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109 Cards in this Set

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Herpes simplex type I (HSVI)
Primary infection: Often subclinical or (gingivo-)stomatis in infants
Recurrent infection: cold sore in the primary infection site (herpes labialis)
Can an HSV1 infected individual trasmit the virus when asymptomatic?
Yes: the small amounts of infectious virus are sporadically released without production of lesions.
Herpes simplex type II (HSVII)
Primary infection: subclinical or bilateral vesicles in genitalia
Latency: infection of sacral or lumbar ganglia
Recurrent infection: unilateral genital herpes
Can an HSV2 infected individual transmit the virus when asymptomatic?
Yes: the small amounts of infectious virus are sporadically released without production of lesions.
Which type of HSV cause a perinatal infection?
HSVII can infect a nenonate during birth by vaginal secretion of asymptomatic or symptomatic mother.
How is the prognosis for neonates infected with HSVII?
Neonatal herpes simple is often fatal. Most organs are invaded by the virus in neonatal disease, but hepato-adrenal necrosis are marked.
Describe pathogenesis and transmissin of the most fatal kind of neonatal herpes simplex.
Mother's acute primary infections without the seroconversion have the highest likelihoood of perinatal infection and of fatal outcome. (No IgG to protect the fetus in the placenta)
Which virus is the most common cause of sporadic encephalitis?
HSVI; seen as both a primary infection and in patients with a history of recurrent lesions.
What would be the clinical indication of herpes simplex encephalitis?
Auditory or olfactory hallucinations due to necrotic lesion in temporal lobe
What technique(s) would you use to test your suspicion for herpes simplex encephalitis in a patient?
PCR detection of herpes simplex DNA in the CSF

and perhaps MRI
Is there any treatment available for herpes simplex encephalitis?
Yes, acyclovir can be used to treat herpes simplex encephalitis.
You see a patient with a unilateral "red eye" with pain and ocular irritation. She also has photophobia. Smear comes back as positive for the presence of multinucleated giant cells. What would be your diagnosis?
Herpes simplex keratitis: when herpes simplex infects the eye causing keratitis with the conjuctiva and eyelids and cornea.

CAN LEAD TO BLINDNESS
Can you treat herpes simplex keratitis?
Yes, topical trifluridine or systemic acyclovir
Are there vaccines for HSVs?
No
Would the result of serologic test for HSV be reliable evidence for diagnosis?
No, it may help diagnose primary infection, but does not work in recurrent infection.
Herpes simplex type I (HSVI)
Primary infection: Often subclinical or (gingivo-)stomatis in infants
Recurrent infection: cold sore in the primary infection site (herpes labialis)
Can an HSV1 infected individual trasmit the virus when asymptomatic?
Yes: the small amounts of infectious virus are sporadically released without production of lesions.
Herpes simplex type II (HSVII)
Primary infection: subclinical or bilateral vesicles in genitalia
Latency: infection of sacral or lumbar ganglia
Recurrent infection: unilateral genital herpes
Can an HSV2 infected individual transmit the virus when asymptomatic?
Yes: the small amounts of infectious virus are sporadically released without production of lesions.
Which type of HSV cause a perinatal infection?
HSVII can infect a nenonate during birth by vaginal secretion of asymptomatic or symptomatic mother.
How is the prognosis for neonates infected with HSVII?
Neonatal herpes simple is often fatal. Most organs are invaded by the virus in neonatal disease, but hepato-adrenal necrosis are marked.
Describe pathogenesis and transmissin of the most fatal kind of neonatal herpes simplex.
Acute primary infections without the seroconversion of mother have the highest likelihoood of perinatal infection and of fatal outcome. (No IgG to protect the fetus in the placenta)
Which virus is the most common cause of sporadic encephalitis?
HSVI; seen as both a primary infection and in patients with a history of recurrent lesions.
What would be the clinical indication of herpes simplex encephalitis?
Auditory or olfactory hallucinations due to necrotic lesion in temporal lobe
What technique(s) would you use to test your suspicion for herpes simplex encephalitis in a patient?
PCR detection of herpes simplex DNA in the CSF

and perhaps MRI
Is there any treatment available for herpes simplex encephalitis?
Yes, acyclovir can be used to treat herpes simplex encephalitis.
You see a patient with a unilateral "red eye, "pain and ocular irritation. She also has photophobia. Smear comes back as positive for the presence of multinucleated giant cells. What would be your diagnosis?
Herpes simplex keratitis: when herpes simplex infects the eye causing keratitis with the conjuctiva and eyelids and cornea.

