Questions and Answers
What percentage of babies born with CMV are asymptomatic at birth?
87%
What is the primary concern for immunocompromised patients receiving solid organ transplants regarding CMV?
The greatest risk is primary infection in donor positive, recipient negative.
List two symptoms included in CMV Syndrome.
Fever and neutropenia.
Which molecular technique is useful for diagnosing CMV in immunocompromised patients?
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What is the role of Ganciclovir in managing symptomatic infants with CMV?
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Name a toxic side effect associated with Ganciclovir.
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In which bodily fluids can CMV DNA be detected using PCR?
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What is the purpose of prophylaxis with oral Valganciclovir in immunosuppressed patients?
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What specific histological finding is associated with CMV infection?
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What challenge exists in developing a vaccine for CMV?
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Study Notes
Types of Abuse and Red Flags in Consulting with Children
- Types of abuse include emotional, physical, neglect, sexual, bullying, internet abuse, radicalization, FGM, domestic abuse, human trafficking, forced marriage, honour-based killings, and modern slavery.
Presentation/Examination Red Flags
- Inconsistent history and late presentation can indicate abuse.
- Unusual injury locations and behavioral changes may suggest underlying issues.
- Sexualized behavior as a red flag can signify exposure to inappropriate situations.
Family/Environment Factors
- Assessment of family structure, resource access, and stressors is crucial.
- Parenting styles and presence of domestic abuse may indicate vulnerability.
Child-Specific Factors
- The toxic triad includes domestic abuse, mental ill-health, and substance misuse impacting the child.
Herpes Simplex Virus (HSV) Infections
Pathogenesis
- HSV replicates in epithelial cells leading to lytic replication and vesicular rashes.
- Latent infection occurs in spinal ganglia and can reactivate due to stress or immunosuppression.
- Virus sheds in oral and vaginal secretions.
Epidemiology
- Over half of HSV infections occur by age 5, transmitted via fomites or close contact.
Clinical Features
- Primary oral herpes (HSV1/2) presents as gingivostomatitis in children and cold sores in adults.
- Genital herpes (HSV2) causes dysuria and vaginal discharge.
- Herpetic whitlow occurs from HSV2 reactivation around nails.
Complications
- Careful monitoring is needed for ocular HSV, encephalitis, meningitis, and skin/eye/mouth infections leading to CNS disease during congenital transmission.
Viral Causes of CNS Infections
Viral Meningitis
- Commonly caused by Coxsackie, Echovirus, HSV1/2, VZV, HIV, and EBV.
- Presents with mild flu-like symptoms, self-limiting nature, and typically resolves within 10 days.
Viral Encephalitis
- Caused by HSV1 (especially in neonates), VZV, enteroviruses, and others.
- Symptoms include altered consciousness, seizures, and paralysis, with a mortality rate of 19% when treated.
Rabies
- Zoonotic disease caused by rabies virus; notably transmitted through dog bites.
- Presents with a lengthy incubation (1-4 months), followed by a prodromal phase with fever, malaise, pain; can become severe with neurological symptoms.
Human Herpes Virus 6 and 7 Infections
- Two types of HHV6 (A and B) infect mononuclear cells, salivary glands, and CNS; transmission occurs through direct contact.
- Symptoms may include roseola infantum, presenting as a rash after fever decline; complications can include febrile convulsions and encephalitis.
Human Herpes Virus 8 (HHV8) Infection
Epidemiology
- Approximately 30% of individuals experience HHV8 infection, prevalent among populations from the Mediterranean and Ashkenazi Jewish descent.
Disease Associations
- Associated with various diseases like Kaposi’s sarcoma, primary effusion lymphoma, and multicentric Castleman’s disease.
- Symptoms vary based on the host's immune status; treatment focuses on managing complications or immunosuppression.
Epstein-Barr Virus (EBV) Pathogenesis and Management
Pathogenesis
- 87% of infected infants are asymptomatic; symptomatic cases often present with jaundice or encephalitis.
Diagnosis
- Serological testing for IgM/IgG and molecular testing of viral DNA via PCR is crucial, especially in immunocompromised patients.
Management
- Ganciclovir is administered to symptomatic newborns; immunocompetent patients may not require treatment.
- Prophylactic measures for immunosuppressed patients include pre-emptive monitoring and antidote treatments to reduce viral activity.
Communication Considerations for Hearing Impaired Patients
- Tailor communication techniques to ensure visibility and clarity, including good lighting and the use of interpreters or lip-readers when needed.
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Description
Test your knowledge on the various types of child abuse, including emotional, physical, and neglect. This quiz also explores red flags to look for when consulting with children, covering issues such as domestic abuse and modern slavery. Gain awareness and understanding of these critical topics.
