Herpes Viruses And Latency

Front 1

Herpes simplex type I (HSVI)

Back 1

Primary infection: Often subclinical or (gingivo-)stomatis in infants
Recurrent infection: cold sore in the primary infection site (herpes labialis)

Front 2

Can an HSV1 infected individual trasmit the virus when asymptomatic?

Back 2

Yes: the small amounts of infectious virus are sporadically released without production of lesions.

Front 3

Herpes simplex type II (HSVII)

Back 3

Primary infection: subclinical or bilateral vesicles in genitalia
Latency: infection of sacral or lumbar ganglia
Recurrent infection: unilateral genital herpes

Front 4

Can an HSV2 infected individual transmit the virus when asymptomatic?

Back 4

Yes: the small amounts of infectious virus are sporadically released without production of lesions.

Front 5

Which type of HSV cause a perinatal infection?

Back 5

HSVII can infect a nenonate during birth by vaginal secretion of asymptomatic or symptomatic mother.

Front 6

How is the prognosis for neonates infected with HSVII?

Back 6

Neonatal herpes simple is often fatal. Most organs are invaded by the virus in neonatal disease, but hepato-adrenal necrosis are marked.

Front 7

Describe pathogenesis and transmissin of the most fatal kind of neonatal herpes simplex.

Back 7

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)

Front 8

Which virus is the most common cause of sporadic encephalitis?

Back 8

HSVI; seen as both a primary infection and in patients with a history of recurrent lesions.

Front 9

What would be the clinical indication of herpes simplex encephalitis?

Back 9

Auditory or olfactory hallucinations due to necrotic lesion in temporal lobe

Front 10

What technique(s) would you use to test your suspicion for herpes simplex encephalitis in a patient?

Back 10

PCR detection of herpes simplex DNA in the CSF

and perhaps MRI

Front 11

Is there any treatment available for herpes simplex encephalitis?

Back 11

Yes, acyclovir can be used to treat herpes simplex encephalitis.

Front 12

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?

Back 12

Herpes simplex keratitis: when herpes simplex infects the eye causing keratitis with the conjuctiva and eyelids and cornea.

CAN LEAD TO BLINDNESS

Front 13

Can you treat herpes simplex keratitis?

Back 13

Yes, topical trifluridine or systemic acyclovir

Front 14

Are there vaccines for HSVs?

Back 14

No

Front 15

Would the result of serologic test for HSV be reliable evidence for diagnosis?

Back 15

No, it may help diagnose primary infection, but does not work in recurrent infection.

Front 16

Herpes simplex type I (HSVI)

Back 16

Primary infection: Often subclinical or (gingivo-)stomatis in infants
Recurrent infection: cold sore in the primary infection site (herpes labialis)

Front 17

Can an HSV1 infected individual trasmit the virus when asymptomatic?

Back 17

Yes: the small amounts of infectious virus are sporadically released without production of lesions.

Front 18

Herpes simplex type II (HSVII)

Back 18

Primary infection: subclinical or bilateral vesicles in genitalia
Latency: infection of sacral or lumbar ganglia
Recurrent infection: unilateral genital herpes

Front 19

Can an HSV2 infected individual transmit the virus when asymptomatic?

Back 19

Yes: the small amounts of infectious virus are sporadically released without production of lesions.

Front 20

Which type of HSV cause a perinatal infection?

Back 20

HSVII can infect a nenonate during birth by vaginal secretion of asymptomatic or symptomatic mother.

Front 21

How is the prognosis for neonates infected with HSVII?

Back 21

Neonatal herpes simple is often fatal. Most organs are invaded by the virus in neonatal disease, but hepato-adrenal necrosis are marked.

Front 22

Describe pathogenesis and transmissin of the most fatal kind of neonatal herpes simplex.

Back 22

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)

Front 23

Which virus is the most common cause of sporadic encephalitis?

Back 23

HSVI; seen as both a primary infection and in patients with a history of recurrent lesions.

Front 24

What would be the clinical indication of herpes simplex encephalitis?

Back 24

Auditory or olfactory hallucinations due to necrotic lesion in temporal lobe

Front 25

What technique(s) would you use to test your suspicion for herpes simplex encephalitis in a patient?

Back 25

PCR detection of herpes simplex DNA in the CSF

and perhaps MRI

Front 26

Is there any treatment available for herpes simplex encephalitis?

Back 26

Yes, acyclovir can be used to treat herpes simplex encephalitis.

Front 27

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?

Back 27

Herpes simplex keratitis: when herpes simplex infects the eye causing keratitis with the conjuctiva and eyelids and cornea.

CAN LEAD TO BLINDNESS

Front 28

Can you treat herpes simplex keratitis?

Back 28

Yes, topical trifluridine or systemic acyclovir

Front 29

Are there vaccines for HSVs?

Back 29

No

Front 30

Would the result of serologic test for HSV be reliable evidence for diagnosis?

Back 30

No, it may help diagnose primary infection, but does not work in recurrent infection.

Front 31

Where are the primary infection sites for HSVI and HSVII?

Back 31

Both HSVI and HSVII are infected at skin or mucous initially.

