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46 Cards in this Set
- Front
- Back
The major difference between HSV-1 and HSV-2 is:
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Preferential sites of recurrence
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Two things that HSV-1 is the cause of:
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~95% of orofacial herpes
10-30% of primary genital herpes |
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What does HSV-2 cause?
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Recurrent genital herpes
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When do the vast majority of HSV-1 infections occur?
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During early childhood & are asymptomatic
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The most common clinical manifestation of HSV-1 is:
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Gingivomatitis
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In Recurrent herpes labialis, where does the virus lay dormant?
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trigeminal ganglion
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What is the most common cause of corneal blindness in the U.S.?
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Keratoconjunctivitis - HSV (normally HSV-1)
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A child or young adult presents with headache, fever, behavioral changes, speech difficulties, hallucinations, and focal seizures. An HSV-related disease to consider is:
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HSV encephalitis
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How is neonatal herpes acquired?
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Contact of neonate with infected genital secretions during passage through the birth canal
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What is the “gold standard” for diagnosis of an HSV infection?
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viral culture
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What are two complications of chickenpox in children?
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1. Bacterial superinfection of lesions
2. Cerebellar ataxia |
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What are some complications of chickenpox in adults?
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1. Encephalitis
2. Varicella pneumonia (pregnant women and adults) |
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What results from reactivation of latent VZV?
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Dermatomal zoster
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What is the classic triad of signs of EBV infection?
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fever
pharyngitis lymphadenopathy |
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What are four things caused by CMV in an immunocompromised host?
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Retinitis
Pneumonitis Colitis Neuropathies |
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What causes Exanthem subitum in infants and a mononucleosis-like syndrome in adults?
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Human Herpes Virus 6
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What does Human Herpes Virus 8 cause?
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Kaposi’s sarcoma
Multicentric Castleman’s Disease Body Cavity B lymphoma |
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What is used to treat acute episodes of HSV?
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Acyclovir
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What are the basic ideas in Herpes virology
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Mild disease enhances transmission
Latency and reactivation Importance of cell-mediated immunity Morbidity: congenital/neonatal disease, immunocompromised, cancers |
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Where is a HSV-1 recurrent infection likely to manifest
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Most likely oral
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Where is a HSV-2 recurrent infection most likely to be
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Most likely genital
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What are the factors implicated in HSV reactivation
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Fever
Trigeminal ganglion decompression Third molar surgery Sunlight (UV) Epithelial Trauma Stress Immunosuppression |
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What are the characteristics of asymptomatic shedding of HSV
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Occurs with both HSV-1 and HSV-2
The only form of recurrence in >50% of patients Detected by culture on 0.5-2% of days May be associated with very mild lesions that are not recognized as HSV Typically lasts <1.5 days Reduced but not eliminated by acyclovir |
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What are some potential interventions to reduce neonatal Herpes morbidity
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Prevention of exposure (Abstinence, C-section)
Potential therapeutic interventions Established: Rapid treatment of neonates with suggestive clinical picture Controversial: Improved early diagnosis of infected neonates (24-48 hr cultures-- controversial); 3rd trimester acyclovir in mothers with identified risk; Antiviral prophylaxis of exposed neonates (positive culture at delivery indicates exposure) |
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What are some HSV infections in immunosuppressed patients
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Herpes labialis
Gingivostomatitis Esophagitis Pneumonitis Hepatitis Cutaneous Disseminated |
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How can HSV infection be diagnosed
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Viral culture (gold standard)
Tzanck smear Culture with monoclonal antibody staining Serology (glycoprotein G can be used to distinguish HSV-1 and HSV-2) DNA probes Polymerase chain reaction |
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How are Chickenpox and Zoster transmitted
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Transmission by aerosol (rarer for zoster) and direct contact
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How does Varicella with cerebellar ataxia present
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Ataxia usually simultaneous with rash (can precede the rash)
Ataxia accompanied by HA, vomiting, lethargy 25% have fever, nuchal rigidity, nystagmus Seizures are rare |
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What are some diagnostic findings in Varicella with Cerebellar ataxia
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Clinical diagnosis sufficient in typical cases
CSF usually normal. Pleocytosis (<100 WBC) in 25% EEG - diffuse slow wave activity (20%) MRI - rarely see focal cerebellar or brain stem lesions |
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How does Varicella encephalitis present
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Symptoms usually appear about one week after rash (though may be earlier or later). Acute or gradual onset.
