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82 Cards in this Set
- Front
- Back
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What is the Herpesviridae genome based on (DNA or RNA)?
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linear dsDNA
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What is the structure of a Herpesviridae virus?
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1. icosahedral structure capsid
2. tegument - lies between capsid and envelope, kind of like cytoplasm 3. envelope - derived from inner nuclear membrane, 11 types of glycoprotein peplomers that assists in absorption, penetration and binding Fc portion of IgG (pic) |
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Herpesviridae experiences latency. What is latency, and what is happening with the virus during this time?
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1. no protein expression
2. no replication, but viral DNA is in cells 3. can occur at many different sites: HSV and VZV occur in ganglia whereas EBV , CMV, and HHV-6 occur in white blood cells |
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What immunological action can stop latency in viruses?
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none. once you have an infection with viruses that use latency, you will experience latency.
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How is Herpes simplex virus transmitted?
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direct contact with lesions or surfaces that will lesion
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What is the Herpes simplex pathogenesis?
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1. personal contact where transmission can occur with lesion, shedding area, mucous membrane or abraded skin
2. ~6 day incubation period 3. primary infection occurs with replication at site of infection 4. in ~ 20 days, virus begins shedding 5. virus infects local nerve ending and travels retrograde to dorsal root ganglia where latency is established 6. initial infection site heals without scarring |
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What is significant about Herpes simplex infections in immunocompromised patients?
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HSV can go systemic
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How does primary infection of HSV present?
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fluid filled vesicles on the surface of the skin that is FULL of HSV (pic)
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How does latent infection of HSV present?
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LATS - latency associated transcripts are produced from HSV in dorsal root ganglia, but doesn't seem to do anything
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How does recurrent infection of HSV present?
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milder and shorter than primary infection, but usually at the same site and produces a similar lesion
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What are the two subtypes of HSV and where they they "traditionally" present.
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HSV-1 - above the waist
HSV-2 - below the waist |
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What types of HSV orofacial primary infections occur?
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mostly subclinical in children < 5 y/o
1. herpes stomatitis 2. acute herpetic gingivostomatits |
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What symptoms occur with primary orofacial infections of HSV?
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fever, anorexia
mouth sores gingivitis swamp breath from anaerobic bacterial growth secondary to HSV salivation/drool containing HSV |
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What is auto-inoculation?
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bursting vesicles contain HSV and can be spread to different sites just by getting the HSV on one's hands
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What is the Tx for orofacial HSV?
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supportive. assist with decreasing pain pain to increase nutrition and hydration because of pain in mouth.
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What is oral herpes labialis?
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fever blisters/cold sores
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What is significant about current culture and oral herpes labialis?
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it is the largest reservoir of HSV infections in our culture
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How long do HSV vesicles typically last?
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48 hrs
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What is the Tx for Oral herpes labialis?
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supportive. there is a topical tx to stop replication, but it will not get rid of cold sores.
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What is the common cause of herpetic keratoconjunctivitis HSV?
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auto inoculation
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What is the problem with HSV conjunctivitis?
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there is scarring in the eye as a result of the immune response to all recurrent infections, so this is slowly hurting the eye.
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What is the tx for recurrent ocular herpes?
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IUdR or trifluorothymidine can be used to stop replication
DO NOT use steroids - can cause ulcers to extend and invade stroma or cause corneal perforation |
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What is Traumatic herpes?
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traumatic event that occurs causing skin lesion that is exposed to HSV shedding at the same time. can happen in high school sports.
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What does HSV-2 genital herpes in children usually imply?
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child abuse.
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Can the neonate get herpes during birth?
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yep.
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What symptoms occur with primary genital HSV infections in females?
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1. bilateral vulva lesions
2. sometimes cervix is involved 3. local tenderness and burning of labia and vaginal mucosa 4. lesions can spread to all of vaginal (internal and external) and perianal areas 5. profuse watery discharge 6. vesicles rupture and leave very tender yellow-gray exudate ulcers surrounded by red areola |
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What symptoms appear in male infection of genital HSV infection?
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1. lesions on glans or shaft, thigh, buttocks, perianal
2. fever, dysuria, malaise 3. anal infection can occur with anal sex |
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What should you always remember about primary versus recurrent infections?
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recurrent will always be shorter and less severe
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Why is there a difference between HSV genital herpes recurrent infections in men and women?
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There really isn't that big of a difference except that 20% of women don't know they have a recurrent infection and they still shed virus. It is much easier to see it when men have a recurrent infection.
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What is Herpetic Whitlow?
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HSV-1 or HSV-2 infections of the fingers
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What is Eczema Herpeitcum?
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generalized HSV skin infection occurs somtimes in burn patients and immunocompromised
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What is Herpes encephalitis?
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HSV-1 (acquired in adulthood) or HSV-2 (usually caused by birth) caused infection of orbitalfrontal and temporal regions
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How is Herpes encephalitis dx?
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PCR of HSV DNA in CSF
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What is the preferred tx for HSV primary infections?
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oral acyclovir
topical acylclovir IV with disseminated infections |
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What is the tx for HSV recurrent infection?
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prophylactic acyclovir
oral acyclovir |
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What is chickenpox?
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Varicella-Zoster Herpes virus
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How is Varicella-Zoster transmitted?
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inhalation of skin particles
direct contact with vesicular lesion HIGHLY contagioius until lesions crust over |
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What is the pathogenesis of Varicella-Zoster?
