119. Viruses Flashcards

Question

Measles exanthem phase features

Answer 1

typical rash; a nonpruritic maculopapular rash beginning on the head and face and spreading down the entire body over the next 2 to 3 days (Fig. 119.3). Patients are contagious 4 days before and 4 days after the onset of the rash.

Answer 2

otitis media, laryngitis, tracheo- bronchitis, bronchiolitis, pneumonitis, severe diarrhea, and acute encephalitis subacute sclerosing panencephalitits

Answer 3

children younger than 5 years old, adults older than 20 years old, pregnant women, and the immunocompromised.

Answer 4

rare but fatal com- plication of measles. SSPE is a slow progressive infection of the central nervous systems (CNS) that results from a prior measles infection ontinual measles infection of the CNS. The mean time of onset of SSPE is 7 years after measles infection. Symptoms include behavior change, decreased intellect, ataxia, and myoclonic seizures followed by progressive neurologic deterioration and death

Answer 5

serologic testing for measles-specific IgM antibody and detection of measles RNA from a nasopharyngeal specimen, blood, or urine by RT-PCR.

Answer 6

1. supportive 2. postepo prophylaxis for those who have no immunity to protect and lessen seveirty; MMR vaccine within 72h or ig within 6d 3. consider children and malnourished patients who are hospitalized with severe measles may benefit from vitamin A.

Answer 7

0.25 mL/kg of immunoglobulin intramuscularly, and immunocompro- mised children should be given 0.5 mL/kg intramuscularly, up to 15 mL.

Answer 8

a single-stranded RNA virus that is a member of the Togavi- ridae family, spreads via resp droplets or in pregnant, placenta to fetal organs

Answer 9

mild febrile illness associated with a diffuse mac- ulopapular rash, malaise, headache, and arthritis.

Answer 10

encephalitis low plt miscarriage IU death premature delivery congenital rubella syndrome

Answer 11

severe birth defects, including hearing impairment, cataracts, retinopathy, developmental delay, microcephaly, and a variety of con- genital heart defects.

Answer 12

measles, roseola, erythema infectiosum (fifth disease), toxoplasmosis, and scarlet fever.

Answer 13

s detection of IgM antibodies or fourfold increase in IgG antibody titer between acute and convalescent specimen. Virus culture and RT-PCR can also be isolated from blood or the nasopharynx.

Answer 14

supportive

Answer 15

Initiated in epidermal and dermal cells. The infection then spreads to the nervous system, where it lays latent in the sensory nerve ganglia. Any stressor such as acute illness, emotional stress, trauma, intense sunlight, or fever can trigger reactivation of the virus. Recurrence rates are high for herpes infectio

Answer 16

gingivostomatitis and pharyngitis. Symptoms include fever, malaise, and vesicular lesions anywhere in the mouth or oropharynx. Infections typically last between 10 to 14 days. Reactivation is usually much less severe a occurs as herpes labialis, small vesicles at the vermilion border of the lip (Fig. 119.4). These vesicles usually crust over within 48 hours.

Answer 17

painful vesicles and ulcers on the external genitalia. The first infection is usually the most severe and can be accompanied by systemic symptoms like fever, headache, malaise, and myalgias. It is also common to have dysuria and tender inguinal lymphadenopathy. Infections can also spread to the perianal and rectal region as well.

Answer 18

Herpes gladiatorum is a skin infection that can arise anywhere on the body and is associated with contact sports. Herpes can also cause ocular infections, including keratitis, conjunctivitis, and acute retinal necrosis.

Answer 19

aphthous ulcers, cox- sackievirus infections (herpangina and hand-foot-and-mouth disease), infectious mononucleosis, Stevens-Johnson syndrome, or Behçet dis- ease. other sexually transmitted infections with ulcers and vesicles, such as syphilis or chancroid or noninfectious diseases like Behçet dis- ease. HSV encephalitis can be difficult to distinguish from other acute CNS emergencies like bacterial meningitis, brain abscess, other viral encephalitides, brain tumor, or stroke.

Answer 20

HSV encephalitis is made by PCR from the CSF. The routine laboratory tests sent after a lumbar puncture (LP) to assess for bacterial meningitis do not adequately assess for HSV encephali- tis. Classically, CSF analysis shows an elevated white blood cell (WBC) count, with lymphocyte predominance. Depending on the degree of brain necrosis, an elevated red blood cell (RBC) count can also be seen.

Answer 21

Acyclovir, valacyclovir, and famciclovir - acyclovir IV Herpes gingivostomatitis or labialis: First episodes are treated with oral acyclovir 200 mg five times a day (alternative regimen: 400 mg three times a day), valacyclovir 1 g twice daily, or famciclovir 250 mg three times a day for 7 days

Answer 22

acyclovir 400 mg five times a day for 5 days, valacyclovir 2 g twice daily for 1 day, or famciclovir 1500 mg as a single dose.

Answer 23

oral acyclovir 200 mg five times a day (alternative regimen: 400 mg three times a day), valacyclovir 1 g twice daily, or famciclovir 250 mg three times a day for 7 to 10 days. A shorter course is usually adequate for treatment of recurrence. For suppression of recurrent episodes, acyclovir 400 to 800 mg twice daily or valacyclovir 500 mg daily can be used.

