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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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Chickenpox (varicella)
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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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Chickenpox (varicella)
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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
varicella zoster virus infection
Antiviral therapy for herpes simplex and
i ll t i i f ti
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Disease state Treatment options
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
varicella zoster virus infection
Antiviral therapy for herpes simplex and
i ll i i f i
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Disease state Treatment options
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
varicella zoster virus infection
Antiviral therapy for herpes simplex andvaricella zoster virus infection
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Disease state Treatment options
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
varicella zoster virus infection
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