Micro Enteric Viruses 2

Question 1

what does coxsackie A cause?

Answer 1

herpangina, hand-foot-and-mouth disease, acute hemorrhagic conjunctivitis

Question 2

what is herpangina?

Answer 2

-acute febrile illness with small vesicular or ulcerative lesions on the posterior oropharyngeal structures that typically occurs in summer - mild and self-limited - typically children

Question 3

what causes herpangina?

Answer 3

MC coxsackie A, but also by coxsackie B and other enteroviruses

Question 4

what is hand-foot-and-mouth disease?

Answer 4

• spread by fecal-oral or contact with skin lesion/oral secretions
• viral invasion of mucus membranes causing widespread apoptosis with characteristic lesion formation (looks like chicken pox which is typically trunk)
• dehydration from refusal to drink/eat with sores

Question 5

what causes hand foot and mouth disease?

Answer 5

MC coxsackie A, also coxsackie B and other enteroviruses

Question 6

what is acute hemorrhagic conjunctivitis?

Answer 6

rapid onset painful conjunctivitis usually in young teens - unpleasant but short
-no treatment available

Question 7

what causes acute hemorrhagic conjuncitivitis?

Answer 7

coxsackie group A24 also enterovirus

Question 8

acute hemorrhagic conjunctivitis complications

Answer 8

rarely neurological sequelae - poliolike paralysis (1/10,000)

Question 9

what does coxsackie A typically cause?

Answer 9

herpangina, hand foot mouth disease, acute hemorrhagic conunctivitis

Question 10

what does coxsackie B typically cause?

Answer 10

viral myocarditis, pleurodynia

Question 11

viral myocarditis pathogenesis

Answer 11

sequel in 1-4% coxsackie B gastroenteritis, necrosis of myocytes, inflammatory infiltrate interferes with heart function and may progress to CHF and pulmonary edema

Question 12

what is seen on viral myocarditis exam - adults, infants, children?

Answer 12

• adults: heart failure, chest pain, dysrhythmia, RECENT HISTORY OF FLULIKE ILLNESS
• infants: irritability, lethary, periodic episodes of pallor, fever, hypothermia, tachypnea, anorexia, failure to thrive
• children: lack of energy, general malaise

Question 13

viral myocarditis labwork

Answer 13

CBC (anemia, lymphcytosis, neutropenia), blood cultures to rule out bacterial infection, C-reactive protein and sedimentation rates (markers of inflammation), creatinine kinase, troponin 1 (myocardial damage)

Question 14

histologic findings viral myocarditis (can be done on children and adults - not infants or super ill)

Answer 14

• focal or diffuse interstitial infiltrate of mononuclear cells, lymphocytes, plasma cells, eosinophils
• necrosis and diarrangement of myocytes
• fibroblasts in chronic and healing stages

Question 15

what is pleurodynia

Answer 15

infection of striated muscle in chest (muscle necrosis around lung) - sudden occurrence of lancinating chest pain attacks

Question 16

what causes pleurodynia?

Answer 16

coxsackie B and other enteroviruses

Question 17

pleurodynia symptoms

Answer 17

pain is paroxysmal, occurring in attacks separated by min-hr

• between attacks, patients usually have constant, dull pleuritic pain
• usually 3-5 days

Question 18

pleurodynia exam

Answer 18

3-5 days of fever, malaise, headache, sore throat/rhinitis/dry cough/n/v/diarrhea, pleural friction rub, herpangina or other mild coxsackie symptoms

Question 19

what is seen on x ray of pleurodynia?

Answer 19

normal! because heart and lung are normal - muscle is abnormal (used for exclusion)

Question 20

when is pleurodynia life-threatening?

Answer 20

newborns

Question 21

aspectic meningitis pathogenesis

Answer 21

enterovirus breaches CNS, infects leptomeninges and immune response creates inflammation - normally self-limited but must rule out infection by bacteria or fungi

Question 22

what is the classic tetrad for aseptic meningitis?

Answer 22

fever, meningisumus, irritability, photophobia

Question 23

aspectic meningitis labwork

Answer 23

CSF: culture, gram stain, acid-fast stain; PCR for viruses; WBC count, protein level, glucose level (normal level for viruses, low for bacteria)

Question 24

treatment for aseptic meningitis

Answer 24

rest, hydration, analgesics, anti-inflammatories

Question 25

symptoms of aseptic meningitis in babies/toddlers

Answer 25

fever, cold hands and feet, refusing food or vomiting, fretful, pale/blotchy skin, blank staring, drowsy, stiff neck, high pitched scream