Answer 24

Administer acyclovir 200 mg five times a day or 400 mg three times a day for 5 days.

Answer 25

Administer acyclovir 400 mg five times a day or vala- cyclovir 500 mg three times a day. Topical antiviral therapy with trifluridine, acyclovir, or ganciclovir are all equally effective.

Answer 26

Administer IV acyclovir 10 mg/kg every 8 hours for 14 to 21 days. Given the high mortality associated with this condi- tion, antiviral therapy should be started as soon as the diagnosis is suspected.

Answer 27

initially infects the nasopharynx and spreads to the lymphoid tissue. The virus is present in vesicles that develop on the skin and then infects the nerve endings in the skin and migrates to the dorsal ganglia where it lays latent.

Answer 28

older age immunosuppression

Answer 29

ebrile illness characterized by malaise and rash. The rash begins first on the scalp and face and then spreads to the trunk and extremities. The lesions start as maculopapular, and progress to fluid-filled vesicles that eventually crust over and form scabs (Fig. 119.6). The lesions occur as crops at various stages of development. Patients are contagious until all lesions are scabbed over, which can typically take 1 to 2 weeks.

Answer 30

secondary bacterial infection of skin lesions - GAS ,nec fasc

Answer 31

GAS, nec fasc immunocomp pt - risk disseminated disease and visceral organ involvement neuro: encephalitis, aseptic meningitis, tranverse myelitis, reye syndrome

Answer 32

sicular rash with an erythematous base that occurs unilaterally in a single dermatome (Fig. 119.7). The rash is often painful and preceded by paresthesias or hypesthesia. In immunocompetent individuals, the rash crusts in 7 to 10 days, and at that time patients are no longer contagious. Post- herpetic neuralgia, defined as pain that persists for more than 90 days, is the feared complication

Answer 33

viral reactivation within the trigem- inal nerve ganglion. Ocular involvement occurs in over 50% of these cases.

Answer 34

vesicle on the tip of the nose, is asso- ciated with ocular involvement.

Answer 35

ramsey hunt - CN 7 palsy, pain and vesicular rash on the ear and in auditory canal

Answer 36

immunocomp pt

Answer 37

e other febrile illnesses with rashes like disseminated HSV infection, coxsackievirus infection, measles, or rickettsialpox. Prior to eradication, smallpox was a consideration, presenting with lesions in the same stage of development. The rash of zoster is also usually very characteristic. Other diagnoses to consider include herpes simplex infection or contact dermatitis.

Answer 38

viral culture, DFA, or PCR testing of the vesicle fluid.

Answer 39

supportive care with antipyretics and antihistamines to decrease the pruritus caused by the skin lesions. Salicylates should be avoided in children because of the association with Reye syndrome.

Answer 40

decrease the duration of fever and total number of lesions in healthy children. It does not reduce the number of varicella-related complications, however. Therefore, we typically do not recommend treatment of otherwise healthy children with varicella. We recommend treating high-risk groups with acyclovir,

Answer 41

older than 12 years old, pregnant patients, persons with chronic cutaneous or pulmonary disorders, persons on long-term salicylate therapy, persons on aerosolized corticosteroids, and immunocompromised patients. The treatment should be initiated within 24 hours after the rash appears for the most benefit. The dose of acyclovir for VZV treatment is higher than that of HSV, 800 mg orally four times a day for 5 days.

Answer 42

immunocomp and severe disease

Answer 43

regimens for 1 week: acyclovir 800 mg five times a day, famciclovir 500 mg three times a day, or valacyclovir 1 g three times a day. Antiviral treatment should be initiated within 72 hours of the onset of rash because the efficacy beyond 72 hours is unclear

Answer 44

Immunocompromised patients should be treated regardless of time of onset of rash. Zoster involving more than one dermatome or disseminated zoster should be treated with IV acyclovir. The disease is often painful enough to require opioid agents CS not clear

Answer 45

Immunocompromised patients, patients with disseminated zoster, or patients with complications require admission to the hospital.

Answer 46

Burkitt lymphoma, nasopharyngeal car- cinoma, Hodgkin disease, and B cell lymphoma.

Answer 47

virus infects the oropharynx and then spreads through the bloodstream and infects B lymphocytes resulting in proliferation of infected B lymphocytes and T lympho- cytes, leading to enlargement of lymphoid tissue.

Answer 48

asx or mild pharyngitis in yo children adol and yo adult: infx mono - fever, exuative pharyngitis, lymohadenoathy, myalgisas, fatigue +/- splenomegaly (mc rupture in first 3 weeks)

Answer 49

splenic rupture GBS retrobulbar neuritis asepctic meningitis encephalitits transverse myeltitis peripheral neuropathy

Answer 50

maculopapular

Answer 51

ebv 90% cmv 10%

Answer 52

test has a sensitivity ranging from 63% to 84% and specificity ranging from 84% to 100%.

Answer 53

. The treat- ment is supportive care with rest, antipyretics, and analgesia. Gluco- corticoids have been used to decrease severity of symptoms, but there is insufficient evidence to support this practice. Antiviral treatment with acyclovir does not reduce the clinical symptoms of the disease. It is important to advise patients to avoid contact sports for at least 3 weeks to avoid the feared complication of splenic rupture.

