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COMMON VIRAL INFECTIONS. Dr.H.N.Sarker MBBS. FCPS.MACP(USA) Assistant professor Medicine. Topics. Introduction Clinical syndromes caused by viruses SYSTEMIC VIRAL INFECTIONS. Introduction. - PowerPoint PPT Presentation
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COMMON VIRAL COMMON VIRAL INFECTIONS INFECTIONS
Dr.H.N.SarkerDr.H.N.Sarker
MBBS. FCPS.MACP(USA)MBBS. FCPS.MACP(USA)
Assistant professorAssistant professor
MedicineMedicine
TopicsTopics
IntroductionIntroduction
Clinical syndromes caused by virusesClinical syndromes caused by viruses
SYSTEMIC VIRAL INFECTIONS SYSTEMIC VIRAL INFECTIONS
IntroductionIntroduction
Viruses are simple infectious agents Viruses are simple infectious agents consisting of a portion of genetic material, consisting of a portion of genetic material, RNA or DNA, enclosed in a protein coat.RNA or DNA, enclosed in a protein coat.
They are essentially intracellular and They are essentially intracellular and cannot exist in a free-living state, needing cannot exist in a free-living state, needing to infect host cells to survive. to infect host cells to survive.
Clinical syndromes caused by virusesClinical syndromes caused by viruses
Classification/viruses involvedClassification/viruses involved Clinical Clinical syndromessyndromesDNA VIRUSES(PHAPH)DNA VIRUSES(PHAPH)
– Poxviruses(Poxviruses(Variola)Variola) SmallpoxSmallpox
– Herpes virusesHerpes viruses
Herpes simplex types 1 and 2Herpes simplex types 1 and 2Acute/recurrent Acute/recurrent
vesicular vesicular rash(Herpes rash(Herpes labialis)labialis)
Varicella zosterVaricella zoster
Chickenpox/shinglesChickenpox/shingles
Clinical syndromes caused by viruses Clinical syndromes caused by viruses
CytomegalovirusCytomegalovirusAcute/recurrent Acute/recurrent
hepatorenal infectionhepatorenal infection
Epstein-Barr virusEpstein-Barr virus Infectious Infectious mononucleosismononucleosis
Burkitt'slymphomaBurkitt'slymphoma Nasopharyngeal carcinomNasopharyngeal carcinom
Clinical syndromes caused by virusesClinical syndromes caused by viruses
– Human erythrovirus 19Human erythrovirus 19 Erythema Erythema infectiosuminfectiosum
– AdenovirusesAdenoviruses Upper respiratory tract Upper respiratory tract
infection/pharyngitisinfection/pharyngitis
Acute diarrhoeaAcute diarrhoea
– PapovavirusesPapovavirusesHuman papillomavirusHuman papillomavirus Common wartCommon wart
Polyoma (human BK and JC)Polyoma (human BK and JC) Progressive Progressive multifocalmultifocal
leucoencephalopathyleucoencephalopathy
HepadnavirusHepadnavirus Hepatitis BHepatitis B
Clinical syndromes caused by virusesClinical syndromes caused by viruses
– RNA VIRUSES(MRTCRP)RNA VIRUSES(MRTCRP)– MyxovirusMyxovirus- - OrthomyxovirusesOrthomyxoviruses InfluenzaA,BInfluenzaA,B
ParamyxovirusesParamyxoviruses MeaslesMeasles
MumpsMumps
Respiratory Respiratory syncytial virus syncytial virus
Clinical syndromes caused by viruses Clinical syndromes caused by viruses
– RetrovirusesRetroviruses HIV-1 and 2HIV infection HIV-1 and 2HIV infection
syndrome/AIDSsyndrome/AIDS
– TogavirusesTogaviruses RubellaRubella
German measles German measles
Dengue fever Dengue fever
Clinical syndromes caused by virusesClinical syndromes caused by viruses
CalicivirusCalicivirus Hepatitis-EHepatitis-E
RhabdovirusesRhabdoviruses
Rabies Rabies
PicornavirusesPicornaviruses
PoliovirusPoliovirus poliopolio
Coxsackie virusesCoxsackie viruses pericarditispericarditis
SYSTEMIC VIRAL INFECTIONS SYSTEMIC VIRAL INFECTIONS
INFLUENZA INFLUENZA
INFECTIOUS MONONUCLEOSIS (IM) INFECTIOUS MONONUCLEOSIS (IM)
ACQUIRED CYTOMEGALOVIRUS ACQUIRED CYTOMEGALOVIRUS INFECTION INFECTION
DENGUE DENGUE
YELLOW FEVER YELLOW FEVER
INFLUENZA INFLUENZA
A specific acute illness caused by a group A specific acute illness caused by a group of myxovirusesof myxoviruses
Aetiology:Aetiology:
Influenza A and B virusInfluenza A and B virus
INFLUENZA INFLUENZA
Clinical feature: Clinical feature:
Sudden onset of pyrexiaSudden onset of pyrexia
Generalized ache and pains , Generalized ache and pains , headache.headache.
