Term
|
Definition
1. intact epidermis
2. cidal properties of skin
3. phagocytosis by WBC
4. normal flora |
|
|
Term
| Qualities of intact epidermis |
|
Definition
acid pH
dryness
salty sweat
low surface temperature |
|
|
Term
|
Definition
excreted chemical compounds: sebum
urea |
|
|
Term
|
Definition
Propionibacterium acnes
diphtheroids
Coagulase-negative staphylococci |
|
|
Term
| non-infectious causes of skin problems |
|
Definition
|
|
Term
| Etiology of Skin infections: |
|
Definition
non-infectious causes (allergies, cancer)
parasites or arthropods
pathogenic patterns caused by microorganisms |
|
|
Term
| Pathogenic Patterns of Skin Disease caused by microorganisms |
|
Definition
1. systemic/blood-borne illness that causes skin manifestations
2. skin infections that have symptoms caused by exotoxins
3. primary skin infection - herpes simplex (most common virus), bacteria (p.acnes, s.aureus, s.pyogenes), fungi (t.rubrum) |
|
|
Term
| Characteristics of primary skin infections |
|
Definition
type of lesion
pattern recognition
progression and distribution
associated symptoms present? |
|
|
Term
|
Definition
macule
papule
vesicle or bullae
pustule
ulcer
petechiae or purpura
blanching or hemorrhagic? |
|
|
Term
|
Definition
| are all lesions the same or in same stage of development |
|
|
Term
| progression and distribution |
|
Definition
| method of spread and evolution of lesions |
|
|
Term
|
Definition
is there prodrome?
fever?
when in relation to rash? |
|
|
Term
Propionibacterium acnes
-what does it cause? |
|
Definition
acne/acne vulgaris
inflammatory acne/inflammatory acne vulgaris |
|
|
Term
Propionibacterium acnes
-etiology |
|
Definition
gram positive
non motile
diphtheroid/pleomorphic rod
anaerobic
normal flora of skin |
|
|
Term
Propionibacterium acnes
epidemiology |
|
Definition
| acne is most common skin disease; involves hair canals in skin; happens in adolescents |
|
|
Term
Propionibacterium acnes
--pathogenesis and clinical manifestations |
|
Definition
in absence of p. acnes microcomedones develop when:
1. increased sebum production after puberty
2. follicular canal of sebaceous follicles becomes plugged due to alterization in keratinization of cells lining the canal |
|
|
Term
Propionibacterium acnes
--pathogenesis and clinical manifestations |
|
Definition
microcomedones will progress to non inflammatory comedones and possibly inflammatory comedones (papules, postules, nodules, cysts)
1. closed comedones - white heads; cant see; slightly raised; small papule
2. open comedones - black heads; follicular impaction of lipid, keratin, melanin causes brown or black appearance (not dirt!) |
|
|
Term
Propionibacterium acnes
--pathogenesis and clinical manifestations |
|
Definition
if sebaceous gland / follicle becomes colonized by p.acnes, an inflammatory, self limiting diagnosis occurs
-inflammatory acne
-papules are most common and rarely result in scarring |
|
|
Term
Propionibacterium acnes
-chronic
--purpose of treatment |
|
Definition
Antikeratinizing
Inhibit sebum production
Anti-p.acnes
Anti-inflammatory |
|
|
Term
Propionibacterium acnes
--inhibition of physiological process |
|
Definition
Salicylic Acid
Retinoic Acid (tretinoin), isotretitnoin, tazarotene, adapalene
Azelaic Acid - naturally in wheat, rye, barley
Benzoyl peroxide? |
|
|
Term
Propionibacterium acnes
--inhibition of P. acnes |
|
Definition
salicylic acid
Retinoic Acid
Azelaic Acid - antibacterial (static and cidal)
benzoyl peroxide
Antibiotics in topics in combination with benzoyl peroxide (ie erythromycin) |
|
|
Term
Propionibacterium acnes
--other treatments |
|
Definition
Gentle medicated cleansing
OTC topical vitamin A or C (antioxidants; may work)
OTC low dose retinol or OTC alphy hydroxy acids
Severe acne - systemic antibiotics or corticosteroids
Estrogens and antiandrogens |
|
|
Term
Propionibacterium acnes
--ineffective / harmful therapy |
|
Definition
frequent, non medicated, vigorous scrubbing
use of abrasive cleansing
restricted diet
squeezing pimples |
|
|
Term
Propionibacterium acnes
--3 things pharmD should recognize |
|
Definition
1. acne patients have levels of social and emotional problems as great as those with chronic asthma, diabetes, arthritis
2. Impact on quality of life does not correlate with severity of acne
3. Patients are usually misinformed (most think acne is curable and treatment is less than 6 months; neither is true) |
|
|
Term
Staphylococcus Aureus
--etiology |
|
Definition
Coagulase Positive (produces coagulase)
Gram positive cocci in pairs, short chains, or clusters |
|
|
Term
Staphylococcus Aureus
--pyodermic infections that it causes |
|
Definition
these pyodermic infections are pyogenic (forms abscesses in any tissue)
1. folliculitis
2. furuncles
3. carbuncles
4. epidemic impetigo
5. bullous impetigo
6. staphylococcal scalded skin syndrome |
|
|
Term
Staphylococcus Aureus
-folliculitis, furuncles, carbuncles, epidemic impetigo |
|
Definition
NONE are toxin mediated diseases
ALL are contagious - that is, if you catch a strain you many not develop dx |