Answer 54

asymptomatic to severe disseminated disease in the immunocompromised patient. CMV is particularly harmful in preg- nant patients because it can lead to congenital infection, causing pro- found neurologic defects and permanent hearing loss

Answer 55

llness can last from 2 to 6 weeks and is characterized by fever, fatigue, malaise, myalgia, and headache. Unlike EBV mononucleo- sis, exudative pharyngitis and lymphadenopathy are less common.

Answer 56

CMV colitis and CNS infection (meningitis, enceph- alitis, transverse myelitis) are the most frequent forms of severe CMV infection in the immunocompetent host. Up to one-third of critically ill immunocompetent patients have evidence of CMV reactivation.

Answer 57

Premature birth, intrauterine growth retardation, microcephaly, seizures, thrombocytopenia, hepatospleno- megaly, or pneumonitis. Sequelae of congenital CMV infection can present up to 2 years after birth. Frequent complications that occur are hearing loss, neurologic impairment, and ocular disturbances.

Answer 58

over 40% of solid organ transplant patients during the first 3 months when immunosuppressive therapy is the strongest. Transplant patients that are CMV seronegative and receive a CMV seropositive donor are at highest risk. HIV patients with CD4 count less than 100/μL are at high risk of CMV infection as well. In the immunocompromised host

Answer 59

leukopenia, pneumonia, esophagitis/gastritis, hepatitis, colitis, enceph- alitis, polyradiculopathy, and retinitis. CMV retinitis is the most com- mon cause of blindness in patients with AIDS.

Answer 60

PCR, viral culture, or anti- body testing. The WBC count may show lymphocyte predominance with more than 10% atypical lymphocytes, much like EBV infections.

Answer 61

Ganciclovir is an IV agent that is used to treat CMV infections. The treatment for CMV retinitis is induction therapy: 5 mg/kg/dose every 12 hours for 14 to 21 days followed by 5 mg/kg/dose once daily maintenance therapy for a prolonged course alganciclovir is an oral prodrug that is metabolized to ganciclovir. The treatment regimen is induction: 900 mg twice daily for 21 days followed by maintenance of 900 mg once daily. Foscarnet and cidofovir are IV agents used to treat CMV resistant to ganciclovir, and both can also be used to treat HSV resistant to acyclovir. The primary limiting toxicity of these drugs is renal toxicity.

Answer 62

group of single-stranded RNA viruses that can mul- tiply within the gastrointestinal tract. Most infections are asymptom- atic or mild undifferentiated illnesses. ex: polio coxsackievius A and B echovirus enterovirus

Answer 63

nonspecific febrile illness with malaise, myalgias, headache, and sore throat. The most feared presentation of the poliovirus infection is paralytic poliomyelitis. This manifests as aseptic meningitis followed by back, neck, and muscle pain and then the development of motor weakness. The paralysis is usually asymmetrical and affects proximal muscles more. Usually some recovery of motor function occurs months later, but approximately two-thirds of patients have some form of permanent weakness.

Answer 64

many enterovirses typ coxsackie B

Answer 65

Herpangina is caused by coxsackievirus A and presents with fever, sore throat, odynophagia, and vesiculopapular lesions on the cheeks and soft palate (Fig. 119.8). Hand-foot-and-mouth disease is caused by coxsackievirus A or enterovirus 71 and commonly manifests as fever and malaise, followed by vesicles in the mouth, and vesicles on the hands and feet (Fig. 119.9). Pleurodynia is a painful illness characterized by fever and spasms of the chest wall and abdomen that occur in paroxysms.

Answer 66

Age less than 2 years Age 65 years and older Chronic pulmonary disorders, including asthma Chronic cardiovascular disorders except hypertension alone Chronic renal insufficiency Chronic hepatic disorders Chronic hematological conditions including sickle cell disease Metabolic and endocrine disorders including diabetes mellitus Neurologic disorders including disorders of the brain, spinal cord, peripheral nerve, and muscle, such as cerebral palsy, seizure disorders, stroke, intellectual disability (mental retar- dation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury Immunosuppression, including that caused by medications or by HIV infection Pregnancy or postpartum state (within 2 weeks after delivery) Ethnicity belonging to American Indians/Alaska Natives Morbid obesity (i.e., body mass index is equal to or greater than 40) Residency in nursing homes and other chronic care facilities

Answer 67

RNA virus from the Orthomyxoviridae family that causes acute respiratory symptoms. This virus is highly contagious and is transmitted through large-particle respiratory droplets. Trans- mission usually requires close contact between individuals less than 1 meter apart.

Answer 68

a b c urther subdivided based on the two major surface glycoproteins present, hemagglutinin (H) and neuraminidase (N)

Answer 69

Sensitivity of these tests can vary from 50% to 65%, with specificities above 95%.18 Molecular assays, such as RT-PCR or rapid antigen tests, are far more sensitive than traditional rapid influenza tests. RT-PCR is the most sensitive test and, if available, is preferred. However, rapid molecular tests have sensitivity and spec- ificity that approach RT-PCR, and results can be back in less than 20 minutes. Rapid molecular tests have sensitivities of over 90%.

