Infect disease Viral disease exam 1

DefinitionEpstein Barr Virus (Mono)

•Epstein Barr virus (EBV) (AKA Human Herpes Virus - 4 (HHV-4))

epidemiologyEpstein Barr Virus (Mono)

•MC teens and young adults

•Risk Factors

•Asian descent

•Living in endemic areas

•Transplant recipient

•Poor sanitation

•"Kissing"

•Daycare centers

•

etiology Epstein Barr Virus (Mono)

•Linear strand DNA virus

•Transmitted via respiratory secretions

•Causes Mononucleosis

Clinical historyEpstein Barr Virus (Mono)

•Fatigue

•Pharyngitis

•Maculopapular rash

Physical examEpstein Barr Virus (Mono)

•Fever

•Posterior cervical lymphadenopathy

•Hepatosplenomegaly

•Palatal petechiae

•Tonsillar exudate

•+/- rash

Differential diagnosisEpstein Barr Virus (Mono)

•Cytomegalovirus (CMV) Mono

•Presents with mono type sx

•Likely have more myalgias and cough

•Strep Pharyngitis

workupEpstein Barr Virus (Mono)

Labs :

•CBC w. diff

•CMP

•Monospot

•Peripheral blood smear

•

•If upper abdominal pain

•Amylase/lipase

Imaging :

•No initial imaging is indicated

How's it diagnosedEpstein Barr Virus (Mono)

•+ Monospot

• atypical lymphocytes on peripheral blood smear

Clinical intervention Epstein Barr Virus (Mono)

•Supportive care

•Avoidance of contact sports

•Supportive care

•Acetaminophen

•Ibuprofen

•Hydration

do not give amoxilicin

Clinical pharmacotherapeutics Epstein Barr Virus (Mono)

•No antiviral or antibiotic medications

Prevention/morbidity/mortalityEpstein Barr Virus (Mono)

Complications

•Can lead to nasopharyngeal CA

•Can cause Burkitt lymphoma

•Splenic rupture

•Malignancy

•Hemolytic anemia

•Tx with rituximab (Rituxan)

Good hygiene

prognosis Epstein Barr Virus (Mono)

•Most patients make a full recovery

Definition Mumps

•Paramyxovirus

Classified in the family Paramyxoviridae - Also includes parainfluenza

Epidemiology Mumps

•Decreased cases due to effective vaccination

•MC in winter and spring

•MC children

Epidemiology Mumps risk factors

•Exposure to patient with mumps or unvaccinated people

•Crowded living environment

•Lack of vaccination

Etiology Mumps

•Paramyxovirus

•Transmission - respiratory secretions

•Causes parotitis and orchitis

•Virus replication in the

nasopharynx and regional lymph nodes

Clinical history Mumps

•Presenting as Parotitis

Otalgia

Jaw pain

•Prodromal

Low-grade fever

Malaise

HA

•Presenting with orchitis -Bilateral testicular pain

Clinical presentation Mumps

parotitis :

•Bilateral or unilateral parotid gland swelling

•Swelling causes ear to be lifted up and back

orchitis:

•Bilateral testicular swelling

Differential diagnosis Mumps

•Epstein-Barr virus

•Mononucleosis

•Acute Bacterial Parotitis

How's it diagnosed? Mumps

•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

Clinical intervention Mumps

•Prevention with MMR vaccination in childhood

•Supportive care

Antipyretics

Analgesics

Hydration, hydration, hydration

Clinical pharmacotherapeutics Mumps

•No antiviral therapy available

Complementary and alternative therapy - Mumps

•Green tea to strengthen immune system

•Chinese herbal medicine

Prognosis of Mumps

Morbidity/complications :

•Childhood vaccination

•Measles/Mumps/Rubella (MMR)

•2 dose series

mortality :