|
|
Term
Staphylococcus Aureus
-folliculitis |
|
Definition
1. superficial infection of individual hair follicle at apocrine regions
2. lesions: small erythematous, sometimes pruritic papule topped by central pustule occurring on any hair-bearing site on body |
|
|
Term
Staphylococcus Aureus
--furuncles and carbuncles |
|
Definition
Developed from folliculitis
Children 3-15 yrs
Occur on neck, face, back, gluts, thighs
infection of hair follicle and subcutaneous tissue |
|
|
Term
Staphylococcus Aureus
--furuncles |
|
Definition
-boils/deep folliculitis
-infection of individual hair follicle
-painful, firm, discrete, tender, red nodule with purulent drainage
-skin around furuncle is hot but no systemic signs |
|
|
Term
Staphylococcus Aureus
--carbuncle |
|
Definition
-larger, deeper, indurated lesions than furuncles
-involve several hair follicles
-erythematous, edematous, painful lesions with central, necrotic crater
-lesions coalesce - spreading, drain to surface along hair follicles
-systemic signs of fever and malaise |
|
|
Term
Staphylococcus Aureus
--epidemic impetigo (crusted skin) epidemiology |
|
Definition
Classic, nonbullous impetigo
-caused primarily be s.aureus but also by strep pyogenes (GAS) or both
-most common bacterial skin infection in children and third most common skin disease overall, after dermatitis and warts
-children 2-5 yrs
-often secondarily infects varicella lesions or lesions present in systemic diseases (AIDS or diabetes); causes scarring
-autoinocculation causes spread |
|
|
Term
Staphylococcus Aureus
--epidemic impetigo manifestations |
|
Definition
-in superficial epidermis, single macule or papule forms small vesicles that develop into pustules with little erythema, then ruptures
-purulent discharge drying on top of lesion results in thickened amber colored adhesive crust that resolves in weeks without scarring
-contagious; passed by fomites or person to person |
|
|
Term
Staphylococcus Aureus
-community acquired infections CAI |
|
Definition
infections acquired in non health care settings
-two strains USA300 or 400
-Resistant to beta lactams, macrolides, clindamycin, tetracyclin; need D test
-associated with skin and soft tissue infections; less so a necrotizing (non-abscessogenic) pneumonia
-strains appear to be more virulent and with greater pathogenicity, than HAI-MRSA strains |
|
|
Term
Staphylococcus Aureus
-ET, ETA, ETB
-exfoliatin exotoxins |
|
Definition
exotoxin mediated diseases caused by s.aureus:
- bullous impetigo
-SSSS (including ritter's disease of newborn) |
|
|
Term
Staphylococcus Aureus
--pathogenesis of exotoxin mediated disease |
|
Definition
1. caused by exfoliatin toxin
2. ET causes exfoliation of superficial intraepidermal layers of skin (cleavage in epidermis) by producing one or both:
a-epidermal necrosis (sloughing of large layers of skin)
b-bullae - flaccid, thin walled, white, serous fluid-filled sacks with hsarp margins and with no surrounding erythema which rupture - painful, moist lesion that dry in 1-2 days to think varnish-like light-brown crusted lesions that resolve without scarring in several weeks, unless secondary infection occurs |
|
|
Term
Staphylococcus Aureus
--bullous impetigo |
|
Definition
1. lesions:
-occur in infants or young kids on diaper area, neck folds, legs
-contain ET producing strain of s.aureus bUT NO OTHER microorganisms
2. toxin and agent do not disseminate in blood, lymph, etc |
|
|
Term
Staphylococcus Aureus
-SSSS
staphylococcal scalded skin syndrome |
|
Definition
1. infants and kids less than 5 yrs or immunocompromised adults
2. focal infection by ET producing strains
-dissemination of staphy is rare
-hematogenous dissemination of ET that is elaborated in focal lesion
-focal infection is contagious; exfoliated skin lesion/bullae are sterile |
|
|
Term
Staphylococcus Aureus
-SSSS manifestations |
|
Definition
2 syndromes
SSSS and Ritters disease of newborn (most severe form)
manifest with:
fever
wiespread, diffuse erythroderma (scarlatiniform rash) that progresses in 1-3 days to extensive in size, widely distributed, exfoliation of skin/bullae that progress as described above; within 5 days of onset, fine, flaky discolored total-body desquamation occurs |
|
|
Term
Staphylococcus Aureus
-treatment of non-bullous and bullous impetigo, SSSS, and Ritters disease |
|
Definition
1. supportive - pain management, fluid replacement
2. antibiotics -
-penicillin resistant strains (MSSA) are common in community and hospital outbreaks of impetigo in nurseries
-for impetigo involving limited body surface area, topical Ab like mupirocin and fusidic acid is preferred first line therapy
-oral Ab that are effective = antistaphy penicillins, amoxicillin, cephalosporins, macrolids
-erythromycin is less effective
-for more extensive impetigo or systemic symptoms, use oral Ab
-oral penicillin V, amoxicillin, topical bacitracin, and neomycin are not remcommended for impetigo
-topical disfectants like hydrogen peroxide should NOT be used in impetigo! |
|
|
Term
