Mucocutaneous Manifestations of Viral Diseases: An Illustrated Guide to Diagnosis and Management, Second Edition

546 Pages·2010·35.88 MB·English

by  Stephen Tyring

Mucocutaneous Manifestations of Viral Diseases Tyring Mucocutaneous
Moore
About the book
Lupi
The only text to comprehensively address issues of skin manifestations
Manifestations of
of viral disease, Mucocutaneous Manifestations of Viral Diseases explores “It was a pleasure to review this profusely illustrated,
the diagnosis, treatment, and pathogenesis of viral diseases that state-of-the-art virology textbook that was written
infiltrate the skin and affiliated mucous membranes. Readers of this and edited by an impressive field of experts. This
extensively revised second edition will find new information on: book, which covers the range of dermatological and M
mucosal manifestations of viral diseases, will appeal to
• The recent HPV and VZV vaccines u Viral Diseases
a wide audience of readers including dermatologists,
• the recently approved antiviral drugs c
paediatricians, pathologists, and general medicine
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• the latest laboratory findings
physicians... The clinical information and the high quality
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• diseases previously known only in developing countries photographs will make this textbook an enduring
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• ocular and oral manifestations of viral disease addition to any personal or institutional medical library.”
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• manifestations of prion infection J American Academy Dermatology, of the first edition
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Organized by specific disease, each chapter in this e Second Edition
user-friendly text includes: o
• a timeline of infection and pathogenesis of the disease “The extensive collection of color photographs is the u
highlight of this book... a clearly written and s
• a brief taxonomy and history of the disease
well-illustrated single-volume textbook... ideal for M
• tabular information to be used for quick reference by the physician
hospitalists, dermatologists, infectious-disease
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• color illustrations of epidermal and cellular manifestations specialists, pediatricians, internists, and family
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• methods of differential diagnosis practitioners.”
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• disease incidence among gender and age groups by New England J Medicine, of the first edition e
geographical region s
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• specific antiviral and prophylaxis recommendations a
• laboratory findings and tests used to confirm diagnosis t
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• specific antiviral drugs and vaccines
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About the editors

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Stephen K Tyring, MD, PhD, MBA, is a Professor of Dermatology, Microbiology/Immunology, f

and Internal Medicine at the University of Texas Health Science Center at Houston, Texas, USA. V
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Angela Yen Moore, MD, is a Dermatologist at the Arlington Center for Dermatology and Clinical r
a
Assistant Professor of Dermatology at Baylor University Medical Center, Dallas, Texas, USA.
l

Omar Lupi, MD, MSc, PhD, is an Associate Professor of Dermatology and Professor of Internal D
Medicine at the Universidade Federal do Estado do Rio de Janeiro, Brazil. i
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Telephone House, 69-77 Paul Street, London EC2A 4LQ, UK and
52 Vanderbilt Avenue, New York, NY 10017, USA
Omar Lupi
www.informahealthcare.com
978-1420073126_TYRING.indd 1 5/3/10 08:32:19
Mucocutaneous Manifestations of
VIRAL DISEASES
Second edition

Mucocutaneous Manifestations of
VIRAL DISEASES
Second edition
edited by
Stephen K Tyring, MD, PhD, MBA
Professor of Dermatology, Microbiology/Immunology,
and Internal Medicine
University of Texas Health Science Center
Houston, Texas, USA
Angela Yen Moore, MD
Clinical Assistant Professor of Dermatology
Baylor University Medical Center and
Arlington Center for Dermatology
Dallas, Texas, USA
Omar Lupi, MD, MSc, PhD
Associate Professor of Dermatology
and Professor of Internal Medicine
Universidade Federal do Estado do Rio de Janeiro
Rio de Janeiro, Brazil
© 2010 Informa UK
Second edition published in 2010 by Informa Healthcare, Telephone House, 69-77 Paul Street, London EC2A 4LQ. Informa Healthcare
is a trading division of Informa UK Ltd. Registered Offi ce: 37/41 Mortimer Street, London W1T 3JH. Registered in England and Wales
number 1072954.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any
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by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP.
Although every eff ort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we
would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention.
A CIP record for this book is available from the British Library.
