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VIRAL DISEASES Part II

VIRAL DISEASES Part II. Adam Wray, D.O. April 11, 2006. Molluscum contagiosum. Poxvirus MCV-1 to -4 and variants MCV-2 in HIV Worldwide Children, sexually active adults and immunosuppressed Direct contact. Molluscum contagiosum.

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VIRAL DISEASES Part II

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  1. VIRAL DISEASES Part II Adam Wray, D.O. April 11, 2006

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

  3. Molluscum contagiosum • Lesions are smooth surfaced, firm and dome shaped pearly papules • Central umbilication • 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

  4. Molluscum histopath • Acanthosis and cup shaped • Eosinophilic and later basophilic inclusion bodies in the prickle cell layer (Henderson-Patterson bodies)

  5. Molluscum contagiosum

  6. Treatment • Topical tretinoin or imiquimod • Extraction • Light cryotherapy • Cantharadin • Surgical tape • Curettage • Podophyllotoxin • Subcutaneous IFN-alpha • 5-FU • HAART for AIDS patients

  7. Human monkeypox • Rare, sporadic zoonosis caused by orthopoxvirus • 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 • Human to human transmission may occur

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

  9. Herpangina • Disease of children worldwide • Coxsackievirus, echovirus and enterovirus 71 • 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

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

  11. 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 • Lesions on hands and feet run parallel to skin lines • Red papules that quickly turn to gray vesicles surrounded by a red halo

  12. Hand-Foot-and-Mouth Disease • 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 • CNS disease in 80% of enterovirus 71 HFMD in Taiwanese outbreak; no CNS disease with Coxsackie A-16

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

  14. PARAMYXOVIRUS GROUP • RNA viruses • Measles • Rubella

  15. 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

  16. Measles • 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 • Appear first on the buccal mucosa nearest to the lower molars as 1mm white papules on an erythematous base.

  17. Erythematous lesions of the measles exanthem

  18. Pink macules with minimally elevated papules with confluence

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

  20. Measles

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

  22. RUBEOLAmanagement • Acute • Vitamin A • decreases morbidity and mortality • given to severe measles even if no nutritional deficit is suspected • <1yr old exposed to measles tx with immune serum globulin • vaccine • MMR given at 12-15 months, and 4-6 years

  23. 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

  24. 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

  25. 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

  26. 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

  27. Rubella

  28. RUBELLA • Forchheimer Spots • Pin-head sized red macules or petechiae on the soft palate and uvula start with onset of rash

  29. 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.

  30. Congenital Rubella

  31. 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

  32. 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

  33. Asymmetric Periflexural Exanthem of Childhood (APEC) • 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

  34. Asymmetric Periflexural Exanthem of Childhood (APEC) • Lymphadenopathy is seen in 70% • Last 2-6 weeks on average • Resolves spontaneously • Topical steroids or oral antibiotic are of no benefit • Oral antihistamines

  35. PARVOVIRUS GROUP • Parvovirus B19 is the most common agent in this group to cause human disease. • More common in the spring in temperate climates • Erythema infectiosum papular purpuric gloves and socks syndrome, arthropathy, aplastic crisis in hereditary spherocytosis and sickle cell disease, and chronic anemia in immunosuppressed patients are clearly related to parvovirus B19. • Children with aplastic crisis due to parvovirus B19 usually do not have a rash.

  36. Erythema Infectiosum(Fifth Disease) • Worldwide benign infectious exanthem occurs in late winter, early spring. • 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

  37. Erythema Infectiosum • 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, heat (esp bathing), exercise, or sunlight exposure over next 2-3 weeks.

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

  39. Papular Purpuric Stocking and Glove Syndrome • Occurs in teenagers and young adults • Pruritus, edema, and erythema of the hands and feet, and a fever is present • Lesions are sharply cut off at the wrists and ankles • Mild erythema of the cheeks, elbows, knees and groin • Syndrome resolves within 2 weeks • May be associated with HBV in adults.

  40. Erythematous patches with petechiae on the palms

  41. ARBOVIRUS GROUP • Comprise the numerous arthropod-borne RNA viruses

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