Human Herpes Virus

Front 1

Describe the structure and genome of herpesviruses, including the nature of the replication

Back 1

Herpesviruses are lipid enveloped icosohedral with dsDNA and repliate using a viral non-structural DNA polymerase

Front 2

What are important clinical characteristics of human herpesviruses in terms of their infection capacity?

Back 2

They have the capacity to persist as latent infection in sensory ganglia or leukocytes and can possibly reactivate; reactivation more common in immunocompromised people

Front 3

What are the herpesviruses that can latently infect sensory ganglia?

Back 3

HSV (herpes simplex) and VZV (varicella zoster)

Front 4

What are the herpesviruses that can chronically or latently infect leukocytes?

Back 4

EBV (epstein barr), CMV (cytomegalovirus) and HHV-6 (huamn herpes virus 6)

Front 5

What are the major routes of transmission leading to primary herpesvirus infection and for what routes are those viruses specific?

Back 5

1) Respiratory secretions (HSV, VZV, EBV, CMV, HHV6 &7) 2) contact with vesicular lesions (HSV1 & 2, VZV) 3) Congenital (CMV), 3) neonatal (HSV 2, VZV) 4) sexual (HSV-2, HHV-8, CMV) 5) transplantation (CMV)

Front 6

What clinical syndromes are associated with HSV-1 and are they primary or secondary?

Back 6

Gingivoststomatitis (1'), keratoconjunctivitis (1'), reactivation for herpes labialis(2'), encephalitis (1' or 2'), and eczema herpeticum (1' or 2')

Front 7

What are the syndromes associated with HSV-2 and are they primary or secondary?

Back 7

Neonatal herpes (especially from primary infection of the mother in the neonatal period) genital herpes (1' and 2'), herpes encephalitis (1' and 2')

Front 8

What type of antiviral therapy is given for herpes simplex viruses causing encephalitis and neonatal herpes?

Back 8

Acyclovir IV

Front 9

What type of antiviral therapy is given for herpes labialis?

Back 9

Topical penciclovir

Front 10

What type of antiviral therapy is given for keratoconjuctivitis or keratitis (ocular herpes)?

Back 10

Topical trifluridine/triflurothymidine

Front 11

What types of antiviral drugs are given for treatment of recurrent genital herpes (secondary infections)?

Back 11

Prodrug forms of acyclovir (valacyclovir) pr penciclovir (famciclovir)

Front 12

What are the clinical syndromes associated with varicella zoster infection and which are primary, secondary?

Back 12

Chickenpox (varicella, 1') shingles (aka zoster, 2')

Front 13

What are potential complications of varicella (chickenpox)?

Back 13

encephalitis, pneumonia or secondary skin infections with strep pyogenes or staph aureus

Front 14

What are the clinical syndromes associated with EBV virus and which are primary/secondary?

Back 14

Infectious mono (1'), latent in B cell with reactivation possibly leading to B cell lymphomas in immunocompromised (2')

Front 15

How do most children with primary HSV-1 usually present?

Back 15

Most infections are asymptomatic, but oral lesions are more common than external skin lesisons; adolescents usually get a pharyngitis or tonsillitis

Front 16

How do latent HSV/VZV viruses reactivate?

Back 16

They move from the neuron cells bodies to the skin/mucosa innervated by that nerve or move retrograde to the CNS

Front 17

What is the classic secondary infection after herpetic gingivostomatitis?

Back 17

Herpes labialis resulting from reactivation of the latent virus in the trigeminal ganglion

Front 18

What is herpatic whitlow?

Back 18

Herpes infection caused by breaks in the skin due to reactivation of the HSV-1

Front 19

What should NOT be given to children with varicella and why?

Back 19

Alicylates should not be given because of the risk of subsequent Reye syndrome

Front 20

Describe how the lesions of herpes genitalis progress and what virus is usually the causitive agent?

Back 20

Herpes genitalis progresses from vesicles to ulcers which then crust and heal; it is caused by HSV-2 more often than HSV-1

Front 21

Describe chronic suppression therapy in treatment of genital herpres

Back 21

It is used to prevent transmission of recurrent genital herpes simplex to an uninfected sexual partner

Front 22

Describe the situation with the highest risk associated with a neonatal herpes infection

Back 22

The mother is infected with a primary herpes virus infection and a vaginal delivery is performed; the infant is treated with IV acyclovir

Front 23

What is the most common cause of encephalitis in adults and adolescents? Neonates?

