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71 Cards in this Set
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- Back
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affects mucoepithelial cells
latency in neurons |
alpha herpes
(Herpes simplex) |
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infect and establish latency in T-cells and macrophage lineages
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beta herpes
(CMV, HHV-6,7) |
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infect and establish latency in B-cells
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gamma herpes
(EBV) |
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Herpes
envelope? strand? |
enveloped
dsDNA |
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neurovirulence
latency reactivation |
HSV
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HSV
5 stages |
1. acute mucocutaneous infection
2. spread to local sensory nerve endings 3. neural latency 4. reactivation and distal spread 5. recurrent cutaneous infection |
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HSV
where does replication occur? |
skin/mucous membrane @ initial site of infection
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HSV-2
latency location? |
lumbar and sacral ganglia
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HSV-1
latency location? |
trigeminal ganglia
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what type of pts face risk of HSV-1 and 2 reactivation
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AIDS
transplant (immunocompromised) |
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reactivators of HSV
what happens? |
sunlight
sunburn trauma stress fever migrates down the neuron -> replicates in skin -> lesion |
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what immunity is important in controlling HSV
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Cell-mediated (CMI)
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associated with lower socioeconomic classes
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HSV-1
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where does HSV-1 initially replicate?
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oral mucosa
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fever
sore throat ulcerating vesicles inside mouth |
HSV-1
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numbness
pins and needles feeling pain itching burning signals what? |
prodrome syndrome
reactivation of HSV-1 |
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cutaneous lesion on lip
"cold sore" painful vesicle surrounded by an erythematous base |
HSV-1
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most often location of an HSV-1 lesion
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vermillion border of the lip
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herpetic keratitis
where did it spread to? |
opthalmic branch of trigeminal nerve involved
HSV-1 |
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tree-like (dendritic) pattern easily seen w/ a slit-lamp using fluorescein and UV light
danger? tx? |
herpes keratinitis
liquefaction of the cornea -> perforation cataracts/blindness tx: aggressive topical antiviral |
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nurses, dentists, anesthesiologists
lesions in finger cause? |
inoculation of HSV-1 on finger from oral secretions
Herpetic whitlow |
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wrestler/football
close contact w/ skin lesion |
herpetic gladiatorum
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can cause eczema and necrotizing skin infections
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Herpes
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esophageal and GI ulcers
hepatitis |
herpes in immunocompromised pt (transplant, AIDS)
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what infection can herpes put you more at risk for?
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HIV
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lesion on penis/vulva
multiple/groups blister-like surrounded by small ring of erythema painful painful dysuria |
HSV-2
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systemic symptoms
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HSV-2
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more responsible for urogenitial and neonatal herpes
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HSV-2
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more responsible for
labialis keratitis herpetic whitlow encephalitis |
HSV-1
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what percentage of herpes carriers develop clinical syndromes?
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small percentage (10-25%)
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most common method of transmitting neonatal herpes
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childbirth
others - in utero - postnatal |
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which carries a higher risk of neonatal herpes transmission during childbirth?
recurrent herpes primary herpes |
primary herpes
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mother has primary herpes
previous seropositive for HSV-1 what does this mean? |
cross protection between viruses
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how is neonatal herpes physiologically transmitted?
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aspiration of vagina contents
skin contact |
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infant
pneumonia hepatitis encephalitis cause? |
neonatal herpes (systemic viremia from the beginning)
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how does herpes encephalitis differ b/w adults and children?
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adults - focal, temporal lobe, from retrograde viral spread from trigeminal ganglion
children - diffuse process from viremic spread |
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neonatal herpes encephalitis
sequelae? tx? |
death
mental retardation IV acyclovir |
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key to managing neonatal herpes
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PREVENTION
- avoid unprotected sex late in pregnancy |
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what can reduce the transmission of neonatal herpes
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C-section before rupture of membranes
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gold standard of diagnosing herpes?
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viral isolation and culture
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from what type of lesion are culture more successful?
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crusted
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what does Tzanck preparation look for
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intranuclear inclusions and giant cells from a scraping of the ulcer
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what lab test would you use to distinguish b/w the 2 types of herpes?
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IFA (antisera and monoclonal Ab)
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4x more sensitive than culture
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PCR
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what does the main drug tx for herpes rely on?
what other drugs rely on it? |
viral thymidylate kinase(200x more affinity than cellular TK)
acyclovir valacyclovir famciclovir ganciclovir |
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CMV
tx? |
ganciclovir
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benefit of valacyclovir
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better bioavailability (can be transported through intestinal peptide transporters)
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herpes becomes resistant to drugs
mutation in what? |
viral TK
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herpes tx
AIDS, transplant pt |
foscarnet
cidofovir |
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shown benefits of acyclovir
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reduce
- duration - symptoms - recurrence |
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special drugs for herpes ocular
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idoxuridine
trifluridine Ara-A famciclovir acyclovir |
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besides herpes, most common cause of genital ulcer
what would you see grossly? |
single lesion 1-2 cm
- RAISED, INDURATED(FIRM) EDGE - PAINLESS - heals on own syphillis |
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what symptom is associated with all the STD's
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inguinal lymphadenopathy
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painful ulcer
nonindurated ragged and undermined (can be lifted) tender papule -> ulcerates pathogen? |
Haemophilus ducreyi
Chanchroid |
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endemic regions
difficult to culture short, pleomorphic Gram-Neg rods clump in "school of fish" pattern what do you need for culture? tx? |
chocolate agar
- add Hb, albumin, vancomycin, high CO2 macrolides fluoroquinolones ceftriaxone Chanchroid |
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papule -> ulcerates
fever headache myalgia buboes supporate and drain spontaneously proctitis complications? |
abscess
chronic granulomas cutaneous fistula genital elephantiasis from lymphatic obstruction (LGV) |
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what type of dz is lymphogranuloma venereum?
what does it affect? |
systemic
hematogenous spread to liver, lungs, brain |
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Africa & latin america
cutaneous fistula which specific strains? tx? |
L1 to L3 of Chlamydia trachomatis
doxycycline or macrolides |
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aka granuloma inguinale or venereum
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Donovanosis
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visit to the tropics
genital papule -> ulcerative lesion -> bleed, extend beyond original border - painless granulomatous inflammation pathogen? |
Klebsiella granulomatis
Donovanosis |
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small rods in macrophages
larger cytoplasmic inclusions |
Donovanosis
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