Common Viral Infections: Characteristic Signs and Symptoms

Parvovirus B19

Also known as Erythrovirus, best known for Erythema Infectiosum. This condition is also called "Fifth Disease" Occurs in young children: Fiery red "Slapped Cheek" Perioral pallor Can get low-grade fever malaise, headache, itchy hands. Subsequent development of a lacy, maculopapular rash on trunk and limbs.

Cytomegalovirus

Congenital infection (from infected mom) is asymptomatic at birth. May develop sensorineural hearing loss or mental retardation CMV can be significant in HIV patients. Leading cause of blindness in HIV population (chorioretinitis) Can also cause gastroenteritis and neurologic conditions Can reactivate over and over in HIV patients

Herpes Simplex Virus

Cutaneous infection results in "fluid-filled vesicles with surrounding erythema." Two main types. May also infect: Herpetic Whitlow Gingivostomatitis Herpes keratitis Neonatal congenital abnormalities Viral pneumonia Bell palsy

Hemorrhagic fevers

Diverse group of viral infections. Most famous presently is Ebola. Early symptoms are flu-like with high fever. Late stages include organ failure, leukopenia, altered mental status and hemorrhage.

Mumps

Exposure by droplets 14-21 days before symptoms start. Parotid gland tenderness and enlargement is most common. Accompanied by overlying facial edema Parotid returns to normal in about 1 week Mumps is leading cause of pancreatitis in kids. Can also develop meningitis or orchitis.

Norwalk Virus

Food handlers are largely responsible (not cleaning well). Major cause of severe diarrhea in adults (epidemic gastroenteritis). Illness is short-lived (12-60 hours), but causes high frequency of vomiting, and some watery diarrhea.

Rotaviruses

Leading cause of dehydrating gastroenteritis in children worldwide. Transmitted by fecal-oral route and can be shed by patient for up to 3 weeks after a severe infection. Prodrome of fever, followed by watery, non-bloody diarrhea.

Poxviruses

Most common manifestation is Molluscum Contagiosum. This viral infection is transmitted by close skin on skin contact. There are 9 different poxviruses that cause disease in humans. Smallpox was one of them; global elimination by 1979. Appears as pearly, raised, umbilicated skin nodules (spares palms and soles).

Coxsackievirus

Most commonly, these include: Herpangina Acute nonspecific pericarditis Myocarditis Hand, foot, and mouth disease Viral conjunctivitis Viral meningitis

Epstein-Barr Virus

One of most ubiquitous human viruses. Infectious Mononucleosis is the common manifestation of EBV. Symptoms include: Fever Sore throat Excessive fatigue General malaise Myalgias (in early days) Other signs of Mononucleosis: Lymphadenopathy (often pronounced) Especially posterior cervical chain Transient upper lid edema "Hoagland sign" Splenomegaly (up to 50% of Pts) Maculopapular rash (especially if ampicillin or amoxicillin Rx'd)

Human Immunodeficiency Virus (HIV)

One of the most famous and feared Retroviruses. Causes HIV.

Influenza

Outbreaks occur during the fall/winter months. Acute febrile illness caused by Influenza Type A or Type B virus. There is a Type C, but this causes mild viral illness. Signs and Symptoms: Abrupt onset of high-grade fever with headaches, myalgias, anorexia, malaise and possibly pneumonia. Cough, sore throat, and runny nasal discharge common as well. Status asthmaticus may occur in asthmatic patients (beware).

Measles

Reportable systemic viral infection transmitted by droplet.Highly contagious, even several days before symptoms. Symptoms: High fever Malaise Coryza (URI-like) Rash Koplik Spots (small, irregular, red and white spots on buccal mucosa) Pathognomonic for measles! "Grains of salt on red backdrop"

Poliomyelitis

Reportable viral illness contracted through fecal-oral route. Abortive Poliomyelitis- Minor illness with fever, headache, vomiting, diarrhea, sore throat (only suspect during epidemic) Non-paralytic Poliomyelitis- In addition to above, can develop meningeal irritation with muscle spasms. Paralytic Poliomyelitis- Flaccid paralysis (possibly even respiratory) can occur at any time during acute, febrile infection. Mortality rate is 50%. Long term motor deficit in other 50% (Post-polio syndrome)

Rubella

Systemic viral illness contracted by inhalation of infective droplet.Symptoms are very similar to other viral illnesses. Ex: Fever, malaise, coryza, and rash. Tender suboccipital lymphadenopathy may precede rash. Fine, pink maculopapular rash appears and fades quickly. Arthralgias can be quite common in Rubella. The main concern with this virus is Congenital Rubella Syndrome! Can cause devastating effects to fetus in utero Infant may be normal at birth, but can develop problems later: Early-onset glaucoma and cataracts Deafness Mental retardation Congenital heart defects Organomegaly Infant death due to heart or other organs.

Human Herpesvirus 6 (Roseola)

The cause of Roseola ("roseola infantum", "sixth disease"). Most common in children under 2 years of age. Causes a high fever and is a common cause of febrile seizures. As fever breaks, Maculopapular rash on neck, trunk and extremities. Other symptoms may include a runny nose.

Varicella Zoster Virus

The viral cause of two very well known conditions: Varicella rash (Chickenpox)- Pruritic. Starts as papular, changing to vesicular ("Dewdrops on a rose petal"), rupture with crusting. Herpes Zoster (Shingles)- Tingling with pain (prodrome), then eruption of vesicles in a dermatomal distribution. Evolve to pustules and then crusting.

Adenovirus

There are over 50 different serotypes that produce human illness. Classic clinical syndromes (which may overlap) include: Common Cold (URI) Viral Pharyngitis Viral bronchiolitis/bronchitis Acute gastroenteritis Viral myocarditis (not common) Others

Rabies

Viral Encephalitis secondary to an animal bite from an infected animal. Virus gains entry into salivary gland of the animal 5-7 days before their death. Encephalitic ("Furious") form (most common): Delirium alternating with periods of calm. Can get painful laryngeal spasm when attempting to drink H2O.Can also get autonomic stimulation and seizures. Paralytic ("dumb") form (less common): Ascending paralysis. Both forms progress relentlessly to coma and death.

Parainfluenza Virus

Viral croup is the most common form of airway obstruction in children 6 months to 6 years of age. A leading cause of hospitalizations in young children. "Croup" is a generic term for illness affecting the larynx and trachea. Inflammation causes airway obstruction, which causes a "barking cough", hoarse voice, inspiratory stridor, and possibly some respiratory distress for the patient. 50% of patients will show "Steeple Sign" on plain film of neck. With croup URI symptoms are gradual, epigottitis is sudden.

Dengue

Viral illness transmitted to human by Aedes mosquito. Sudden onset of high fever, chills, severe myalgias, arthralgias, sore throat, headache, and depression. Some can develop hemorrhages resulting in Dengue Shock Syndrome. Can be fatal. Dengue Hepatitis is common. A widespread maculopapular rash occurs, sparing palms and soles.

Respiratory Syncytial Virus

Wintertime outbreaks between mid October and early January.RSV is the leading cause of hospitalizations for US children. RSV causes bronchiolitis. Necrosis of the bronchiolar epithelium occurs with sloughing, which can result in obstruction.Lung hyperinflation with respiratory distress are common. Other signs and symptoms include low-grade fever, wheezing, mild runny nose, and tachypnea