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58 Cards in this Set
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Human Herpes Viruses
(general) |
Large
Enveloped dsDNA (makes sense b/c latency!) |
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Human Herpes Viruses
(Classification Scheme) |
Alpha, Beta and Gamma Subfamilies
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Human Herpes Viruses
(Alpha Subfamily) |
Include HHV 1/2/3 and Herpes simiae (Herpes B)
Characterized by rapid cell growth, variable host range and latency in sensory ganglio |
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Human Herpes Viruses
(Beta Subfamily) |
CMV (5) and HHV6
SLOW GROWTH (culture) Latency in CD4/Monocytes/Macs/Mesenchymal cells |
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Human Herpes Viruses
(Gamma Subfamily) |
4 (EBV) and 8 (Kaposi's Sarcoma HIV)
POOR GROWTH |
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Herpes
(Virus-Host Interactions) |
All encode enzymes involved in NA metabolism (important in antiviral therapy!)
Lysis/latency Reactivation of latent phase may be symptomatic or asymptomatic |
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Herpes Simplex Viruses
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HHV 1 & 2
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HSV
(Structure) |
As HHVs, they're enveloped w/dsDNA
They're envelope is coated with glycoproteins that facilitate their attachment to cells but also enable serotyping |
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How do you serologically distinguish HSV1 and HSV2?
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Serology is based on antibodies to gG (envelope glycoprotein)
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HSV1 vs. HSV2
(Seroepidemiology) |
HSV1: indidence begins at childhood (most adults seropositive)
HSV2: incidence at puberty & less than 1/2 adults seropositive |
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HSV Infections
(Pathogenesis) |
Inoculate skin/mucous membranes
Productive infection of surrounding area and sensory neurons LATENCY (in sensory ganglia) External/internal stressors result in reactivation of infection (majority are subclinical) |
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HSV Primary Infection
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Generally subclinical
Most common manifestation = PAINFUL vesicular rash |
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HSV Rash Evolution
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Erythema, Papule, Vesicle, Pustule, Ulcer, Scab
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HSV 1
(Typical Primary Infections) |
Gingivostomatitis
Keratoconjunctivitis |
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HSV 1
(Typical Recurrent Disease) |
Herpes labialis
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HSV 2
(Typical Primary Infection) |
Genital/neonatal herpes
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HSV 2
(Recurrent disease) |
Genital Herpes
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HSV and the Immunocompromized Host
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MORE FREQUENT
DISSEMINATED INFECTIONS are cause of significant mortality |
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Shared Clinical Syndrome of HSV 1 and 2
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ENCEPHALITIS
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HSV
(Diagnosis) |
Tzank Smear (multinucleated giant cells w/inclusions)
Culture or serology |
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Tzank Smear
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Multinucleated Giant cells w/inclusions (seen in HSV lesions)
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HHV 3
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Varicella-Zoster Virus
Chickenpox and Shingles |
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VZV
(Epidemiology) |
Majority of US adults are seropositive
Primary infections at childhood Incidence of recurrent infection increase with age |
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VSV
(Pathogenesis) |
Aerosol or direct contact
Latency established in sensory ganglia (note: you have this interstitial viremia which causes virus to set up shop in multiple dermatomes) |
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VSV
(Primary Infection) |
Symptomatic
"Chickenpox" Morbidity greater in adults vs. children Serious complications if immunocompromized Primary infection during pregnancy may give rise to birth defects |
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Reye Syndrome and VSV
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Associated w/aspirin treatment
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Reye Syndrome
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Unexplained GI problems (vomiting/diarrhea)
Generally afebrile "Brain Fevor" symptoms . . . lethary . . . delerium later, etc |
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Herpes Zoster
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Reactivated latent VSV infection
Dermatomal banding pattern More severe in immunecompromized host |
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VSV
(Prevention and Control) |
Live vaccine recommended for 1 yr olds
Must isolate VSV infection in hospital Immune globulin possible for those at risk for severe infecotion |
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Cytomegalovirus
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CMV (HHV 5)
As HHV, tells you its dsDNA and enveloped |
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CMV
(Risk Factors) |
Day Care
Promiscuity (Homosexuality) Blood/transplant recipients |
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CMV
(Routes of Transmission) |
Perinatal
Intimate contact Blood transfusion/transplants |
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CMV
(Clinical Presentation) |
Majority of infecotions are ASYMPTOMATIC but 3 groups of symptomatic infections exist (depends on host state)
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CMV
(Symptomatic Infections) |
(1) Fetus/Neonate
(2) Older children/adults (3) Immunocompromized |
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CMV
(Fetal/Neonatal Infection) |
Severe, disseminated disease
Fever, jaundice, hepatospenlomegaly, anemia/thrombocytopenia, lymphocytosis |
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What is the most common congenital infection?