Back 23

The most common cause of encephalitis in adults is HSV-1 and in neotates HSV-2

Front 24

Describe the physical characteristics of a VZV infection

Back 24

Varicella (chicken pox) shows lesions mainly on the trunk with all stages of lesions seen at the same time

Front 25

When does neonatal varicella occur and how should it be treated?

Back 25

It occurs when a non-immune mother is infectced at the end of pregnancy; prompt VZ immune globulin should be given with IV acyclovir

Front 26

What should be done before pregnancy if a woman is not immune?

Back 26

Live varicella vaccine should be given

Front 27

What is zoster and what should be done to treat it?

Back 27

Zoster is the same as "shingles" and it occurs from reactivation of latent VZV; valacyclovir or famciclovir should be used

Front 28

What is the most common congenital viral infection which is the most significant cause of microbial birth handicap?

Back 28

CMV

Front 29

Describe most childhood infections with CMV

Back 29

Most childhood infections are asmyptomatic (or show occasional hepatosplenomegaly)

Front 30

Describe three common pathways for transmission of CMV

Back 30

Congenital infection, sexual transmission, organ transplantation with CMV positive donor

Front 31

Describe the smyptoms of a neonate with a CMV infection

Back 31

Microcephaly, hepatosplenomegaly, cognitive impairment, hearing or vision loss

Front 32

What drug should be given to patients with CMV infection?

Back 32

Gangciclovir or Valganciclovir; foscarnet or cidofovir should be given if resistance to the previous two drugs occurs; CMV immune globulin can also be given

Front 33

What is the causitive agent of "post transfusion mononucleosis?"

Back 33

It was caused by CMV infection in leukocytes transmitted in blood products which is less common now due to leukoreduction

Front 34

What are the complications of primary or reactivated CMV infection in immunocompromised patients?

Back 34

Pneumonia, retinitis (AIDS patients), infection of the gastrointestinal tract, hepatitis (immunosuppressed transplant patients), and other widely disseminated disease

Front 35

What is the cause of mononucleosis?

Back 35

Epstein-Barr virus

Front 36

What is the principle target of the EBV?

Back 36

It targets B cells, inducing proliferation and activation

Front 37

What are two cancer's with which EBV is associated?

Back 37

Burkitt's lymphoma and nasopharyngeal carcinoma

Front 38

What assays are done to diagnose mononucleosis?

Back 38

Serological assays for anti-EBV IgM or IgG, assays for heterophile antibodies and the observation of atypical lymphocytes in the peripheral blood

Front 39

What are complications of EBV virus infection in immunodeficient individuals?

Back 39

Oral hairy leukoplakie, B cell lymphomas, and fatal infection (patients with rare X-linked lymphoproliferative syndrome)

Front 40

What are the most common symptoms of those with mononucleosis?

Back 40

Sever pharyngitis with swollen tonsils and uvula, fever, fatigue, lymphadenopathy, hepatosplenomegaly

Front 41

What virus causes 6th disease/roseola

Back 41

HHV-6B

Front 42

Describe the symptoms of sixth disease/roseola/exanthem subitum

Back 42

Febrile, diffuse macular or maculopapular exanthem

Front 43

What kind of cells does HHV-6 infect and how do they cause the maculopapular lesions?

Back 43

HHV-6 infects T-lymphocytes; the lesions are due to hypersensitivity

Front 44

When does HHV-7 infection occur and with what is it associated?

Back 44

It commonly ocurs at a later age in childhood and may be a minor cause of 6th disease/roseola

Front 45

What is the virus that causes Kaposi's sarcoma in AIDS patients?

Back 45

HHV-8

Front 46

What is the lymphoma that can be caused by HHV-8?

Back 46

It can cause body cavity based lymphomas and primary effusion lymphoma

Front 47

Why is acyclovir so specific for viral polymerases?

Back 47

It is required to be phosphorylated by viral tryrosine kinases

Front 48

What drug is given for primary genital herpes?

Back 48

Acyclovir

Front 49

What is given to a transplant patient receiving an organ from a CMV positive donor?

Back 49

Ganciclovir is given prophylactically

Front 50

What is a characteristic of CMV antiviral drugs?

Back 50

They are generally have more serious side effects