View source for Coxsackie virus

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{{CMG}}{{AE}}{{USAMA}}

{| class="infobox bordered" style="width: 15em; text-align: left; font-size: 90%; background:AliceBlue"
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| colspan="1" style="text-align:center; background:DarkGray" |
'''Coxsackie Virus'''

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[[Coxsackie virus#Overview|Overview]]
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|- bgcolor="Pink"
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[[Coxsackie virus#Classification|Classification]]
:[[Coxsackie A virus]]
:[[Coxsackie B virus]]
:[[Coxsackie B4 virus]]
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!

|- bgcolor="Pink"
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[[Coxsackie virus#Differential Diagnosis|Differential Diagnosis]]
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==Overview==

Coxsackie ([[virus]]) is a cytolytic virus of the [[picornaviridae]] family, an [[enterovirus]] (a group containing the [[poliovirus]]es, coxsackieviruses, and [[echovirus]]es). There are 61 non-polio enteroviruses that can cause disease in humans, of which 23 are [[coxsackie A virus]]es (6 are [[Coxsackie B]] viruses). [[Enterovirus]] are the second most common viral infectious agents in humans (after the [[rhinovirus]]es)

==Classification==
[[Coxsackie viruses]] consist of [[coxsackie A virus]] and [[coxsackie B virus]]. [[Coxsackie B virus]] has 6 serotypes, one of the significant serotypes is called [[coxsackie B4 virus]]. {{familytree/start}}
{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01= '''Coxsackie Virus'''}}
{{familytree | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| }}
{{familytree | | | | B01 | | | | | | | | | | | | | | | | B02 | |B01='''[[Coxsackie A virus]]''' | B02 ='''[[Coxsackie B virus]]'''<ref name="Fields Virology"> {{cite book
  | last = Fields
  | first = Bernard N.
  | coauthors = David M. Knipe, Robert M. Chanock, Joseph L. Melnick, Bernard Roizman, Robert E. Shope
  | title = Fields Virology
  | publisher = Raven Press
  | date = 1985
  | location = New York
  | pages =739-794
  | isbn = 0-88167-026-X}}</ref>
}}
{{familytree | | | | |!| | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.}}
{{familytree | | | | |!| | | | | | | | | | | | | |!| | | | | | | |!| | | | | | | | | | }}
{{familytree | | | | |!| | | | | | | | | | | | | B01 | | | | | | B02 | | B01 = '''Common [[Coxsackie B virus]] diseases''' | B02 = '''[[Coxsackie B4 virus]] diseases'''}}
{{familytree | | | | |!| | | | | | | | | | | | | |!| | | | | | | |!| | | | | | | | | | }}
{{familytree |boxstyle=text-align: left;  | | | | C01 | | | | | | | | | | | | C02 | | | | | | C03 | | | C01 =• [[Hand foot mouth disease|Hand, foot and mouth disease]]<br> • [[Acute hemorrhagic conjunctivitis]]<br>• [[Herpangina]]<br>• [[Aseptic meningitis]] | C02 =• [[Pericarditis]]<br>• [[Myocarditis]]<br>• [[Pericardial effusion]]<br>• [[Pleurodynia]] <br>• [[Hepatitis]] <br>• [[Sjögren's syndrome|Sjogren's syndorme]]<br>| C03 =• [[Diabetes mellitus]]<br>• Acute flaccid myelitis<ref name="pmid28324262">{{cite journal| author=Cho SM, MacDonald S, Frontera JA| title=Coxsackie B3/B4-Related Acute Flaccid Myelitis. | journal=Neurocrit Care | year= 2017 | volume=  | issue=  | pages=  | pmid=28324262 | doi=10.1007/s12028-017-0377-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28324262  }} </ref>
}}
{{familytree/end}}