Library of Congress Cataloging-in-Publication Data
Data available on application
ISBN: 9781420073126
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Informa Healthcare
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Typeset by Amnet International, Dublin, Ireland
Printed and bound in Great Britain by MPG Books Ltd, Bodmin, Cornwall, UK
Table of Contents
List of contributors vi 15. Human T-Lymphotropic Virus 1 340
Preface viii Francisco Bravo and Kristien Verdonck
1. Cutaneous Virology 1 16. Reoviridae 349
Stephen K Tyring Brenda L Bartlett and Stephen K Tyring
2. Cutaneous Resistance to Viral Infections 20
17. Paramyxoviruses 353
Melissa C Morgan, Rashid M Rashid, and
Th ais Sakuma, Daniel Coimbra, Vera Y Soong,
Stephen K Tyring
and Tricia J Brown
3. Poxviruses 36
18-I. Filoviruses: Pathology and Eff ects on the
Jessica Clark and Dayna Diven
Innate Immune Response 368
Ramin Mollaaghababa Hakami and
4. Herpes Simplex Viruses 65
Derron A Alves
Richard J Whitley and John W Gnann Jr
18-II. Filoviruses: Clinical Manifestations 375
5. Varicella-Zoster Virus 98
Dieudonné Nkoghe, Eric Leroy,
Rosella Creed, Anita Satyaprakash,
Médard Toung Mve, and Jean Paul Gonzalez
and Stephen K Tyring
19. Bunyaviruses 383
6. Epstein-Barr Virus 123
Omar Lupi, Cinthia Diniz, Fabiana de Carvalho
S David Hudnall and Angela Yen Moore
Serra, and Elba Regina Sampaio de Lemos
7. Cytomegalovirus 145
20. Arenaviruses 400
Istvan Boldogh, Janak A Patel, Stephen K Tyring,
Omar Lupi, Cinthia Diniz, Fabiana de Carvalho
and Tasnee Chonmaitree
Serra, and Elba Regina Sampaio de Lemos
8. Human Herpesvirus 6 165
21. Enteroviruses 407
Jing Feng Gill and Angela Yen Moore
Kelly B Conner and Stephen K Tyring
9. Human Herpesvirus 7 178
22. Flaviviruses 419
Jing Feng Gill and Angela Yen Moore
Omar Lupi and Carlos Gustavo Carneiro
10. Human Herpesvirus 8 184
23. Togaviruses 447
S David Hudnall, Angela Yen Moore, and
William R Faber, Henry JC de Vries, and
Stephen K Tyring
Stephen K Tyring
11. Cercopithecine Herpesvirus 1 (Herpes B) 198
24. Hepatitis Viruses 466
L Katie Morrison, Beau Willison,
Catherine C Newman and John J Poterucha
Natalia Mendoza, and Stephen Tyring
12. Human Papillomaviruses 207 25. Prions 481
Anita Satyaprakash and Claire Mansur Omar Lupi
13. Parvovirus B19 253 26. Oral Manifestations of Viral Diseases 493
Alexandre Carlos Gripp, Elisa Fontenelle, Juan F Yepes
and Karen Wiss
27. Ocular Manifestations of Viral Diseases 504
14. Cutaneous Manifestations of HIV Infection 263 Alay S Banker, Urvashi Goja, and Deepa A Banker
Melissa C Morgan, Brenda L Bartlett,
Clay J Cockerell, and Philip R Cohen Index 519
v
List of contributors
Derron A Alves. United States Army Medical Research Elisa Fontenelle. Santa Casa da Misericórdia do Rio de Janeiro
Institute of Infectious Diseases Frederick, Maryland, USA and Hospital Municipal Jesus, Rio de Janeiro, Brazil
Alay S Banker. Banker’s Retina Clinic and Laser Centre, Jing Feng Gill. University of Washington School of Medicine,
Ahmedabad, Gujarat, India Seattle, Washington, USA
Deepa A Banker. Banker’s Retina Clinic and Laser Centre, John W Gnann, Jr. University of Alabama at Birmingham,
Ahmedabad, Gujarat, India Birmingham, Alabama, USA
Brenda L Bartlett. Center for Clinical Studies, Houston, Texas, Urvashi Goja. Banker’s Retina Clinic and Laser Centre,
USA Ahmedabad, Gujarat, India
Istvan Boldogh. University of Texas Medical Branch at Jean Paul Gonzalez. Centre International de Recherches Médi-
Galveston, Galveston, Texas, USA cales de Franceville, Franceville, Gabon
Francisco Bravo. Instituto De Medicina Tropical Alexander Alexandre Carlos Gripp. Universidade Estadual do Rio de
Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Janeiro, Rio de Janeiro, Brazil
Peru
Ramin Mollaaghababa Hakami. Faculty Research Partici-
Tricia J Brown. University of Oklahoma Health Sciences pation Program Oak Ridge Associated Universities Belcamp,
Center, Oklahoma, USA Maryland and United States Army Medical Research Institute of
Infectious Diseases Frederick, Maryland, USA
Carlos Gustavo Carneiro. Policlínica Geral do Rio de Janeiro,
Rio de Janeiro, Brazil S David Hudnall. Pathology and Laboratory Medicine, Yale
University School of Medicine, New Haven, Connecticut, USA
Tasnee Chonmaitree. University of Texas Medical Branch at
Galveston, Galveston, Texas, USA Elba Regina Sampaio de Lemos. Instituto Oswaldo Cruz, Rio
