Class: Herpes : HSV1, 2, VZV Flashcards
WHat type of herpes virus are HSV and VZV
alpha
Which herpesvirus causes neonatal herpes
HSV 2
Which herpesvirus causes oral herpes
HSV 1
Which herpesvirus causes encephalitis
HSV-1
What antivirals to use if viral resistance develops (2) (MOA)
Cidofovir and Foscarnet - Don’t need to be activated by viral kinases
ADEs of Acyclovir: (1)
IV - can crystalize in the kidney - need to infuse slowly and hydrate
ADEs of gangciclovir (2)
neutropenia, thrombocytopenia
Cidofovir ADEs (2)
renal toxicity
neutropenia
Foscarnet ADEs (2)
renal toxicity
neutropenia
Where do HSV 1 and 2 infect
mucosal epithelial cells,
What site is especially rare for HSV-2 infx but common for HSV-1
oral mucosa
MC form of transmission of genital HSV-1
oral sex (that’s right)
How is HSV-2 MC spread
Most commonly get HSV-2 from asymptomatically shedding partner.
Where are HSV-1 and 2 latent (2)
oral - trigeminal ganglia
genital - sacral ganglia
VSV is latent in what 3 places
dorsal root, cranial nerve, trigeminal nerve
What drugs used to treat primary outbreaks of HSV
All cyclovirs work.
3 complications fo HSV 1 and 2 infx
Meningitis with HSV-2 but not HSV-1
cervicitis-70-90%
Herpes proctitis (rectal lesions)
Which complication is seen in HSV-2 but NOT in HSV-1
meningitis
What is diffrence between primary and recurrent outbreaks of HSV 1 and 2?
Not as long and without systemic symptoms of primary outbreak - so no fever malaise
Which virus (1 or 2 ) asx sheds more often
HSV 2»_space;>HSV 1
How often does HSV 2 shedding occur?
every 10 days for 2-12 hours
What 3 antivirals are used to reduce shedding, transmission and recurrences? how often dosed?
acyclovir, valacyclovir, or famciclovir
Daily
When do you have to take oral acyclovir, valacyclovir or famciclovir to reduce symptoms of recurrence
prodromal stage.
Which HSV is spread through sex
both
over half of genital herpes is what type
HSV 1
both viruses express what in latency?
LAT (Latency Associated Transcripts)
The risk of acquiring HIV infection is higher if you have what location of what type of HSV infx
genital HSV-2
which HSV is MC cause of herpetic whitlow
HSV-1
which HSV is MC cause of herpetic gladitorum
HSV -1
which HSV is MC cause of ocular herpes
HSV-1
The number 1 cause of infectious blindness in developed countries
Herpes Keratitis
Sx of herpes keratitis
Staining of the eye shows dendritic lesion, areas of ulceration
tx to avoid in herpes keratits
steroids
Which eye infx of herepes is less common in primary infx but MC in recurrences?
Stromal Keratitis
What is tx for ocular herpes (2)
antiviral eye drops, and/or oral acyclovir
Which HSV is MC cause of temporal/frontal lobe encephalitis
HSV-1
What are 2 ways to dx HSV encephalitis?
PCR of CSF (may be negative in early infx)
MRI
tx for temporal/frontal lobe encephalitis
IV acyclovir as early as possible
Which herpes virus is a TORCH vinfx
HSV-2
What is risk of transmission to baby if primary infx occurs < 12 weeks before birth
40%
What is risk of transmission to baby if primary infx occurs MORE THAN 12 weeks before birth or with RECURRENT infx
1-2%
What is tx for pregnant woman having any Herpes lesions in pregnancy. (drug and # of weeks given and the procedure) - so 2 things
Acyclovir suggested at 36 weeks
C-sections reduce but do not abolish risk
Dx of neonatal Herpes (3 tests you must do all three)
1) Surface cultures
2) If vesicles are present: scrapings/swabs with culture
3) PCR of CSF
What are the main means of spread of varicella (2)
respiratory droplets, lesions
Complications Varicella infection (4)
secondary bacterial infx of skin
Reyes syndrome - with ASA use
CNS manifestations
PNA-
3 CNS manifestations of VZV infx
1) Cerebellar ataxia
2) Meningitis
Encephalitis
infection of a pregnant woman in first 20 weeks of pregnancy carries risk of?
Congenital varicella syndrome. = birth defects
If get varicella < 5 days before delivery increased risk of ?
congenital varicella zoster = disseminated, systemic disease
What are the MC sites of Shingles? (3)
thoracic, ophthalmic and cervical most common.
What are the two main complications of Shingles?,
postherpetic neuralgia
herpes zoster ophthalmicus and treatments
Tx for shingles
Acyclovir, Famciclovir, Valacyclovir treatment best started < 72 hours after first lesion
What is Hutchinson’s sign? what does it portend? =
Herpes lesions on tip of nose–> higher chance of ocular involvement (herpes zoster ophthalmicus)
Tx for herpes zoster ophthalmicus
cyclovirs, topical steroids
What are the 1st and 2nd MC viruses that cause Bell’s Palsy?
#1 - HSV-1 #2 - VZV
What kind of vaccine is the VZV vaccine
Live, Attenuated virus vaccine
When it should VZV vaccine be given for varicella and when it should be given for zoster
varicella (chickenpox)- First dose 12-14 months, second dose 4-6 years
Zoster -(Shingles) - over 60 years old