==Differential Diagnosis==
[[Coxsackie A virus]] and [[coxsackie B virus]] can cause multiple diseases in humans. The wide array of diseases caused by [[coxsackie viruses]] can be differentiated from one another easily on the basis of involvement of the organs systems, clinical presentation and diagnostic techniques.
<small>
{| class="wikitable"
!Virus Type
!Disease
!Clinical Features
!Diagnosis
!Image
|-
| rowspan="4" |'''[[Coxscakie A virus]]''' 
|[[Hand foot and mouth disease]]
|
*[[Fever]]
*[[Headache]]
*Loss of [[appetite]]
*Maculopapular or [[vesicular rash]] with very small blisters on [[hand]]s, [[feet]], and diaper area; may be tender or painful if pressed
*[[Sore throat]]
*[[Ulcers]] in the [[throat]] (including [[tonsil]]s), [[mouth]], and [[tongue]]
|
*Throat and lesion swabs 
*[[Tzanck test]]
| [[File:Hand foot mouth disease-1.jpg|Hand foot and mouth disease|400px]]
|-
|[[Acute hemorrhagic conjunctivitis]]
|
*Rapidly progressive
*Infection starts [[ipsilaterally]], but rapidly involves the fellow eye within 1 or 2 days
*Eyelids swelling
*Tearing
*Eye redness
*Severe [[eye pain]]
*[[Purulent]] discharge
*Subconjunctival [[hemorrhage]]
|
*Positive conjunctival scraping for [[polymerase chain reaction|polymerase chain reaction (PCR)]]
*Positive viral culture of corneal epithelial cells for [[HSV]]
|[[File:Pink eye-1.jpg|Viral conjunctivitis|400px]]
|-
|[[Herpangina]]
|
*Sudden [[fever]]
*[[Sore throat]] and [[dysphagia]]- May occur up to 24 hours before the appearance of the xanthem
*[[Vomiting]]
*[[Abdominal pain]]
*[[Myalgia]] 
*[[Headache]]
*[[Pharyngeal]] lesions
|
*Primarily clinical
*[[Pharyngeal]] viral [[culture]]s may be helpful 
* Approximately 1 week after infection, type-specific [[antibodies]] appear in the blood
| [[File:Herpangina 2.jpg|Herpangina|400px]]
|-
|[[Aseptic meningitis|Aseptic Meningitis]]
|
*[[Headache]]
*[[Nuchal rigidity]] 
*[[Fever]] 
*[[Altered mental status]]
|
*Clinical
*[[Lumbar puncture]] [[CSF]] analysis
*[[CT]] rarely
|
|-
| rowspan="6" |'''[[Coxsackie B virus]]''' 
|[[Pericarditis]]
|
*[[Chest pain]] that radiates to the back, relieved by sitting up and leaning forward and is worsened by lying down. Deep [[inspiration]] and [[cough]] can increase the pain.
*[[Cough]] (either dry or productive)
*[[Fever]]
*[[Fatigue]]
*[[Anxiety]]
*[[Breathlessness]]
|
*Clinical
*[[EKG]]
*[[Cardiac biomarkers]]
**[[Creatine kinase]]
**[[Cardiac troponin]]-I (cTnI)
**Serum [[LDH]] , serum [[myoglobin]] and [[SGOT]] ([[AST]])
*[[Echocardiography]] and [[Percardiocentesis]]
| [[File:Pericarditis-1.jpg|Pericarditis|400x600px]]
|-
|[[Myocarditis]]
|
* [[Chest pain]] often described as stabbing, pleuritic or sharp in character 
* Swelling of the feet 
* [[Breathlessness]]
* [[Dyspnea on exertion]]
* [[Orthopnea]] 
* [[Palpitation]]s
* [[Syncope]] in setting of high grade [[AV block]]
* [[Fever]] (especially when infectious, e.g. in [[rheumatic fever]])
* [[Joint pains]] 
* [[Fatigue]] 
* [[Cyanosis]]
|
*Clinical
*Markers of Myonecrosis
**[[Creatine kinase]] (CK-MB)
**[[troponin|Cardiac troponin]] I (cTnI) or T (cTnT) are elevated more frequently than CK-MB (34-53% versus 2-6 %) as reported in two series.<ref name="pmid8994432">{{cite journal| author=Smith SC, Ladenson JH, Mason JW, Jaffe AS| title=Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates. | journal=Circulation | year= 1997 | volume= 95 | issue= 1 | pages= 163-8 | pmid=8994432 | doi= | pmc= | url= }} </ref>
**[[Lactate dehydrogenase]] (LDH)
**[[Alanine transaminase]] (ALT)
**[[Aspartate transaminase]] (AST)
| [[File:File:Acute Rheumatic Myocarditis-1.jpg|Viral myocarditis|400px]]
|-
|[[Pericardial effusion]]
|
*[[Chest pain]]
*[[Dyspnea]] 
*Nonspecific chest discomfort
|
*Clinical
* Thoracic [[X-ray]] showing the presence of an enlarged cardiac silhouette with clear lungs
*[[CT scan]]
| [[File:Pericardial_effusion-1.jpg|Pericardial effusion|400px]]
|-
|[[Pleurodynia]]
|
*[[Fever]]
*[[Headache]]
*Attacks of severe pain in the lower chest, often on one side
*[[Pleuritic pain]] with the slightest movement of the [[rib cage]] 
*[[Dyspnea]]
*Very few have classic muscle pain in the chest and upper abdomen
*May be accompanied by a panic attack
|
*Clinical
*[[CXR]]
|
|-
|[[Hepatitis]]
|
* [[Abdominal pain]] or distention
* [[Gynecomastia]]
* Dark urine and pale or [[clay-colored stools]]
* [[Fatigue]]
* [[Fever]], usually low-grade
* General [[itching]]
* [[Jaundice]] (yellowing of the skin or eyes)
* [[Loss of appetite]]
* [[Nausea]] and [[vomiting]]
* [[Weight loss]]
|
* [[Liver function tests]]
|
|-
|[[Sjogren's syndrome]]
|
*Dry eyes
*Dry mouth
*[[Xerosis]]
*[[Raynaud phenomenon]] and [[vasculitis]]
*Joint and muscle abnormalities
*[[Interstitial lung disease]]
*Gastrointestinal manifestations
*[[CNS]] involvement
|
*Clinical
*[[Autoantibodies]]
**Anti-Ro/SSA and anti-La/SSB antibodies
**[[Anti-centromere antibodies]]
| [[File:Sjogren's syndrome-1.jpg|Sjogren's syndrome|400px]]
|}</small>
{{viruses}}