Streptococcus pyogenes
-etiology |
|
Definition
Group A beta-hemolytic strep
Gram positive cocci in chains |
|
|
Term
Streptococcus pyogenes
-classic impetigo |
|
Definition
epidemic in preschool children
Unrelated to pharyngeal strep (different M types)
complication:
Acute Glomerulonephritis |
|
|
Term
Streptococcus pyogenes
-cellulitis |
|
Definition
See other
Erysipelas is a form of cellulitis associated with blocked lymphatics |
|
|
Term
Streptococcus pyogenes
-scarlet fever |
|
Definition
Caused by strains producing streptococcal pyrogenic exotoxins (SPE) -AKA erythrogenic exotoxins - which are superantigens
is a complication of streptococcal pharyngitis or classical impetigo
signs and symptoms of either plus:
1. systemic signs that can lead to DS
2. enanthem - pronounced hyperemia of the entire pharynx with petechial lesions on palate, bleeding lips and gums, and white strawberry tongue that progresses to a red strawberry tongue and finally a raspberry tongue
3. exanthem:
a. diffuse, generalized, blanching, macular erythroderma as base for scarlatiniform (fine, red, punctate, sandpaper like rash); worse in folds of skin
b. rash first appears on trunk then spreads peripherally to cover whole body within hours or days
c. rash resolves with desquamation of sheets of skin (esp palms and soles) which occurs 1-2 weeks after onset of illness
4. complications: RF or AGN |
|
|
Term
Streptococcus pyogenes
-infections that it causes |
|
Definition
1.classic impetigo
2. cellulitis / erysipelas
3. scarlet fever |
|
|
Term
|
Definition
1. gram positive cocci
2. gram negative rods
3. atypical mycobacteria
4. fungal agents |
|
|
Term
Cellulitis
-gram positive cocci agents |
|
Definition
MUST ALWAYS INCLUDE THESE AGENTS IN COVERAGE FOR CELLULITIS (target therapy at GP and GN anaerobes)
-s. pyogenes
-s.aureus
-s.pneumoniae |
|
|
Term
Cellulitis
-Gram Negative Rods |
|
Definition
BOTH facultative and obligate anaerobes
-MUST ALWAYS INCLUDE THESE AGENTS IN COVERAGE FOR CELLULITIS |
|
|
Term
Cellulitis
- atypical mycobateria |
|
Definition
Cause Necrotizing skin lesions
1. mycobacterium ulcerans -buruli ulcer
2. mycobacterium marinum
3. M.fortuitum, M. abscessus, M. chelonae (fortuitum complex) |
|
|
Term
|
Definition
Agents of systemic mycoses
1. blastomycosis
2. histoplasmosis
3. coccidioidomycosis
4. mucormycosis (aka zygomycosis) - group of ubiquitous fungi |
|
|
Term
|
Definition
things that can cause cellulitis
A. exposure to water (fresh or seawater)
B. animal bite/scratch
C. infections in areas around oral cavity or contaminated with oral secretions |
|
|
Term
Cellulitis
-epidemiology
-exposure to water |
|
Definition
predisposes to cellulitis with bacteremia as common complication
Caused by:
1. facultative, anaerobic, GN rods
2. atypical mycobacteria
a. mycobacterium marinum - fish tanks
b. m. fortuitum, M. abscessus, M. chelonae - pedicures
3. vibrio vulnificus (saltwater) |
|
|
Term
Cellulitis
-epidemiology
-animal bites |
|
Definition
mostly cats and dogs
bite/scratch predisposes to cellulitis caused by:
1. gram positive cocci
2. diphtheroids/corynebacteria
3. facultative anaerobic, GN rods
a. pasteurella pestis and multicoida
b. capnocytophaga canimorsus
--TARGET THERAPY HERE
4. anaerobic GN rods |
|
|
Term
Cellulitis
-epidemiology
-infections by oral cavity |
|
Definition
infections in areas adjacent to oral cavity (head and neck soft tissues, sinuses, RT)
or
infections contaminated by oral secretions (bite and clenched hand; aka fist wounds)
predisposes to cellulitis caused by:
Eikenella Corrodens
-facultative anaerobic, GN rod
-Normal Flora of mucosal surfaces (oral, GI, UR tracts) |
|
|
Term
Cellulitis
-initial portal of entry |
|
Definition
1. lesions such as:
interdigital tinea pedis
skin fissures
viral lesions
psoriasis
eczema
2. cuts
surgical incision
traumatic injury
punctures/IV
3. animal/insect bites
4. diabetes --diabetes foot ulcer
5. abrasion
6. burns |
|
|
Term
Cellulitis
-surgical wounds |
|
Definition
occur 0.1%
suture line gets reddened, tender |
|
|
Term
Cellulitis
-clinical manifestations; systemic signs |
|
Definition
infection of skin (deep dermis) and subcutaneous fat
manifestations develop within few days after inciting event
systemic signs:
fever
chills malaise
leukocytosis
--like carbuncles of s.aureus |
|
|
Term
Cellulitis
--local infection signs |
|
Definition
1. inflammation - pain, erythema, edema, warmth; never sharply demarcated (sharply demarcated is syphillis)
2. suppurative, local abscess can develop and small patches of overlaying skin may undergo necrosis
3. subcutaneous tissues can be palpated
4. lymphangitis or lymphadenitis can occur |
|
|
Term
|
Definition
IV ANTIBIOTICS MUST BE DONE
symptoms resolve 1-2 days |
|
|
Term
Bacillus Anthracis
-etiology |
|
Definition
Gram Positive
Box car shaped
rod
aerobic
ENCAPSULATED - polyglutamic acid
facultative intracellular pathogen |
|
|
Term
Bacillus Antracis
-epidemiology |
|
Definition
enzootic disease
-herbivores (sheep, goats, cattle, horses)
-excreted in feces, urine, saliva
