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56 Cards in this Set

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Herpes Virus GC:

- Replicates where?
- Endogenous enzymes? x2
- Envelope?
Nucleus

DNA Polymerase
Enzymes for nucleotide biosynthesis

Yes
HSV I and HSV II:

- family
- subfamily
- genus
- natural host
- prevalence
- body fluid person to person
Herpesviridae
Alphaherpesvirinae
Simplexvirus

Humans

Worldwide

Person to person via body fluid
Define recurrent infection
Reactivation of latent genome
HSV Primary Infection:

- Route of entry x2
- Avg. incubation rate
- Avg. length of lesion formation
Abraded skin
Mucous membrane

6 days

7-10 days
T/F - During convalescence, scarring does not occur in HSV.
True
On the cellular level, primary infection lesions usually occur where?
Local nerve endings
In the head region, primary infection would manifest as what?
Herpes gingivostomatitis
For latent infection, what is the neuronal ganglia associated with:

- HSV - 1
- HSV - 2
Trigeminal

Sacral
What is the name of the genomic sequence associated with the latency of HSV pathogenesis?
LAT

Latency associated transcripts
T/F - HSV latency infection is subject to immune surveillane.
False

It is NOT subjected
List the primary infection stages
Early stage
Mid stage
Full stage
Late stage
Define recurrent infection
Reactivation of the latent genome
Viral DNA persists in the target cell of the host for how long?
The LIFE of the host
In comparison to the primary lesion, describe the duration and severity of the recurrent infections.
Milder

Shorter duration
In the head region, recurrent infection would manifest as what?
Herpes labialis
What are the primary orofacial symptoms associated with HSV-1? x3
1. Herpes stomatitis
2. Herpetic gingivostomatitis
3. Fever blisters/cold sores
In HSV-1, _______ is the rule.
Asymptomatic infection
What are the symptoms that are associated with HSV-I? x7
Fever
Anorexia
Malaise

Gingivostomatitis
Lymphadenopathy (localized)
Ulcerative/vesicular lesions
Edema
For children with HSV-I, some may come in with inability to swallow liquids. Why?
B/c significant edema of the mucosal membrane and the associated pain.
For young adults with HSV-I, primary infection may be associated with what?
HSV pharyngitis

associated with mononucleosis-like syndrome
What percent of HSV-1 seropositive individuals have recurrent infections?

From here, what percent has it once a month?

What percent has it once between 2-11 months?

What percent has it once of 1 year or less?
33%
Most are asymptomatic

5%

34%

61%
Herpetic keratitis is the second leading cause of what?
Corneal blindness
Primary Herpetic Keratitis:

- limitation
- pathognomonic finding
- associated symptoms x3
Usually limited to one eye

Branching dendritic lesions

Photophobia
Eyelid edema
Tearing
What is herpes gladiatorum?

How does the virus transmit?

What population group is most prone to this disease?
Herpes infection of the body.

Through cuts and abrasions of the skin

Wrestlers and rugby players
Most severe clinical symptoms are encountered when for HSV-2 patients?
Most severe are encountered following primary infection.
HSV-2 Acquisition probability for heterosexual men:

- 1 partner
- 2-10 partners
- 11-50 partners
- >59 partners
0%
20%
35%
70%
HSV-2 Acquisition probability for heterosexual women:

- 1 partner
- 2-10 partners
- 11-50 partners
- >59 partners
<10%
40%
62%
>80%
What are the associated symptoms of HSV-2? x7
Fever
Malaise
Dysuria
Inguinal adenopathy
Photophobia
Stiff neck
Headache
Primary infection of women with HSV-2, usually results in what?
A more severe form of associated symptoms.
What is the main clinical symptoms associated with primary infections of HSV-2 in men?
Vesicular lesions on the penis glans/shaft.
T/F - For HSV-2 in men, extragenital lesions can occur in thighs, buttocks, perineum, and anus.
True
For men with primary infections of HSV-2, are there any complications?

If so, name and describe prevalence.
Aseptic meningitis
(Systemic complication)

Rare
For primary infections of HSV-2 in women, what is the most common clinical symptom?
BILATERAL lesions of the vulva
For women, primary infections in women can lead to lesions where else besides the most obvious location?
Perineum
Buttocks
Cervix
Vagina
Anus
What are the severe complications that can occur with women who have a primary infection of HSV-2?

List the probability also.
Urinary Retention syndrome
(10-15%)

Aseptic Meningitis
(25%)
List the frequency of recurrent infections for HSV-2.
Less than 4 per year (33%)

Between 4 to 7 per year (33%)

Greater than 7 per year (33%)
Which is usually worse?

Primary infection or recurrent infection?
Primary is worse
Does HSV-1 cause genital infections?

If so, how severe is it and what is the frequency?
Yes.

Less severe with less recurrent infections than HSV-2
Herpetic Whitlow:

- what is it?
- virus responsible?
- seen in what population?
HSV infection of the digits

HSV-1 or HSV-2

Medical and dental personnel
List two neurological complications that can arise from Herpes.

List which virus type causes it.
Herpes encephalitis
(HSV-1 and HSV-2)

Herpes meningitis
(HSV-2)
T/F - Herpes encephalitis with HSV-1 is not so serious.
False.

Severe morbidity and mortality
Herpes encephalitis with HSV-2 is associated with what type of infection?
Associated with

Neonatal infection
List the types of neonatal infections

What viruses are associated wiht them.

State the most common form.

Which one results in congenital infection.
In utero: HSV-2
(results in congenital infection)

Intrapartum: HSV-2
(75-80% of neonatal infections)

Postnatal: HSV-1
Neonatal infection is almost always ________ and can often be ________.
Symptomatic

Lethal
Which types of herpetic neonatal infections most severely afflict babies?

What are the symptoms of such?

Mortality rate?
Congenital infections

(In utero)

Microcephaly, multiorgan system involvement, skin scarring/vesicles, eye disease

50%
Infection of babies intrapartum or postnatally can be divided into three categories. List the three categories.
1. SEM (Skin Eye Mouth) disease

2. Localized CNS disease

3. Disseminated disease
List the laboratory tests used to diagnose HSV.
Cell culture (definitive)

Cytology/histology
What would you see on a positive cell culture for HSV?
CPE of syncytial (cell fusion)
What types of smears would you use for cytology/histological labs? x3

What would a positive lab look like?
Tzanck smear
Papanicolaou smear
Biopsy

Cowdry type A intranuclear inclusions
Can you use serology for HSV diagnosis?
Yes but only useful for diagnosing a primary infection or epidemiology
What would you use to treat HSV keratitis? x3

Describe the mechanism of these drugs.
Vidarabine (adenosine analog)
Idoxuridine (thymidine analog)
Trifluridine (thymidine analog)

Nucleoside analog will inhibit HSV DNA polymerase.
What would you use to treat Acyclovir resistant infections?

Describe mechanism of this drug.
Foscarnet (pyrophosphate analog)

Binds and inhibits HSV DNA polymerase
List four drugs used to treat HSV.

Describe the mechanism.

Which one is topical?
Acyclovir (guanosine analog)
Valacyclovir (Acyclovir prodrug)
Famciclovir (prodrug of penciclovir)

Penciclovir (topical cream)

HSV TK phosphorylates these compounds, which will prevent DNA replication
Are antivirals used for primary infection or recurrent infection?
Both
HSV resistance can be localized to where?
HSV TK

polymerase gene
List the vaccines associated with HSV.
None presently available