Anorexia , nausea and vomitingAnorexia , nausea and vomiting
INFLUENZAINFLUENZA
Harsh nonproductive coughHarsh nonproductive cough
Acute symptoms subside within 3-5 days but Acute symptoms subside within 3-5 days but may be followed by post may be followed by post influenza influenza asthenia which may persist asthenia which may persist for several for several weeks.weeks.
INFLUENZAINFLUENZA
Complication: Complication:
Most patients donot develop Most patients donot develop complication.complication.
Trachitis, bronchitis, bronchiolitis , Trachitis, bronchitis, bronchiolitis , BronchopneumoniaBronchopneumonia
Secondary bacterial invasion by Secondary bacterial invasion by Streptococcus pneumoniae, H. Streptococcus pneumoniae, H. influenzae, Staph. aureus.influenzae, Staph. aureus.
INFLUENZAINFLUENZA
Complication: Complication:
Rare Rare
Toxic cardiomyopathy may cause Toxic cardiomyopathy may cause sudden deathsudden death
EncephalitisEncephalitis
Demyelinating encephalopathyDemyelinating encephalopathy
Peripheral neuropathy Peripheral neuropathy
INFLUENZAINFLUENZA
Management: Management:
Bed rest till fever subsidesBed rest till fever subsides
Parectamol .5-1 gm(1-2 tab) 4-6 hrlyParectamol .5-1 gm(1-2 tab) 4-6 hrly
Pholcodine 5-10 mg 6-8 hrlyPholcodine 5-10 mg 6-8 hrly
Antibiotic if secondary bacterial Antibiotic if secondary bacterial infection. infection.
INFECTIOUS MONONUCLEOSIS (IM)INFECTIOUS MONONUCLEOSIS (IM)
INFECTIOUS MONONUCLEOSIS (IM) INFECTIOUS MONONUCLEOSIS (IM) is caused by the is caused by the Epstein-Barr virus (EBV), a gamma herpes virus.Epstein-Barr virus (EBV), a gamma herpes virus.
Virology and epidemiology Virology and epidemiology
Epstein-Barr virus (EBV) is a B Epstein-Barr virus (EBV) is a B lymphotropic human herpes virus which is lymphotropic human herpes virus which is worldwide in worldwide in distribution.distribution.
Primary infection with EBV which occurs Primary infection with EBV which occurs during childhood is usually subclinical. during childhood is usually subclinical.
Between 25-70 % of adolescents are Between 25-70 % of adolescents are usually subclinical. usually subclinical.
Virology and epidemiologyVirology and epidemiology
Between 25-70 % of adolescents and adults who Between 25-70 % of adolescents and adults who undergo a primary EBV infection develop the undergo a primary EBV infection develop the clinical syndrome of infectious mononucleosis.clinical syndrome of infectious mononucleosis.
Saliva is the main means of spread, either by Saliva is the main means of spread, either by droplet infection or environmental contamination droplet infection or environmental contamination in childhood, or by kissing among adolescents in childhood, or by kissing among adolescents and adults.and adults.