Answer 70

neuraminidase inhib oselatamivir, zanamivir, peramivir - They work by inhibiting the release of viral progeny from infected cells. These drugs are active against both influenza A and B. amantane antivurals - They prevent or greatly reduce the uncoating of the viral RNA of influenza A after attachment and endocytosis by host cells oseltamivir treated within 48 hours of symptom onset but did not affect hospitalization or reduce severe influenza complications. greatest benefit is in very early treatment, but some studies have demonstrated benefit up to 5 days after symptoms onset in hospitalized patients

Answer 71

rhinovirus

Answer 72

Infections peak in the fall and spring but can occur all year. The infec- tion is spread via infected respiratory secretions and direct contact with infected patients. The virus can remain contagious on surfaces for several hours. Hand-to-face inoculation is likely one of the predomi- nant mechanisms of spread, underscoring the importance of frequent handwashing to decrease transmission.

Answer 73

double-stranded DNA viruses consisting of 7 spe- cies (A–G) and greater than 100 types. They commonly cause upper respiratory tract infections, gastrointestinal symptoms, and conjunc- tivitis. Infection is spread via respiratory droplets and close contact.

Answer 74

most common presentation of adenovirus is as a URI with sore throat, cough, and fever. Gastroenteritis and conjunctivitis are also common manifestations. Other syndromes less frequently caused by adenoviruses include hemorrhagic cystitis, urethritis, infantile diar- rhea, myocarditis, encephalitis, and meningoencephalitis. In infants and immunocompromised patients, particularly hematopoietic stem cell transplant and solid organ transplant patients, adenovirus can cause severe life-threatening illness.

Answer 75

There have been reports of using cidofovir in immunocompromised patients with life-threatening adenovirus infection, but this is not rou- tinely recommended

Answer 76

single-stranded RNA virus that belongs to the Paramyxoviridae family. This infection is usually acquired in child- hood. In the United States, parainfluenza infections have been reported to account for up to a quarter of respiratory disease in children. In adults, the burden of illness caused by parainfluenza is much less. Parainfluenza is transmitted by close contact via infected respiratory secretions. There are four types, each with its own clinical presentation.

Answer 77

croup 2 can as well but less moribidity

Answer 78

more often causes bron- chitis, bronchiolitis, and pneumonia

Answer 79

mild resp illness

Answer 80

mild and moderate croup, a sin- gle dose of oral dexamethasone (0.15–0.6 mg/kg, maximum dose 20 mg) or oral prednisolone (1 mg/kg) can be given.28 For severe croup, nebulized racemic epinephrine should be administered in addition to oral or intramuscular dexamethasone (0.6 mg/kg, maximum dose 20 mg). Glucocorticoids improve symptoms, reduce rates of return visits, admissions, and readmissions.

Answer 81

RNA virus that belongs to the Paramyxoviridae family. RSV causes significant morbidity in children. It is an important cause of death in young children in the low- and middle-income countries. In the United States, RSV is associated with approximately 20% of hospi- talizations and 18% of ED visits in children younger than 5 years old. RSV is also a significant cause of respiratory illness in older patients, affecting 3% to 10% of the population over age 65 each year. RSV is spread via contact with infected individuals, by exposure to respiratory secretions and fomites.

Answer 82

llness is most severe in infants, causing pneumonia and bronchiolitis. Newborns with RSV can present with apnea. Symptoms usually begin with nasal congestion, rhinorrhea, low-grade fever, and cough. Then 1 to 2 days after symp- tom onset, patients develop wheezing and increased respiratory effort. Symptoms can last up to 2 weeks. In adults and older children, RSV usually causes a benign URI typically lasting less than 5 days. Geriatric patients, immunosuppressed patients, and adults with chronic medical problems can develop severe lower respiratory tract disease.

Answer 83

o2 if o2 <90% dehydration tx

Answer 84

RSV infection in high-risk patients, the AAP recommends the use of palivizumab, a monoclonal anti-RSV anti- body preparation, during the first year of life for infants with hemody- namically significant heart disease or chronic lung disease of prematurity defined as preterm infants younger than 32 weeks’ gestation who require more than 21% oxygen for at least the first 28 days of life.

Answer 85

hypoxemia, respiratory distress, or dehydra- tion.

Answer 86

Caliciviridae mc nonbacterial cause of gastroenteritis

Answer 87

highly infectious because only a few particles are necessary to transmit the disease. Nor- ovirus is spread through direct transmission from person to person via the fecal-oral route. Transmission can also occur through contaminated water, food, and surfaces. Because of its structure as a nonenveloped RNA virus, norovirus is very stable in the environment and is resistant to most disinfectants, including alcohol hand wash.

Answer 88

vomiting, diarrhea, and abdominal cramping. In infants and children, vomiting is the primary symptom, whereas adults more commonly have diarrhea. The gastrointestinal symptoms can be accompanied by fever, headache, and myalgias as well. The diarrhea is typically nonbloody, watery, and profuse. The acute illness usually lasts for half a day to 3 days.

Answer 89

Rotaviruses are double-stranded RNA viruses that belong to the Reoviridae family. These viruses are ubiquitous, and by 5 years old most children have been exposed to them.

Answer 90

manifests as sudden onset of nausea, vomiting, and profuse watery diarrhea, with fever, headache, and myalgias. The disease course is usually 3 to 7 days. The spectrum of disease can range from asymptomatic to severe and fatal dehydration.