Coxsackie virus oral lesions must be differentiated from other mouth lesions such as oral candidiasis and aphthous ulcer

=== Oral Involvement<small><small> ===
Coxsackie virus infection must be differentiated from other diseases presenting with pain and blistering within the mouth such as gingivostomatitis and glossitis.
<div style="width: 70%;">
<small><small>
{| class="wikitable"
!Disease
!Presentation
!Risk Factors
!Diagnosis
!Affected Organ Systems
!Important features
!Picture
|-
! colspan="3" |Diseases predominantly affecting the oral cavity
!
!
!
!
|-
|[[Oral candidiasis|Oral Candidiasis]]
|
* [[Dysphagia]] or [[odynophagia]]
* White patches on the mouth and tongue
|
*[[Newborn]] babies

*Denture users

*Poorly controlled [[diabetes]]

*As a side effect of medication, most commonly having taken [[antibiotic]]s. Inhaled [[corticosteroids]] for the treatment of lung conditions (e.g, [[asthma]] or [[COPD]]) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication.

*People with poor [[nutrition]], specifically [[vitamin A]], [[Iron deficiency anemia|iron]] and [[Folate deficiency|folate deficiencies]].

*People with an [[immune deficiency]] (e.g. as a result of [[AIDS]]/[[HIV]] or [[chemotherapy]] treatment).

*Women undergoing hormonal changes, like [[pregnancy]] or those on [[birth control pills]].