CAN LEAD TO BLINDNESS
Can you treat herpes simplex keratitis?
Yes, topical trifluridine or systemic acyclovir
Are there vaccines for HSVs?
No
Would the result of serologic test for HSV be reliable evidence for diagnosis?
No, it may help diagnose primary infection, but does not work in recurrent infection.
Where are the primary infection sites for HSVI and HSVII?
Both HSVI and HSVII are infected at skin or mucous initially.
Where are the latent infection sites for HSVI and II?
HSVI- trigeminal ganglion
HSVII- sacral or lumbar ganglion
Is there a vaccine for HSVs?
No
Is meningitis caused by HSVII fatal?
No, mild ad self-limited
Disease caused by varicella-zoster virus.
Primary infection- varicella (chickenpox)
Recurrent infection- zoster (shingles)
Major route of transmission for VZB
Respiratory droplet or direct contact with the lesions with subsequent viremia
Would you expect to find multinucleated giant cells with intranuclear inclusion in zoster vesicles?
Yes
Is immunity for VZV life-long?
Yes: you get chickenpox only once in your lifetime.
How long is the incubation period of VZV?
2~3 weeks
True or false:
varicella is more severe in adults than in children
True: so before the vaccines moms tried to get their children infected with VZV young so that it won't be fatal.
True or false:
varicella is not a fatal disease even for an immuno-compromised individual.
False. Varicella can be fata for immuno-compromised individuals and in adults.
Can varicella-zoster virus be transmitted to a fetus from a pregnant mother?
Yes, VZV infection during the first and second trimester causes congenital varicella syndrome (limb atrophy and scarring of the skin on the affected limb)- rare (0.5%~2% incidence)
Describe clinical symptoms of zoster.
Unilateral vesicular lesions along dermatonal distribution. After recovery from zoseter, "post-herpetic neuralgia" may occur.
True or false:
immunosuppresed patient have a higher incidence of zoster and are at risk for disseminated zoster.
True. All patients who get zoster are already seropositive as a result of their original chicken pox. This antibody usually prevents viremic spread and results in the dermatomal distribution. In immunosuppresed patients, there is not enough Abs to prevent viremia.
Is there a treatment for zoster?
Yes, acyclovir.
Where are the primary infection sites for HSVI and HSVII?
Both HSVI and HSVII are infected at skin or mucous initially.
Where are the latent infection sites for HSVI and II?
HSVI- trigeminal ganglion
HSVII- sacral or lumbar ganglion
Is there a vaccine for HSVs?
No
Is meningitis caused by HSVII fatal?
No, mild ad self-limited
Disease caused by varicella-zoster virus.
Primary infection- varicella (chickenpox)
Recurrent infection- zoster (shingles)
Major route of transmission for VZB
Respiratory droplet or direct contact with the lesions with subsequent viremia
Would you expect to find multinucleated giant cells with intranuclear inclusion in zoster vesicles?
Yes
Is immunity for VZV life-long?
Yes: you get chickenpox only once in your lifetime.
How long is the incubation period of VZV?
2~3 weeks
True or false:
varicella is more severe in adults than in children
True: so before the vaccines moms tried to get their children infected with VZV young so that it won't be fatal.
True or false:
varicella is not a fatal disease even for an immuno-compromised individual.
False. Varicella can be fata for immuno-compromised individuals and in adults.
Can varicella-zoster virus be transmitted to a fetus from a pregnant mother?
Yes, VZV infection during the first and second trimester causes congenital varicella syndrome (limb atrophy and scarring of the skin on the affected limb)- rare (0.5%~2% incidence)
Describe clinical symptoms of zoster.
Unilateral vesicular lesions along dermatonal distribution. After recovery from zoseter, "post-herpetic neuralgia" may occur.
True or false:
immunosuppresed patient have a higher incidence of zoster and are at risk for disseminated zoster.
True. All patients who get zoster are already seropositive as a result of their original chicken pox. This antibody usually prevents viremic spread and results in the dermatomal distribution. In immunosuppresed patients, there is not enough Abs to prevent viremia.
Is there a treatment for zoster?
Yes, acyclovir.
Do all age groups have the same attack frequency of zosters?
No, attack frequency increases with age after 50.
Can zoster vesicles be the source of chicken pox epidemic?
Yes, the zoster vesicles contain virus.
Is there a vaccine available for VZV? What kind?
There is a live-attenuated vaccine available. Recommended for elderly to boost their immune system for herpes zosters.
What are the histological characteristics of cytomegalovirus-infected cells?
Enlarged
Nuclear inclusion
What are some diseases caused by cytomegalovirus?
CONGENITAL ABNORMALITIES
pneumonia
heterophil-negative mononucleosis
What is mononucleosis? What is the usual cause of mononucleosis?
Mononucleosis is characterized by a large number of abnormal mononuclear cells in the blood. The usual cause of MONO is EB virus (heterophil-positive).
What is unique about the replication cycle of cytomegalovirus among the herpesviruses?
It has mRNA brought into the infected cell by the parental virion.
Describe the major routes of transmission for cytomegalovirus.
Close contact required
1) Infacts: across the placenta, within birth canal, in breast milk
2) Children- saliva (nursery school)
3) Adults- sexual transmission
Congeital infection with cytomegalovirus is relatively common. What are the symptoms?
The most common: neuro-sensory deafness
Rest: microcephalic mental retardation with calcification (c.f. ifection with protozoan parasite)
Jaundice, enlarged liver/ spleen
Anemia
What is the most frequent viral congenital infection now?
Cytomegalovirus is. Rubella vaccine has reduced the incidence of rubella.
Can asymptomatic mother infect a fetus?
Yes
What is the best source for cmV detection in neonates?
Urine
Does the infected fetus make anti-CMV IgM or IgG?
anti-CMV IgM before birth
anti-CMV IgG after birth. Virus continues to be excreted for years
Is there asymptomatic congenital infection of CMV?
Yes
Is there a treatment for symptomatic CMV-infected neonates?
Yes, ganciclovir have a significantly improved outcome as measured by tests of hearing, resolution of hepatitis and cognitive development.
True or false:

