viral infections
Terms
undefined, object
copy deck
- 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
- ABCD EE F G H
- A
- Asymmetry
- B
- Border irregularity
- C
- Color irregularity
- D
- Diameter greater than 6mm
- E
- Exterior (note texture, hydration, etc. of tissue compared to surrounding tissue)
- F
- Feeder vessesl
- G
- gut feeling (refer out)
- H
- 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
- supportive
- what is a bacterial cause of follicular conjunctivitis
- moraxella
- 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
- supportive
- 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