de Janeiro, Brazil
Jessica Clark. University of Texas Medical Branch, Galveston,
Texas, USA Eric Leroy. Centre International de Recherches Médicales de
Franceville, Franceville, Gabon
Clay J Cockerell. University of Texas Southwestern Medical
Center, Dallas, Texas, USA
Omar Lupi. Universidade Federal do Estado do Rio de Janeiro,
Rio de Janeiro, Brazil
Philip R Cohen. University of Houston and University of Texas
M.D. Anderson Cancer Center, Houston, Texas, USA
Claire Mansur. New England Medical Center, Boston, Massa-
chusetts, USA
Daniel Coimbra. Universidade Federal do Estado do Rio de
Janeiro, Rio de Janeiro, Brazil
Natalia Mendoza. Center for Clinical Studies, Houston, Texas,
USA
Kelly B Conner. University of Arkansas Medical School, Little
Rock, Arkansas, USA
Angela Yen Moore. Clinical Assistant Professor of Derma-
tology, Baylor University Medical Center and Arlington Center
Rosella Creed. University of Texas Health Science Center,
for Dermatology, Dallas, Texas, USA
Houston, Texas, USA
Melissa C Morgan. Th e University of Texas Health Science
Cinthia Diniz. Policlínica Geral do Rio de Janeiro, Rio de
Center at Houston, Houston, Texas, USA
Janeiro, Brazil
Dayna Diven. University of Texas Medical Branch, Austin, L Katie Morrison. Th e University of Texas Health Science
Texas, USA Center at Houston, Houston, Texas, USA
William R Faber. Academic Medical Center, University Of Médard Toung Mve. Centre International De Recherches Médi-
Amsterdam, Amsterdam, Th e Netherlands cales De Franceville, Franceville, Gabon
vi
Catherine C Newman. Mayo Clinic, Rochester, Minnesota, Vera Y Soong. University of Alabama at Birmingham School of
USA Medicine, Birmingham, Alabama, USA
Dieudonné Nkoghe. Centre International de Recherches Médi- Stephen K Tyring. Th e University of Texas Health Science
cales de Franceville, Franceville, Gabon Center At Houston, Houston, Texas, USA
Kristien Verdonck. Instituto De Medicina Tropical Alexander
Janak A Patel. University of Texas Medical Branch at Galveston,
Von Humboldt, Universidad Peruana Cayetano Heredia, Lima,
Galveston, Texas, USA
Peru
John J Poterucha. Mayo Clinic, Rochester, Minnesota, USA
Henry JC de Vries. Academic Medical Center, University of
Amsterdam, Amsterdam, Th e Netherlands
Rashid M Rashid. Th e University of Texas M.D. Anderson
Cancer Center, Houston, Texas, USA
Richard J Whitley. University of Alabama at Birmingham,
Birmingham, Alabama, USA
Th ais Sakuma. Universidade Federal do Estado do Rio de
Janeiro, Rio de Janeiro, Brazil
Beau Willison. Center for Clinical Studies, Houston, Texas, USA
Anita Satyaprakash. Loyola University Medical Center, Karen Wiss. University of Massachusetts Medical School,
Maywood, Illinois, USA Worcester, Massachusetts, USA
Fabiana de Carvalho Serra. Instituto Oswaldo Cruz, Rio de Juan F Yepes. University of Kentucky Colleges of Dentistry and
Janeiro, Brazil Medicine, Lexington, Kentucky, USA
vii
Preface to the second edition
Th e skin is the window of the body. Many viral diseases express transportation, social exchange and political boundaries, it is not
themselves through changes in skin appearance, skin lesions, only feasible that one or more of these rarer viral diseases could
edema, etc. Oft en the skin becomes a warning of internal mani- present itself at any physician’s offi ce in the world, many examples
festations signaling the physician to look beyond the window for of this occurrence have been documented since the fi rst edition of
other impacts. Th e contributors to the second edition of Muco- this book was published. Animal vectors and reservoirs are oft en
cutaneous Manifestations of Viral Diseases interact on a regular immigrants on baggage or agricultural products. Each chapter
basis with other dermatologists and virologists, or combinations includes, as appropriate, a timeline of infection and progress of
thereof. Th e book is an outgrowth of those daily consultations and the disease, numerous quality color illustrations of characteristic
discussions with other colleagues in various fi elds of medicine. As epidermal and cellular manifestations, a means to reference the
family practitioners are increasingly being called upon to provide diff erential diagnosis of viral diseases from other infectious or
their diagnosis and treatment of a wider variety of illnesses (those noninfectious diseases, a brief taxonomy and history of the dis-