*[[Organ transplantation]] patients
|
* Clinical diagnosis
* Confirmatory tests rarely needed
|'''Localized candidiasis'''
* [[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]]
* [[Candida vulvovaginitis]]
* [[Chronic mucocutaneous candidiasis]]

'''Invasive candidasis'''
* [[Candidiasis|Candidaemia]]
* [[Endocarditis|Candida endocarditis]]
* [[Osteoarthritis|Candida osteoarticular disease]]
|
* [[Osteoarthritis|Oral candidiaisis is]] a benign self limiting disease unless accompanied by [[immunosuppression]].
|[[File:Human tongue infected with oral candidiasis--By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|thumb|Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|400x400px]]
|-
|[[Herpes simplex|Herpes simplex oral lesions]]
|
* [[Fever]]  
* [[Sore throat]]
* Painful [[ulcer]]s
|
* Stress
* Recent [[URTI]]
* Female sex
|
* Physical examination
* [[Viral culture]]
* [[Tzanck smear]]
|
* Orofacial Infection
* [[Herpes simplex anogenital infection|Anogenital Infection]]
* [[Herpes simplex ocular infection|Ocular Infection]]
* [[Herpes simplex encephalitis|Herpes Encephalitis]]
* [[Herpes simplex neonatorum|Neonatal Herpes]]
* [[Herpetic whitlow|Herpetic Whitlow]]
* [[Herpes gladiatorum|Herpes Gladiatorum]]
|
* The symptoms of primary [[HSV]] infection generally resolve within two weeks
|[[File:Herpesinfection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|thumb|Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|400x400px]]
|-
|[[Aphthous ulcer|Aphthous ulcers]]
|
* Painful, red spot or bump that develops into an open [[ulcer]]
|
* Being a female
* Between the ages of 10-40
* Family history of [[Aphthous ulcer|aphthous ulcers]]
|
* Physical examination
* Diagnosis of exclusion
|
* Oral cavity
|
* Self-limiting , [[Pain]] decreases in 7 to 10 days, with complete healing in 1 to 3 weeks
|[[File:Afta foto - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358.jpg|thumb|Apthous ulcer on the under surface of the tongue|By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358|400x400px]]
|-
|[[Squamous cell carcinoma]]
|
*Non healing [[ulcer]], [[nodule]], indurated plaque or mass
*May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]]
|
* Chronic sun or [[Ultraviolet|UV exposure]]
* Fair [[skin]]
* [[Elderly]] age (>45 yrs)
* [[Male sex]]
* [[Smoking]]
|
*[[Physical exam]]
*[[Biopsy]]
|
*[[Oral Cavity]]
**Floor of [[mouth]]
**Lateral [[tongue]]
*[[Throat]]
*[[Esophagus]]
|
*[[Malignant]]
*Can spread to [[TMJ]]
*Some times associated with [[leukoplakia]]
|[[File:PLoS oral cancer.png|thumb|400x400px| |Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632]] 
|-
|[[Leukoplakia]]
|
*White leathery spots on the [[mucous membranes]] of the [[tongue]] and inside of the [[mouth]]
*Lateral borders of [[tongue]]
|
*Atypical [[Tobacco]] use
*Chronic [[irritation]]
*[[Immunodeficiency]]
*[[Bloodroot]] ([[Sanguinarine|sanguinaria]])
|
*[[Physical exam]]
*Diagnosis of exclusion
*[[Biopsy]]
|
*[[Vulva|Vulvar]] lesions occur independent of oral lesions
|
*Associated with [[HIV]]
*Persistant white spots
*[[Benign]] but can progress to [[carcinoma]] after almost 10 years
*Oral proliferative [[Leukoplakia|verrucous leukoplakia]] is an aggressive sub type with multiple lesions and higher conversion to [[warts]] or [[carcinoma]]<ref>{{Cite journal
 | author = [[Ann M. Gillenwater]], [[Nadarajah Vigneswaran]], [[Hanadi Fatani]], [[Pierre Saintigny]] & [[Adel K. El-Naggar]]
