Infectious Disease Case 1

7/25/2019 Infectious Disease Case 1

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2/92

ROSEOLA INFANTUM

ROSEOLA INFANTUM


3/92

ETIOLOGY

HHV-6 and HHV-7

CD46 & CD4 T cells !"#$a"%

a"'e cells #n (#()


4/92

E*IDEMIOLOGY

Ea"l% #n l#+e

*ea, 6-./$)s

0 %1)2 7-.3 %131


5/92

*ATHOLOGY#nc5a#)n !e"#)d

Saliva, enters the

hostoral, nasal,conjunctival mucosa

HHV-6 & HHV-7attach to cellular

receptors

Viral replication,High level of viremia

develops in PB!s

Viruses evade immune

s"stem trudo#nregulation of H! $response

- %nhancement of ' (-cell activit"

- $nduction of proin)ammator" c"to*ineresponse


6/92

CLINICAL MANIFESTATIONS

H#'8 e$!1 971:-43c a(e1 )+ 9:c;9-/Da%s

R)se)la "as8 +)" .-9 da%s

Na'a%a$a s!)s

M#ld c)n


7/92

R)se)la "as8?


8/92

Na'a%a$a s!)s?


9/92

RU@EOLA

ETIOLOGY

Measles (#"5s Re$a#n (#ale +)" aleas

948" a "))$ e$!1


10/92

ROSEOLA INFANTUM


11/92

+B.(.$%S

T)al @C B:33L

L%$!8)c%e 9433L

Ne5")!8#l 4/33LT8")$)c%)!en#a

se"5$ "ansa$#nase

A%!#cal l%$!8)c%e


12/92

/$0S$S

H#'8 +e(e" 9 da%s

lanc8#n' $ac5l)!a!5la"

"as8 "5n,

!"esence )+ ac#(el%

"e!l#ca#n' (#"5s

0+/ S(/./

V#"al c5l5"e


13/92

V#"al DNA *CR

Re(e"se "ansc"#!ase *CR

Se")l)'#c $e8)ds

Asence )+ I'G an#)d% "e!l#ca#n' (#"5s


14/92

!P+$!($S

C)n(5ls#)ns

Se#5"e !ea, a'e .0-./ $)n8s

!)s-#cal !a"al%s#s93 - !")l)n'ed se#5"es

0: - +)cal se#5"es

9B - "e!eaed se#5"essa5s e!#le!#c5s


15/92

Ence!8al##s Ac5e d#sse$#naed de$%el#na#)n

Ac5e ce"eell##s

He!a##s M%)ca"d##s


16/92

De(el)!$enal d#sa#l##es

A5#s#c l#,e +ea5"es

*ALE !)s"ans!lan ac5e l#$#cence!8al##s


17/92

(.%(%(

inimum of 1 #ee*s


18/92

P.0S$S


19/92

P.%V%($


20/92

INFECTIOUS

MONONUCLEOSI

S


21/92

ETIOLOGY

%pstein 2 Barr Virus d)5le-s"anded DNA (#"5s

%-8e"!es(#"5s E@V . & 0

%BV 3 $)"e !"e(alen )"ld#de

Ind5ces '")8 "ans+)"$a#)n )+ @ cells %BV 4 5 frica


22/92

E*IDEMIOLOGY

(

)"al sec"e#)ns

6 $) a+e" ac5e #n+ec#)n

#ne"$#enl% +)" l#+e

seJ5al #ne"c)5"se

P.$. $%!($ during childhood

Us5all% as%$!)$a#c

M#ld )" #nd#s#n'5#s8ale

P.$. $%!($ in adolescents & adults

93 ) /3

!+SS$! (.$/8

+a#'5e2 !8a"%n'##s2 'ene"al#ed l%$!8aden)!a8%


23/92


24/92

CLINICAL MANIFESTATION

$!9B($ P%.$/ 93 ) /3 da%s ad)lescens

P./.+ P%.$/ . ) 0 ee,s


25/92

CLINICAL MANIFESTATION


26/92


27/92

CLINICALMANIFESTATION

>P$!$++$ .SH?