previously referred to a specialist), a quick reference is needed. ease, incidence among gender and age groups by geographical
Th is book not only helps distinguish the cutaneous manifesta- region, pathogenesis, clinical manifestations, dermatopathology,
tions of one virus from another, but also helps diff erentiate viral laboratory fi ndings, diff erential diagnoses, and treatment/pro-
diseases from other infectious and noninfectious diseases. It is phylaxis. To the extent possible, we have used tabular information
intended for internists, dermatologists, pediatricians, and family for quick reference by the physician.
practitioners worldwide. Th e second edition of Mucocutaneous Manifestations of Viral
Th e goal of this book is to enhance the expertise of physicians Diseases is unique in that it covers the fi eld of viral diseases having
in the diagnosis, treatment and pathogenesis of viral diseases mucocutaneous manifestations and off ers the quality color photo-
that express their presence in the skin and its affi liated graphs associated with an atlas. Th e book also serves as a bibliog-
mucous membranes. No other text currently addresses the issues raphy for physicians wishing to broaden their knowledge of the
of the skin manifestations of viral diseases. Photographs in other primary literature. We envision the physician using the color pho-
texts to aid diagnoses were previously black and white and of tographs in considering the possible diagnoses. Th e diff erential
limited use to the physician. Many color atlases only encompass diagnosis section helps the physicians narrow the search for the
one or a few viral diseases, leaving the practioner with a desire virus causing the epidermal insult. Th e text would then provide
for more detail and/or a better explanation of possible mimics suggestions as to which laboratory tests might be useful to con-
of the diseases. fi rm the diagnosis. Finally, it outlines the appropriate treatment,
Th e contributing authors and editors have provided a text that including specifi c types of antiviral drugs and vaccines.
serves as a central resource for each of the viral diseases described. In summary, the editors hope that the second edition of
It should be of interest to physicians worldwide as we have Mucocutaneous Manifestations of Viral Diseases will fi ll a void in
included many diseases previously known only in third world, the medical literature and provide a valuable resource to a variety
developing countries. Given the global aspects of international of practicing physicians worldwide.
Stephen K Tyring
Angela Yen Moore
Omar Lupi
viii
1
Cutaneous Virology
Stephen K Tyring
Introduction range of presentations includes erythematous macules in epider-
Viral diseases may produce mucocutaneous manifestations either modysplasia verruciformis, smooth papules in bowenoid papu-
as the result of viral replication in the epidermis or as a secondary losis, and fungating Buschke-Lowenstein tumors. Th e primary
eff ect of viral replication elsewhere in the body. Most primary lesions in herpes simplex virus (HSV), varicella-zoster virus
epidermal viral replications result from three groups of viruses: (VZV), and many coxsackievirus infections are vesicles. Ery-
human papillomaviruses (HPV), herpesviruses, and poxviruses. thema and papules oft en precede the vesicles, which are followed
Secondary skin lesions are produced by such virus families as by pustules, crusts, or shallow ulcers. Cytomegalovirus (CMV)
retroviruses, paramyxoviruses, togaviruses, parvov iruses, and infections of the skin and mucous membranes, as well as HSV,
picornaviruses. Rhabdoviruses, rotavirus, etc., rarely induce skin VZV, or coxsackievirus infections of mucous membranes, can
lesions and are beyond the scope of this book. Th e mucocutaneous present as ulcers without other stages. Measles and rubella can
manifestations of subviral agents, such as viroids and prions, are be associated with both macules and papules. Epstein-Barr virus
only beginning to be understood. (EBV), human herpesvirus type 6 (HHV-6), and parvovirus B19
A number of cutaneous diseases appear to be viral exanthemas, infections may result in macules that coalesce into larger ery-
but no virus has been proven to be the etiologic agent in some of thematous patches. A spectrum of nonspecifi c skin lesions, such
