C272 Principles of Antiviral Therapy
C273 Measles
C274 Rubella
C275 Mumps
C276 Polioviruses
Almost eradicated worldwide, but still endemic in Pakistan and Afghanistan.
Acute LMN weakness that begins asymmetrically in lower extremities and ascends over hours to days.
CSF analysis: lymphocytic pleocytosis
C277 Nonpolio Enteroviruses
Coxsackie virus
Herpangina
- ???? ??, ??, ??, ???, ????
- ??: ?? ?? ???? 1~2mm? ?? -> 3~4mm? ??, ???? ??
- ??? ?? ?? ??? ?? ??? ??
Hand, foot and mouth disease
- ????
- ?? ???, ??, ???, ??? ????, ???.
- ?, ?? ??
- ?>?, ??/?? > ???/???.
- 3~7mm ??? ???.
C278 Parvoviruses
C279 Herpes Simplex Virus
Etiology
Epidemiology
Pathogenesis
Vertical transmission (intrauterine, perinatal, postnatal)
Clinical manifestations
Acute oropharyngeal infections
Mucocutaneous vesicles
Herpes labialis
Cutaneous infections
- Herpes gladiatorum
- In wrestling
- Scrum pox
- In rugby
- Herpes whitlow
- Finger or toe
- Eczema herpeticum
- In a child with underlying eczema
Genital herpes
Ocular infections
Central nervous system infections
- Typically presents sin the 2nd or 3rd week of life
- Seizures, fever, lethargy
- Temporal lobe hemorrhage/edema
Infections in immunocompromised persons
Perinatal infections
Diagnosis
Viral surface cultures
HSV PCR (blood, CSF)
Lab findings
Treatment
Prognosis
Prevention
C280 Varicella-Zoster Virus
Neonatal varicella-zoster infection
Fever, vesicular eruption (chickenpox), systemic involvement (eg, pneumonia, hepatitis, meningoencephalitis)
????: ?? ? 24-48??? ?? ?? ? 3-7? (?? ??? ??? ? ???)
??? ?, ?? ???? ???? ??? ??? ??? ???? ??? ?? (centrifugal)
?? ???? 24?? ? acyclovir ??.
Vaccine
- Varicella-like rashes
- Causes
- Attenuated vaccine virus can replicate after immunization and cause mild infection in approximately 3% of immunized children
- Wild-type VZV can cause classic varicella if acquired before the child’s immunization results in protective antibody.
- Very mild and is not a contraindication to future VZV vaccine administration.
- Avoid contact with high-risk individuals who are susceptible to varicella (eg, pregnant women, people receiving chemotherapy) until the rash has completely crusted over.
- Causes
| Vaccine strain | Wilde type |
| Incubation period: 1-3 weeks <10 lesions Maculopapular &/or vesicular Mildly contagious | Incubation period: 1-3 weeks >100 lesions Vesicular in successive crops Highly contagious |
Varicella post-exposure prophylaxis
- Varicella-zoster immune globulin (VZIG)
- Must be given within 10 days (ideally, within 4 days)
- Neonate – if maternal infection developed 5 days before or 2 days after delivery.
- Premature(>28w) – mother with a no evidence of immunity to VZV
- Premature(<28w) – ALL
- Infants (age <1 year) – do not require as they are at lower risk than neonates or older children.
- Pregnant women
- Immunocompromised patients
- VZV vaccine (live-virus)
- Contraindicated for patient age <1 year
C281 Epstein-Barr Virus
C282 Cytomegalovirus
The Virus and Its Interaction With the Host
Epidemiology
Number 1 cause of mental retardation
Number 1 cause of chorioretinitis
Clinical Manifestations
Normal host
Immunocompromised host
Congenital infection
| Prematurity (<37 wk) | 24 |
| Jaundice (direct bilirubin >2 mg/dL) | 42 |
| Petechiae | 54 |
| Hepatosplenomegaly | 19 |
| Purpura | 3 |
| Microcephaly | 35 |
| IUGR | 28 |
| 1 clinical finding | 41 |
| 2 clinical findings | 59 |
| LABORATORY FINDINGS | |
| Elevated ALT (>80 IU/mL) | 71 |
| Thrombocytopenia (<100,000 k/mm3 ) | 43 |
| Direct hyperbilirubinemia (>2 mg/dL) | 54 |
| Head CT abnormalities | 42 |
- Ultrasound findings
- Microcephaly, FGR, hydrops fetalis
- Periventricular calcifications, ventriculomegaly
- Neonatal features
- Petechiae
- Hepatosplenomegally
- Chorioretinitis
- Microcephaly
- Long-term sequelae
- Sensorineuronal hearing loss
- Seizures
- Developmental delay
Diagnosis
- Maternal infection
- Serology
- Urine culture
- Fetal infection
- Amniocentesis
- PCR of amniotic fluid
Treatment
- Maternal antiviral therapy is not indicated (not been proven to prevent fetal infection)
- Management is generally expectant
- Pregnancy termination may be considered for fetuses with severe congenital CMV infection identified early during pregnancy.
Prevention
TORCHES ? ???? ???? ??.
Passive immunoprophylaxis
Active immunoprophylaxis
Counseling
C283 Roseola (Human Herpesviruses 6 and 7)
C284 Human Herpesvirus 8
C285 Influenza Viruses
C286 Parainfluenza Viruses
C287 Respiratory Syncytial Virus
Risk factors
- Comorbidities: preterm birth, congenital heart disease, immunocompromised
C288 Human Metapneumovirus
C289 Adenoviruses
C290 Rhinoviruses
C291 Coronaviruses
C292 Rotaviruses, Caliciviruses, and Astroviruses
C293 Human Papillomaviruses
C294 Arboviral Infections
C295 Dengue Fever, Dengue Hemorrhagic Fever, and Severe Dengue
C296 Yellow Fever
C297 Ebola and Other Viral Hemorrhagic Fevers
C298 Lymphocytic Choriomeningitis Virus
C299 Hantavirus Pulmonary Syndrome
C300 Rabies
C301 Polyomaviruses
C302 Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome
Etiology
High maternal viral load is the most important risk factor in transmission.
Clinical manifestations
??? ?? ??? ??, 2? ?? ??
CD4 ??? ???. ???? ??? ??, CNS ??? ? ?
Diagnosis
18??> : IgG? ???? ??? ?? ? ELISA? ?? ??! ? PCR or ?? 2?
18??< : ??? ?? ELISA 2? ? western blot?? ??
Prevention
?? 14??? Anti retroviral Tx. ???? ??
??? : BCG, polio? ?? / ??, MMR? ???? ??