-spores survive for years in soil
cutaneous anthrax requires DIRECT CONTACT with either: soil bearing spores,
infected animals, or
animal products bearing spores
worldwide distribution, also in US |
|
|
Term
Bacillus Antracis
-cutaneous anthrax |
|
Definition
-accounts for 95% of human cases
-spores or cells enter skin through small abrasions and multiply locally
-small, PAINLESS, papule develops, progresses to a vesicle filled with fluid, then ruptures, producing an eschar (painless ringed lesion with edematous ridge - malignant pustule)
-death is due to both toxemia and bacteremia |
|
|
Term
Bacillus Antracis
-differential diagnosis |
|
Definition
1.ecthyma (pyoderma) gangrenosum
-caused by p. aeruginosa
2. ulceroglandular tularemia
-caused by rancisella tularensis
3. NOT ecthyma contagiosum (Orf pox) or ecthyma (GAS) |
|
|
Term
Bacillus Antracis
-control |
|
Definition
-bury infected animals or bury
-subunit purified vaccine for humans
-live attenuated vaccine for livestock |
|
|
Term
Erysipelas - St. Anthony's Fire
-etiology |
|
Definition
| group a strep; strep pyogenes |
|
|
Term
|
Definition
-young and elderly
-preceded by URT or skin infection caused by GAS
-recurrent erysipelas due to lymphatic obstructions |
|
|
Term
|
Definition
-distinctive form of rapidly progressing (hours) superficial cellulitis with involvement of cutaneous lymphatics
-occurs on extremities and face |
|
|
Term
|
Definition
same as cellulitis except
lesions differ!
-illness begins with systemic signs and burning or itching at site of infection than rapidly spreading (mins to hours) erythema forms that is bright RED and INDURATED - peau d'orange
sharply demarcated! |
|
|
Term
|
Definition
vaccine is cow origin
antiviral drug may work
vaccine is open bottle w/cap; refrigerate
--use "tyne?", not needle; dab and break skin to get into body
- can be catastrophic with eczema so be careful
in smallpox, lesions are same over time (unlike chicken pox) |
|
|
Term
Varicella Zoster Virus
-synonyms |
|
Definition
chickenpox and zoster
part of herpes virus group HHV3 |
|
|
Term
Varicella Virus- chickenpox
-epidemiology |
|
Definition
-1-6 yr old
-winter-spring
-portal of entry: URT via direct contact with respiratory secretions or with lesions
-highly contagious; all exposed manifest with disease
-mild, self limiting childhood disease, but DOES CAUSE SIGNIFICANT morbidity and mortality in children, ESPECIALLY in adults
-humans are sole host and reservoir |
|
|
Term
Varicella Virus - chickenpox
-clinical manifestations |
|
Definition
-virus is in lesions of both varicella and zoster
-lesions are contagious
-incubation is long 2 weeks
-no prodrome
-actue onset of fever, flulike symptoms, pruritic exanthematous maculopapular lesions that become vesicles, then pustular, then crust, then scab
-lesions develop first on head then spread to trunk and extremities
-appear in successive crops for 3-6 days; every time with fever
-different stages of lesions all at once
-lesions can scar if they become secondarily infected by GAS s.aureus - most common cause for hospitalization in kids
-in adults, morbidity and mortality is directly due to VZV's cytolytic activity - causes interstitial pneumonia, hepatitis, meningoencephalitis, and thrombocytopenia
-virus becomes latent in nerves after primary infection; no way to remove it or cure it
-zoster patient is infectious and a susceptible person infected with VZV from a zoster lesion manifests with varicless (chicken pox), NOT zoster (shingles |
|
|
Term
|
Definition
Belt or Girdle
aka Shingles
Varicella Zoster Virus |
|
|
Term
Herpes Zoster (HHV3)
-epidemiology |
|
Definition
incidence is rising
-adults or immunocompromised children
-cancer patients
-no predisposing factor - stress or sunlight
-no seasonality |
|
|
Term
Herpes Zoster
-pathogenesis |
|
Definition
| recrudescence of VZV - reactivated latent VZV infection due to waning cellular immunity |
|
|
Term
Herpes Zoster
-manifestations |
|
Definition
-tingling - severe pain in innervated areas precedes
-asymmetrical maculopapular or vesicular-crusting rash following a single thoracic dermatome (stops at midline) or cranial nerve distribution while tingling - severe pain continues
- systemic signs of fever, malaise, headache |
|
|
Term
Herpes Zoster
-complications |
|
Definition
1. ophthalmic (ocular) zoster, herpes zoster oticus (ear) - refer to specialist
2. postherpetic neuralgia (severe burning, lancinating pain) can persist for months-years; can be debilitating, accompanied by allodynia (pain from non-noxious stimuli)
3. acute peripheral facial palsy, idiopathic peripheral facial palsy (bell's palsy) (either caused by VZV-no rash- or HSV reactivation) |
|
|
Term
|
Definition
for symptoms in immunocompetent children with varicella:
-lotion or antihistamines for pruritis
-aspirin is contraindicated because of association with Reye's syndrome
-post exposure prophylaxis VZIG; for adolescents, adults, leukemia patient, or pregnant women with no immunity |
|
|
Term
|
Definition