$)"#ll#+)"$2 (asc5l##c "as8

>0$(($- !.S($ S/.% > s%$$e"#c "as8 )n c8ee,s $5l#!le

e"%8e$a)5s !a!5les

c)alesce #n) !laK5es !e"s#s ./ ) /3 da%s

a!!ea"s l#,e a)!#c de"$a##s

a!!ea" )n eJ"e$##es & 5)c,s


28/92

DIAGNOSIS In+ec#)5s$)n)n5cle)s#s

!"es5$!#(e !"esence )+ %!#cal cl#n#cal s%$!)$s #8

a%!#cal l%$!8)c%)s#s c)n"$a)"%

se")l)'#c es#n' 8ee")!8#le As2 )" s!ec#c E@V As

c5l5"e "ans+)"$a#)n assa% "eK5#"es 4-6 ee,s

)")!8a"%n'eal )" 'en#al sec"e#)ns2!e"#!8e"al l))d .3-93 $L2 )" 5$)" #885$an 5$#l#cal c)"d l%$!8)c%es


29/92

La)"a)"% Tess

:3 )+ cases

le5,)c%)s#s )+.32333-032333

cellsL 09s a"el%$!8)c%es

a%!#call%$!8)c%es 03-

43 )+ 8e )aln5$e"


30/92

La)"a)"% Tess

Hee")!8#le An#)d% Tes "ans#en 8ee")!8#le an#)d#es *a5l-

@5nnell an#)d#es I'M As deeced % 8e *a5l-@5nnell-

Da(#ds)8n es +)" "ed s8ee! a''l5#na#)n

'"eae" sens##(#% a''l5#nae #n s8ee! "c

#n 7/ cases .s ee,

#n :3-:/ cases 0nd ee,


31/92

La)"a)"% Tess

S*ECIFIC E*STEIN-@ARR VIRUSANTI@ODIES es#n' #s 5se+5l ) c)n"$

ac5e E@V #n+ec#)n2 #n 8ee")!8#le-ne'a#(e cases

) c)n"$ !as #n+ec#)n

dee"$#ne s5sce!##l#% ) +55"e #n+ec#)n

An#'ens E@NA2 EA and VCA

Ac5e IM VCA I'G and I'M2 EA I'G


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33/92

T"ea$en

NO s!ec#c "ea$en Ma#nsa% Mana'e$en

rest2 enc)5"a'#n' adeK5ae =5#d andn5"##)n #na,e

s%$!)$a#c "ea$en #8 acea$#n)!8en)" NSAIDS +e(e"2 8")a d#sc)$+)"2$ala#se

S8)" c)5"ses )+ c)"#c)se")#ds 0 , !"edn#s)ne . $','da% $aJ#$5$ 63

$'da% a#"a% )s"5c#)n2 8")$)c%)!en#a #8

8e$)""8a'#n'2 a5)#$$5ne2 8e$)l%#cane$#a2 se#5"es2 and $en#n'##s


34/92

T"ea$en

An#(#"al 8e"a!% #s n)"ec)$$ended ac%cl)(#"2 #8 )" #8)5 c)"#c)se")#ds

dec"eases (#"al "e!l#ca#)n and)")!8a"%n'eal s8edd#n' d5"#n'

# d)es NOT "ed5ce 8e se(e"#% )" d5"a#)n)+ s%$!)$s )" ale" 8e e(en5al )5c)$e


35/92

C)$!l#ca#)ns

s5ca!s5la" s!len#c 8e$)""8a'e )"s!len#c "5!5"e )cc5"s d5"#n' 0nd ee,2 "ae )+ 31/

)+ cases #n ad5ls

Sell#n' )+ 8e )ns#ls and)")!8a"%n'eal l%$!8)#d #ss5e

ca5se a#"a% )s"5c#)n $an#+es d"))l#n'2 s"#d)"2 and #ne"+e"ence

#8 "ea8#n'