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1. exposure and transmission
2. respiratory epithelial cells are infected 3. 2 week incubation period 4. prodrome accompanying viremia 5. lesions form in the order of scalp, trunk, extremeties |
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What is the difference between child chickenpox and adult chickenpox?
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adult = much more severe
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What is the tx for chickenpox?
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supportive.
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What should you NOT give a child with chickenpox?
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aspirin -> Reye's Syndrome
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What is shingles?
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reactivated Varicella-Zoster virus, so you have to have been exposed to chickenpox. increases with age. Zoster is the part of VZV that is the shingles virus. occurs within one dermatome.
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What is VZV?
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Varicella-Zoster Virus
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What is the most troubling VZV shingles?
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PAIN PAIN PAIN
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What is the tx of VZV shingles?
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IUdR will shorten duration and can reduce pain
Acyclovir can help in pts over than 50 |
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How can you prevent VZV?
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Live attenuated vaccine - Oka/Merck strain
First dose - 12 to 15 mos old Second dose - 4-6 y/o doses must be 3 mos apart |
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What is VZIG?
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Passive immunization for immunocompromised pts.
VZIG = Varicella-Zoster immune globin |
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What family of virus is Cytomegalovirus?
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Herpesviridae
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What times of life are humans most prone to getting cytomegalovirus?
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infancy by congenital transmission
reproductive years through sexual contact |
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Where is cytomegalovirus found in the body?
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oropharyngeal, urine, cervical, vaginal, spermatic, breast milk, tears, feces, blood
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How does CMV present in healthy individuals?
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asymptomatic and benign
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How does CMV present in fetus, neonates and immunosuppressed patients.
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With pregnant primary infections, CMV is the #1 cause of viral birth defects - hearing loss, mental retardation. Immunosuppressed can have all kinds of problems.
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How are fetus and neonates infected?
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Transplacental transmission
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At what time during pregnancy is the fetus at greatest risk for the hazards of primary infection of the mother?
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first 2 trimesters
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What is Post-perfusion syndrome?
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CMV infection by recipients of blood products
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What is an Owl's eye inclusion?
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caused by CMV infection and there is an inclusion in the cell nucleus of the infected host cell that looks like a giant owl's eye histologically
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What is CMV mononucleosis?
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a rare clinical presentation characterized by fever, tonsillitis, generalized mild lymphadenophthy, splenomegally, leukocytosis, self-limiting
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What is a clinically signal that pt has CMV mononucleosis?
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pt will be heterophil-negative
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what disease causes the problems for the fetus with CMV infection of the mother?
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Cytomegalic Inclusion Disease (CID)
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What clinical symptom is apparent with fetal infection of CMV?
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fetus displays hepatosplenomegaly and microcephaly, and later in life a lot of mental retardation and CNS related deficiencies
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What is the worst place for a seronegative pregnant woman to be if they want to avoid CMV infection?
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say care centers!
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CMV pneumonia
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second most common cause of primary or reactivated CMV infections in transplant pts usually happens after bone marrow transplant
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Cotton wool spots
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CMV caused Chorioretinitis that usually occurs with immunosuppressed patients and is scar tissue built up in the eye
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What is the tx for chorioretinitis relative to CMV infection?
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life-long treatment of foscamet, but foscamet is associated with renal failure
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Dx of CMV
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Owl's eye inclusions, serotyping, mono-like symptoms with heterophil antibody negative, newborns with microcephaly, jaundice, hepatosplenomegaly
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Tx of CMV
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1. ganciclovir is virostatic
2. CMV immune globulin (Cytogam) |
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How is Epstein-Barr virus transmitted?
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saliva
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Epstein-Barr virus primary target?
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epithelial cells within the oropharynx
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Epstein-Barr abortive infection?
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B cells can be infected, but EBV cannot replicate in a B cell, so they cannot be lysed by EBV
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What happens when EBV infects many B cells?
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an infected B cell will display monoclonal Ab and heterophil Ab, so you can use heterophil positive Ab serotyping to diagnose EBV
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What is significant about the hetrophil Ab that EBV infected B cells secrete?
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nothing except that it's diagnostically relevant. the Ab are not specific for anything.
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What common disease is caused by EBV?
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mononucleosis (glandular fever)
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What is the main complaint of an EBV infection?
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pharyngitis and bilateral cervical lymph node swelling, high fever, night sweats, profound fatigue
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What's the weird thing about amphicillin and mono?
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100% of pts that have mono, if you give them amphicillin, they will break out in a rash. interesting.
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What is an atypical lymphocyte?
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found via blood smear with EBV mono that shows a lymphocyte with a giant nearly 50% segmented portion of cytoplasm
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Why should mono (IM) patients NOT play contact sports?
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splenic rupture is a concerning complication of IM
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What is Burkitt's lymphoma (BL)?
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EBV caused lymphoma found more often in Africa and Paupau New Guinea. Usually considered to be a problem with genetically predisposed conditions.
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What two diseases are related to EBV Burkitt's lymphoma?
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malaria and HIV
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How does BL present?
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tumors that form near the jaw, but can also form in the kidney, liver, lymph node, tissue of the gut, salivary glands, adrenal, ovaries, testes
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What other disease is correlated with EBV in that they both display rising titers to EBNA and VCA?
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multiple sclerosis (MS)
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Is Chronic Fatigue Syndrome the same as mono EBV?
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NO
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What is the treatment for EBV?
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supportive
avoid ampicillin Acyclovir is not usually effective |
