Viral Diseases Chart PDF

DISEASE ETIOLOGY PATHOPHYSIOLOGY EPIDEMIOLOGY SYMPTOMS COMPLICATIONS PHYSICAL EXAM DIAGNOSIS OTHER RELEVANT TESTING TREATMENT/MA...

DISEASE ETIOLOGY PATHOPHYSIOLOGY EPIDEMIOLOGY SYMPTOMS COMPLICATIONS PHYSICAL EXAM DIAGNOSIS OTHER RELEVANT TESTING TREATMENT/MANAGEMENT Respiratory Viruses Influenza Influenza A Enters the body via respiratory ​Frequently spread in crowded PRODROME: 3-24 hours COMMON: PNEUMONIA: ​ELISA Rapid Antigen (15-20 ​CBC Supportive care Influenza B droplets areas ​Myalgias ​Pneumonia ​Productive cough minutes) ​CMP Influenza C -> ​Malaise ​Croup ​Inspiratory crackles ​Chest X-ray If within 72 hours window of Affects both upper and lower ​Highest rates seen in >5 y/o ​Headache ​Otitis Media ​** PCR ** (24 hours) ○​Should obtain chest x-ray in symptoms starting, patients can respiratory passages. and ​LAD patient with pulmonary IVIG in immunocompromised virus Can affect the respiratory system, the ​More common ​Dry Cough ​Cardiac Injury ○​48-87% accurate ​Coagulation Panel treat COVID-19 Can affect all parts of the respiratory ​Patients ages 50-64 y/o are 25x ​Sore Throat ​Arrhythmia ​ESR system (most common) and multiple more likely to die from infection ​Anosmia ​Septic Shock ​** PCR ** ​C-reactive Protein Ritonavir/Nirvatrelvir (Paxlovid), organ systems than those 50% of people infected ​Respiratory Insufficiency patient with pulmonary experience a reduction in symptoms to rule out quality of life for at least 3 pneumonia months after infection ○​If positive, chest x-ray would show bilateral ​Approximately 80% of “multifocal alveolar symptomatic patients present opacities) with mild disease Vaccine Preventable Viral Diseases Measles Rubeola Virus Enters the upper respiratory tract via ​Highly contagious (greatest PRODROME: (2-3 days) ​Bronchopneumonia MACULOPAPULAR RASH: ​** PCR ** Patient needs to be isolated! droplets during pre-eruptive stage) ​Cough ​Pneumonitis ○​Confirmatory test -> ​Conjunctivitis ​Encephalitis ○​Detection in serum after 3 Supportive care Travels to lymphatic tissues ​90% of susceptible contacts will ​Coryza ​Encephalomyelitis days of rash -> be infected ​High fever ​Otitis media High dose Vitamin A injection IM Spreads to ovaries/testes, thyroid, ​Photophobia ​Cervical adenitis Positive results need to be is effective in children pancreas, and CNS ​140,000 global deaths in 2018 ​Diarrhea reported to the CDC -> (most in age to endemic areas or Lyses cells under-vaccination DISEASE: (days 4-5) 30% of cases get one of these PREVENTION: MMR vaccine -> ​Maculopapular rash that starts ​Given at 12 months and 4 Spreads virus behind ears/neck and spreads to years of age -> entire body over 2-3 days. Causes immunosuppression and ○​Rash may become confluent on hypersensitivity reaction face and neck RISK FACTORS: ​History of no vaccinations INCUBATION PERIOD: 2-3 weeks  KOPLIK SPOTS: Mumps Paramyxovirus Enters respiratory tract via respiratory PRODROME: ​Orchitis -> Sterility ORCHITIS: ​** PCR ** ​Testicular ultrasound Supportive care droplets ​Fever ​Aseptic meningitis ​Unilateral epididymitis ○​Confirmatory test -> ​Severe headache ​Testicular swelling Testicular support in those with Spreads to parotid gland, testes, and ​Arthralgia Positive results need to be orchitis epididymis ​Anorexia PAROTITIS: reported to the CDC ​Parotid gland swelling (bilateral DISEASE: in 70-80% of cases) PREVENTION: MMR vaccine RISK FACTORS: ​Fever ​Ear displaced upward & ​Given at 12 months and 4 ​History of no vaccinations ​Headache outward years of age ​Anorexia ​Mandibular angle obliterated ​Testicular tenderness INCUBATION PERIOD: 14-21 days ​Testicular swelling INFECTIOUS PERIOD: 2 days before to 5 days after the onset of parotitis Rubella (German Measles) RNA Togavirus RISK FACTORS: ​Not as infectious as measles PRODROME: ​Arthritis MACULOPAPULAR RASH: ​PCR Supportive care ​History of no vaccinations ​Fever ​Encephalitis ○​Oral secretions or urine 1 ​Cough ​Maternal/congenital week before to 2 weeks after ​Conjuntivitis manifestations rash PREVENTION: MMR vaccine INCUBATION PERIOD: 14-21 days ​Malaise ​Serum Rubella IgM ​Given at 12 months and 4 ​Postauricular ○​Very important for pregnant years of age ​Occipital adenopathy people INFECTIOUS PERIOD: 5 days before development of rash to 5 days after Positive results need to be the rash appears DISEASE: reported to the CDC ​Maculopapular rash that starts on face/hairline, rapidly spreading to entire body (not always including LEs) on day 1 and disappearing by day 4 ​Forchheimer Spots ​Arthralgias​ FORCHHEIMER SPOTS: Poliomyelitis Enterovirus Fecal-Oral Route Transmission ​Polio has been eliminated from MILD: (2-6 days) ​Permanent damage to anterior PARALYSIS: ​** PCR ** Supportive care more than 99% of the world’s ​Fever horn cells -> Paralysis ​Poor reflexes ○​Often present in throat and population ​Myalgias ​Pharyngeal dysfunction ​Asymmetrical paralysis stool cultures weeks after Some antivirals are under RISK FACTORS: ○​Endemic areas include ​Sore throat ​Bowel dysfunction infection investigation for enteroviruses ​History of no vaccinations Nigeria, Pakistan, and ​Headache ​Bladder dysfunction ○​Rarely present in spinal fluid Afghanistan ​Respiratory dysfunction -> Death PREVENTION: IPV vaccine ​90-95% of cases are 5% OF INFECTED: asymptomatic ​Recurrent fever ​Headache ​Vaccine-associated paralytic ​Nuchal rigidity polio (VAPP) and ​Nausea vaccine-derived polio viruses (VDPV) is a consequence of the oral polio vaccine (OPV) 1-2% OF INFECTED: (due to anterior that has mutated and reverted horn damage) to neurovirulant ​High fever ○​Since 2000, the inactivated ​Severe myalgias polio vaccine (IPV) has been ​Loss of reflexes the only polio vaccine given ​Asymmetrical paralysis (proximal  to children in the US lower limbs involved more than distal or upper limbs) ​Disease is worse in adults and ​Dysphagia pregnant women ​Speech issues ​Decreased cardiorespiratory function ​Post-polio muscular atrophy occurs in 30-40% of paralyzed limbs 20-30 year later Herpes Viruses Herpes Simplex Virus 1 (HSV-2) Human Herpes Virus 1 Skin-Skin Contact Transmission ​Highly contagious ​Fever ​Recurrency GINGIVOSTOMATITIS: ​** Clinical Diagnosis ** GINGIVOSTOMATITIS, (Cold Sores) (HHV-1) -> ​Malaise ​Blindness HERPETIC WHITLOW, & Virus spreads to autonomic and ​Headache ​** PCR ** HERPES GLADIATORUM: sensory nerve endings ​LAD Acyclovir, Famciclovir, or -> ​Tzanck smear Valacyclovir Remains latent until reactivation ○​Prior standard (poor (precipitated by sunlight, stress, GINGIVOSTOMATITIS: (primary specificity) Treat pain with viscous lidocaine illness, trauma, and fatigue) presentation) ○​Shows giant, multinucleated Vesicles on an erythematous base on cells DO NOT I&D HERPETIC the mouth (commonly on tongue, WHITLOWS palate, buccal mucosa, gingiva, and fingertips) HSV-1 KERATITIS: Trifluridine or Ganiciclovir Eye HERPETIC WHITLOW: (typically Drops HSV-1, but can be HSV-2) Vesicles on an erythematous base on the finger (caused by direct inoculation of infection into cuts/abrasions) HERPETIC WHITLOW: HERPES GLADIATORUM: (typically HSV-1, but can be HSV-2) Vesicles on an erythematous base on the body (commonly seen in wrestlers) HSV-1 KERATITIS: ​Eye pain ​Conjunctivitis (unilateral vesicles on eyelid) HERPES GLADIATORUM: ​Dendritic lesions on cornea  HSV-1 KERATITIS: Herpes Simplex Virus 2 (HSV-2) Human Herpes Virus 2 Skin-Skin Contact Transmission ​Highly contagious ​Fever ​Recurrency ​** PCR ** Acyclovir, Famciclovir, or (Genital Herpes) (HHV-2) -> ​LAD Valacyclovir Virus spreads to autonomic and ​Linked to HIV in prevalent ​Vesicles on an erythematous base ​** Viral Culture ** sensory nerve endings areas (on the genitals) -> ​Tzanck smear Remains latent until reactivation ○​Prior standard (poor specificity) ○​Shows giant, multinucleated INCUBATION PERIOD: 2-12 days cells Varicella Zoster Virus (Chickenpox) Human Herpes Virus 3 Mainly spread by respiratory droplets ​Highly contagious PRODROME: EXANTHEM: ​** Clinical Diagnosis ** Supportive care (HHV-3) or aerosols. ​Fever Sometimes spread by direct contact ​No longer contagious once ​Malaise ​PCR with vesicles/pustules. crusting begins ​Pharyngitis Manage itching with ​Loss of appetite ​Viral culture antihistamines, calamine lotion, INCUBATION PERIOD: 10-21 days ​Headache and oatmeal baths ​Tzanck smear (Wright-Giemsa  DISEASE/EXANTHEM: stain) Widely scattered red macules and Acyclovir or valacyclovir in papules concentrated on the face ​Serologic testing immunocompromised patients or before spreading to the trunk. Rapidly severe cases progresses to clear pruritic vesicles on an erythematous base. Become pustules before crusting over 5-6 PREVENTION: Varicella vaccine days. ​Given at 12 months and 4 “Pearl on a rose petal” years of age ​80% effective Herpes Zoster Virus (Shingles) Human Herpes Virus 3 Caused by reactivation of Varicella ​1.2 million cases annually PRODROME: POST HERPETIC NEURALGIA: EXANTHEM: ​** Clinical Diagnosis ** If patient presents to clinic within (HHV-3) Zoster Virus Paresthesias and “burning & stabbing” Pain persists at least 90 days post 72 hours of onset, treat with ​Chance increases with age pain in one dermatome prior to eruption ​PCR Valacyclovir, Famciclovir, or eruption (most often thoracic or ​Occurs in 10-15% of cases Acyclovir In varicella, the virus passes from lumbar) lesions in the skin and mucosa to sensory ganglia via sensory fibers HERPES ZOSTER POST HERPETIC NEURALGIA: -> DISEASE/EXANTHEM: KERATITIS/OPHTHALMICUS: Treat pain with gabapentin Establish long term latency Painful vesicular rash in one Affects ophthalmic division of the -> dermatome that starts crusting in 7-10 5th (trigeminal) cranial nerve Reactivation occurs in those ganglia days. ​Hutchinson Sign PREVENTION: Shingrix vaccine with the highest density of the virus ○​Lesions in root of ophthalmic (recombinant zoster vaccine) (precipitated by immunosuppression, branch ​2 shots trauma, tumors, or irradiation) ○​Signifies increased risk ​2-6 months apart ​Can cause blindness ​Ages 50+ RAMSAY-HUNT SYNDROME: Affects 8th cranial nerve ​Ipsilateral facial paralysis ​Otalgia ​Vesicles in ear canal ​Can cause deafness, loss of HERPES ZOSTER taste, and changes in lacrimation KERATITIS/OPHTHALMICUS:  RAMSAY-HUNT SYNDROME: Epstein-Barr Virus (Infectious Human Herpes Virus 4 Enters the body via through ​90-95% lifetime prevalence PRODROME: ​Hepatosplenomegaly TONSILLITIS/PHARYNGITIS: ​Monospot/Heterophile Antibody ​CBC Supportive care Mononucleosis) (HHV-4) respiratory droplets/saliva worldwide ​Malaise ​Splenomegaly Test ○​Lymphocytic leukocytosis -> ​Headache ○​Uses agglutination card to (atypical lymphocytes) Replicates almost exclusively in ​Occurs in fall and spring ​Low-grade fever detect antibodies Avoid contact sports to avoid human epithelial cells of oropharynx ○​85% sensitive; 100% ​Splenic ultrasound if splenic rupture and in B lymphocytes ​Children and adolescents aged specificity hepatosplenomegaly is present 15-19 y/o are most affected DISEASE: on exam ​Fever ​EBV Specific Antibody Test Steroids should only be given if ​Posterior cervical chain LAD ○​Tests for viral capsid antigen necessary (anemia or airway ​Fatigue and antibody issues) ​Tonsillitis/Pharyngitis ○​IgG and IgM ○​Typically exudative, uvular Hepatosplenomegaly occurs in edema/erythema, halitosis, 50% of cases petechiae at junction of hard/soft palate ○​“Worst strep you’ve ever had” ​Rash ○​If given amoxicillin/ampicillin Cytomegalovirus (CMV) Human Herpes Virus 5 After initial infection, virus will be ​Present in 70-80% of the PRIMARY INFECTION: (if RETINITIS: ​PCR ​CBC Ganciclovir for reactivation or (HHV-5) latent in myeloid cells (primarily T population, but doesn’t cause symptomatic) Fundi with hemorrhages and ○​Lymphocytic leukocytosis congenital illness cells) disease ​Fever yellow/white exudates ​Antigen serologies (atypical lymphocytes) -> ​Cough (scrambled eggs/pizza pie) Reactivated with immunosuppression ​Myalgias ​Biopsy of Tissues ​Arthralgias ○​“Owl’s Eye