Front 32

Where are the latent infection sites for HSVI and II?

Back 32

HSVI- trigeminal ganglion
HSVII- sacral or lumbar ganglion

Front 33

Is there a vaccine for HSVs?

Back 33

No

Front 34

Is meningitis caused by HSVII fatal?

Back 34

No, mild ad self-limited

Front 35

Disease caused by varicella-zoster virus.

Back 35

Primary infection- varicella (chickenpox)
Recurrent infection- zoster (shingles)

Front 36

Major route of transmission for VZB

Back 36

Respiratory droplet or direct contact with the lesions with subsequent viremia

Front 37

Would you expect to find multinucleated giant cells with intranuclear inclusion in zoster vesicles?

Back 37

Yes

Front 38

Is immunity for VZV life-long?

Back 38

Yes: you get chickenpox only once in your lifetime.

Front 39

How long is the incubation period of VZV?

Back 39

2~3 weeks

Front 40

True or false:
varicella is more severe in adults than in children

Back 40

True: so before the vaccines moms tried to get their children infected with VZV young so that it won't be fatal.

Front 41

True or false:
varicella is not a fatal disease even for an immuno-compromised individual.

Back 41

False. Varicella can be fata for immuno-compromised individuals and in adults.

Front 42

Can varicella-zoster virus be transmitted to a fetus from a pregnant mother?

Back 42

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)

Front 43

Describe clinical symptoms of zoster.

Back 43

Unilateral vesicular lesions along dermatonal distribution. After recovery from zoseter, "post-herpetic neuralgia" may occur.

Front 44

True or false:
immunosuppresed patient have a higher incidence of zoster and are at risk for disseminated zoster.

Back 44

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.

Front 45

Is there a treatment for zoster?

Back 45

Yes, acyclovir.

Front 46

Where are the primary infection sites for HSVI and HSVII?

Back 46

Both HSVI and HSVII are infected at skin or mucous initially.

Front 47

Where are the latent infection sites for HSVI and II?

Back 47

HSVI- trigeminal ganglion
HSVII- sacral or lumbar ganglion

Front 48

Is there a vaccine for HSVs?

Back 48

No

Front 49

Is meningitis caused by HSVII fatal?

Back 49

No, mild ad self-limited

Front 50

Disease caused by varicella-zoster virus.

Back 50

Primary infection- varicella (chickenpox)
Recurrent infection- zoster (shingles)

Front 51

Major route of transmission for VZB

Back 51

Respiratory droplet or direct contact with the lesions with subsequent viremia

Front 52

Would you expect to find multinucleated giant cells with intranuclear inclusion in zoster vesicles?

Back 52

Yes

Front 53

Is immunity for VZV life-long?

Back 53

Yes: you get chickenpox only once in your lifetime.

Front 54

How long is the incubation period of VZV?

Back 54

2~3 weeks

Front 55

True or false:
varicella is more severe in adults than in children

Back 55

True: so before the vaccines moms tried to get their children infected with VZV young so that it won't be fatal.

Front 56

True or false:
varicella is not a fatal disease even for an immuno-compromised individual.

Back 56

False. Varicella can be fata for immuno-compromised individuals and in adults.

Front 57

Can varicella-zoster virus be transmitted to a fetus from a pregnant mother?

Back 57

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)

Front 58

Describe clinical symptoms of zoster.

Back 58

Unilateral vesicular lesions along dermatonal distribution. After recovery from zoseter, "post-herpetic neuralgia" may occur.

Front 59

True or false:
immunosuppresed patient have a higher incidence of zoster and are at risk for disseminated zoster.

Back 59

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.

Front 60

Is there a treatment for zoster?

Back 60

Yes, acyclovir.

Front 61

Do all age groups have the same attack frequency of zosters?

Back 61

No, attack frequency increases with age after 50.

Front 62

Can zoster vesicles be the source of chicken pox epidemic?

Back 62

Yes, the zoster vesicles contain virus.

Front 63

Is there a vaccine available for VZV? What kind?

Back 63

There is a live-attenuated vaccine available. Recommended for elderly to boost their immune system for herpes zosters.

Front 64

What are the histological characteristics of cytomegalovirus-infected cells?

Back 64

Enlarged
Nuclear inclusion

Front 65

What are some diseases caused by cytomegalovirus?

Back 65

CONGENITAL ABNORMALITIES
pneumonia
heterophil-negative mononucleosis

Front 66

What is mononucleosis? What is the usual cause of mononucleosis?

Back 66

Mononucleosis is characterized by a large number of abnormal mononuclear cells in the blood. The usual cause of MONO is EB virus (heterophil-positive).

Front 67

What is unique about the replication cycle of cytomegalovirus among the herpesviruses?

Back 67

It has mRNA brought into the infected cell by the parental virion.

Front 68

Describe the major routes of transmission for cytomegalovirus.

Back 68

Close contact required
1) Infacts: across the placenta, within birth canal, in breast milk
2) Children- saliva (nursery school)
3) Adults- sexual transmission

Front 69

Congeital infection with cytomegalovirus is relatively common. What are the symptoms?