36/92

C)$!l#ca#)n

A#"a% c)$!")$#se #8 !")'"ess#(e s%$!)$s)cc5"s

/ )+ cases

c)$$)n #nd#ca#)n +)" 8)s!#al#a#)n

ele(a#n' 8e 8ead ed2 #n"a(en)5s8%d"a#)n2 85$#d#ed a#"2 and s%se$#cc)"#c)se")#ds

Res!#"a)"% d#s"ess #8 #nc#!#en )" ac5ala#"a% )ccl5s#)n $ana'ed %

)ns#ll)aden)#dec)$%

end)"ac8eal #n5a#)n +)" .0-04 8"


37/92

C)$!l#ca#)n

Headac8e /3 )+ cases

Headac8e #8 se(e"e ne5")l)'#c$an#+esa#)ns se#5"es and aaJ#a2 #n .-/ )+ cases

Al#ce-#n-)nde"land s%nd")$e$ea$)"!8)!s#a *e"ce!5al d#s)"#)ns )+ s#es2 s8a!es2

and s!a#al "ela#)ns8#!s


38/92

C)$!l#ca#)n

G5#lla#n-@a"" s%nd")$e )" Re%es%nd")$e

He$)l%#c ane$#a C))$s es "es5l and #8 c)ld

a''l5#n#ns s!ec#c +)" "ed cell an#'e2)cc5"s #n 9 )+ cases

.s 0 , )+ #llness and lass +)" . $)1


39/92

C)$!l#ca#)n

A!las#c Ane$#a 9-4 , a+e" 8e )nse "ec)(e"% #n 4-B da%s s)$e cases d) "eK5#"e )ne $a"")

"ans!lana#)n

M#ld 8")$)c%)!en#a and ne5")!en#a M%)ca"d##s )" #ne"s##al !ne5$)n#a

"es)l(#n' #n 9-4 ,

Ra"e !anc"ea##s2 !a")##s2 and )"c8##s


40/92

*")'n)s#s

+)" c)$!lee "ec)(e"% #s EPCELLENT

$a


41/92

*"e(en#)n

#$!"ac#cal ) !"e(en (#"5s #s 5#K5#)5s

$a


42/92

CYTOMEGALOVIRUSINFECTION

ETIOLOGY

-la"'es )+ 8e 8e"!es (#"5s


43/92

CYTOMEGALOVIRUS INFECTION

E*IDEMIOLOGY

AcK5#"ed #n d#Qe"en se#n's

.1 C)$$5n#% eJ!)s5"e

01 N)s)c)$#al "ans$#ss#)n91 In"a5e"#ne #n+ec#)n

T"ans$#ss#)n Sal#(a2 @"eas$#l,2 5"#ne2ce"(#cal and (a'#nal sec"e#)ns2 5"#ne2 se$en2s))ls2 l))d and #ss5e )" )"'an "ans!lan