1. varicella: oral acyclovir administered within 9 days post infection or within 24 hours of onset of varicella symptoms can prevent/minimize signs and symptoms
--only recommended for persons at high risk for severe disease
2. zoster:
acyclovir, famciclovir, valacyclovir
administer within 72 hrs of rash onset to reduce pain |
|
|
Term
|
Definition
live attenuated vaccine for kids 13m-12yr
same schedule as MMR vaccine
HIGHLY EFFICACIOUS with 1 dose in children, 2 in adolescents and adults
-children immunized with varivax will have a decline in immunity to both vaccine strain and wild-type VZV. THEY CAN MANIFEST WITH VARICELLA DUE TO VZV OR ZOSTER DUE TO VARIVAX STRAIN OR VZVA.
HOWEVER, in all cases, symptoms are MILD and immunity to both are boosted
recommendations for varivax administration:
3-5 days post exposure to prevent disease in immunocompetent persons or persons with HUMORAl deficiency
contraindications:
pregnant women
immunocompromised children
zostavax - prevent shingles in 60yr or older |
|
|
Term
Human Parvovirus B19
-epidemiology |
|
Definition
PVB-19
Erythema Infectiosum, fifth disease
-winter, spring
-enters URT via respiratory secretions
-common in childhood, half of adults are immune - possess anti HPV B19 igG
-erythema infectiosum primarily occurs in children 4-15 yrs; arthropathy is rare
-arthropathy in adults, esp women |
|
|
Term
Human Parvovirus B19
-manifestations |
|
Definition
3 presentations based on severity of symptoms:
1. erythema infectiosum (5th disease)
2. Arthropathy
3. Aplastic crisis
4. in pregnant women, mom not affected but unborn child can die and have CHF |
|
|
Term
Human Parvovirus B19
-erythema infectiosum (fifth disease) |
|
Definition
prodomal illness with mild symptoms that last 2-3 days
-fever
-headache
-malaise
-respiratory symptoms
-sometimes GI symptoms; nausea, vomiting, abdominal pain
fever quickly drops then:
RASH. erythematous maculopapular lacy appearance rash; fever usually gone
-initially on face (slapped cheek appearance)
-may also involve limbs; maybe pruritic
-rash resolves in 1-2 weeks
-lesions are not contagioius |
|
|
Term
Human Parvovirus B19
-arthropathy |
|
Definition
also include other rheumatoid manifestations, vasculitis
adults manifest with acute onset of flulike symptoms for 2-3 days then:
polyarthralgia and symmetric polyarthropathy
joints involved - hands, knees, wrists, ankles
-usually self limiting 2 weeks up to a month
-in adults, rash is less typical |
|
|
Term
Human Parvovirus B19
-aplastic crisis |
|
Definition
patient has aplastic crisis (severe anemia/reticulocytopenia) if they are infected with HPVB19 and suffer from:
chronic hemolytic anemia
sickle cell Dx
acquired anemia
chronic hemolysis
-agent replicates in bone marrow where rbc are made; major loss of rbc
--not age dependent like other two
patient has severe anemia symptoms for 7-10 days:
dyspnea
fatigue
malaise
confusion
maculopapular rash, polyarthropy may occur
anemia may be protracted in immunocompromised patients who are unable to control the infection - chronic bone marrow failure in the immunocompromised patient |
|
|
Term
Human Parvovirus B19
-treatment |
|
Definition
supportive only
-antipyretics, analgesics, nonsteroidal, anti inflammatory drugs
-transfusions for patients in aplastic crisis or fetus with hydrops fetalis (detected in utero) |
|
|
Term
Human Herpes Virus 6 and 7
-infections it causes |
|
Definition
Exanthem subitum
Roseola Infantum
Sixth Disease |
|
|
Term
Human Herpes Virus 6 and 7
-etiology |
|
Definition
herpes DNA virus
closely related to cytomegalovirus
acyclovir/ganciclovir resistant |
|
|
Term
Human Herpes Virus 6 and 7
-drug resistance |
|
Definition
1. acyclovir/famciclovir, and valacyclovir
2. ganciclovir sensitive, but less than CMV
3. foscarnet, valganciclovir sensitive |
|
|
Term
Human Herpes Virus 6 and 7
-epidemiology |
|
Definition
-in immunosuppressed persons, reactivation or re-infection of HH7 or HH6 can occur, causing severe disease
-can be co-infection with CMV |
|
|
Term
Human Herpes Virus 6
-epidemiology |
|
Definition
-shed in saliva of adults; primary mode of transmission
-primary infection is first 3 yrs of life; adults are seropositive for HH6
-most infants are asymptomatic
-primary infections in infants 3m-3yr MAY lead to exanthem subitum
-primary HHV6 in 6-12m is usually responsible for first febrile illness
-primary HH6 infection in 6-12 m accounts for MANY visits to ER and MANY first time febrile seizures in kids under 2 yr
-forms active, life long infections in salivary glands and latent persistent infections of PBMC (wbc) |
|
|
Term
Human Herpes Virus 7
-epidemiology |
|
Definition
-secreted in saliva
-80% of kids 1-4 yr are seropositive
-agent of pityriasis rosea? |
|
|
Term
Human Herpes Virus 8
-epidemiology |
|
Definition
-not in US so much, but high elsewhere
-secreted in saliva, maybe chronically or just during infection
-latent in B cells
-associated with all forms of karposi sarcoma including:
classical KS - mediterranean
endemic KS - africa
iatrogenic KS-organ transplant pt
