22. Herpes Viruses

Question 1

Which antiviral agent is used in the treatment of Cytomegalovirus (CMV)?

Answer 1

Foscarnet

Question 2

Cytomegalovirus (CMV) is a member of which virus families?

Answer 2

Herpes virus

Question 3

What is the most likely presentation in an immunocompetent adult with Cytomegalovirus (CMV) infection?

Answer 3

Pharyngitis and lymphadenopathy

Question 4

What is the most likely route of spread of Cytomegalovirus (CMV)?

Answer 4

Sexual

Question 5

What test should be performed on a serum sample to monitor response to treatment in an immunocompromised patient with systemic Cytomegalovirus (CMV) infection?

Answer 5

Quantitative PCR

Question 6

Classify the herpes viruses?

Answer 6

Herpes simplex 1 and 2
Varicella-zoster
Cytomegalovirus
Epstein-Barr
Human herpes virus 6, 7 and 8

Question 7

Are herpes viruses enveloped or non-enveloped?

Answer 7

Enveloped

Question 8

Are herpes viruses DNA or RNA viruses?

Answer 8

DNA

Question 9

What feature of herpes viruses is targeted by antivirals?

Answer 9

DNA polymerase

Question 10

What cells do herpes simplex 1&2 infect?

Answer 10

Muco-epithelial

Question 11

How is herpes virus 1&2 contracted?

Answer 11

Contact with vesicular fluid

Question 12

How is herpes virus 1&2 detected?

Answer 12

PCR on vesicular fluid or CSF in the case of encephalitis

Question 13

Where is latent herpes simplex contained?

Answer 13

Within neurons, especially trigeminal ganglion

Question 14

What diseases are caused by herpes simplex infection?

Answer 14

Cold sores
Genital herpes
Keratitis

Question 15

What serious diseases are caused by herpes simplex?

Answer 15

Eczema herpeticum
Encephalitis
Disseminated disease

Question 16

What part of the brain is typically affected by herpes simplex encephalitis?

Answer 16

Fronto-temporal lobe

Question 17

What is the treatment for herpes simplex encephalitis?

Answer 17

IV aciclovir

Question 18

How is neonatal herpes simplex acquired?

Answer 18

Vaginal canal

Contact with coldsore or herpetic whitlow

Question 19

What are the consequences of neonatal herpes simplex?

Answer 19

Death

Intellectual disability

Question 20

What lab tests can be done to confirm neonatal herpes simplex?

Answer 20

Swabs for culture

CSF and blood for PCR

Question 21

What are the complications of chicken pox?

Answer 21

Bacterial superinfection
Pneumonitis
CNS manifestations

Question 22

What risk is chicken pox during the 1st 20 weeks of pregnancy?

Answer 22

Congenital varicella syndrome

Risk increases as infection gets nearer to delivery time

Question 23

What is shingles?

Answer 23

Reactivation of dormant VZV in dorsal root ganglion

Question 24

What are the symptoms of shingles?

Answer 24

Rash
Could cause herpetic neuralgia
Sight loss if it affects the opthalmic division of trigeminal nerve

Question 25

How can VZV infections be prevented?

Answer 25

Live varicella vaccine can prevent chicken pox Zoster vaccine prevents shingles Ig given to high risk patients as PEP

Question 26

What isolation precautions are needed for chicken pox?

Answer 26

Airborne

Question 27

What is CMV acquired from?

Answer 27

Bodily secretions

Question 28

What are the symptoms of CMV?

Answer 28

Majority mild or asymptomatic | Uncommonly can cause infectious mononucleosis like syndrome

Question 29

What cells hold latent CMV?

Answer 29

Lymphocytes

Question 30

What are the symptoms of congenital CMV?

Answer 30

``` Small birth weight Microcephaly, intra-cerebral calcifications chorioretinitis encephalitis Jaundice hepatomegaly rash thrombocytopaenia ```

Question 31

What disease does CMV cause in HIV patients?

Answer 31

CMV retinitis

Question 32

What disease can CMV cause in transplant patients?

Answer 32

CMV colitis and pneumonitis

Question 33

What samples can be sent to the lab for a patient with CMV?

Answer 33

BAL in penumonitis Biopsy in collitis Can be isolated from any bodily fluid

Question 34

What test is done on cell culture in CMV?

Answer 34

DEAFF test

Question 35

How is EBV transmitted?

Answer 35

Saliva

Question 36

What disease does EBV cause?

Answer 36

Infectious mononucleosis

Question 37

What are the symptoms of infectious mononucleosis?

Answer 37

Exudative pharyngitis | Lymphadenopathy and hepatosplenomegaly

Question 38

What may happen if a patient with EBV is misdiagnosed as having strep throat?

Answer 38

Ampicillin used to treat strep throat causes a rash

Question 39

What is serology used to detect in EBV?

Answer 39

Heterophile antibody | Antibodies to capsid or nuclear antigens

Question 40

What is seen on a blood film for EBV?

Answer 40

Atypical lymphocytes

Question 41

What cell does EBV persist in?

Answer 41

B cells

Question 42

What are possible complications caused by EBV?

Answer 42

B and T cell lymphomas Nasopharyngeal carcinoma Post-transplant lymphoproliferative disease Oral hairy leukoplakia in HIV

Question 43

What disease is caused by human herpes viruses 6 and 7?

Answer 43

Roseola infantum

Question 44

What are the symptoms of roseola infantum?

Answer 44

high fever maculopapular rash febrile seizures

Question 45

How is human herpes virus 8 acquired?

Answer 45

sexually

Question 46

What disease is associated with human herpes virus 8 and HIV?

Answer 46

Kaposi's sarcoma