Fever, HA, vomiting, altered mental status Focal neurologic findings -- hyper/hypo-reflexia, hemiparesis, sensory changes Seizures 29-52% of cases |
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What are risk factors for more severe Varicella disease
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Late pregnancy
Neonates Steroid use- Includes inhaled steroids Other immunocompromise Non-vaccinated, varicella naive |
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What is the definition of Disseminated zoster
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>20 vesicles outside primary dermatome and/or visceral or CNS involvement
Incidence and severity increase with degree of immunocompromise, especially CMI |
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Epstein Barr Virus is implicated in what cancers
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Burkitts lymphoma (Africa)
Nasopharyngeal carcinoma (Asia) Oral hairy leukoplakias Lymphoproliferative syndrome (especially in the immunocompromised) |
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How does CMV mononucleosis syndrome present
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Fever, malaise, mild adenopathy and hepatosplenomegaly, little sore throat
Mild hepatitis Lymphocytosis, 20% atypicals Heterophile antibodies positive in about half IgM seroconversion |
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What are some characteristics of CMV post-transfussion syndrome
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Risk: 3-4% per unit of whole blood
Follows 5-20% of exposures Incubation average 3 weeks (range 1-6 wks) Symptomatic in 30% Fever, malaise, hepatitis splenomegaly Relative lymphocytosis, with atypicals |
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How does CMV in the immunocompromised host present
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retinitis
encephalitis pneumonitis viremia hepatitis neutropenia, leading to fungal infections |
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What is the Antigenemia (pp65) test
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CMV antigen production in neutrophils predicts positive blood culture in bone marrow transplant patients
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What are some characteristics of Congenital CMV
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Mother:
-50% of pregnant women are susceptible -2% of these develop primary infection -Virus shed in saliva, milk, urine, from cervix Baby -1% infected in utero, mostly primary -90% initially subclinical, developmental problems later (e.g., mental retardation, deafness) -10% cytoplasmic inclusion disease: petichiae, hepatosplenomegaly, jaundice, microcephaly, chorioretinintis |
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What are some diseases caused by HHV-6 or 7
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Roseola
Infectious mononucleosis-like syndrome Infections in immunocompromised -Fever in BMT patients -Encephalitis -Pneumonitis |
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What are some characteristics of HHV-8
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Cause of:
-Kaposi’s sarcoma -Multicentric Castleman’s Disease -Body Cavity B lymphoma Primary infection unknown Probably sexually transmitted |
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What is valacyclovir
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An oral acyclovir prodrug which gives higher blood drug levels
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What is acyclovir used for
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HSV treament for:
-Acute episodes -Recurrences (benefit is very modest) -Suppression of recurrences in patients with frequent recurrences |
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How is chickenpox treated
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Do not treat children
Use acyclovir for adults or the immunocompromised |
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When is Zoster treated
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Antivirals are recommended for age greater than 50, severe pain, immunocompromised, or eye involvement
Pain should always be managed aggressively |
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What are some characteristics of live-attenuated varicella vaccine
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Developed in Japan in the 1970s
Indicated to prevent/reduce complications of varicella 70-90% effective in preventing varicella >99% effective in preventing “severe” varicella High dose formulation can prevent zoster 1 dose for children, 2 doses above age 12 Vaccination required in many states |
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How are CMV infections managed
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Prevention
-Tissue, blood screening -Immunoglobulin prophylaxis: CMV-Ig reduces incidence of severe infections post-transplant -Prophylactic antivirals Vaccine: none licensed Treatment: Ganciclovir- including ocular implants. Can cause bone marrow toxicity Foscarnet-nephrotoxicity Cidofovir-nephrotoxicity |