Viral syndrome

Background

• Among the most common illnesses encountered in ED
• Majority trivial, some may be life-threatening
• Depending on the type of virus: may be transmitted via direct contact, droplet, fecal-oral, saliva, sexual contact, venereal, or vertical transmission.

Clinical Features

• Generalized viral features
  • Myalgia
  • Arthralgia
  • Fever
  • Lymphadenopathy
  • Rash
• Specific viral syndromes
  • Gastroenteritis
  • Encephalitis
  • Hepatitis
  • Meningitis
  • Pneumonia
  • URI

Differential Diagnosis

Viral infections

• Adenovirus
• Acute Bronchitis
• Arbovirus
• CMV
• Coronavirus
• Coxsackievirus
  • Hand-foot-and-mouth disease
• Herpesvirus
  • Herpangina
• HIV (Acute Retroviral Syndrome)
• Infectious mononucleosis (EBV)
• Influenza virus
• Laryngitis
• Rhinovirus
• Varicella

Diagnosis

• Clinical diagnosis
• Serology testing may be indicated to diagnose or rule-out life-threatening causes

Management

• Symptomatic management
• Exclude other causes if serious presentation
  • Consider empiric acyclovir and antibiotics until HSV and bacterial causes ruled out.

References

• Takhar SS, Moran GJ. Disseminated Viral Infections. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011.