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Fitz 9th > 164 - Herpes Simplex > Flashcards

164 - Herpes Simplex Flashcards

1
Q

Most prevalent sexually transmitted disease worldwide

Most common cause of ulcerative genital disease

A

Genital herpes

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2
Q

The incidence of primary infection with HSV-1 is greatest during

A

Childhood

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3
Q

Acquisition of HSV-2 correlates with

A

Sexual behavior

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4
Q

Y/N: Most persons infected with HSV-1 or HSV-2 are asymptomatic

A

Yes

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5
Q

Y/N: Even though HSV-asymptomatic persons shed virus less frequently than symptomatic persons, the amount of HSV-2 shed during asymptomatic shedding is similar in symptomatic and asymptomatic groups

A

Yes

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6
Q

It is estimated that more than _____% of HSV-2 transmission is associated with asymptomatic shedding

A

70

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7
Q

As with other sexually-transmitted infections, the rate of acquisition of HSV-2 infection is higher for (men/women)

A

Women

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8
Q

Asymptomatic HSV-2 infection is more common among

A

Men

Persons who are also seropositive for HSV-1

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9
Q

(Primary/Recurrent) infections with HSV are usually more severe, frequently involve systemic signs and symptoms, and have a higher rate of complications

A

Primary

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10
Q

Most commonly affected area in orofacial herpes reactivation

A

Outer one-third of the lower lip

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11
Q

Stages of classical herpes lesions

A

Prodromal, erythema, and papule (developmental stage)
Vesicle, ulcer, and hard crust (disease stage)
Dry flaking and residual swelling (resolution stage)

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12
Q

Triggers for oral herpes recurrences

A 
Emotional stress
Illness
Exposure to sun
Trauma
Fatigue
Menses
Chapped lips
Season of the year
Exposure to UV irradiation
Trigeminal nerve surgery
Oral trauma
Epidural administration of morphine
Abrasive laser
Chemical facial cosmetic procedures
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13
Q

HSV-2 orolabial infections are 120 times (more/less) likely to reactivate than orolabial HSV-1 disease

A

Less

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14
Q

Y/N: Acquisition of HSV-1 in a person with prior HSV-2 infection is unusual

A

Yes

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15
Q

Y/N: HSV-2 acquisition in the presence of previous HSV-1 infection is common

A

Yes

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16
Q

Infections caused by HSV-2 reactivate approximately 16 times (more/less) frequently than HSV-1 genital infections

A

More

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17
Q

Average recurrence of HSV-2 genital infections per year

A

3 to 4 times

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18
Q

Infection of the fingers by HSV acquired by direct inoculation or direct spread from mucosal sites at the time of primary infection

A

Herpetic whitlow

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19
Q

Y/N: Surgical drainage is often needed for herpetic whitlow

A

No - unnecessary and potentially harmful

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20
Q

Cutaneous herpes transmitted in wrestling

A

Herpes gladiatorum

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21
Q

Cutaneous herpes transmitted in rugby

A

Herpes rugbiorum or scrum pox

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22
Q

Results from widespread infection following inoculation of virus to skin damaged by eczema

A

Eczema herpeticum (Kaposi varicelliform eruption)

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23
Q

Antimicrobial peptides that inhibit HSV replication

A

Cathelicidin

Beta-defensins

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24
Q

Mortality in eczema herpeticum was primarily caused by

A

Bacterial superinfection and bacteremia

25
Q

Recurrent HSV infection is the most common precipitating event in cases of

A

Recurrent erythema multiforme

26
Q

Primary maternal genital herpes is associated with a risk of neonatal infection of _____% for vaginally-delivered babies

A

25-50

27
Q

Recurrent maternal HSV infection is associated with a risk of neonatal transmission of less than _____%

A

3

28
Q

Neonatal herpes infections manifest in 1 of 3 forms

A

Skin, eye, and mouth involvement
Encephalitis
Disseminated disease

29
Q

All HSV infections involve the _____ system

A

Nervous

30
Q

HSV encephalitis usually presents with acute focal neurologic symptoms, fever, and involvement of the _____ lobe