Answer 91

bite from a rabid animal, the risk of developing clinical dis- ease is unknown and depends on viral inoculation or migration into nerve tissue. The risk of death following untreated clinical disease, however, is almost 100%, and the risk of developing clinical disease following proper treatment approaches 0%

Answer 92

bat racoon skunk fox

Answer 93

squirrel hamster guinea pig chipmunk rat rabbit

Answer 94

RNA virus from the genus lyssavirus, in the family Rhabdoviridae.

Answer 95

Bites through the dermis allow the virus to enter tissues and initi- ate infection. virus spread m to peripheral nervous system, NMJ and travels to SC and brain Host cell machinery is usurped, and rapid replication occurs, resulting in clinically apparent disease. Infection of the brain is followed quickly by peripheral viral dissemination. For the reservoir species, transmission to the salivary glands proceeds through the parasympathetic and sympathetic nervous systems. The associated aggressive behavior and hypersalivation promotes transmission to new hosts

Answer 96

encephalitic (mc, 80%) - burden in brain paralytic - burden in sc

Answer 97

adache, malaise, pharyngitis, and weakness which are followed by or concomitant with pruritus and paresthesia at the site of inoculation. Fever, tachycardia, and tachypnea foretell the acute behavioral changes characteristic of rabies: agitation, aerophagia, hydrophobia, seizures, and coma

Answer 98

1. exposure 20-90 days 2. first sx of fever pruritis and paresthesia of a prodrome 1-2d then leads to 3.encephalitis or paralysis phase acute neuro phase 1-4d 4. coma and daeth at 1-7d

Answer 99

difficulty swallowing from involuntary muscle spasms of the pharynx, and hypersalivation occurs. If offered water, the patient may develop pharyngeal spasm with resultant gagging. Patients are unable to handle salivary secretions, leading to characteristic drooling and foaming of the mouth. The findings of hydrophobia with resultant gagging and hypersalivation are so characteristic of rabies infection that in many developing countries, water is offered to the patient as a diagnostic test.

Answer 100

tetanus dystonia strychnine poisoning

Answer 101

gbs acute flaccid paralysis envenomation hypokalemia

Answer 102

hydrophobia, aerophobia, aggressive behavior, and seizures.

Answer 103

A suspected case is one that is compatible with clini- cal findings, probable cases have a reliable history of contact suspected, probably or confirmed rabid animal as well as suspected clinical find- ings, and confirmed case definition indicates laboratory confirma- tion

Answer 104

􏰜 Presence of viral antigens in samples (e.g., brain tissue, skin); 􏰜 Isolation of virus from samples in cell culture or in laboratory animals; 􏰜 Presence of viral-specific antibodies in the cerebrospinal fluid or serum of an unvaccinated person; and/or 􏰜 Presence of viral nucleic acids in samples (e.g., brain tissue, skin, saliva, concentrated urine).

Answer 105

inactivated cell culture vac- cines that can be administered to immunocompromised individuals. Patients with immunosuppressive disorders and those taking corti- costeroids, immunosuppressive agents, or antimalarials may have a reduced response to the vaccine, necessitating a 5-dose regimen.

Answer 106

local reactions, mild systemic reactions, and immediate hypersensitivity reactions. Typical local reactions include pain, swelling, redness, and induration at the injection sit

Answer 107

recommended for travelers to endemic areas and those in high-risk professions (e.g., veterinar- ians, laboratory staff handling the virus).

Answer 108

1. if livestock/herbavore/primate/rabbit: 2. was the animal provoked, vaccine status, epi of area, animal wild or stray 3. decide in discussion with pt/provider +/- pep or not domestic animal 10d quarantine - 72h search for animal if animal not quarantined, use above questions if yes and is health after 10d quarantine then no pep, wound care only vs ill during quarantine = postmortem test for rabies 3. bat, wild carnicore, high risk domestic animal - if immed available for postmortem rabies test, do this - if not - pep and wound care

Answer 109

WHO categorizes expo- sures in areas enzootic for rabies into three categories.36 Category I includes touching or feeding animals, licks on intact skin, and contact of intact skin with secretions or excretions of a rabid animal or human. These are not regarded as significant exposures, and postexposure prophylaxis is not required. Category II includes nibbling of uncov- ered skin, minor scratches, or abrasions without bleeding. If these are caused by a bat, treat as category III. Vaccine should be injected as soon as possible, but RIG is not recommended for Category II. Category III includes single or multiple transdermal bites or scratches, licks on bro- ken skin, contamination of mucous membrane with saliva from licks, and indoor exposure to bats. Category III contact requires full rabies prophylaxis including vaccine and rabies immunoglobulin.