 | title = Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!
 | journal = [[Advances in anatomic pathology]]
 | volume = 20
 | issue = 6
 | pages = 416–423
 | year = 2013
 | month = November
 | doi = 10.1097/PAP.0b013e3182a92df1
 | pmid = 24113312
}}</ref>
|[[File:Oral hairy leukoplakia (EBV, in HIV)a.jpg|thumb|400x300px|Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087]]
|-
|[[Melanoma]]
|
*A lesion with [[ABCD]]
**[[Asymmetry]]
**Border irregularity
**Color variation
**[[Diamete]]r changes
*[[Bleeding]] from the lesion
|
*[[Ultraviolet|UV radiations]]
*[[Genetic predisposition]]
*[[Old age]]
*[[Male gender]]
*Family or personal history of [[melanoma]]
*Multiple benign or atypical [[Nevus|nevi]]
|
*[[ABCD]] characteristics
*[[Bleeding]] or [[ulceration]] may show [[malignancy]]
*Serum [[LDH]] may be elevated in case of [[malignancy]]
*[[Biopsy]]
|
*Can [[metastasize]]
*All [[UV radiation]] or sun exposed areas can be effected independently
*1-2 to hundreds of [[granules]]
|
*[[Neural crest cell]] derivative
*Development begins with disruption of [[nevus]] growth control
*Progression involves [[MAPK/ERK pathway]]
*[[RAS|N-RAS]] or [[BRAF]] [[oncogene]] also involved
|[[File:Palate malign melanoma 01.jpg|thumb|400x400px|Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), [1], CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811]]
|-
|[[Fordyce spots]]
|
*Rice-like [[granules]] or [[spots]]
*Small, [[painless]], [[raised]], [[pale]], red or white
*1 to 3 mm in [[diameter]]
|
*Greasy skin types
*Some [[Rheumatic|rheumatic disorders]]
*[[Hereditary nonpolyposis colorectal cancer]]
**Lower [[gingiva]] (gums) 
**[[Vestibular system|Vestibular mucosa]]
|
*[[Physical exam]]
*Small [[keratin]]-filled [[pseudocysts]]
*May be seen on [[incidental]] [[mucosal]] [[biopsy]]
**[[Biopsy]] not done for them primarily
|
*[[Oral cavity]]
**[[Vermillion border|Vermilion border]] of the lips
**[[Oral mucosa]] of the upper lip
*[[Buccal mucosa]] in the commissural region often bilaterally
*[[Genitals]]
|
*[[Benign neoplasms]] with [[sebaceous]] features
*Visible [[sebaceous glands]]
*No surrounding [[mucosal]] change
*Several adjacent [[glands]] may coalesce into a larger cauliflower-like cluster
|[[File:Fospot.jpg|thumb|400x400px|Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899]]
|-
|[[Burning mouth syndrome]]
|
*Burning or [[tingling]] on the [[lips]], [[tongue]], or entire [[mouth]]
|
*[[Nutritional deficiencies]]
*Chronic [[anxiety]] or [[depression]]
*[[Diabetes type 2]]
*[[Menopause]]
*[[Oral thrush]] or [[dry mouth]], or damaged [[nerves]] transmitting taste
*[[Female gender ]]
*[[Menopause]]
|
*[[Presentation]]
*[[Physical exam]]
|
*[[Oral cavity]]
|
*Pain typically is low in the morning and builds up over the day
*Low dosages of [[benzodiazepines]], [[tricyclic antidepressants]] or [[anticonvulsants]] may be effective
|
|-
|[[Torus palatinus]]
|
*Bony growth on midline of the [[hard palate]]
*[[Nodular]] mass covered with normal [[mucosa]]
|
*[[Genetic predisposition]]
**[[Autosomal dominant]]
|
*[[Physical exam]]
*Types
**[[Torus palatinus|Flat tori]]
**[[Torus palatinus|Spindle tori]]
**[[Torus palatinus|Nodular tori]] 
**[[Torus palatinus|Lobular tori]] 
|
*[[Hard palate]]
|
*More common in [[Asian]] and Inuit populations
*Twice more common in [[females]]
*Repeated [[trauma]] can cause [[bleeding]]
*[[Surgery]] may be required in symptomatic
