Viral Diseases - Clin Med

What is this referring to

• 15-year-old female presents to urgent care with a few days of fever and sore throat.

• She had recently gone to an outdoor music festival and shared multiple drinks and cigarettes with friends, who had similar symptoms.

• She denies having a cough. She also had not taken anything for it

• Physical exam, she has palatal petechiae and cervical lymphadenopathy.

• A peripheral blood smear showed atypical lymphocytes and a Monospot test confirmed the diagnosis.

• She is counseled to avoid any contact sports.

Epstein-barr virus (mono)

What is this referring to

“Epstein Barr virus (EBV) (AKA Human Herpes Virus – 4 (HHV-4))”

Epstein Barr Virus (Mono)

What is this referring to

• MC teens and young adults

• Risk Factors

  • Asian descent

  • Living in endemic areas

  • Transplant recipient

  • Poor sanitation

  • “Kissing”

  • Daycare centers

EpidemiologyEpstein Barr Virus (Mono)

What is this referring to

• Linear strand DNA virus

• Transmitted via respiratory secretions

• Causes Mononucleosis

EtiologyEpstein Barr Virus (Mono)

What is this referring to

• Fatigue

• Pharyngitis

• Maculopapular rash

Clinical historyEpstein Barr Virus (Mono)

What is this referring to

• Fever

• Posterior cervical lymphadenopathy

• Hepatosplenomegaly

• Palatal petechiae

• Tonsillar exudate

• +/- rash

Physical examEpstein Barr Virus (Mono)

What is this referring to

• Cytomegalovirus (CMV) Mono

  • Presents with mono type sx

  • Likely have more myalgias and cough

• Strep Pharyngitis

Differential diagnosis ofEpstein Barr Virus (Mono)

What is this referring to

Workup for Epstein Barr Virus (Mono)

What is this referring to

• + Monospot

• ↑ atypical lymphocytes on peripheral blood smear

How to diagnose Epstein Barr Virus (Mono)

What is this referring to

• Supportive care

• Avoidance of contact sports

• Supportive care

  • Acetaminophen

  • Ibuprofen

  • Hydration

Clinical intervention of Epstein Barr Virus (Mono)

What is the treatment for Epstein Barr Virus (Mono)

No antiviral or antibiotic medications

What is this referring to

• Complications

  • Can lead to nasopharyngeal CA

  • Can cause Burkitt lymphoma

  • Splenic rupture

  • Malignancy

  • Hemolytic anemia

    • Tx with rituximab (Rituxan)

• Good hygiene

Prevention/morbidity/mortalityEpstein Barr Virus (Mono)

What is the prognosis of Epstein Barr Virus (Mono)

Most patients make a full recovery

What is this referring to

• A 26-year-old teacher presents to his primary care physician for a low-grade fever, swollen jaw, and painful testes.

• He teaches at an elementary school in Oregon, where many parents decline vaccination for their children.

• The patient immigrated from China when he was 5 and does not recall if he had been vaccinated prior to immigrating.

• On physical exam, he has right-sided swollen and tender parotid glands.

• His bilateral testes are also swollen and tender.

• He is prescribed antipyretics and analgesics and instructed to be isolated for at least 5 days.

Mumps

What is this referring to

• Paramyxovirus

  • Classified in the family Paramyxoviridae

    • Also includes parainfluenza

Mumps

What is this referring to

• Decreased cases due to effective vaccination

• MC in winter and spring

• MC children

• Risk Factors

  • Exposure to patient with mumps or unvaccinated people

  • Crowded living environment

  • Lack of vaccination

EpidemiologyMumps

What is this referring to

• Paramyxovirus

• Transmission – respiratory secretions

• Causes parotitis and orchitis

• Virus replication in the nasopharynx and regional lymph nodes

Etiology of Mumps

What is this referring to

• Presenting as Parotitis

  • Otalgia

  • Jaw pain

• Prodromal

  • Low-grade fever

  • Malaise

  • HA

• Presenting with orchitis

• Bilateral testicular pain

Clinical history of Mumps

What is this referring to

Clinical Presentation Mumps

What is this referring to

• Epstein-Barr virus

  • Mononucleosis

• Acute Bacterial Parotitis

Differential of Diagnosis of Mumps

What is this referring to

• Although not diagnostic – amylase is often elevated

• Antibody (Ab) detection IgG and/or IgM

• Buccal or oral swab with viral isolation

  • + reverse transcriptase (RT)-PCR

How to diagnose Mumps

What is this referring to

• Prevention with MMR vaccination in childhood

• Supportive care

  • Antipyretics

  • Analgesics

  • Hydration, hydration, hydration

Clinical Intervention of Mumps

What is the treatment for Mumps

No antiviral therapy available

What is this referring to

• Green tea to strengthen immune system

• Chinese herbal medicine

Complementary and alternative therapy – Mumps

What is this referring to

Complications

• Sterility in males who have orchitis after puberty

• Sensorineural deafness

• Most patients are asx

Prognosis of Mumps

What is this referring to

• 25-year-old woman presents to the clinic for routine check-up.