-"eK5#"es (e"% cl)se )" #n#$ae c)nac


44/92

C)$$5n#% eJ!)s5"e

@F #s 8e $)s c)$$)n ")5e )+ CMV#n+ec#)n #n ea"l% c8#ld8))d

In'es#)n )+ @M +")$ Se")!)s##(e$)8e"s- 63-73 )+ #n+ans #n+eced

In+ec#)n c)$$)n #n 8e .s6$)s

Ad)lescens- Inc1 #n+Jn d seJ5alc)nac


45/92

N)s)c)$#al T"ans$#ss#)n

EJ!)s5"e ) l))d !")d5c2 all)'"a+"ans!lana#)n


46/92

C)n'en#al CMV #n+n

Rae )+ c)n'en#al #n+ec#)n As#a &A+"#ca- 0

Rae )+ "ans$#ss#)n +")$ M)8e"s

!"#$a"% #n+ec#)n d5"#n' !"e'nanc%-93

N)n!"#$a"% #n+Jn !"e(1#n+eced

)$en- .-0ROT


47/92

*a8)l)'%


48/92

RU@ELLA

Ge"$an $easles )" 9 da% $easles

INFANTS AND CHILDREN

ADULTS


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ETIOLOGY

Fa$#l% T)'a(#"#dae and #s 8e )nl% s!ec#es)+ 8e 'en5s R5#(#"5s1

S#n'le s"anded RNA (#"5s

SENSITIVE ) 8ea2 UV l#'82 andeJ"e$es )+ !H

STA@LE a c)ld e$!e"a5"es

H5$ans


50/92

E*IDEMIOLOGY

*REVACCINE ERA

INTRODUCTION OF THE VACCINE

AFTER SEVERAL YEARS 0 d)se "ec)$$enda#)n +)" "5ella

(acc#ne

0.scen5"% decl#ne


51/92

*ATHOLOGY

L%$!8)"e#c5la" #n=a$$a#)n and

$)n)n5clea" !e"#(asc5la" and$en#n'eal #nl"a#)n1


52/92

*ATHOGENESIS


53/92

CLINICAL MANIFESTATIONS

Inc5a#)n !e"#)d .4 0. da%s

S%$!)$s )+ L) '"ade +e(e"