Appearance” RISK FACTORS: ​Immunosuppression REACTIVATION: ​Congenital Transmission ​Diarrhea ​Daycare ​Abdominal pain ​Sexual contact ​Fever ​Bloody stools ​Retinitis ​Dysphagia ​Pneumonitis Roseola Infantum (Sixth Disease) Human Herpes Virus 6 Transmission via respiratory droplets ​Most common in children ages ​High Fever (3 days) MACULOPAPULAR RASH: ​** Clinical Diagnosis ** Supportive care (HHV-6) or Human Herpes -> 6-36 months ​Rose/pink blanching maculopapular Virus 7 (HHV-7) HHV-6 usually affects monocytes rash that starts on the trunk (once ​PCR HHV-7 usually affects lymphocytes ​Occurs in fall and spring fever subsides) that can spread to Ganiciclovir in limb and face ​Indirect immunofluorescence immunocompromised ​Cervical and post auricular LAD INCUBATION: 5-15 days ​Nagayama spots ​ELISA ​Conjunctivitis ​Otitis media ​Edema of the eyelids ​Cough ​Rhinorrhea ​Diarrhea ​Vomiting NAGAYAMA SPOTS: Other Viruses Erythema Infectiosum (Fifth Disease) Parvovirus B19 Enters upper respiratory tract via ​Most common in children PRODROME: ​Arthritis ​* Clinical Diagnosis ** ​CBC Supportive care respiratory droplets/saliva between 3 and 15 years of age ​Non-specific flu-like symptoms ​Aplastic crisis ○​Check for anemia -> ​Maternal/congenital ​IgG and IgM Virus spread ​More common in late winter, manifestations -> spring, and early summer DISEASE: Virus is cytotoxic to bone marrow ​Edematous, erythematous plaques -> on cheeks Causes decrease in reticulocytes and ○​“Slapped cheeks” anemia ​Erythematous lacy eruption on trunk and extremities ○​More common in children INCUBATION PERIOD: 5-10 days ​Joint pain Human Papilloma Virus (HPV 6 & 11 are most common Virus enters the nucleus of squamous ​Soft, skin-colored, fleshy papules in ​Acetic Acid Test Supportive care (many cases will 16 & 18 cause cancer epithelial cells anogenital region resolve spontaneously, but may -> ○​Can become enlarged, ​PCR reappear) Oncogene in the virus produces “cauliflower-like” proteins that promote cell growth and ○​Males: under foreskin, penile ​HPV serotyping viral replication shaft, around anus/rectum Removal via cryotherapy -> ○​Women: vulva, vaginal wall, ​Colposcope to visualize Causes skin to thicken and grow cervix, perineum warts ​Biopsy to identify Electrocauterization (LEEP) RISK FACTORS: Topical management (5-fluoracil) ​Unprotected sex ​Multiple partners ​Immunocompromised PREVENTION: Gardasil vaccine (first vaccine to prevent cancer) INCUBATION PERIOD: 1-6 months Rabies Rhabdoviridae Family Virus enters through bite ​Most commonly spread through PRODROME: ​Death ANIMAL TESTING: WOUND CARE: -> bats ​Pain/paresthesia at bite site ​If caught, animal that seems Scrub with solution (soap, iodine, Replicates in muscles ○​But raccoons, skunks, foxes, ​Fever Once symptoms start, survival is well is quarantined for 10 days & alcohol) with pressure irrigation -> cats, dogs, and cattle can ​Malaise rare (death within 7-10 days) Spreads via ACH receptor cellular spread it too ​Headache ​Sick/dead animals are tested uptake ​Nausea for rabies MEDICATION: -> ​17 million cases per year ​Vomiting ○​Autopsy will show Negri ​Human Rabies Immune Causes encephalitis when it reaches worldwide ​Hypersexuality bodies Globulin (HRIG) - 20 IU/kg the brain once, infiltrated around the ​59,000 deaths ​If not caught, assume it has wound ENCEPHALITIC FORM: rabies ​Rabies Vaccine (Immunovax or RISK FACTORS: ​Highest incidence in rural ​Confusion RabAvert) - 4 injections into the ​Occupational exposure Africa/Asia ​Agitation deltoid on days 0, 3, 7, and 14 ​Bizarre behavior HUMAN TESTING: after exposure ​Hallucinations ​Fluorescent Antibody Testing ​If previously vaccinated, omit INCUBATION PERIOD: 10 days-years ​Insomnia with skin biopsy from nape of the HRIG  (typically 3-7 weeks) ​Hydrophobia neck ​Laryngeal spasms ​Diaphragm spasms ​Antibody serology ​Quantitative RT-PCR of saliva PARALYTIC FORM: or CSF ​Ascending paralysis ​AMS ​Autopsy will show Negri bodies ​Respiratory muscle paralysis HIV/AIDS