Answer 110

Bite by a wild terrestrial mammal other than small rodent or lagomorph Rabies is abundant in wildlife and cross-species transmission occurs. Many small rodents and lagomorphs paralyze and die before salivary excretion of virus occurs. Animal will be sacrificed and submit head to public health authorities to test brain for rabies. Urgent PEP pending test resultsa If animal unavailable for testing, prepare for PEP and consult public health authorities for risk assessment. Unprovoked bite by a pet (dog, cat, or ferret) Pet vaccination is imperfect. Cross-species transmission occurs. Incubation periods are well-defined. Report to animal control authorities as required. Observation for 10 db,c Urgent PEP if animal is determined to have rabies Unprovoked bite by a domestic mammal (horse, cow, or other pet) Vaccinations exist for horses, cattle, and sheep, but efficacy and incubation period are poorly defined. Report the incident to the local public health department. The animal may be sacrificed and the head submitted for testing.b Urgent PEP pending test results. Dog or cat brings fresh prey to their master. Without direct bite by the prey, there is no human exposure. The dog or cat is exposed. Refer the pet to a veterinarian for assessment and treatment. Dog or cat brings dead, desiccated prey to their master. Virus is rapidly inactivated by desiccation or sunlight—no exposure. No action Physical contact with a bat Bat bites are hard to appreciate or find by examination. Most American deaths from bat rabies have no known exposure, so known exposure confers very high odds for death from rabies. Animal will be sacrificed and submit for testing. If positive or if animal cannot be tested, urgent PEP Bat seen in the same room as a responsible child (>6 y) or adult Physical contact can be reliably excluded—no exposure No action Bat seen in the same room as a young child (<7 y),dsleeping, intoxicated or cognitively impaired person Eight percent of bats found indoors are rabid. Physical contact CANNOT be reliably excluded— exposure occurred Animal will be sacrificed and submit for testing. If positive or if animal cannot be tested, urgent PEP Bat found in a room that was previously occupied or seen in a hallway or room adjacent to persons who cannot report physical contact with a bat. Risk of undetected contact is substantially lower—no exposure No action

Answer 111

all mammal bites require meticulous wound care, and if rabies prophylaxis is considered the initial wound care is critical. Rabies virus is very sensitive to sunlight, soap, and drying. When performed within 3 hours of inoculation, scrubbing and flushing with benzalkonium chloride, 20% soap solution, or Ivory soap is nearly 100% protective. High-risk animals should be scrubbed with soap, water, and a virucidal agent (e.g., povidone-iodine) and then flushed with saline or water.33 any indicated wound closure should be sutured loosely with delayed scar revision as needed - face highest risk + neck, genitals, hands

Answer 112

1 week, 2 sites WHO Number of accin per clinic visit (day 0, 3, 7, 14, 21, 28) 2-2-2-0-0 Intradermal 2 week, 1 site WHO 1-1-1-1-0 Intramuscular 3 weeks, 1 site WHO 2-0-1-0-1 Intramuscular 1 month, 2 sites WHO 2-2-2-0-2 Alternative Intradermal 1 month, 4 sites WHO 4-0-2-0-1 Alternative Intradermal 1 week, 4 sites WHO 4-4-4-0-0 Alternative Intradermal 2 weeks, 1 site CDC 1-1-1-1-0 Intramuscular

Answer 113

If previously vaccinated: 1 day, 4 sites WHO 4-0-0-0-0 Intradermal If previously vaccinated:3 day, 2 sites CDC 1-1-0-0-0 Intramuscular

Answer 114

Human rabies immunoglobulin, 20 IU/kg, should be administered soon after the bite occurs and not more than 7 days after the first dose of rabies vaccine. As much RIG is injected into and around the wound site as the patient will tolerate, with the remainder injected intramus- cularly at a distance from the vaccine administration site.

Answer 115

Pain, induration, swelling, and erythema have been reported in 30% to 100% of injections. Headache is the most com- mon systemic reaction to HRIG occurring in more than 50% of recipi- ents. No deaths have been reported from human RIG.

Answer 116

transmitted via arthropod vectors, generally mosquitoes and ticks. Encephalitis is a common manifestation of arboviral infection. Most of these viruses are pri- marily transmitted from the arthropod vector to another animal, and humans are only incidentally infected. The arboviral viruses that cause encephalitides belong to the following families: Flaviviridae, Togaviri- dae, Bunyaviridae, and Reoviridae.

Answer 117

St. Louis encephalitis virus, West Nile virus (WNV), Powassan virus, and Japanese encephalitis virus

Answer 118

La Crosse virus and California encephalitis virus

Answer 119

Eastern equine encephalitis (EEE) virus, Western equine encephalitis virus, and Venezuelan equine encephalitis virus belong to the Togaviridae family

Answer 120

wide range of presentations, including subclinical disease, nonspecific febrile illness, hemorrhagic fever, meningitis, acute flaccid paralysis, and severe encephalitis. Typically encephalitis patients begin with a nonspecific febrile illness accom- panied by malaise, sore throat, and respiratory symptoms. Headache, photophobia, meningismus, lethargy, somnolence, and altered mental status will then follow. Severe disease can manifest as paralysis, coma, and seizures.