Clinical features Clinical features
Infectious mononucleosis is defined by the Infectious mononucleosis is defined by the clinical triad of fever, lymphadenopathy, clinical triad of fever, lymphadenopathy, and pharyngitisand pharyngitis
combined with the transient appearance of combined with the transient appearance of heterophil antibodies and an atypical heterophil antibodies and an atypical lymphocytosis.lymphocytosis.
Clinical featuresClinical features
Other features-Other features-
splenomegaly, palatal petechiae, splenomegaly, palatal petechiae, periorbital oedema, clinical or biochemical periorbital oedema, clinical or biochemical evidence of hepatitis, and a non-specific evidence of hepatitis, and a non-specific rash. rash.
Diagnosis Diagnosis
Diagnosed by the clinical triad of fever, Diagnosed by the clinical triad of fever, lymphadenopathy, and pharyngitis in lymphadenopathy, and pharyngitis in typical age group(10-30 yrs).typical age group(10-30 yrs).
combined with an atypical lymphocytosis.combined with an atypical lymphocytosis.(20% or more of peripheral lymphocytes (20% or more of peripheral lymphocytes must have an atypical morphology).must have an atypical morphology).
andand
DiagnosisDiagnosis
the transient appearance of heterophil the transient appearance of heterophil antibodies byantibodies by
1.the classical Paul-Bunnell titration1.the classical Paul-Bunnell titration
OrOr
2. a more convenient slide test such as the 2. a more convenient slide test such as the 'Monospot'. 'Monospot'.
DiagnosisDiagnosis
Specific EBV serology Specific EBV serology (immunofluorescence) can be used to (immunofluorescence) can be used to confirm the diagnosis if necessary.confirm the diagnosis if necessary.– antiviral capsid (VCA) antibodies in the IgM class antiviral capsid (VCA) antibodies in the IgM class – antibodies to EBV early antigen (EA) antibodies to EBV early antigen (EA) – absent antibodies to EBV nuclear antigen (anti-absent antibodies to EBV nuclear antigen (anti-
EBNA). EBNA).
COMPLICATIONS COMPLICATIONS
CommonCommon– Severe pharyngeal oedema Severe pharyngeal oedema – Antibiotic-induced rash Antibiotic-induced rash – Chronic fatigue syndrome (10%) Chronic fatigue syndrome (10%)
COMPLICATIONSCOMPLICATIONS
UncommonUncommon
NeurologicalNeurological
Cranial nerve palsies Cranial nerve palsies
Polyneuritis Polyneuritis
Transverse myelitis Transverse myelitis
Meningoencephalitis Meningoencephalitis
HaematologicalHaematological
Haemolytic anaemia Haemolytic anaemia
Thrombocytopenia Thrombocytopenia
COMPLICATIONSCOMPLICATIONS
RenalRenal Glomerulonephritis Glomerulonephritis Interstitial nephritis Interstitial nephritis
CardiacCardiac Myocarditis Myocarditis Pericarditis Pericarditis
PulmonaryPulmonary Interstitial pneumonitis Interstitial pneumonitis
COMPLICATIONSCOMPLICATIONS
RareRare
Ruptured spleen Ruptured spleen
Respiratory obstruction Respiratory obstruction
Arthritis Arthritis
Agranulocytosis Agranulocytosis
Agammaglobulinaemia Agammaglobulinaemia
Management Management
Treatment is largely symptomatic: Treatment is largely symptomatic:
aspirin gargles to relieve a sore aspirin gargles to relieve a sore throat. throat. If a throat culture yields a β-If a throat culture yields a β-haemolytic haemolytic streptococcus, a course of streptococcus, a course of
erythromycin should be prescribed. erythromycin should be prescribed.
ManagementManagement
Amoxicillin and similar semi-synthetic Amoxicillin and similar semi-synthetic penicillins should be avoided because they penicillins should be avoided because they commonly induce a maculo-papular rash commonly induce a maculo-papular rash in patients with IM.in patients with IM.
ManagementManagement
When pharyngeal oedema is severe a When pharyngeal oedema is severe a short course of corticosteroids, e.g. short course of corticosteroids, e.g. prednisolone 30 mg daily for 5 days, may prednisolone 30 mg daily for 5 days, may help to relieve the swelling.help to relieve the swelling.