Viral syndrome

Clinical presentations of primary HIV infection vary, but patients often have a viral syndrome or mononucleosis-like illness with fever, pharyngitis, and adenopathy (Table 40-3). Symptoms may last for 2 weeks. 

Clinical presentations of primary HIV infection vary, but patients often have a viral syndrome or mononucleosis-like illness with fever, pharyngitis, and adenopathy (Table 40-3). Symptoms may last for 2 weeks. Probability of progression to acquired immune deficiency syndrome (AIDS) is related to RNA viral load in one study, 5-year progression rates to AIDS were 8% and 62% for RNA copies per mElfliter of less than 4,530 and greater than 36,270, respectively. The mortality rates were 5% and 49%, respectively. 

Acute abdominal pain is a common complaint in the pediatric age group. A total of 10% of school-age children have recurrent abdominal pain and in only 10% of these children can etiology be detected. The majority of these children have self-limited disease. The most common associated conditions include upper respiratory tract infection, pharyngitis, viral syndrome, gastroenteritis, and constipation (Henderson et al. 1992). Therefore, it is uncommon for the underlying condition in these children to require surgical intervention. 

Viruses are small infectious agents composed of a nucleic acid genome (DNA or RNA) encased by structural proteins and in some cases a lipid envelope. They are the causative agents of a number of human infectious diseases, the most important for public health today being acquired immunodeficiency syndrome (AIDS), hepatitis, influenza, measles, and vituses causing diarrhoea (e.g., rotavirus). In addition, certain viruses contribute to the development of cancer. Antiviral drugs inhibit viral replication by specifically targeting viral enzymes or functions and are used to treat specific virus-associated diseases. 

Inhibition of immunomodulatory cytokines (Fig. 1) Anti-T-cell receptor antibodies Muromonab (OKT3, Orthoclone ) binds to the CD3 complex of the T-cell receptor and induces depletion of T-lymphocytes. It is applied to prevent acute rejection of kidney, liver, and heart allografts. Rapid side effects (within 30-60 min) include a cytokine release syndrome with fever, flu-like symptoms, and shock. Late side effects include an increased risk of viral and bacterial infections and an increased incidence of lymphproliferative diseases due to immunosuppression. 

Reye syndrome is a rare disorder in children, characterized by a combination of severe liver disorder and encephalopathy (central nervous system (CNS) disturbances) that can follow an acute viral illness and which has a relatively high mortality. It has been found to be... 

M ore than 200 viruses have been identified as capable of producing disease Acute viruses, such as the common cold, have a rapid onset and quick recovery. Chronic viral infections, such as acquired immunodeficiency syndrome (AIDS), have recurrent episodes of exacerbations (increases in severity of symptoms of the disease) and remissions (periods of partial or complete disappearance of the signs and symptoms). Display 14-1 describes the viruses discussed in this chapter. 

Antiemetics and antivertigo drag s are used cautiously in patients with glaucoma or obstructive disease of the gastrointestinal or genitourinary system, those with renal or hepatic dysfunction, and in older men with possible prostatic hypertrophy. Piromethazine is used cautiously in patients with hypertension, sleep apnea, or epilepsy. Trimethobenzamide is used cautiously in children with a viral illness because it may increase the risk of Reye s syndrome... 

Bacterial and viral myositis is well recognized as a clinical entity by muscle pathologists. The viruses most commonly involved appear to be the Coxsackie viruses, the arboviruses, influenza virus, and HIV, but the mechanism whereby the viral infection gives rise to the myositic syndrome is not known. A detailed discussion of such problems is presented later on pages 333-334. 

Gendelman HE, Baca LM, Turpin J, Kalter DC, Hansen B, Orenstein JM, Dieffenbach CW, Friedman RM, Meltzer MS (1990) Regulation of HIV rephcation in infected monocytes by IFN-alpha. Mechanisms for viral restriction. J Immunol 145 2669-26676 Giovannini M, Zuccotti GV, Biasucci G, Locatelh V, Riva E (1992) Combined zidovudine and interferon-alpha 2a therapy in children with acquired immune deficiency syndrome. J Int Med Res 20 295-301... 

A generalized systemic illness may accompany HIV seroconversion (Cooper et al. 1985). Guillain-Barre syndrome (GBS) (Piette et al. 1986), unilateral (Wiselka et al. 1987) or bilateral facial palsies (Wechsler and Ho 1989), bibra-chial palsy (Calabrese et al. 1987) and sensory neuropathy (Denning 1988) have been reported to occur during this process, usually within 1-2 weeks of the acute febrile illness. Spinal fluid analysis may show a mild to moderate mononuclear pleocytosis and a mild increase in protein levels. The precise relationship to HIV viral load in the cerebrospinal fluid (CSF) or plasma is unknown (Brew 2003). There is no proven therapy, but most patients recover spontaneously without any treatment. 

The human immunodeficiency virus (HIV lymphadenopathy-associated virus, LAV human T-cell lymphotrophic virus type 3, HTLV III) is responsible for acquired immune deficiency syndrome (AIDS see Chapter 3). Because of the hazard and difficulties of growing the virus outside humans, a different approach has to be examined for determining viral sensitivity to disinfectants. 

Reye s syndrome A sudden, sometimes fatal, syndrome characterized by encephalopathy and liver degeneration it occurs in children after viral infection and may be associated with aspirin use. 

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