A

Temporal

31
Q

Most common diagnostic technique for HSV encephalitis

A

PCR of the cerebrospinal fluid for HSV DNA

32
Q

Y/N: Recurrent and persistent ulcerative HSV lesions are among the most common and defining opportunistic infections in patients with AIDS

A

Yes

33
Q

Constant immune surveillance and engagement are required to maintain latency, mainly by HSV-specific _____ lymphocytes

A

CD8+

34
Q

Patients with defects in (cellular/humoral) immunity have no increase in HSV disease severity

A

Humoral

35
Q

Only approximately _____% of fresh genital lesions are culture positive

A

60-70

36
Q

Isolation of virus is most successful when lesions are cultured

A

During the vesicular stage

When specimens are taken from immunocompromised patients or from patients suffering from a primary infection

37
Q

More sensitive than viral isolation

Preferred method for diagnosis

A

PCR

38
Q

Enable typing of the isolate as HVS-1 or HSV-2

A

Viral culture

PCR assays

39
Q

Tzanck test is positive in fewer than _____% of culture-proven cases

A

40

40
Q

Cesarean section delivery may not reliably prevent neonatal HSV infection when

A

Membranes are ruptured for long periods (24 hours or more)

41
Q

For women at or beyond _____ of gestation who are at risk for recurrent HSV infection, suppressive antiviral therapy has been recommended

A

36 weeks

42
Q

Acyclovir must be phosphorylated to be active, and it requires the viral _____ for phosphorylation

A

Thymidine kinase

43
Q

Oral prodrug of acyclovir that achieves 3- to 5-fold higher bioavailability

A

Valacyclovir

44
Q

Well absorbed oral form of penciclovir

A

Famciclovir

45
Q

Topical cream approved by the US FDA for the treatment of herpes simplex labialis

A

Penciclovir 1% cream

46
Q

Approved by the FAD for nonprescription treatment of recurrent herpes labialis
Long-chain saturated alcohol that inhibits entry of lipid-enveloped virus into the cell

A

Docosanol 10% cream

47
Q

Treatment of choice for disseminated or severe herpes infections

A

Intravenous acyclovir 10 to 15 mg/kg every 8 hours

48
Q

Dose of intravenous acyclovir for neonatal herpes

A

20 mg/kg per dose given every 8 hours

49
Q

Most effective management strategy for persons with frequent or complicated genital recurrences

A

Long-term suppressive therapy with acyclovir or its analogs

50
Q

Y/N: Suppressive therapy with valacyclovir was more effective to reduce the burden of genital herpes disease than episodic therapy

A

Yes

51
Q

Y/N: Orolabial HSV infections warrant the same antiviral treatment as do genital infections

A

No - warrant antiviral treatment less often

52
Q

Y/N: Oral infections are inherently briefer and less symptomatic than genital herpes

A

Yes

53
Q

Y/N: Creams and ointments containing 5% and 10% acyclovir are not beneficial in recurrent herpes labialis

A

Yes

54
Q

Y/N: The use of suppressive acyclovir for recurrent herpes labialis is recommended

A

No - controversial

55
Q

Virtually all clinically relevant drug resistance has been seen in

A

Immunocompromised patients

56
Q

Effective in the treatment of acyclovir-resistant HSV
Does not require activation by HSV thymidine kinase
Requires IV therapy

A

Foscarnet

57
Q

Adverse effects of foscarnet

A

Nephrotoxicity
Electrolyte disturbances
Anemia
Seizures

58
Q

Intravenous cidofovir is associated with considerable nephrotoxicity and requires the coadministration of

A

Saline hydration and probenecid

59
Q

Treatment for acyclovir-resistant HSV

A 
Foscarnet
Cidofovir
Imiquimod
Resiquimod
Continuous IV acyclovir

Fitz 9th (108 decks)

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