•Not typically seen with mumps

Mumps Complications

•Complications

Sterility in males who have orchitis after puberty

Sensorineural deafness

•Most patients are asx

Definition Cytomegalovirus (CMV) Adult

•DS-DNA virus

•Associated conditions

Congenital CMV infection

EpidemiologyCytomegalovirus (CMV) Adult

•Common viral illness

EpidemiologyCytomegalovirus (CMV) Adult Risk factors

•Immunosuppression

•MSM

•Poor socioeconomic status

•Working in childcare

•Transplant recipients

Clinical historyCytomegalovirus (CMV) Adult : immunocompetent

•Most patients asx

-Fever ,malaise ,myalgias,arthralgia ,splenomegaly

-Rash

•If symptomatic

Mono-like syndrome

Fevers

Myalgias

Arthralgias

Cough

Clinical historyCytomegalovirus (CMV) : immunosuppressed

•Esophagitis

•Colitis*

•Encephalitis

•Pneumonia

•Retinitis

•Congenital CMV

•Hemolytic anemia

CMV Immunocompetent complication

Mucosla GI,damage,encephalic,thrombocytopnia ,guillian barre,pericarditis,myocarditis

Differential diagnosisCytomegalovirus (CMV) Adult

•Mononucleosis

•EBV (Epstein Barr v.)

•CMV

DiagnosticsCytomegalovirus (CMV) Adult

labs : •CBC w. diff

•CMP

•Heterophile antibody negative

•Viral load

Imaging : None

How's it diagnosed? Adult

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

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

•Active infection

Clinical intervention Cytomegalovirus (CMV) Adult

Clinical interventionCytomegalovirus (CMV) Adult

Clinical pharmacotherapeutics Cytomegalovirus (CMV) Adult

•1st line antivirals

•Ganciclovir (Cytovene)

•Valganciclovir (Valcyte)

Prognosis Cytomegalovirus (CMV) Adult

PrognosisCytomegalovirus (CMV) Adult :

•Thrombosis

•Colitis

•Permanent vision changes

mortality:

•When it does occur usually in immunocompromised or multi-organ system involvement

•Often self-limiting in immunocompetent patients

Definition Rabies

•Negative, single stranded linear RNA virus

•Rhabdovirus

Epidemiology Rabies

•MC in children

•MC in Asia and Africa

•Interaction with non-domestic animals is significant risk factor

Etiology Rabies

•Transmission

Bites of infected animals

Bats > raccoons and skunks > dogs (US)

•Rare aerosol transmission

Bats

•Incubation period weeks to months

Clinical historyRabies

•Non-specific prodrome

Malaise

Fever

HA

Clinical presentation Rabies

Encephalitic rabies:

•Hydrophobia

•Muscle spasms ® foaming mouth

•Photophobia

•Autonomic dysfunction

• sweating

•Piloerection

•Hypersalivation

•Agitation

Paralytic rabies:

•Quadriparesis

•Bilateral facial weakness

Differential diagnosis Rabies

•Botulism

•Temporal lobe HSV-1 encephalitis

DiagnosticsRabies

Lab :

•CBC w. diff

•CMP

•Viral studies

Imaging :

•CT head indication

•Neurologic deficits

How's it diagnosed? Rabies

Viral studies

•Reverse transcription and PCR

•Virus isolation

Histology

Brain biopsy

+ negri bodies

Eosinophilic inclusion bodies are pathognomonic

Clinical intervention Rabies

•Wound cleaning

•Wound healing by secondary intention if possible

Clinical pharmacotherapeuticspost-exposure prophylaxis

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

Clinical pharmacotherapeuticspost-exposure prophylaxis •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

Clinical pharmacotherapeuticspost-exposure prophylaxis •Dosing schedule

•Administered as soon after the bite as possible THEN

•on days 3, 7, and 14

Clinical pharmacotherapeuticsRabies

•Animal bites

•1st line abx

•Amoxicillin-Clavulanic Acid (Augmentin)

•Alternative regimens

•Clindamycin

•Ciprofloxacin

Prognosis Rabies

Morbidity/complications:

•Prevention

•Whole virus inactivated vaccine

•Passive immunization

•Rabies immunoglobulin

•Active immunization

Mortality ;

•Most cases without early diagnosis and intervention lead to coma and death witinin weeks

•Full recovery with early diagnosis and treatment

•Respiratory failure leading to death if not managed aggressively