Answer 121

symptomatic WNV is West Nile fever, a self-limiting illness characterized by fever, headache, malaise, and myalgias. Patients can also experience gastrointestinal symptoms. round 1% of WNV causes neuroinvasive disease. The neuroinvasive disease manifests as meningitis, encephalitis, or flaccid paralysis. WNV neuroinvasive disease carries with it a 10% mortality rate. Age and immunosuppression have been identified as a risk factor for severity

Answer 122

ost dangerous of the viruses that cause equine encephalitides. It occurs along the Gulf and Atlantic coast with predominance in the late summer months. The usual manifestation is fever, chills, headache, and myalgias lasting 1 to 2 weeks, typically followed by resolution. A small portion of patients will go on to develop encephalitis with headache, nausea, vomiting, altered mental status, and focal neurologic deficits encephalitis 30% mortality

Answer 123

majority of infections are asymptomatic, but as patients get older the rate of symptomatic infections increases dramatically. The incubation period varies from 4 to 21 days. Symptomatic disease presents as fever, myalgias, and headaches. Patients older than 60 frequently present with encephalitis, with mental status ranging from lethargy to coma. Acute flaccid paralysis occurs in approximately 6% of patients with encephalitis.

Answer 124

fever with neurologic complaints including headache, confusion, weakness, paralysis, lethargy, or even seizures. The mortality rate is near 10%, and survivors are often left with long-term neurologic impairment.

Answer 125

WNV encephalitis is diagnosed by detecting IgM antibody in CSF. Viral culture is not commonly used for these diagnoses. There is often a broad differential diagnosis when evaluating these patients, so it is crucial to elicit travel and potential exposure history to narrow the differential diagnosis. When performing a lumbar puncture, it can be helpful to obtain an extra tube or vial of CSF to put on hold CSF demonstrates an elevated WBC count with lymphocyte predominance. Early during a WNV infection there may be a neutrophil predominance. Ancillary testing with CT or MRI may be indicated, depending on the severity of neurologic symptoms.

Answer 126

ost infec- tions occurring in Southeast Asia, the Western Pacific, and Central and South America. mosquito via Aedes aegypti and Aedes albopictus

Answer 127

asx vs Dengue fever is a self-limited illness characterized by fever, headache, retro- orbital pain, severe myalgias, and arthralgias. Symptoms can last up to 1 week. Dengue hemorrhagic fever (DHF), a more severe syndrome, occurs when the following four criteria are present: (1) increased vascular permeability (pleural effusion, ascites, hemoconcentration), (2) thrombocytopenia, (3) fever lasting 2 to 7 days, and (4) hemorrhagic tendency or spontaneous bleeding. D

Answer 128

following four criteria are present: (1) increased vascular permeability (pleural effusion, ascites, hemoconcentration), (2) thrombocytopenia, (3) fever lasting 2 to 7 days, and (4) hemorrhagic tendency or spontaneous bleeding. Dengue shock syndrome (DSS), the most severe presentation of dengue infection, is present when DHF occurs with circulatory shock.

Answer 129

Zika, malaria, chikungunya, rickettsial infections, leptospirosis, and other viral hemorrhagic fevers, including Ebola, Marburg, yellow fever, or bunyaviruses.

Answer 130

rologic testing with IgM assay, antigen testing of the viral antigen nonstructural protein 1 (NS1), or viral RNA detection with RT-PCR. Early in the course the IgM is often negative. Other laboratory findings that may be present with dengue infection include leukopenia, thrombocytopenia, elevated hematocrit (

Answer 131

supportive - nsaid and aspirin AVOID

Answer 132

arbovirus in the Flaviviridae family that is transmitted to humans via the Aedes species mosquitos. Although transmission is predominantly from mosquitos, there have been reports of perinatal, in utero, sexual, and blood product transfusion–related transmission as well.

Answer 133

microcephaly

Answer 134

aculopapular rash, fever, nonpurulent conjunctivitis, headache, retro-orbital pain, myalgias, arthralgias, and vomiting. The most commonly reported symptom is an erythematous maculopapular rash

Answer 135

ariety of neurologic complications, including Guillain-Barré syndrome, meningoencephalitis, and myeliti

Answer 136

RT-PCR or serology. In nonpregnant symptomatic patients with symptoms for less than 7 days, serum RT-PCR is the preferred method for diagnosis. If symptoms are present for more than 7 days, then serology is the preferred method.

Answer 137

supportive acetaminophen if worried about possible dengue, avoid nsaid

Answer 138

rbovirus in the Alphaviridae family that was originally endemic to West Africa. Aedes aegypti and Aedes albopictus mosquitoes.

Answer 139

elf-limiting disease very similar to dengue. Fever, myalgias, and polyarthralgias are the hallmark of this disease. The joint pain can be so severe that ambulation is impaired. Symptoms typically last for 7 to 10 days. More than half of infected individuals develop a maculopapular rash several days after fever onset. Risk factors for severe disease with higher mortality include age older than 65, diabetes, and underlying cardiopulmonary disorders.

Answer 140

enzyme- linked immunosorbent assay (ELISA) testing for antibodies, RT- PCR for detecting viral RNA, or viral culture. Lab abnormalities associated with acute infection include abnormal liver function tests, thrombocytopenia, and lymphopenia.

Answer 141

, antiinflammatory agents, and analgesics play an important role in symptom control. IV fluids may be necessary, depending on disease severity. Prevention of disease centers on reducing mosquito exposure. Most patients can be treated at home. Patients that present with severe disease may require admission for IV hydration and observation until they are stable.

