posterior cervical, suboccipital, and postauricular lymphadenitis occurs in more than half • can be confirmed with serology • course and prognosis • typically mild, requiring only symptomatic treatment • lesions last 24 -48 hours, followed by desquamation • prevention • MMR given at 12-15 months, and 4-6 years

37. rubella

38. RUBELLA • Forchheimer Spots • red palatal lesions start with onset of rash

39. Congenital Rubella Syndrome • Infants born to mothers who have had rubella during the first trimester of pregnancy • transplacental transmission as high as 80% in the first trimester • Typical anomalies include IUGR, deafness, mental retardation, cataracts, retinopathy, cardiac defects, and “blueberry muffin” rash. • Prior to pregnancy antibody titer should be verified. Immunization is contraindicated in pregnancy.

40. Asymmetric Periflexural Exanthem of Childhood (APEC) • AKA unilateral laterothoracic exanthem • Children 8 mo to 10 yrs • Cause is unknown • Viral origin has been proposed • Symptoms of mild upper respiratory or gastrointestinal infection usually precede the eruption

42. Erythematous macules and papules involving the axilla, lateral trunk and flank. In this patient the exanthem progressed to bilateral distribution but maintained left-sided predominance

43. Erythematous papules coalesce to form poorly marginated morbilliform plaques • Mild pruritis • Lesions begin unilaterally, close to a flexural area, usually the axilla • Centrifugal spread to adjacent trunk and extremity • The contralateral side is involved in 70% of cases, asymmetrical nature is maintained

44. Lymphadenopathy is seen in 70% • Last 2-6 weeks on average • Resolves spontaneously • Topical steroids or oral antibiotic are of no benefit • Oral antihistamines

45. PARVOVIRUS GROUP

46. Erythema Infectiosum(Fifth Disease) • Worldwide benign infectious exanthem • Parvovirus B19 • Spread by respiratory droplets • Viral shedding has stopped by the time the exanthem has appeared • Incubation 4-14 days • prodrome • pruritus, low-grade fever, sore throat, malaise seen in 10% of cases

49. Three distinct overlapping stages • facial erythema. Red papules on the cheeks that rapidly coalesce. Resembles erysipelas. “slapped cheek.” • net pattern erythema. Fishnet like pattern, begins on extremities then extends to trunk • recurrent phase. Eruption may reappear following emotional upset or sunlight exposure over next 2-3 weeks.

50. Lacy, reticulated skin eruption over the arm during the second stage of the exanthem