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viral infections


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herpes simplex virus overview
ds DNA virus; 2 forms HSV-1 and HSV-2; most common cause of corneal opacification
when does herpes simplex virus primary infection occur
between 6 months and 5 years old
percentage of adults who have and how many manifest herpes simplex virus
80% have antibodies, but only 20-25% manifest disease
what happens after first infection of herpes infection
first exposure/infection infects peripheral end organ (ex. eyelid) then the virus travels to ganglia where it may become latent (trigeminal and crevical)
relapses of herpes simplex virus in immunocompromised people
relapses from activation of latent virus are common with immunocompromised (steroids, UV exposure, stress, fatigue, irradiation, fever, etc.); relapses occur in 25-50% of patients
does basal cell carcinoma metastasize
not usually, however it may be highly invasive to surrounding tissues
treatment for basal cell carcinoma
photodocument and excise
what are the two forms of nevus
dermal (most common) and junctional (at the dermal/epithelial junction)
dermal nevi
a dermal nevi can be flat or raised and rarely progresses to malignancy
junctional nevi
are usually flat and may progress to malignant melanoma
what is the visual differentiation between dermal and junctional nevi
this is difficult so refer out any suspicious lesions. Borders of both types of nevi are distinct and pigmentation varies from lesion to lesion.
will an nevi grow
nevi may grow with advancing age in the absence of malignancy
etiology of malignant melanoma
arise from pre-existing nevi or de nevo
what does malignant melanoma de novo mean
anew; when you first see it is already malignant
are de novo malignant melanoma common
no de novo malignant melanoma are not common but most are deadly.
s/s of malignant melanoma
pigmentation variability within the lesion should cause suspicion of malignancy
who gets kaposi's sarcoma usually
Aids patients; at least 1/3 of aids patients
s/s of kaposi's sarcoma
pink to dark purple nodules or plaques
treatment for kaposi's sarcoma
surgery, radiation, or chemotherapy
what are the rules of thumb for malignancies
Border irregularity
Color irregularity
Diameter greater than 6mm
Exterior (note texture, hydration, etc. of tissue compared to surrounding tissue)
Feeder vessesl
gut feeling (refer out)
Height (same as elevation)
Viral infections that cause conjunctivitis
simple adenoviral conjunctivitis; Epidemic Keratoconjunctivitis; pharyngoconjunctival Fever; Acute Hemorrhagic Follicular Conjunctivitis; Molluscum contagiosum
causes of follicular conjunctivitis
Newcastle disease; Moraxella; Parinaud's Oculoglandular Conjunctivitis; Axenfeld's Conjunctivitis; Measles Mumps Rubella; Chronic folliculosis
etiology of simple adenoviral conjuctivitis
any number of serotypes of adenovirus;
is adenoviral conjunctivitis severe
it has a spectrum of severity
adenoviral conjunctivitis is also known as
pink eye
s/s of adenoviral conjunctivitis
follicles in lower lid fornix; serous discharge; conjunctival chemosis; an acute onset of a pink eye(day or two); usually starts unilaterally and then rapidly becomes bilateral; swelling and erythema of eyelids; PAN may be present; often history of URTI
treatment for adenoviral conjunctivitis
this condition is self limiting usually so the treatment is usually supportive
what is the supportive treatment for adenoviral conjunctivitis
artifical tears, cool compresses, vasoconstrictors. Topical NSAIDS (voltaren) can be prescribed is patient complains of significant discomfort or pain
is adenoviral conjunctivitis contagious
yes it is highly contagious so encourage the patient to observe good hygiene to limit disease spread
whatis good hygiene for a patient with adenoviral conjunctivitis
wash hads thoroughly and frequently, do not share toweling or bedding with anyone else; use disposable paper towels to dry your face and hands; avoid touching your eyes; do not re-use kleenex or handkerchiefs; If you use eye makeup discard it and buy new cosmetics after infection is cleared up; if you wear contact lenses discontinue wearing them until the infection clears up
Epidemic KeratoConjunctivitis etiology
adenoviral 8,19,37 and others
what is the difference between epidemic keratoconjunctivitis and adenoviral conjunctivitis
epidemic keratoconjunctivitis is a more serous variation of simiple adenoviral conjunctivitis. It is HIGHLY CONTAGIOUS
what is the rule of eight
epidemic keratoconjunctivitis follows the rule of 8; day 1-7 is incubation period; day 8 is when the patient first shows symptoms, day 16 is when the cornea develops infiltrates and patient is supposedly no longer contagious
why is epidemic keratoconjunctivitis named epidemic
because the disease tends to occur in large groups of patients at the same time. It may be spread from OD offices.
