Aani Micro: Herpes

Question 1

Where is VZV stored as a latent infection?

Answer 1

Dorsal Root ganglia

Question 2

What are the symptoms of shingles?

Answer 2

Painful rash in specific dermatone

Question 3

What is the treatment of shingles?

Answer 3

800mg Acyclovir 5 times a day
OR
250mg Famciclovir TDS
OR 
1000mg Valacyclovir TDS

Question 4

What is the spread of Herpes infection HSV1/2?

Answer 4

Mucocutaneous

Question 5

What is the spread of VZV?

Answer 5

Droplet infection

Question 6

Describe the genetic make up of Herpes?

Answer 6

double stranded DNA

Question 7

Which Herpes strain most commonly causes herpes encephalitis?

Answer 7

HSV1

Question 8

Which Herpes strain most commonly causes Mollaret’s Meningitis?

Answer 8

HSV2

Question 9

What is another differential for Cold sores?

Answer 9

Could be Herpangina (hand foot and mouth in adults- caused by Coxsackie A)

Question 10

What genital symptoms do you get from Herpes Simplex?

Answer 10

Pain
Rash
Sacral Radiculomyelitis (urinary retention)

Question 11

What eye symptoms can you get from HSV if you are immunocompromised?

Answer 11

PORN

Progressive Outer Retinal Necrosis

Question 12

Which trimester is associated with transmission of HSV to foetuses?

Answer 12

Third

Question 13

What treatment do you give if a mother has HSV and is pregnant

Answer 13

TO MOTHERS. Give oral or IV Acyclovir 6weeks before EDD

Question 14

What will you see in CSF if someone has Herpes enceph or molarett’s meningitis?

Answer 14

Raised protein

Question 15

Treatment of Herpes Enceph/Molarett’s meningitis?

Answer 15

STAT IV Acyclovir 10mg/kg
THEN
Oral Acyclovir for 2-3 weeks

Question 16

What are scrum pox?

Answer 16

Herpes Simplex skin lesions on the face caused by skin contact e.g. scrumming in Rugby

Question 17

What other skin lesions can you get from Herpes Simplex?

Answer 17

Red painful finger (Whitlow)
Erythema Multiforme
Eczema Herpeticum

Question 18

Which strain of herpes is in the Varicella Zoster vaccine?

Answer 18

Oka Strain

Question 19

Describe the skin rash in VZV?

Answer 19

Vesicles - droplet (raindrops on roses_)

Question 20

What cells will be present in VZV infection?

Answer 20

Multinucleated giant cells i.e. Tzanck Cells

Question 21

What symptoms can a baby get if they have congenital varicella syndrome?

Answer 21

Cataracts
Psychomotor Retardation
Hypoplastic limbs

Question 22

Who should you treat for VZV? and How?

Answer 22

Adults
neonates
Immunocompromised
People with painful symptoms
People with eye-involvement

Treat with 800mg Acyclocvir PO TDS 1 week

Question 23

What are the 3 broad categories of Herpes Virus? And the viruses within them?

Answer 23

Alpha- HS1, HS2 and VZV
Beta- CMV, HH6 and HH7
Gamma- HH8 and EBV

Question 24

What do HH6 and 7 cause?

Answer 24

Roseola Infantum i.e. 6th disease i.e. Exanthum Subitum

Question 25

What can HH8 cause?

Answer 25

Castleman's Syndrome (benign LN growth) or Kaposi's Sacrcoma

Question 26

Which cells will you see in Kaposi Sarcoma?

Answer 26

Spindle Cells AND Kaposi Sarcoma Herpes Virus Cells (KSHV)

Question 27

What can EBV become?

Answer 27

In immunocomp when T cells cannot keep B cells in check, there is uncontrolled B cell prolif and you can get Post Transplant Lymphoprolif disease (PTLD) or Burkitt's Lymphoma

Question 28

What is the Tx of EBV?

Answer 28

In immunocomp: Rituximab for Lymphoma and PTLD

Question 29

What type of infection is EBV?

Answer 29

Mononucleosis

Question 30

Tx of HH8?

Answer 30

Ganciclovir | 2nd line: Foscarnet or cidofovir

Question 31

Tx of HH6/7?

Answer 31

Ganciclovir | 2nd line: Foscarnet or cidofovir

Question 32

Which of the alpha Herpes Virus is most/least sensitive?

Answer 32

Most: HSV1 Least: VZV (high medication dose needed)

Question 33

Which cells do you get in CMV?

Answer 33

Owl Eye Inclusion bodies Monocucleosis Swollen large cells hence 'megalovirus'

Question 34

What symptoms can you get in CMV if you are immunocompetent?

Answer 34

80% asymptomatic | Fever, SOB, penumonia

Question 35

What symptoms can you get in CMV if you are immunosuppressed?

Answer 35

Retinitis (haemorrhagic exudate changes)

Question 36

Tx of CMV?

Answer 36

1st: ganciclovir or valganciclovir 2nd: foscarnet or cidofovir

Question 37

Investigations for CMV?

Answer 37

Blood- owl eye inclusion bodies | Paul Bunnel Ab test- clumping of sheep RBCs

Question 38

Which conditions does Paul Bunnell Test identify? (positive clumping of sheep RBC)

Answer 38

EBC and CMV

Question 39

Which cells do CMV stay latent in?

Answer 39

B Lymphocytes

Question 40

Which cells do HH6 and HH7 Stay latent in?

Answer 40

Monocytes/T cells/ epithelial cells

Question 41

Which people get Burkitt's lumphoma? What do they look like?

Answer 41

African kids with big jaw

Question 42

Treatment of Burkitt's Lymphoma?

Answer 42

Rituximab

Question 43

Which virus can cause Burkitt's Lymphoma?

Answer 43

EBV