|[[File:06-06-06palataltoria.jpg|thumb|Torus palatinus|400x400px|Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591]]
|-
| colspan="4" |'''Diseases involving oral cavity and other organ systems'''
|
|
|
|-
|[[Behçet's disease|Behcet's disease]]
|
*Painful [[mouth sores]]
*[[Acne]] like skin lesions
*Headache, [[fever]], poor [[balance]], [[disorientation]]
*[[Abdominal pain]], [[diarrhea]] or [[bleeding]]
*[[Uveitis]]
*Joint [[swelling]] and joint [[pain]]
*Genital [[sores]] wit [[pain]] and [[scaring]]
*[[Aneurysms]]
|
*Over active [[immune system]]
|
*[[Physical examination]]
|
*[[Mouth]]
*[[Genitals]]
*[[GIT]]
*[[Eye]]
*[[Joints]]
*[[Skin]]
*[[Vascular system]]
*[[Brain]]
|
*[[Outbreaks]] of exaggerated [[inflammation]]
*Affects smaller [[blood vessels]]
|[[File:Behcets disease.jpg|thumb|400x400px|Behcet's disease - By Ahmet Altiner MD, Rajni Mandal MD - http://dermatology.cdlib.org/1611/articles/18_2009-10-20/2.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17863021]]
|-
|[[Crohn's disease]]
|
*Chronic, episodic [[diarrhea]] or [[constipation]]
*[[Abdominal pain]]
*[[Vomiting]]
*[[Weight loss]] or [[weight gain]]
|
*[[Smoking]]
*[[Whites]] and [[European]] [[Jews]]
*[[Hormonal contraception]]
*Diets high in microparticles, sweet, fatty or refined foods
*Industrialized country
|
*Typical [[history]] and [[symptoms]]
*[[Skip lesions]] on [[biopsy]]
*[[Anti saccharomyces cerevisiae antibodies|Anti-Saccharomyces cerevisiae antibodies (ASCA)]]
*[[Anti-neutrophil cytoplasmic antibodies]] ([[ANCA]])
|
*[[Eyes]]
*[[Joints]]
*[[Skin]]
|
*May lead to
**[[Obstruction]]s
**[[Abscess]]es
**Free [[perforation]]
**[[Hemorrhage]]
|
|-
|[[Agranulocytosis]]
|
*[[Fever]] or [[chills]]
*Frequent [[infections]]
*Unusual [[redness]], [[pain]], or [[swelling]] around a wound
*Mouth [[ulcers]]
*[[Abdominal pain]]
*[[Burning sensation when urinating]]
*[[Sore throat]]
|
*[[Medications]]<ref name="PMID17142169">{{cite journal |author=Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. |title=Idiosyncratic drug-induced agranulocytosis: Update of an old disorder. |journal=Eur J Intern Med. |volume=17|issue=8 |pages=529-35 |year=2006|pmid 17142169|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17142169}}</ref>
*[[List of chemotherapeutic agents#Cytotoxic Chemotherapy|Cytotoxic chemotherapy]]
*[[Hematological malignancy|Hematologic malignancies]]
*[[Autoimmune disorders]]
|
*[[Neutropenia]] <100 cells per micro litre
*[[Eosinopenia]]
*[[Basopenia]]
|
*[[Oral cavity]]
*[[Skin]]
*[[GIT]]
*[[Urinary system]]
*[[Conjunctiva]]
|
*[[Immunocompromised|Immunocompromization]]
*Types
**[[Drug-induced]]
**[[Malignant]]
**[[Autoimmune]]
|
|-
|[[Syphilis]]<ref> title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"</ref>
|
*[[Chancre]]
*Regional [[lymphadenopathy]]
|
*[[Multiple sexual partners]]
*Illicit [[drug use]]
*[[Unprotected sex]]
*[[Homosexual men|Men who have sex with men]]
*Residence in highly prevalent areas
*[[Human Immunodeficiency Virus (HIV)|HIV]] infection
*Presence of other [[STI]]s
*Previous history of [[Sexually transmitted disease|STIs]]
*[[Intravenous drug use]]
|
*[[Darkfield microscope|Darkfield microscopy]]
*Non [[Treponema|treponemal]] tests like [[VDRL]] and [[RPR test]]) 
*[[Treponema|Treponemal]] tests[[FTA-ABS|FTA-ABS tests]], (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]])
|
*[[Oral cavity]]
*[[Penis]]
*[[Cervix]]
*[[Labia]]
*[[Anal canal]]
