Viral Infections

What are the 3 main Blood Borne Viral Pathogens?

Hepatitis B (HBV), Hepatitis C (HCV), HIV

What is the purpose Blood Borne Pathogen Standard?

* By OSHA (occupational safety and health administration)
* To minimize exposure to HBV, HCV, HIV, and other blood borne pathogens

The use of Blood Borne Pathogen “Standard precautions” is to...

Decrease contact w/ potentially contaminated body fluids

According to CDC guidelines for Infected HCW treating pts, based off assumption the risk of transmission is greatest when what?

* Based on assumption that risk of transmission is greatest when performing invasive procedures

According to CDC guidelines for Infected HCW treating pts, avoidance of the procedures unless what?

Avoidance of such procedures unless guided by expert panel on performance safety

According to CDC guidelines for Infected HCW treating pts, when must you notify the pt regarding their infected status?

Must notify pt regarding infected status before performing invasive procedure

Is HBV a serious risk for HCW? (Health care workers)

YESS

The risk of HBV is dependent on what 2 factors?

- Exposure to blood degree of exposure
- Presence of HBV e-antigen (HBeAg) and hepatitis surface antigen (HBsAg)

How is HBV transmitted?

via percutaneous injury or direct/indirect contact w/ infected blood or bodily fluids

How long does HBV in blood survive on environmental surfaces

1 week

What is incubation period of HBV?

45-180 days

What preventative measure is strongly recommended for HCWs at risk?

Vaccination

What should a HCW do if exposed to HBV? (2)

- HBsAg levels taken
- Post exposure prophylaxis is given if needed

OSHA blood borne pathogen standard mandates what for HBV? (3)

* HBV vaccine and immunoglobulin
* Strict adherence to hand washing and standard precautions
* Use of barriers ( to prevent accidental pokes with needles)

What’s the highest mode of transmission to HCW’s for HCV?

Through Percutaneous injuries (needles or anything sharp)

What is Incubation period of HCV?

6-7 weeks

Nearly all infected HCV will develop what?

Chronic HCV

What happens after developing chronic HCV?

* Persistent viremia
* Transmittable to others over time
* Cirrhosis, hepatocellular carcinoma, and liver failure

Is there a vaccine available against HCV?

NO

What is the best route of prevention for HVC?

* Prevention
* Hand Washing
* Standard Precautions
* Barriers

How can HCW be exposed to HIV?

Nosocomial transmission from pt can affect HCW through percutaneous or mucocutaneous(body fluid exposure) exposure to blood/body fluids

What is there Risk of HIV after percutaneous exposure?

~ 0.3%

What is the Risk of HIV after Mucous Membrane Exposure?

~ 0.09%

Seroconversion after percutaneous exposure to infected blood depends on what 3 things?

- Visible blood on device prior to injury
- Involves needle placement into artery of vein
- Deep injury w/ contaminated device

What does CDC recommend if HCW is exposed to HIV?

- Counseled
- Offered HIV and baseline follow-up testing ASAP
- Treated w/ antiviral therapy per protocol

What should HCW do post exposure to HIV?

- Contact area immediately washed w/ antiseptic soap and rinse
- Antiretrovirals for 4 weeks

What are the Prevention tactics for HIV?

- Hand washing
- Standard precautions
- Barriers

How many types of Herpesvirus is there?

8

Herpes is usually what type of infection vs symptomatic or asymptomatic presentation?

* Usually subclinical primary infection vs symptomatic presentation

“Subclinical primary infection vs symptomatic presentation” means what? (Herpes)

Means that some can be latent and you can be a carrier without knowing unless triggered by stress in the future.

Regarding herpes, can it be latent? And for how long?

It may exist in latent state for life of host

Regarding Herpes, Reactivation in compromised host can cause what 3 things?

- Widespread lesions on affected organs or CNS
- Severe Illness in infants or immunocompromised
- Death

At what age group is harboring Herpes Simpex Virus Type 1 (HSV-1)?

Approx. 70% \> 12 y/o

How does HSV-1 usually manifest? And what else does it infect?

- As vesicles/sores in mouth and oral cavity
- Infects Genitourinary System

What are Systemic Symptoms of HSV-1 and how long do these symptoms take to resolve?

* Fever, Malaise, Myalgias
* 3-14 days (lesions as well)

What is a HSV-1 infection of the finger?

Herpetic Whitlow

HSV-1 has some association with what condition?

Bell's Palsy

At what age group is harboring Herpes Simplex Virus Type 2 (HSV-2)?

Approx 20% \> 12 y/o

What is the principal cause of genital herpes?

Sexual contact

HSV-2 Ulcers may also affect what 5 body parts?

- Cervix
- Ass
- Rectum
- Urethra
- Bladder

Individuals w/ HSV-2 may experience what type of sensations?

* Painful, small, grouped lesion with itching

How long do HSV - 2 sores take to heal?

Usually heal in 1-3 weeks

Women with genital herpes may pass the virus to who?

Infant during birth (if pregnant)

How does a pregnant mom with HSV-2 prevent infection to child during birth?

C-Section Birth

HSV 1 and 2 infect what?