S)"e 8")a

Red e%es #8 )" #8)5 !a#n Headac8e

Mala#se

An)"eJ#a

In )lde" '#"ls and )$en2 !)l%a"8"##s $a% )cc5" #8

a"8"al'#a2 sell#n'2 ende"ness2 and eQ5s#)n 5 L%$!8aden)!a8%

S5)cc#!#al2 !)sa5"#c5la" and ane"#)" ce"(#cal l%$!8 n)des a"e$)s !")$#nen


54/92

RASH9 da%s


55/92

EJa$#na#)n )+ 8e

)")!8a"%nJ #n%2 ")se-c)l)"ed les#)ns

orschheimer spots )"!eec8#al 8e$)""8a'es )n8e s)+ !alae1


56/92


57/92

LA@ORATORY FINDINGSDIAGNOSIS

Cl#n#cal s#'ns and s%$!)$s

Le5,)!en#a Ne5")!en#a

M#ld 8")$)c%)!en#a

I'M an#)d#es a"e deecale #n 8e "s +e da%s

)+ #llness and a"e d#a'n)s#c S!leen #s )+en sl#'8l% enla"'ed

C5l5"e )+ R5ella (#"5s +")$ 8e nas)!8a"%nJ andl))d


58/92

DIFFERENTIAL DIAGNOSES

Measles

Aden)(#"5s #n+ec#)ns

*a"()(#"5s #n+ec#)ns e"%8e$a

#n+ec#)s5$ E#!se#n-@a"" (#"5s

Ene")(#"5s

M%c)!las$a !ne5$)n#ae


59/92

COM*LICATIONS

Postinfectious throm@oc"topenia

C8#ld"en and '#"ls

Man#+ess a)5 0 ee,s Q )nse )+

"as8

*eec8#ae2 e!#saJ#s2 GI leed#n'28e$a5"#a


60/92

COM*LICATIONS

rthritis

Ad5ls )$en

@e'#ns #8#n . ee, )+ )nse


61/92

COM*LICATIONS

%ncephalitis

*)s#n+ec#)5s ence!8al##s

A!!ea"s #8#n 7 da%s a+e" )nse )+

"as8 Headac8e2 se#5"es2 c)n+5s#)n2 c)$a2

+)cal ne5")l)'#c s#'ns and aaJ#a

N)n #n+ec#)5s !a8)'enes#s


62/92

COM*LICATIONS

%ncephalitis

*")'"ess#(e "5ella !anence!8al##s *R*

In+ec#)5s !a8)'enes#s

Dea8 )cc5"s 0-/ %"s a+e" )nse


63/92

TREATMENT

N) s!ec#c "ea$en a(a#lale

S5!!)"#(e Ca"e

An#!%"e#cs2 anal'es#cs

C8#ld"en #8 CRS #s $)"e c)$!leJ


64/92

*ROGNOSIS

EJcellen !")'n)s#s

Re#n+ec#)n #8 #ld (#"5s


65/92

*REVENTION

Is)la#)n +")$ s5sce!#le #nd#(#d5als+)" 7 da%s a+e" )nse )+ "as8

Sanda"d !l5s d")!le !"eca5#)ns

C8#ld"en #8 CRS $a% eJc"ee (#"5s5! ) . %" )+ a'e


66/92

VACCINATION

.sa .0 ./ $)n8s

0nda 4 6 %"s )+ a'e

*)seJ!)s5"e !")!8%laJ#s #8#n 9da%s )+ eJ!)s5"e

S8)5ld n) e '#(en ) se(e"el%#$$5n)c)$!")$#sed !J

S8)5ld n) e '#(en d5"#n'!"e'nanc%


67/92

MeaslesR5e)la

%tiolog"


68/92

%tiolog"

Measles V#"5s Gen5s M)"#ll#(#"5s

Fa$#l%*a"a$%J)(#"#dae

*")d")$al !e"#)ds8ed #n

Nas)!8a"%n'ealsec"e#)ns

@l))d

U"#ne

Ne5"al##n'an#)d#es

L#$#!")l#+e"a#)n d5"#n'#n+ec#)n


69/92

%pidemiolog"

Ende$#c 8")5'8)5 8e )"ld :3 )+ c8#ld"en acK5#"e 8#s e+)"e ./ %ea"s )ld

e+)"e #$$5n#a#)ns

Cases 8a(e dec"eased

#8 (acc#na#)ns

Res5"'ence )cc5""ed $)sl% a$)n'Vacc#ne +a#l5"e

L) c)(e"a'e )+ !"esc8))l a'ed c8#d"enM)"e "a!#d an#n' )+ $ae"nal A #n #n+ans

03.. 317 !e" .23332333 !)!5la#)n


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/% (.S$SS$

*)"al )+ en"% Res!#"a)"% "ac

C)n


71/92

Pathogenesis

incu@ation

MV $#'"aes ) l%$!8 n)des *"#$a"% (#"e$#a Sec)nda"% (#"e$#a

Prodromal

Ass)c#aed #8 . e!#8el#al nec")s#s and 0 '#an cell+)"$a#)n #n )d% #ss5es

V#"5s s8edd#n'

%Aanthematous

Onse )+ "as8es . An#)d% !")d5c#)n e'#ns2 0 (#"al "e!l#ca#)n 9 s5s#d#n')+ s%$!)$s In+ecs CD4 T cells

.ecover"

DesK5a$a#)n )+ "as8es

!li i l if t ti


72/92

!linical anifestations

*a8)'n)$)n#c S#'n )!l#, S!)s anda"8#n-F#n,elde% Cell

.1 H#'8 +e(e"

01 Enan8e$

91 C)5'8

41 C)"%a

/1 C)n


73/92

!linical anifestations *")d")$al

Sa'eLass 9-/da%s

. 0

A!!ea"s .-4 da%s e+)"e)nse )+ "as8es

L)ca#)n #nne" c8ee,s a

C)n


74/92

!linical anifestations

F#nal Sa'eInc"ease #n

!")d")$al s%$!)$s8en "as8es a!!ea"