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CMV
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What is the most common cause of viral-induced deafness/MR?
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CMV
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CMV
(Older Children/Adults) |
Systemic infection mimics Infectious Mononucleosis (due to EBV)
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CMV
(Immunocompromized Host) |
Hepatitis
Retinitis Encephalitis Colitis |
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CMV
(Diagnosis) |
Detect viral antigen/DNA (via PCR), IgM or histopathology (see cytoplasmic/nuclear inclusions)
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EBV
(general) |
Epstein-Barr Virus
HHV4 (tells you enveloped, as dsDNA) |
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EBV
(Seroepidemiology) |
Vast majority seropositive
In children, infections are generally subclinical Most common presentation in young adults |
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EBV
(Pathogenesis) |
Replication in oropharynx and B cell infection
EBV stimulates proliferation of B cells and CMI/humoral response |
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What causes symptoms of EBV infection (mono)?
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The immune response to B cell proliferation
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EBV
(Clinical Manifestations) |
(1) Infectious Mononucleosis (fever, sore throat and lymphadenopathy)
(2) OHL (3) Cancer |
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OHL
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Oral Hairy Leukoplakia
Seen in HIV patients Lytic EBV replication on tongue epithelium NOTE: EBV is required but not sufficient for OHL |
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EBV and Cancer
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Nasopharyngeal carcinom
African-type Burkitt's Lymphoma Non-Hodkin's Lymphoma Hodkin's Disease NOTE: these cancers arise in *10%* of transplant patients (b/c their immune system is so shoddy - if you cut back on immunosuppressive drugs, these cancers may regress) |
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EBV
(Diagnosis) |
1) CBC w/diff: Lymphocytosis w/atypical lymphocytes
2) Heterophile antibodies (during acute infection) 3) anti-VCA (viral capside antigen) IgM antibodies (for specific diagnosis) |
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What should you look for to specifically diagnose acute EBV infection?
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IgM antibodies to VCA (viral capsid antigen)
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EBV
(Managment of Symptoms) |
Steroids (if airway obstruction, thromobocytopenia/anemia, etc)
Avoid contact sports (splenic rupture) |
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HHV 6
(general) |
Beta HHV Subfamily (?)
Tells you it's enveloped, dsDNA |
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HHV 6
(Clinical Manifestations) |
MAJORITY of cases are SYMPTOMATIC
Causes Roseola (a.k.a. SIXTH disease) - high fever and following rash |
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HHV 8
(general) |
Gamma HHV virus (enveloped, dsDNA)
a.k.a. Kaposi's Sarcoma-Associated Herpesvirus (KSHV) |
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HHV 8
(Epidemoiology) |
Low seroprevalence in US
Higher seroprevalence in Mediterranean/East African Population HIGH seroprevalence (75%) in HIV patients |
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HHV 8
(Transmission - Endemic Areas) |
Oral and suggested mother-child
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HHV 8
(Transmission) |
Patterns of sexual transmission (virus predominates in saliva and other secretions)
NOTE: different route of infection in endemic countries (likely oral) b/c acquired during childhood |
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HHV 8
(Diseases) |
Tumors (Kaposi's Sarcoma), primary effusion/body cavity lymphomas, AIDS-related multicentric Castleman's Disease
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Herpes Simiae
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Herpes B
Primate herpes that is highly infectious among humans, with severe CNS complications Generally follows animal bites NOTE: antiviral therapy EXISTS. Therefore, need to catch and treat early! |