epidemic KS-AIDS pt |
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Term
Human Herpes Virus 6 and 7
-manifestations |
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Definition
-prodrome high fever 2-5 days
-fever goes away and fine, macular, blanching rash appears that lasts 48 hr
-virus NOT in lesions/rash
-kids go to ER with high fever, no obvious cause; major cause for spinal taps (remember fever, lethargy, irritability = aseptic meningitis)
-other signs:fever, no rash or rash, no fever, or both |
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Term
Human Herpes Virus 6 and 7
-complications |
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Definition
children: otitis media
adults: mononucleosis-like syndrome
aseptic meningitis
seizures
GI distress, hepatitis
in utero infection
for immunosuppressed, many organ systems can be involved |
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Term
|
Definition
Also called rubeoloa or hard measles
ONE serotype
enveloped ssRNA virus; cause syncytia formation |
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Term
|
Definition
-next to be eliminated
-children less than 5
-winter, spring
-enters URT; passed via respiratory secretions TWO DAYS BEFORE PRODROME or 5 days after onset of rash
-highly contagious; nearly all infected get it; primary attack rate is high
-infection without disease = lots and lots of spread
complications - diarrhea or pneumonia are leading causes of death for kids 1-5yr in developing countries due to malnutrition, poor medical care |
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Term
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Definition
virus produces exanthem AND enanthem
-prodrome occurs 10-12d post infection and 3-4d before rash
-coryza (cold like symptoms)
-cough
-conjunctivitis----THREE C'S
-fever
-lymphadenopathy
-koplik's spots on buccal mucosa; looks like grains of salt
-pharyngitis
-pathognomonic |
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Term
Measles
-manifestations part 2 |
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Definition
prodromal manifestations continue and then exanthem appears:
symmetrical, non pruritic, red maculopapular rash on face and scalp line; descends to lower extremities
-rash is strong on head then thins and becomes discrete
-rash appears 3 days after onset of prodrome
-viral antigen IS IN lesion |
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Term
|
Definition
| 24-48 hr later, as Ab titers rise, disseminated viremia halts and symptoms abort; rash clears in order it appears |
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Term
|
Definition
severe otitis media is most common
-pneumonia (leading cause of death bc of measles)
-diarrhea
-CNS-encephalitis
-agent can cross placenta and infect unborn child |
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Term
|
Definition
supportive
administer vitamin A
administer gamma globulin for immunocompromised or prevaccines within 6 days of exposure |
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Term
|
Definition
trivalent measles, mumps, rubella
live attenuated
two doses-15-18m then 4-6yr or 11-13y
three doses: 15-18m then 4-6 yr, then 11-13yr
NOT RECOMMENDED FOR PREGNANT WOMEN |
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Term
|
Definition
German Measles
Soft-mild-Measles
3 Day Measles
Little Red
-ssRNA virus |
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Term
|
Definition
older children young adults
-winter spring
-enters URT; passed via respiratory secretions during prodrome or 2 weeks after onset of rash
-asymptomatic infections occur, not as infectious as chicken pox or measles
-due to vaccination, incidence of rubella and congenital disease is rare in US |
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Term
|
Definition
prodrome symptoms are minimal or absent (viral replicates in pharynx for up to 2 weeks)
-conjunctivitis
-coryza
-lymph node enlargement
-pharyngitis
-malaise
-low grade fever
-discrete rash 3-5days; face then extremities
-arthralgia occurs; more in women
-all symptoms occur at same time; not prodrome like the other one |
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Term
|
Definition
Congenital Rubella Syndrome
-no risk to mother
-mom infects placenta
-timing is crucial; first trimester is most critical
-organogenesis is disrupted
-chronic and persistent infection of child is likely
-isolation of neonate because virus sheds for months in urine and respiratory secretions
-CRS leads to cardiac, vision, hearing defects, and speech/learning deficits
-lower the birth weight, more chance of severe complications |
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Term
|
Definition
can be hard because many ECHO viruses mimic manifestations
lab diagnosis for newborn - STORCH
-measure specific igM Ab in cord blood
-tests for immune status via LCAT at prenatal exam, not via TORCH |
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Term
|
Definition
NOT RECOMMENDED to treat with IG!!