Back 69

The most common: neuro-sensory deafness
Rest: microcephalic mental retardation with calcification (c.f. ifection with protozoan parasite)
Jaundice, enlarged liver/ spleen
Anemia

Front 70

What is the most frequent viral congenital infection now?

Back 70

Cytomegalovirus is. Rubella vaccine has reduced the incidence of rubella.

Front 71

Can asymptomatic mother infect a fetus?

Back 71

Yes

Front 72

What is the best source for cmV detection in neonates?

Back 72

Urine

Front 73

Does the infected fetus make anti-CMV IgM or IgG?

Back 73

anti-CMV IgM before birth
anti-CMV IgG after birth. Virus continues to be excreted for years

Front 74

Is there asymptomatic congenital infection of CMV?

Back 74

Yes

Front 75

Is there a treatment for symptomatic CMV-infected neonates?

Back 75

Yes, ganciclovir have a significantly improved outcome as measured by tests of hearing, resolution of hepatitis and cognitive development.

Front 76

True or false:

Recurrent disease caused by cytomegalovirus is seen only when the immune response is defective.

Back 76

True

Front 77

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.

Back 77

True

Front 78

Where are the primary infection sites for HSVI and HSVII?

Back 78

Both HSVI and HSVII are infected at skin or mucous initially.

Front 79

Where are the latent infection sites for HSVI and II?

Back 79

HSVI- trigeminal ganglion
HSVII- sacral or lumbar ganglion

Front 80

Is there a vaccine for HSVs?

Back 80

No

Front 81

Is meningitis caused by HSVII fatal?

Back 81

No, mild ad self-limited

Front 82

Disease caused by varicella-zoster virus.

Back 82

Primary infection- varicella (chickenpox)
Recurrent infection- zoster (shingles)

Front 83

Major route of transmission for VZB

Back 83

Respiratory droplet or direct contact with the lesions with subsequent viremia

Front 84

Would you expect to find multinucleated giant cells with intranuclear inclusion in zoster vesicles?

Back 84

Yes

Front 85

Is immunity for VZV life-long?

Back 85

Yes: you get chickenpox only once in your lifetime.

Front 86

How long is the incubation period of VZV?

Back 86

2~3 weeks

Front 87

True or false:
varicella is more severe in adults than in children

Back 87

True: so before the vaccines moms tried to get their children infected with VZV young so that it won't be fatal.

Front 88

True or false:
varicella is not a fatal disease even for an immuno-compromised individual.

Back 88

False. Varicella can be fata for immuno-compromised individuals and in adults.

Front 89

Can varicella-zoster virus be transmitted to a fetus from a pregnant mother?

Back 89

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)

Front 90

Describe clinical symptoms of zoster.

Back 90

Unilateral vesicular lesions along dermatonal distribution. After recovery from zoseter, "post-herpetic neuralgia" may occur.

Front 91

True or false:
immunosuppresed patient have a higher incidence of zoster and are at risk for disseminated zoster.

Back 91

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.

Front 92

Is there a treatment for zoster?

Back 92

Yes, acyclovir.

Front 93

What is the most common cause of infectious mononucleosis?

Back 93

Epstein-Barr virus

Front 94

Which age groups are most susceptible to mononucleosis?

Back 94

Teenagers and young adults

Front 95

Incubation period of EBV infection.

Back 95

4~6 wks

Front 96

What are the symptoms of mononucleosis?

Back 96

fever, sore throat and lymphadenopathy that mimic acute HIV infection

Front 97

Pathogenesis of EBV infection

Back 97

oropharynx --> viremia --> B-lymphocytes --> latency in B-lymphocytes

Front 98

Natural immune response against EBV.

Back 98

IgM and IgG against viral capsid antigen. IgG provides a life-long immunity.

Front 99

Which quick test would you use to diagnose EBV?

Back 99

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

Front 100

Can EB virus be fata?

Back 100

Yes, in immunosuppressed patients, it can result in a fatal LYMPHOPROLIFERATIVE DISEASE THAT MAY LEAD TO TUMOR DEVELOPMENT.

Front 101

True or false:
you can culture EBvirus-producing B-lymphocytes during the acute disease.

Back 101

True

Front 102

True or false:
The EB virus production in the oro-pharynx may continue for months after the disease is over.

Back 102

True

Front 103

True or false:
It is impossible to infect others while in latency.

Back 103

False. Subclinical EB virus production is common in latently infected persons.

Front 104

Is primary infection with EB virus in young children subclinical or sever?

Back 104

Subclinical, but may develop to produce infectious mononucleosis in adolescents or young adults.

Front 105

What is the common symptom of EB virus infection in AIDS patients?

Back 105

oral hairy leucoplakia

Front 106

Which virus is probably the cause of Kaposi's sarcoma in AIDS patient?

Back 106

Human Herpesvirus-8 (sexually transmitted as HIV)

Front 107

Which herpes virus cause a systemic infection with rash or high fever in infants?

Back 107

Human herpesvirus-6

Front 108

What is roseola infantum?

Back 108

Systemic infection with rash.
Caused by human herpesvirus-6.

Front 109

Is there a vaccine for EBV infection?

Back 109

No