VIRAL INFECTION

1. Pox Virus :
- Moluscum Contagiosu
- Small pox.
2. Human Papiloma Virus :
- Cutaneous inf :
- common wart
- veruca plana
- mucous membran inf
3. Human Herpes viruses :
- Herpes Simplex Virus
- Varicella Zoster Virus :
- Varicella
- Herpes zoster
4. Infectious Exanthems :
- Measles
- Rubella
- Hand-food-and-mouth disease

MOLUSCUM CONTAGIOSUM

Def: self limited epidermal viral infection,

characterized clinically by skin-colored papules

that are often umbilicated.
Etiol : Moluscum Contagiosum Virus (MCV)
Epid : - chidren, sexually active adults
- transmission : skin to skin contact
Duration of lesions : 6 m regression
Physic exam :
papules/nodules
pearly white or skin colored
round, oval hemispherical, umbilicated (dome
shape appearance)

DD : flat wart, syringoma, keratoacantoma

Lab : smear of keratotic plug Giemsa
stained moluscum bodies
Tx :
- topical : imiquimod cream 3x/w 3m
- curettage
- cryosurgery
- electrodesication

SMALL POX
(variola)

Def : acute exanthematous disease caused

by infection pox virus variolae, severe 3-d
prodromal illness, generalized rash
spreading centrifugally, rapid succesive
papules, vesicles, pustules, umbilications,
and crusting within 14day
Etiol : variola virus, family poxviridae, genus
orthopoxvirus.
Epid : 1977 endemic
1980 declare
Inc periode : 7-17 d

Prodrome : 2-3dsevere
headache, backache, fever
DD : severe Chicken pox
Tx :
- symptomatic
- AB bacterial superinf

VERUCA VULGARIS
VERUCA VULGARIS
(COMMON WART)

Def : discrete benign epidermal hyperplasia caused

by human papiloma viruses. Variying degrees of
surface hyperkeratosis, minute papules large
plaques
Etiol : papilloma viruses, papovirus class
Epid :
- transmission : skin-skin contact
- most in children
- predilection : extensor of extremities
Physic exam :
firm papules 1-10mm larger, hyperkeratotic,
clefted surface, red, brown or grey color

VERUCA PLANA
(FLAT WARTS)

Physic exam : sharply defined, round, oval, polygonal, flat

papules, flat surface,1-2 mm thickness, skin-colored or
light brown
DD:
- Veruca vulgaris : molluscum contagiosum, seborheic
keratosis
- Veruca plantaris : callus
- Veruca plana : syringoma, molluscum contagiosum
Dx : clinical finding
Tx :
- patient : - small lesions : 10-20% SA + LA
- large lesions : 40% SA plaster 1w
- clinician: - cryosurgery
- electrosurgery
- CO2 laser
- surgery

HERPES SIMPLEX

Def: grouped vesicles arising on an erythematous base on

keratinized skin or mucous membrane
Etiol :
1.Herpes simplex virus-1 (HSV-1):
- Herpetgingivostomatitis
- Herpes simplex labialis
2. Herpes simplex virus-2 (HSV-2)Herpes genitalis
Epid :
- Transmission : skin-skin, skin-mucous, mucous-skin
- Inc periode : 2-20d (average 6d)
- Precipit facs : UV radiation, altered hormonal milieu
(menstruation), fever, common cold, altered immune
states
*Genital Herpes recures more frequently than labial.

Pathogenesis:
person sedding virus
(peripheral site, mucosal or secretion)

mucosal surface, break skin

replicates in parabasal & intermediate epithelial

cells
lysis cell
vesicle formation (primary inf)

enter peripheral sensory nerves or autonomic nerve

root (vagal) ganglia (latent)
*Latency symptomatic & asymptomatic primary inf
*Periodically
skin & mucosal

sensory neuron

Physic exam :
A group vesicles arising on an erythematous base on skin
& mucous membran pustules ulcers crustae (2-4w)
*Primary :vesicles fever, headache, malaise, myalgia (34d) resolve during 3-4d

*Recurrent: prodrome: tingling, itching or burning, 24h

visible skin changes
*Nongenital :labial, perioral, oropharyngeal, distal fingers

Lab:
-Tzank smear : Giemsas/Wrights stain multinucleated
giant acantolytic keratinocytes
- Antigen detection: monoclonal antibodies specific
HSV1&2
- Serology : glycoprotein (g) G1&G2

DD: Apthous stomatitis, hand-foot-and-mouth

disease, erythema multiforme
Tx :
*antiviral agents more effective in treating primary
inf than recurrences

Episode I:
- acyclovir 400mg 3x/d / 200mg 5x/d 7-10d
- valacyclovir 1g bid 7-10d
- famciclovir 250mg tid 5-10d

Chronic suppression (1y) :

- acyclovir 400mg bid
- valacyclovir 500-1000mg qd
- famciclovir 250mg bid

VARICELLA
(CHICKEN POX)
Def:highly contagious primary inf
varicella-zoster virus, characterized succesive
crops of pruritic vesicles pustules crusts
scar
Epid :
- age of onset : 90% children <10y, <5% >15y
- transmission :
- airborne droplet
- direct contact
*Px are contagious several days before exanthem
appears and untill last crop of vesicles

Patogenesis:
viral in airborne droplet

URT & oropharynx local replication & primary viremia

replicates in reticuloendothelial cells system.(sec viremia)

skin & mucous membranes

sensory nerves sensory ganglia (latent infection)

immunocompromise
sensory nerve

initial dermatomal pain

skin lessions

Incubation period:14 days (10-23 days)

Prodrome:-absent or mild children

-headache,general aches&
pains, severe backache,malaise adult
2-3d
exanthem pruritic

papules

vesicles umbilicated pustule crusts

8-12 hours
*Crusts fall off in 1-3 weeks

Distribution:on face & scalp tear drops lession trunk &

extremities
Complicated superinfection:
staphylococ/streptococimpetigo,furunkle
*Pneumonitis : immunocopromise
DD : eczema herpeticum
small pox
Lab :
VZV antigen detection
Viral cultures
Tzanck smear
Tx :
- Prevention :immunization
- Lotion
pruritus
- Oral antihistamin
- Antipyretic
- Antiviral : acyclovir 5x20mg/kgw (max 800mg) 7-8d
valacyclovir 3x1000mg 7d
famciclovir 3x500mg7d
- AB topical : mupirocin oint
oral

HERPES ZOSTER
(SHINGLES)
Def : an acute dermatomal inf associated with
reactivation of VZV, unilateral pain,
vesicular/bulous eruption limited to dermatome
innerveted by a corresponding sensory ganglion
Etiol : = varicella
Epid : >50year 66%
<15year 5%
Prodrome : - neuritic pain/paraesthesia 2-3w
- acute vesiculation 3-5d
- crust formation 2-3d
pain, tenderness, paresthesia (itching, tingling, burning)
in the involve dermatome
flu like symptoms

Physical exam:
-papules (24h) vesicles-bullae (48h) pustules
(96h) crust (7-10d)
- new lesions 1week
DD: -Herpes simplex
- prodromal: paincardiac/pleural disease,
acute abd/vertebral disease
Lab: = varicella
Course & prognosis :
- Ramsay hunt syndfacial&auditory nerve
- PHN40% PX>60y,
-1month after onset of the rash60%,
-3months24%
-6months13%

Management :
- Prevention : Immunization
- Goal :- relieve constitutional symp
- minize pain
- reduce viral shedding
- prevent sec bact inf
- prevent/minimize PHN
- Tx: = varicella