-postexposure prophylaxis does not prevent rubella infection or viremia
-if susceptible pregnant woman is exposed and will not terminate it, MAYBE IG will reduce risk
--most physicians do therapeutic abortion if CRS is likely! |
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Term
|
Definition
live attenuated
trivalent vaccine for measles, mumps, rubella
for CRS: vaccinate non-pregnant women; inform pregnant women to stay away from rashes |
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Term
Fungal infections
-superficial mycoses |
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Definition
infections confined to outermost layers of skin - stratum corneum
cause little tissue reaction and only mild symptoms |
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Term
Fungal infections
-cutaneous mycoses |
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Definition
dermatomycoses
infections involve entire cutis (epidermis, maybe dermis)
prefer keratin containing tissue
-ie candida albicans |
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Term
Fungal infections
-subcutaneous mycoses |
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Definition
| invade through superficial sources, cause chronic ulcerated lesions with regional lymph node involvement, numerous genera, sporotrichosis |
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Term
Fungal infections
-systemic mycoses |
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Definition
most serious infections
enter respiratory tract or break in skin |
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Term
Fungal infections
-opportunisitc infections |
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Definition
| normal flora and in environment; usually produce lesions on mucus membranes, skin, and RT of compromised host |
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Term
Superficial Mycosis
-agents that cause it |
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Definition
infections confined to outermost layer of skin (stratum corneum)
-malassezia furfur
-piedra hortai
-trichosporon beigelii
-exophiala werneckii |
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Term
Pityriasis Versicolor
-agents that cause it |
|
Definition
-superficial
AKA tinea versicolor
caused by malassezia furfur
aka pityrosporum orbiculare |
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Term
Pityriasis Versicolor
-malassezia furfur
-epidemiology |
|
Definition
young adults
predisposing factors: malnutrition, hyperridosis, antibiotics |
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Term
Pityriasis Versicolor
-malassezia furfur
-pathogenesis |
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Definition
| chronic, mild, asymptomatic superficial infection when agent transitions from yeast form (NF) to hyphal form |
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Term
Pityriasis Versicolor
-malassezia furfur
-manifestations |
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Definition
brown colored or hypopigmented patches
no itching
non inflammatory
lesions on chest, stomach, back; cosmetically unappealing
causes pityrosporum folliculitis - papules pustules on trunk/upper arms that resemble acne
causes dandruff - seborrheic dermatitis |
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Term
Pityriasis Versicolor
-malassezia furfur
-therapy |
|
Definition
antifungal topicals
-ketoconazole
-ciclopirox
for acute occurrence, use topical anti-inflammatory or steroid
OTC:
selenium sulfide - selson blue
zinc pyritihon - head and shoulders
salicylic acid
use shampoo daily for 2wk, then maintain by using 2x per week
chronic disease; relapses will happen |
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Term
Black piedra - piedra hortai
White piedra - trichosporon beigelii
-epidemiology |
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Definition
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Term
Black piedra - piedra hortai
White piedra - trichosporon beigelii
-pathogenesis |
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Definition
| form ectothrix (sheath of arthrospores only on external hair shaft, most often on face; no involvement of epidermis or follicular hair portion |
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Term
Black piedra - piedra hortai
White piedra - trichosporon beigelii
-manifestations |
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Definition
no symptoms
white piedra - resembles lice; results in unneeded toxic pesticide treatments
black piedra - resembles ectothrix of microsporum
NOTE: pediculosis captis is lice, lays eggs on outside of hair shaft near scalp |
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Term
Black piedra - piedra hortai
White piedra - trichosporon beigelii
-treatment |
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Definition
| cut or shave off infected hair |
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Term
Tinea nigrans (keratomycosis nigrans)
hortaea (exophiala) werneckii
-epidemiology |
|
Definition
-superficial
tropical regions
under 18 yr
female
direct contact or autoinoculation |
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Term
Tinea nigrans (keratomycosis nigrans)
hortaea (exophiala) werneckii
-manifestations |
|
Definition
discrete brown macule on palm or fingers
no inflammation, induration, or scaling