*[[Rectum ]]
*[[CNS]]
*[[Cardiovascular|CVS]]
|
*[[Primary syphilis]]
**[[Chancre]]
*[[Secondary syphilis]]
**[[Condyloma latum|Condylomata lata]]
*[[Latent syphilis]]
**[[Asymptomatic]]
*[[Tertiary syphilis]]
**[[Gumma|Gummas]]
**[[Neurosyphilis]]
|[[File:Hutchinson teeth congenital syphilis PHIL 2385.rsh.jpg|thumb|400x400px|oral syphilis - By CDC/Susan Lindsley - http://phil.cdc.gov/phil_images/20021114/34/PHIL_2385_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134349]]
|-
|[[Coxsackie virus]]
|
*[[Fever]] 
*[[Sores]] in the [[mouth]]
*[[Rash]] with [[blisters]]
*[[Aches]]
|
*[[Pregnancy]]
*[[immunodeficiency]]
|
*[[History]] and [[Physical exam]]
*[[Swabbing|Throat swabs]]
*Swabs from the lesion 
*[[Tzanck test]]
|
*[[Oral cavity]]
*[[Skin]]
|
*Symptomatic treatment
|[[File:Hand foot mouth disease 07a.jpg|Hand-foot-and-mouth disease|400x400px]]
|-
|[[Chickenpox|Chicken pox]]
|
*[[Conjunctival]] symptoms
*[[Catarrhal]] symptoms 
*Characteristic [[spots]] on the trunk appearing in two or three waves
*[[Itching]]
|
*[[Pregnancy]]
*[[Premature infants]] born to susceptible mothers
*All [[infants]] born at less than 28 weeks [[gestation]] or who weigh =1000 grams
*[[Immunocompromised]]
|
*[[History]] and [[physical exam]]
*[[PCR]] to detect [[VZV]] in [[skin lesions]] ([[vesicles]], [[scabs]], [[Maculopapular|maculopapular lesions]])
|
*[[Oral cavity]]
*[[Skin]]
|
*[[Sodium bicarbonate]] in baths or [[antihistamines]] for [[itching]]
*[[Paracetamol]] ([[acetaminophen]]) for [[fever]]
*[[Prednisolone]] is [[contraindicated]]
|[[File:Herpangina2016.jpg|thumb|400x400px|Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565]]
|-
|[[Measles]]
|
*[[Fever]]
*[[Rash]]
*[[Cough]]
*[[Coryza]] (runny nose)
*[[Conjunctivitis]] (pink eye)
*[[Malaise]]
*[[Koplick spots]] in mouth
|
*Unvaccinated individuals<ref name="pmid11135778">{{cite journal| author=Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE| title=Individual and community risks of measles and pertussis associated with personal exemptions to immunization. | journal=JAMA | year= 2000 | volume= 284 | issue= 24 | pages= 3145-50 | pmid=11135778 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11135778  }} </ref><ref name="pmid9009400">{{cite journal| author=Ratnam S, West R, Gadag V, Williams B, Oates E| title=Immunity against measles in school-aged children: implications for measles revaccination strategies. | journal=Can J Public Health | year= 1996 | volume= 87 | issue= 6 | pages= 407-10 | pmid=9009400 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9009400  }} </ref>
*Crowded and/or unsanitary conditions
*Traveling to less developed and developing countries
*Immunocompromized
*Winter and [[spring]] seasons
*Born after 1956 and never fully vaccinated 
*Health care workers
|
*[[History]] and [[examination]]
*[[PCR]] for [[Measles]]-specific [[IgM|IgM antibody]]
*[[PCR]] for [[Measles]] [[RNA]]
|
*[[Oral cavity]]
*[[Skin]]
*[[Respiratory tract]]
*[[Eyes]]
*[[Throat]]
|
*Caused by [[Morbillivirus]]
*Primary site of infection is the [[respiratory epithelium]] of the [[nasopharynx]]
*Transmitted in [[respiratory secretions]], via [[aerosol droplets]] containing [[Virus|virus particles]]
|[[File:Koplik spots, measles 6111 lores.jpg|thumb|400x400px|Koplick spots (Measles) - By CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=824483]]
|}</small></small>
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