these diseases. For example, pityriasis rosea (PR) is an acute, self- as erythema multiforme, urticaria, and petechiae, may be viral
limiting, cutaneous eruption with a distinctive course. Th e initial or nonviral in etiology. Mucocutaneous manifestations of viral
lesion, the herald patch, is followed aft er 1–2 weeks by a general- diseases can range from very specifi c (e.g., dermatomal vesicles
ized secondary rash, which typically lasts about 6 weeks (Fig. 1.1). of herpes zoster) to very general (e.g., urticaria); thus, the dif-
Like most viral infections, PR shows seasonal variability, with an ferential diagnosis must take the total clinical presentation of the
increased incidence in the autumn and winter and a decreased patient into consideration (Table 1.1). Some skin changes may be
incidence in the summer. A preceding upper respiratory infection is highly suggestive of a specifi c viral disease, such as the verrucous
oft en noted with PR, as are clusters of cases in time and space. papules seen with papillomavirus infection or smooth umbili-
Recently, PR was hypothesized to be due to infection with human cated papules resulting from poxvirus infection. Oft en, further
herpesvirus 7, and most controlled studies have supported this diagnostic tests may not be needed for these conditions. A dif-
hypothesis. ferential diagnosis, including both viral and nonviral etiologies,
Likewise, asymmetric perifl exural exanthem of childhood may be suggested by vesicles induced by HSV-1 or -2 or VZV
(APEC) or unilateral laterothoracic exanthem (ULE) is suspected or they may be diagnostic. Th e diagnosis may not be obvious
to be of viral etiology. It presents in children, six months to fi ve when any of these three viruses produce mucous membrane
years of age, in the winter and spring. Th e rash is unilateral on the lesions and further diagnostic procedures may be required. Less
trunk, oft en in the axillae or large fl exures of the limbs (Figs. 1.2 frequent skin manifestations may be produced by other herpes
and 1.3). It spreads centrifugally and to the contralateral side over viruses, such as EBV, CMV, and HHV-6. Th ese infections are
2–4 weeks and resolves in 6 weeks. Initially, red, 3-mm papules most accurately diagnosed only when the systemic manifesta-
appear, followed by a scarlatiniform or eczematous rash. Th ere tions of the viral infection are simultaneously considered. Th e
are no constitutional symptoms, but an enlarged lymph node is cutaneous manifestations would indicate the need to evaluate
usually observed at the primary site. Viruses that are suspected, systemic signs and symptoms and to institute appropriate diag-
but not proven to be of etiologic signifi cance, include parvovirus nostic tests in other diseases where viral replication is not in the
B-19, parainfl uenza 2 or 3, and adenoviruses. epidermis.
On the other hand, several new viral diseases, or viral diseases in
new geographic areas have been described recently. Th ese diseases
Pathophysiology
include infections due to Lujo virus (an arenavirus), bocavirus
Th ree diff erent routes are used by viruses to infect the skin:
(a parvovirus), bannavirus (a reovirus), TTV (a circovirus), Nipah
direct inoculation, local spread from an internal focus, or sys-
virus and metapneumovirus (paramyxoviruses), and zika virus
temic infection. Papillomaviruses, most poxviruses, and primary
(a fl avivirus). When cutaneous manifestations of such viruses are
HSV infect the skin by direct inoculation. Th e skin in primary VZV
reported, the description in the general medical literature is rarely
is infected from systemic infection, while recurrent VZV (shingles)
more specifi c than “rash” or “skin rash.” More specifi c descrip-
or recurrent HSV reaches the skin from an internal focus.
tions in the dermatology literature might aid in the more rapid
Skin lesions may be the direct eff ect of virus replication on
diagnosis of these diseases.
infected cells or the skin lesions may be the result of the host
response to the virus. Alternatively, an interaction of viral rep-
Clinical Manifestations lication and the host response may produce the lesions. Viruses
Viral infections can result in a wide spectrum of skin lesions. that replicate in the epidermis, for example, are generally directly
HPV infection frequently results in verrucous papules, but the responsible for the lesions. Skin lesions of rubella and measles, on