differentiate between tinea nigrand and malignant melanoma and junctional nevus (birthmark) |
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Term
Tinea nigrans (keratomycosis nigrans)
hortaea (exophiala) werneckii
-treatment |
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Definition
| topical keratinolytic agents |
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Term
Cutaneous -Dermatophytoses
-ringworm infections
-etiology |
|
Definition
infections involve enture cutis
caused by 3 fungal agents
-know which fungi infect which tissues to have best therapy
epidermophyton - skin and nails
microsporum - hair and skin
tricophyton - hair, skin, nails (t.rubrum is most common and most difficult to treat) |
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Term
Cutaneous -Dermatophytoses
-ringworm infections
-epidemiology |
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Definition
worldwide
same risk factors as pityriasis versicolor
acquired from: other humans, soil, or animals |
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Term
Cutaneous -Dermatophytoses
-ringworm infections
-pathogenesis |
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Definition
| keratinolytic fungi have strong affinity for keratinized tissue of nails, hair, skin |
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Term
Cutaneous -Dermatophytoses
-ringworm infections
-manifestations |
|
Definition
-cutaneous
-ringworm
tinea capitis: ringworm of scalp and hair
t.pedis: athletes foot
t.cruris: jock itch
t.unguium: onychomycosis -nail infection
t.manuum: hand
t.barbae: barbers itch - beard
t.corporis: smooth skin; ie trunk |
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Term
Cutaneous -Dermatophytoses
-ringworm infections
-t. pedis, cruris, manuum, barbae |
|
Definition
etiology is big three:
t.mentagrophytes
t.rubrum
e.floccosum
manifests: scales, vesicles, or ulcers |
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Term
Cutaneous -Dermatophytoses
-ringworm infections
-t.unguium |
|
Definition
onychomycosis
etiology: big three predominate but ANY trichophyton species can be involved
manifests: leukonychia mycotica; nails lose luster, opaque, brittle, have crumbling consistency |
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Term
Cutaneous -Dermatophytoses
-ringworm infections
-t.capitis |
|
Definition
etiology:
microsporum audouinii
m. canis
trichophyton mentagrophytes
t.rubrum
microsporum: ectothrix; spores produced OUTSIDE hair shaft; fluoresces; infected hair becomes dull, breaks off 3mm above scalp
trichophyton: endothrix; spores produced inside hair shaft; breaks at scalp "blackdot" |
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Term
Cutaneous -Dermatophytoses
-ringworm infections
-treatment |
|
Definition
depends on area, occupation, age, cost, severity
-best way to treat is orally but requires blood work and monitoring; lot of agents available |
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Term
Cutaneous -Dermatophytoses
-ringworm infections
-onychomycosis |
|
Definition
progressive, recurring superficial fungal infection that begins in nail bed and progresses to nail plate
leukonychia: whitening of nail plate |
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Term
Cutaneous -Dermatomycosis
-cutaneous candidosis (candida albicans)
-etiology |
|
Definition
any fungal infection of skin, nails or maybe hair, caused by fungi other than dermatophyte
c.albicans has 3 INVASIVE forms:
yeast
pseudohyphae
hyphae |
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Term
Cutaneous -Dermatomycosis
-cutaneous candidosis (candida albicans)
-epidemiology |
|
Definition
risk factors:
diabetes
obesity
pregnancy
AIDS
broad-spectrum ab |
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Term
Cutaneous -Dermatomycosis
-cutaneous candidosis (candida albicans)
-manifestations |
|
Definition
intertriginous candidosis: "weeping" or "scaled skin" lesions
paronychial/onychomycotic candidosis: chronic infection; painful reddened swelling up to paronychial edge; nail is hardened, thickend; grooved |
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Term
Cutaneous -Dermatomycosis
-cutaneous candidosis (candida albicans)
-therapy |
|
Definition
for cutaneou candidosis:
crystal violet
topical antifuncal agents
for candidal paronychia or onychomycosis with ointment and systemicallY:
nystatin
amphotericin B
ketoconazole |
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|
Term
Subcutaneous Mycoses
-sporotrichosis (sprothrix schenckii)
-etiology |
|
Definition
sporothrix schenckii
-thermally dimorphic fungus |
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Term
Cutaneous -Dermatomycosis
-cutaneous candidosis (candida albicans)
-epidemiology |
|
Definition
worldwide
contact with plants (thorns, splinters)
gardeners and lumber worker at risk |
|
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Term
Cutaneous -Dermatomycosis
-cutaneous candidosis (candida albicans)
-manifestations |
|
Definition
painless chronic infection
nodular lesions of subcutaneous or cutaneous tissues and adjacent lymphatics |
|
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Term
Cutaneous -Dermatomycosis
-cutaneous candidosis (candida albicans)
-therapy |
|
Definition
apply heat to affected extremity 3-4 times a day
give AIDS pt itraconazole or amphotericin B |
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