• She reports that about a month ago, she had what she thought was mononucleosis.

• She had fevers, chills, a red rash, muscle pain, and joint pains.

• She works in a daycare center, and some of her colleagues had similar symptoms.

• This resolved in 1 week.

• Today, there are no significant findings on physical exam.

• Laboratory evaluation reveals that she is positive for CMV-specific immunoglobulin M (IgM).

• Other laboratory tests are negative.

Cytomegalovirus (CMV) Adult

What is this referring to

• DS-DNA virus

• Associated conditions

  • Congenital CMV infection

Cytomegalovirus (CMV) Adult

What is this referring to

• Common viral illness

• Risk Factors

• Immunosuppression

• MSM

• Poor socioeconomic status

• Working in childcare

• Transplant recipients

EpidemiologyCytomegalovirus (CMV) Adult

What is this referring to

• DS DNA virus

• Classified as CMV or HHV-5

• Largest virus that causes human infection

• Primary infection or reactivation of latent infection

• Transmission

  • Body fluids

  • Vertical transmission

EtiologyCytomegalovirus (CMV) Adult

What is this referring to

Clinical historyCytomegalovirus (CMV) Adult

What is this referring to

• Fever

• Cervical lymphadenopathy

• Hepatomegaly

• Maculopapular rash

• Retinitis

Clinical presentationCytomegalovirus (CMV) Adult

What is this referring to

CMV in Immunocompetent

What is this referring to

• Mononucleosis

  • EBV (Epstein Barr v.)

  • CMV

Differential diagnosisCytomegalovirus (CMV) Adult

What is this referring to

DiagnosticsCytomegalovirus (CMV) Adult

What is this referring to

• CMV-specific immunoglobulin G (persists for 4-6 months)

• CMV-specific immunoglobulin M (2-3 weeks)*

• Active infection

How Cytomegalovirus (CMV) Adult is diagnosed

What is this referring to

Support care

• Antipyretics

• Analgesics

• Hydration, hydration, hydration

Clinical interventionCytomegalovirus (CMV) Adult

What is this referring to

1st line antivirals

• Ganciclovir (Cytovene)

• Valganciclovir (Valcyte)

Clinical pharmacotherapeuticsCytomegalovirus (CMV) Adult

What is the prognosis for Cytomegalovirus (CMV) Adult

Often self-limiting in immunocompetent patients

What is this referring to

• A 13-year-old boy in rural Asia presents to a local hospital after a dog bite.

• The dog did not belong to anybody and is often seen running around the area.

• His parents report that this occurred a few weeks ago, but that they weren’t concerned until the boy started having low-grade fever and chills.

• While the physician explains that they can administer both active and passive immunity, as symptoms have already started, the parents must prepare for the worst.

Rabies

What is this referring to

• Negative, single stranded linear RNA virus

• Rhabdovirus

Rabies

What is this referring to

• MC in children

• MC in Asia and Africa

• Interaction with non-domestic animals is significant risk factor

EpidemiologyRabies

What is this referring to

• Transmission

  • Bites of infected animals

    • Bats > raccoons and skunks > dogs (US)

• Rare aerosol transmission

  • Bats

• Incubation period weeks to months

EtiologyRabies

What is this referring to

Non-specific prodrome

• Malaise

• Fever

• HA

Clinical history of rabies

What is this referring to

Clinical presentation of Rabies

What is this referring to

• Botulism

• Temporal lobe HSV-1 encephalitis

Differential Diagnosis of Rabies

What is this referring to

Diagnostics for Rabies

What is this referring to

• Viral studies

  • Reverse transcription and PCR

  • Virus isolation

• Histology

  • Brain biopsy

    • + negri bodies

      • Eosinophilic inclusion bodies are pathognomonic

How is rabies diagnosed

What is this referring to

• Wound cleaning

• Wound healing by secondary intention if possible

Clinical intervention of rabies

What is this referring to

• Indications

  • Bitten by known rabid animal

  • Bite from rapid or potentially rabid animal can’t be ruled out

• Domestic animal

  • Observe for signs of rabies in domestic animals for 24-48 hours

• If animal euthanized

  • Brain bx specimen to test for rabies

• Drug regimen

  • Rabies vaccine monotherapy if patient has had previous rabies vaccine in the past

  • Rabies vaccine (IM) + rabies immune globulin

    • Patients who have not had a rabies vaccine in the past

  • Dosing schedule

    • Administered as soon after the bite as possible THEN

    • on days 3, 7, and 14

Clinical pharmacotherapeuticspost-exposure prophylaxis

What is this referring to

• Animal bites

  • 1st line abx

    • Amoxicillin-Clavulanic Acid (Augmentin)

  • Alternative regimens

    • Clindamycin

    • Ciprofloxacin

Clinical pharmacotherapeuticsRabies

What is this referring to

• Full recovery with early diagnosis and treatment

• Respiratory failure leading to death if not managed aggressively

Prognosis of rabies