Answer 142

yellow fever ebola lassa fever marburg

Answer 143

Flaaviridae Aedes or haemogogus mosquito in africa and south america

Answer 144

3 to 6 days. Patients present with an acute febrile illness accompanied by chills, malaise, headache, myal- gias, nausea, and dizziness. Patients can have a much lower heart rate than expected in reference to the high fever that is present. This acute febrile phase of the illness can last between 3 to 6 days. Patients then experience a short period of remission, lasting up to 24 hours; some patients recover completely, whereas others go on to have a more severe recurrence of illness with fever, vomiting, jaundice, acute liver injury, acute renal failure, and hemorrhagic manifestations. The hall- mark feature of yellow fever is jaundice with hemorrhagic fever. The mortality of patients with hepatorenal involvement ranges from 20 to 50%.

Answer 145

IgM and ab in serum elevated aspartate transaminase (AST), alanine transaminase (ALT), and direct bilirubin. Patients with severe disease also have hematologic labs consistent with disseminated intravascular coagulation (DIC).

Answer 146

Personal protection measures to avoid mosquito bites and vector control at the community level are important in preventing disease. The live-virus vaccine is recom- mended for individuals 9 months old and older who live in or are trav- eling to endemic areas. Many countries where yellow fever is endemic require a certificate of vaccination for entry.

Answer 147

NA virus that belongs to the Filoviridae family. Ebola virus disease (EVD) causes severe viral hemorrhagic fever. mortality 25-90% infected bodily fluids, including blood, saliva, vomit, feces, or semen. Individuals are not contagious until they show symptoms. The usual incubation time is 5 to 7 days but can range from 2 to 21 days.

Answer 148

high fever, headache, myalgias, mal- aise, sore throat, and profuse vomiting and diarrhea. After 5 to 7 days, patients can progress to develop the hemorrhagic manifestations, which include spontaneous bleeding, ecchymosis, and petechia. rythematous maculopapular rash can occur during that time that eventually desquamates. Patients can become hypovolemic and develop severe metabolic derangements secondary to fluid losses via the gastrointestinal tract. Eventually patients advance to shock and multiorgan failure.

Answer 149

of EVD. The hospi- tal should also have a protocol for handling lab specimens of potential EVD patients. The risk of acquiring EVD through lab testing is low but not zero. RT-PCR assay Laboratory findings that can accompany Ebola infection include thrombocytopenia, anemia, coagulopathy, transaminitis, elevated creatinine, hypocalcemia, and hypokalemia. All patients should have testing for malaria performed with thin and thick smear of the blood.

Answer 150

supportive care. Patients are empirically managed with malaria treatment, broad-spectrum antibiot- ics, and antipyretics. They also require rehydration therapy, preferably with IV fluid and electrolyte repletion.

Answer 151

All hospitals should have and follow infection control protocols, ensure that staff is trained and competent in safe PPE prac- tices, and have a system to manage waste disposal, cleaning, and disin- fection. Patients with suspected EVD are admitted to hospital isolation rooms, and many of them will need ICU care.

Answer 152

RNA virus that belongs to the Filoviridae family. It is an important cause of viral hemorrhagic fever in central Africa

Answer 153

Marburg and Ebola virus cause a very similar clinical syndrome. Mar- burg virus illness initially causes fever, headache, malaise, and myalgias. After the third to fifth day, severe abdominal pain, cramping, vomiting, and diarrhea occurs. Around the same time, a maculopapular rash may develop. Half of the patients will also develop hemorrhagic manifesta- tions during this time. Hematemesis, diarrhea, oropharyngeal bleed- ing, and bleeding from venipuncture sites can all occur. Death usually occurs because of acute blood loss and septic shock.

Answer 154

Direct transmission occurs with contact with blood, secretions, or solid organs of infected individuals. It is currently thought that the natu- ral host of the Marburg virus is the African fruit bat. The incubation period is 3 to 9 days. The disease carries a similar fatality rate to Ebola, with case fatality rate ranging from 24% to 88%.

Answer 155

RT-PCR, ELISA, antigen detection tests, serum neutraliza- tion tests, and viral culture.

Answer 156

isolation with own bathroom and room supportive and at sx

Answer 157

Arenavirus that is endemic to West Africa. Its reser- voir is the African rodent Mastomys natalensis. Humans contract the disease by exposure to urine or feces of Mastomys natalensis. uman- to-human transmission can occur via contact with blood or bodily secretions from infected humans.

Answer 158

incubation period is usually around 10 days, but can range from 3 to 21 days. Unlike Ebola and Marburg, the majority of Lassa infections are asymptomatic. The case fatality rate is less than 2%.

Answer 159

often asx sx: fever, symptoms usually begin with gradual onset of fever and malaise. Headache, myalgias, sore throat, cough, chest pain, abdominal pain, nausea, vomiting, and diarrhea can all occur after a few days. Patients can also develop facial edema, pleural effusion, myocarditis, and encephalitis. Less than 20% of symptomatic patients progress to develop hemorrhagic manifesta- tions. Patients that do go on to have full-blown hemorrhagic fever have a much higher mortality rate. Third-trimester pregnancy is associated with more severe disease with higher mortality as well.

Answer 160

Diagnosis on clinical grounds alone is difficult, because Lassa fever shares features with many other diseases. Diagnosis can be made via RT-PCR, ELISA, antigen detection tests, and viral culture.

Answer 161

Ribavarin - initiated early within the first 6 days after fever onset. The remainder of treatment is supportive care

119. Viruses Flashcards

(195 cards)