VIRAL INF one PDF(1).pdf

7/28/2019 VIRAL INF one PDF(1).pdf

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Dr. Abdulameer Abdullah Al-AshbalConsultant Physician

Department of Medicine; Al-yarmuk Teaching Hospital;

Al Mustensiriya University

First lecture


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What are VirusesA virus is a non-cellular

particle made up of geneticmaterial and protein that can

invade living cells.


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The Structure Of a Virus

Viruses are composed of

a core of nucleic acid

The Nucleic acid core is

surrounded by a proteincoat called a capsid

The Nucleic core is

either made up of DNA

or RNA but never both


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Systemic viral infections

with exanthem


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Exanthem ( ) is the term classicallyused to describe a widespread rash associated

with fever in childhood.

Maternal antibody gives protection for thefirst 6-12 months of life and infection occurs

thereafter.

Comprehensive immunisation programmeshave eradicated many of these conditions but

lapses in vaccination result in continued

infections, which now often present in older

children and adults.

Systemic viral infections with exanthem


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Measles (Rubeola)

Rubella (German measles)

Parvovirus B19 (erythrovirus B19) Human herpesvirus 6 and 7 (HHV-6 and

HHV-7)

Chickenpox (varicella)

Shingles (herpes zoster)

Enteroviral exanthems

Systemic viral infections with exanthem


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Measles (Rubeola)


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Measles (Rubeola)

Before immunisation campaigns, measles occurred

in almost 100% of children world-wide.

The WHO has set the objective of eradicating

measles globally by 2010, using the live attenuated

vaccine.

However, vaccination of only 70-80% of the

population for example is insufficient to prevent

outbreaks in older children and adults who are moresusceptible to complications.

Natural illness produces lifelong immunity.


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Clinical featuresMeasles

Infection is by respiratory droplets with anincubation period of 6-19 days.

A prodromal illness, 1-3 days before the rash,

occurs with upper respiratory symptoms,

conjunctivitis and the presence of Koplik's

spots.

Koplik's spots on the internal buccal mucosa

are small white spots surrounded by erythema

are pathognomonic of measles.


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Antivirals, although effective if commencedwithin 48 hours of rash appearance, are not

licensed in the UK for uncomplicated

primary VZV infection, since published

evidence suggests the benefits are marginal.

They are, however, widely used around the

world for uncomplicated chickenpox inadults.

Management and prevention


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Treatment is required in individuals with

complications and those who are

immunocompromised, including pregnant

women.

More severe disease, particularly inimmunocompromised hosts, requires initial

parenteral therapy.

Immunocompromised patients may haveprolonged viral shedding and may require

prolonged treatment until all lesions crust

over.

Management and prevention


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Antiviral therapy for herpes simplex and


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Disease state Treatment options

Primary genital HSV Famciclovir 250 mg 8-hourly for 7-10 days

Valaciclovir 1 g 12-hourly for 7-10 days

Oral aciclovir 200 mg 5 times daily or 400

mg 8-hourly for 7-10 days

Severe and preventing

oral intake

Aciclovir 5 mg/kg 8-hourly i.v. until

patient can tolerate oral therapy

Recurrent genitalHSV-1 or 2

Oral aciclovir 200 mg 5 times daily or 400mg 8-hourly for 5 days

Famciclovir 125 mg 12-hourly for 5 days

Valaciclovir 500 mg 12-hourly for 5 days

varicella zoster virus infection

Antiviral therapy for herpes simplex andvaricella zoster virus infection


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Disease state Treatment optionsPrimary or recurrent

oral HSVUsually no treatment

If required, usually shorter duration and

lower dose than for genital lesions, e.g.

valaciclovir 500 mg 12-hourly for 3-5 daysMucocutaneous HSV

infection in

immunocompromised

host

Aciclovir 5 mg/kg 8-hourly i.v. for 7-10 days

Oral aciclovir 400 mg 6-hourly for 7-10 days

Famciclovir 500 mg 8-hourly for 7-10 daysValaciclovir 1 g 12-hourly for 7-10 days



i ll t i i f ti


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Chickenpox in adult orchild

Oral aciclovir 800 mg 5 times a dayfor 5 days

Famciclovir 500 mg 8-hourly for 5

days

Valaciclovir 1 g 8-hourly for 5 days

Immunocompromised

host/pregnant woman

Aciclovir 5 mg/kg 8-hourly i.v. until

patient is improving, then complete

therapy with oral therapy until all

lesions crusting over



i ll i i f i


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Shingles Treatment and doses as for

chickenpox but duration

typically 7-10 days

Visceral involvement

(non-CNS) in HSV

Aciclovir i.v. 5 mg/kg 8-hourly

for 14 days


Antiviral therapy for herpes simplex andvaricella zoster virus infection


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Severe complications

(encephalitis,

disseminated infection)

Aciclovir i.v. 10 mg/kg 8-hourly (up to

20 mg/kg in neonates) for 14-21 days

HSV disease suppression Aciclovir 400 mg 12-hourly

Famciclovir 250 mg 12-hourly

Valaciclovir 500 mg daily



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