Ras8es a!!ea" ands%$!)$s s5s#de

Ras8 +ade )(e" 7da%s

COUGH lass l)n'es

Gene"al#edl%$!8aden)!a8%

forehead

Behindears

9ppernec*

(orsoandeAtremit

ies

Palmsand

soles


75/92

VELOSO

FIFTH DISEASE


76/92

FIFTH DISEASE

ERYTHEMA

INFECTIOSUM


77/92

ALEGAR@ES


78/92

0


79/92

%P$/%$+0

P.VV$.9S B3 Ras8 and "ans#en a!las#c c"#s#s

sc8))l-a'ed c8#ld"en

Seas)nal !ea,s lae #ne" and s!"#n' MOT "es!#"a)"% ")5e2 l))d and

l))d !")d5cs

T"ans$#ss#)n "ae ./-93


80/92

H9 B!V$.9S F)5nd #n "es!#"a)"% sec"e#)ns

*"e(alen 0 %ea"s )ld

Ass)c#aed #8 8ee#n' "es!#"a)"%

#llness F)5nd as a c)#n+ec#)n

"es!#"a)"% s%nc%#al (#"5s

85$an $ea!ne5$)(#"5s

"8#n)(#"5s


81/92


82/92

Biphasic $llness 7 ) .. da%s a+e" #n)c5la#)n

V#"e$#a

Dec"eased "e#c5l)c%e c)5ns Nas)!8a"%n'eal (#"al s8edd#n'

Fe(e"

Mala#se

R8#n)""8ea

Cl#n#cal Man#+esa#)n


83/92

Cl#n#cal Man#+esa#)n*a"()(#"5s @.:

E"%8e$a In+ec#)s5$ F#+8 D#sease $)s c)$$)n en#'n2 sel+-l#$#ed eJan8e$a)5s

#llness )+ c8#ld8))d #nc5a#)n !e"#)d 4-0B da%s a(e"a'e

.6-.7 da%s !")d")$al !8ase

$#ld l)-'"ade +e(e" #n ./-93 )+ cases2

8eadac8e2 s%$!)$s )+ $#ld URTI

E"%8e$a In+ec#)s5$ F#+8 D#sease


84/92


Hall$a", c8a"ace"#s#c "as8

9 sa'es

#n##al sa'e +ace =5s8#n'

sla!!ed-c8ee,a!!ea"ance



85/92


0nd sa'e "5n, and !")J#$al

eJ"e$##es

d#Q5se $ac5la" e"%8e$a

Cen"al clea"#n' lac%2 "e#c5laed a!!ea"ance

!")$#nen )n eJens)"s5"+aces2 - !al$s and s)les

a+e"#le

"as8 "es)l(es s!)nane)5sl%#8)5 desK5a$a#)n

aJ and ane )(e" .-9 ,

"ec5" s5nl#'82 8ea2 eJe"c#se2s"ess

A8 8


86/92

A8")!a8%

A"8"##s and a"8"al'#a ad5ls and )lde" ad)lescens


87/92

T"ans#en A!las#c C"#s#s

"ans#en a""es )+ e"%8")!)#es#s andas)l5e "e#c5l)c%)!en#a s5dden +all #n se"5$ 8e$)'l)#n

)cc5"s #n !a#ens #8 c8")n#c 8e$)l%s#s and)" "a!#d R@C 5"n)(e"

#ll #8 +e(e"2 $ala#se2 and le8a"'%

ssJ )+ !")+)5nd ane$#a !all)"2 ac8%ca"d#a2

ac8%!nea Ras8 #s "a"el% !"esen

I$$5n)c)$!")$#sed


88/92

5 )c) ! ) sed*e"s)ns

C8")n#c ane$#a acc)$!an#ed % ne5")!en#a2

8")$)c%)!en#a2 )" c)$!lee $a"")

s5!!"ess#)n cance" c8e$)8e"a!% )"

#$$5n)s5!!"ess#(e 8e"a!%

C8")n#c #n+ec#)ns

F l I + #


89/92

Feal In+ec#)n

/ "#s, +)" +eal l)ss a+e" #n+ec#)n *"#$a"% $ae"nal #n+ec#)n ass)c#aed

#8

n)n#$$5ne +eal 8%d")!s #n"a5e"#ne +eal de$#se

$ec8an#s$ (#"al #nd5ced R@Ca!las#a

M%)ca"d##s


90/92

M%)ca"d##s dJ se")l)'#c nd#n's2

@.: DNA #n ca"d#ac#ss5e

O8e" C5ane)5sMan#+esa#)ns !a!5la"!5"!5"#c

'l)(es-and-s)c,ss%nd")$e **GSS +e(e"2

!"5"#5s2!a#n+5l

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Infectious Disease Case 1