Any organs or musculocutaneous site

HSV 1 and 2: What usually occurs immediately prior to sores appearing?

Asymptomatic shedding

How can HSV 1 and 2 be transmitted?

Contact through break in mucous membranes/skin \> especially if host is immunocompromised

Initial infection of HSV 1 and 2 may be what?

Asymptomatic

HSV 1 and 2 virus typically remains latent with what?

Periodic reactivation

During primary infection, HSV 1 and 2 travel along what?

Along axons of peripheral sensory nerve to nerve ganglia is CNS

What may reactivate latent HSV 1 and 2?

Physical/Physiological stress (may have been been dormant and then triggered by stress)

HSV 1 and 2 travels down sensory nerves to body surfaces and form what?

Lesions

HSV 1 and 2: recurrences are usually ____

Milder

HSV 1 and 2 may also cause what 3 conditions?

- Meningitis
- Encephalitis
- Keratitis

How is diagnosis for HSV 1 and 2 confirmed?

Through Cultures

Is there available vaccine for HSV 1 and 2?

NOO

What are pts w/ HSV 1 and 2 usually treated with?

Anti-virals and education

How often for Nosocomial transmission of HSV 1 and 2 occur?

Rarely

What is incubation period for HSV 1 and 2?

2-14 days

How to prevent HSV 1 and 2?

- Hand washing
- Standard Precautions
- Barriers

What is Varicella Zoster Virus (VZV) also known as?

Herpesvirus Type 3

What conditions is VZV responsible for?

Chicken Pox and Shingles

VZV most common complication is what?

Secondary bacterial skin infection

How is Chicken Pox transmitted?

Contact w/ airborne droplets or direct contact w/ vesicular fluid into respiratory tract

Viremia occurs how many days after infection?

4-6 days

Chicken pox decimates into where in the body?

Organs and sensory ganglia and then replicated further

Chicken Pox: Second Viremia with infection on what?

Infection of skin and mucosa

Chicken Pox: Vesicles are filled with what?

High titers of infectious virus

What is incubation period for Chicken Pox?

14-16 days from exposure (10-21 day range)

(Dormant for 14 - 16 days)

Chicken Pox is present in WBC up to how long before rash?

5 days

When is Chicken Pox contagious?

1-2 days prior to rash \>> all lesions crusted

When are the chicken pox lesions not contagious anymore?

Once the lesion is sealed and crusted over

How is Chicken Pox contracted?

Airborne and Contact transmission

Are Second Episodes of Chicken Pox common?

Uncommon unless unless initial infection < 1 y/o

If they do get a second episode, how aggressive will it be?

The second episode wont be as aggressive as the first

What may precede Chicken Pox rash?

Fever and Malaise

What does the rash look like for Chicken Pox pts? (2)

* Rash w/ "dew drop on a rose petal"
* Vesicle w/ erythematous base

What are the stages of Chicken Pox rash?

Macules \> Papules \> Vesicles \> Pustiles \> Crusting

Where is the first appearance of Chicken Pox rash? Then where after that?

* On the scalp
* THEN successive lesion continue to appear for several days (starts to spread out)

What does Chicken Pox pts c/o?

Pain and Itching

Chicken pox can be ______ on your body and sometimes what?

Anywhere and sometimes painful

Can someone with chicken box get a second infection? And how ?

Yes, they can get a 2nd bacterial infection

Ex) if a child scratches it and breaks it open. It could lead to a different infection separate to the chicken poc

Chicken Pox complication is most common in what population?

Adults and Immunocompromised

What 2 things could be involved when you have chicken pox?

Organ or CNS involvement

When infected with chicken pox and the organ/CSN is involved, what can it lead to?

Pneumonitis and encephalitis

Chicken Pox diagnosis is usually based on what? And what could it be confirmed by?

* Symptoms BUT can be confirmed w/ cultures

How do they confirm if its chicken pox?

If they are not certain, then they take a sample of one of the blisters and run a culture test to find out what it is.

chicken pox creates a risk during what?

Risk during pregnancy

What is treatment for Chicken Pox?

- Bed rest till afebrile
- Skin kept clean
- Itching creams OR oral antihistamines

What is provided for adults and children w/ high risk for complications?

Antivirals

Are there vaccines available for Chicken Pox pts? If yes, then what type?

Prophylaxis Rx with Varicella vaccine up to 3 days post exposure or VZV immune globulin

What infection is this?

Varicella/chicken pox

How does Herpes Zoster/Shingles usually present itself?

* Unilateral lesions along erupting dermatome

Pts with herpes zoster/shingles, where is the highest concentration of unilateral lesions?

Highest concentration is on trunk and usually T3 - L3

(Harrison has seen it on the face as well)

What age group is usually affected by Shingles?

\> 50 y/o or immunocompromised

Shingles is usually contagious to what population?

Those who have NOT had Chicken Pox or vaccination

What is one complication of Shingles?

Post herpetic neuralgia

What age group should get Shingles vaccine?

Adults > 60 y/o

What does that vaccine for shingles/herpes zoster reduce?

reduces incidence of Shingles and post herpetic neuralgia

What can the affected area feel like after the shingles heals up?

That area can still feel sensitive and painful after its healed