Recurrent disease caused by cytomegalovirus is seen only when the immune response is defective.
True
True or false:
Cytomegalovirus infection is a major problem in organ transplants when the donor is seropositive and the recipient is seronegative. The transplanted organ generally contains latently infected cells.
True
Where are the primary infection sites for HSVI and HSVII?
Both HSVI and HSVII are infected at skin or mucous initially.
Where are the latent infection sites for HSVI and II?
HSVI- trigeminal ganglion
HSVII- sacral or lumbar ganglion
Is there a vaccine for HSVs?
No
Is meningitis caused by HSVII fatal?
No, mild ad self-limited
Disease caused by varicella-zoster virus.
Primary infection- varicella (chickenpox)
Recurrent infection- zoster (shingles)
Major route of transmission for VZB
Respiratory droplet or direct contact with the lesions with subsequent viremia
Would you expect to find multinucleated giant cells with intranuclear inclusion in zoster vesicles?
Yes
Is immunity for VZV life-long?
Yes: you get chickenpox only once in your lifetime.
How long is the incubation period of VZV?
2~3 weeks
True or false:
varicella is more severe in adults than in children
True: so before the vaccines moms tried to get their children infected with VZV young so that it won't be fatal.
True or false:
varicella is not a fatal disease even for an immuno-compromised individual.
False. Varicella can be fata for immuno-compromised individuals and in adults.
Can varicella-zoster virus be transmitted to a fetus from a pregnant mother?
Yes, VZV infection during the first and second trimester causes congenital varicella syndrome (limb atrophy and scarring of the skin on the affected limb)- rare (0.5%~2% incidence)
Describe clinical symptoms of zoster.
Unilateral vesicular lesions along dermatonal distribution. After recovery from zoseter, "post-herpetic neuralgia" may occur.
True or false:
immunosuppresed patient have a higher incidence of zoster and are at risk for disseminated zoster.
True. All patients who get zoster are already seropositive as a result of their original chicken pox. This antibody usually prevents viremic spread and results in the dermatomal distribution. In immunosuppresed patients, there is not enough Abs to prevent viremia.
Is there a treatment for zoster?
Yes, acyclovir.
What is the most common cause of infectious mononucleosis?
Epstein-Barr virus
Which age groups are most susceptible to mononucleosis?
Teenagers and young adults
Incubation period of EBV infection.
4~6 wks
What are the symptoms of mononucleosis?
fever, sore throat and lymphadenopathy that mimic acute HIV infection
Pathogenesis of EBV infection
oropharynx --> viremia --> B-lymphocytes --> latency in B-lymphocytes
Natural immune response against EBV.
IgM and IgG against viral capsid antigen. IgG provides a life-long immunity.
Which quick test would you use to diagnose EBV?
heterophile antibody (to sheep red cells) can be used to detect the short term increase in heterophile. The EB viral antigen happens to cross-react with sheep red cells so we use this test to determine EBV infection
Can EB virus be fata?
Yes, in immunosuppressed patients, it can result in a fatal LYMPHOPROLIFERATIVE DISEASE THAT MAY LEAD TO TUMOR DEVELOPMENT.
True or false:
you can culture EBvirus-producing B-lymphocytes during the acute disease.
True
True or false:
The EB virus production in the oro-pharynx may continue for months after the disease is over.
True
True or false:
It is impossible to infect others while in latency.
False. Subclinical EB virus production is common in latently infected persons.
Is primary infection with EB virus in young children subclinical or sever?
Subclinical, but may develop to produce infectious mononucleosis in adolescents or young adults.
What is the common symptom of EB virus infection in AIDS patients?
oral hairy leucoplakia
Which virus is probably the cause of Kaposi's sarcoma in AIDS patient?
Human Herpesvirus-8 (sexually transmitted as HIV)
Which herpes virus cause a systemic infection with rash or high fever in infants?
Human herpesvirus-6
What is roseola infantum?
Systemic infection with rash.
Caused by human herpesvirus-6.
Is there a vaccine for EBV infection?
No