Viral Infections

Definitions

Xanthems: Dermatosis that erupts or flowers quickly, and includes papular vesciular, pustular eruptions

Enanthem: Eruption upon mucous membrane

Examples

Classic Eythemas

Rubeola - Measles, scarlet fever, rubella - German measles, Erythema infectiosum, Roseola infantum

Human Parvovirus B19

Erythema infectiosum or fifths disease, spread respiratory droplet, pregnancy

Slapped cheeks followed by erythamatous eruption on trunk and extremities, spread via respiratory droplet

Rubella, Measles, Roseola

Rubella: Rash appears after mild fever, starts on face and moves, pink or light red spots that may merge, may itch

Measles: rash appears about 3 days after first symptoms, fever often spikes, starts of hairline, red to reddish-brown spots

Roseola: High fever, rash appears when fever ends, usually starts, pinkish-red flat or raised, spot that turn white when touched

Viral Exanthemata

Macular Rash: Rubella, Roseola (Herpes)

Macular and Papular: Measles, HPV (B-19)

Vesicular: Herpes Simplex, Coxsackie A (Hand, food, mouth)

Vesciulo Pustular: Varicella-Zoster

Papulovesiculopustular: Vaccinia (smal pox vaccination), Variola (Small pox)

Papulovesciular: ORF, Milkers nodule

Papular: Mollusca contagiosa, Warts

Types of Viruses

DNA (DS)

Herpes Virus

Pox Virus

Variola (Small pox), ORF (contagious ecthyma), Milkers Nodule, Molluscum Contagiosum Virus

Papovirus

Papillomavirus (warts)

DNA (SS)

Parvoviridae - HPV B19

HSV, Varicella Zoster, EBV, CMV, HHV-7, B virus, HHV - 8

RNA (SS+)

Retroviridae - HIV (AIDS)

RNA (SS-)

Picornaviridae - Enterovirus (Coxsackie A)

Oral/Facial "cold sores" most common manifestation of HSV

Genital Herpes - Caused by HSV1, HSV2, HSV2 is more clinically unapparent

Herpetic Whitlow - Primary, recurrent, fingers or hands

Herpetic Keratoconjunctivitis - Initial corneal ulcer, leading cause of infectious blindness

Eczema Herpeticum - Widespread cutaneous HSV infection, loss of epidermal barrier, more common in patients with atopic dermatitis

Immunocompromised and HIV - More frequent, prolonged, severe infectons, deeper ulcers

Recurrent HSV and Erythema Multiforme: May develop 7-10 days after recurrent HSV infection, targetoid, vesicular lesions, usually acral location

Varicella - Hihgly contagious, eruption starts on face and scalp, spreads to trunk and extremities, can result in secondary bacterial infection

Varicella - Zoster: Primary infection from respiratory entry, hematogenous spread, chickenpox rash

Risk Factors

Immunosuppresion, H.I.V infection, Transplants, Radiotherapy, Drugs -> Chemotherapy, high odse corticosteroids, Cancer -> Lymphoma, CLL, MM

Post-Herpetic Neuralgia

Typically along dermatomes, burning pain, lancinating pain, and can be worsened by touch or contact

EBV

Infectious Mononucleosis, Oral Hairy Leukoplakia

CMV

Dermatologic manifestations rare and non-specific, perineal ulcers in paitents

Pityriasis Rosea

Infectiious case -> Immune post infection, prodrome, herald primary

HHV-8

Karposi's Sarcoma, and opportunistic neoplasm, atypical proliferation of vascular tissue, HSV

Subsets of Kaposi's Sarcoma

Classic, Immuno-suppression associated, endemic, AIDS related

Molluscum Contagiosum: Most common pox virus, papular exanthem, dome shaped, pink umbilicated papules

Transmission: Skin to skin contact from minor trauam with breaks in stratum corneum, sexual contact, typically in immunocompromised individuals

Verruca Vulgaris: Firm papules with vegetations, can be linear, annular, butcher's warts or filiform warts

Can be plantar warts that appear on hyperkeratotic surface, flat warts taht are sharply defined papules on flat surface

Condylomata Acuminata: Papules or nodules on perineum, genitaelia, folds, anus

Laryngeal Papiullomas: Associated with HPV-6, HPV-11, arise mostly on vocal cords

HPV in immunocompromised: HIV patients suffer from increased HPV rates, present more larger, more numerous with increased duraation and length of diseas

Immunosuppression and HPV-Rleated malignnacy: More common in immunocompromosied and present with more clinically severe neoplasias

Milker's Nodule: Acquired from cows, self limited

Hand foot, mouth disease, painful vesciular lesions, very contagious

Infects human CD4 T cells, Agent of AIDS, HIV infected paitents have cutaneous manifestations

Primary HIV Infection: HIV exposure, acute illness, fever 22

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