How long are the patients infected
2 weeks from inoculation
what is a major sign of EKC epidemic keratoconjunctivitis
SEI's subepithelial infiltrates; the appearance of these is associated with the passing of the infectious period; most SEI's disappear within 3-4 months
s/s epidemic keratoconjunctivitis
aute onset; usually one eye then both affected; pt is quite uncomfortable; follicles; petechial hemorrhages; chemosis; edema of caruncle; PAN; may have pseudomembranes (in moederate to severe cases); corneal involvement is usually a diffuse PEK that by day 16 form elevated epithelial lesions that still stain, often causing a FBS. SEI's then form which may reduce VA, sometimes dramatically.
treatment for epidemic keratoconjunctivitis
supportive treatment
what is supportive treatment for epidemic keratoconjunctivitis
artificial tears, cool compress, vasoconstriction with prophylactic antibiotic drop (because the cornea has disrupted areas); the pt should not return to work or school until the infectious process is over
what is the prophylactic antibiotic drop for epidemic keratoconjunctivitis
polytrim QID
should you use steroids for epidemic keratoconjunctivitis
It is discouraged because steroids are effective in intially eliminating the SEI's but they tend to rebound as soon as the steroid is discontinued
why would a dr. use stseroids
for highly symptomatic patients (pts who have pseudomembranes or whoes vision is reduced from the SEI's
If you use steroids how should you stop the pt from taking them
taper. The taper process may take 4 months or even longer
what is pharyngoconjunctival fever also known as
swimming poolconjunctivitis
s/s of pharyngoconjunctival fever
adenoviral infection presenting with conjunctival findings similar to simple adenoviral infection accompanied by fever, pharyngitis (sore throat)
what is the inicubation time for pharyngoconjunctival fever
1-2 days
is pharyngeal unilateral or bilateral
pharyngealconjunctivitis fever begins unilaterally and the fellow eye is usually involved in 2-5 days
is the cornea involved with pharyngealconjunctivitis fever
corneal involvement when present tends to be mild and transient
treatment for pharyngealconjunctivitis
self-limiting, supportive therapy is usually all that is necessary
causitive organisms of Acute Hemorrhagic Follicular Conjunctivitis
enterovirus, coxsackievirus
s/s of acute hemorragic follicular conjunctivitis
follicular conjunctivitis with prominent subconjunctival hemorrhages (eye looks bloody)
what is the incubatiion time for acute hemorragic follicular conjunctivitis
18-24 hours
is acute hemorragic follicular conjunctivitis unilateral or bilateral
bilateral onset
how long do the symptoms of acute hemorragic follicular conjunctivitis persist
3-5 days
involvemtent of acute follicular hemorragic conjunctivitis
no corneal involvement, no systemic symptoms
is acute hemorragic follicular conjunctivitis contagious
yes it is highly contagious
can there be bacterial causes of acute hemorragic follicular conjunctivitis
yes bacterial causes of acute hemorragic follicular conjunctivitis are possible but in these cases you would see mucopurulent discharge and papillary vs. follicular response
site of mollluscum contagiosum
eyelid margin and a secondary follicular conjunctivitis may be present
etiology of molluscum contagiosum
an immune reaction to the poxvirus particles which are shed into the eye
treatment of the molluscum contagiosum
If the lid lesion is excised the follicular reaction will resolve without further treatment. Treat the pts symptoms supportively during resolution with artificial tears, cool compresses and vasocontrictors as necessary
who are the most susceptible to molluscum contagiosum
immunocompromised patients so be sure to look for other manifestations arising from a compromised immune system (HIV and AIDS)
other causes of follicular conjunctivitis
newcastle disease; moraxella;parinaud's oculoglandular conjunctivitis; axenfeld's conjunctivitis; measels, mumps rubella, chronic folliculosis
etiology of newcastle disease
from paramyxovirus group
who gets newcastle disease
poultry workers
newcastle disease treatment
what is a bacterial cause of follicular conjunctivitis
who gets moraxella follicular conjunctivitis
young girls sharing eye makeup
moraxella follicular conjunctivitis treatment
topical erythromycin or tetracycline; ZINCFRIN (OTC topical decongestant which contains zinc) may be enough to eradicate
parinaud's oculoglandular conjunctivitis s/s
abrupt unilateral onset associated with ipsilateral lymphadenopathy, fever, and conjunctival ulcerations and granulomas with conjunctivitis
which systemic diseases are parinaud's oculoglandular conjunctivitis associated with
cat scratch disease, tularemia, TB, syphilis
parinaud's oculoglandular conjunctivitis treatment
do a systemic workup treating underlying disease as necessary; apply hot compresses to tender lymph nodes.; use gentamicin, bacitracin ung q2h to cover conjunctiva ; analgesics PRN
Axenfeld's conjunctivitis s/s
mild usually asymptomatic upper large palpebral follicles
treatment for axenfeld's conjunctivitis
no treatment necessary ; usually chronic
Measles, mumps, rubella conjunctivitis
these 3 conditions may be accompanied by a mild follicular conjunctivitis which appears similar to simple adenoviral infection
treatment for measles, mumps, rubella conjunctivitis
who gets chronic folliculosis
common in pre-adolescent children
s/s of chronic folliculosis
mardked inferior conjunctival follicular response which is asymptomatic
etiology of chronic folliculosis
chronic viral infection? Or lymphoid hyperplasia?
treatment for chronic folliculosis
no treatment usually resolves as child reaches adolescence
NaFl and kerato-conjunctivitis
all of the above viral conjunctivitis conditions may be accompanied by corneal staining as seen with NaFl. If this is the case it is generally referred to as kerato-conjunctivitis.
potential risk of kerato-conjunctivitis
bacterial infection
treatment for kerato-conjunctivitis
treat the cornea prophylactically in at risk cases with a broad spectrum antibiotic (polytrim) drop QID or an antibiotic ointment if the condition is unilateral or in infants
betadine solution
off label way to treat viral eye disease

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