Class: Herpes : HSV1, 2, VZV

Question 1

WHat type of herpes virus are HSV and VZV

Answer 1

alpha

Question 2

Which herpesvirus causes neonatal herpes

Answer 2

HSV 2

Question 3

Which herpesvirus causes oral herpes

Answer 3

HSV 1

Question 4

Which herpesvirus causes encephalitis

Answer 4

HSV-1

Question 5

What antivirals to use if viral resistance develops (2) (MOA)

Answer 5

Cidofovir and Foscarnet - Don’t need to be activated by viral kinases

Question 6

ADEs of Acyclovir: (1)

Answer 6

IV - can crystalize in the kidney - need to infuse slowly and hydrate

Question 7

ADEs of gangciclovir (2)

Answer 7

neutropenia, thrombocytopenia

Question 8

Cidofovir ADEs (2)

Answer 8

renal toxicity

neutropenia

Question 9

Foscarnet ADEs (2)

Answer 9

renal toxicity

neutropenia

Question 10

Where do HSV 1 and 2 infect

Answer 10

mucosal epithelial cells,

Question 11

What site is especially rare for HSV-2 infx but common for HSV-1

Answer 11

oral mucosa

Question 12

MC form of transmission of genital HSV-1

Answer 12

oral sex (that’s right)

Question 13

How is HSV-2 MC spread

Answer 13

Most commonly get HSV-2 from asymptomatically shedding partner.

Question 14

Where are HSV-1 and 2 latent (2)

Answer 14

oral - trigeminal ganglia

genital - sacral ganglia

Question 15

VSV is latent in what 3 places

Answer 15

dorsal root, cranial nerve, trigeminal nerve

Question 16

What drugs used to treat primary outbreaks of HSV

Answer 16

All cyclovirs work.

Question 17

3 complications fo HSV 1 and 2 infx

Answer 17

Meningitis with HSV-2 but not HSV-1
cervicitis-70-90%
Herpes proctitis (rectal lesions)

Question 18

Which complication is seen in HSV-2 but NOT in HSV-1

Answer 18

meningitis

Question 19

What is diffrence between primary and recurrent outbreaks of HSV 1 and 2?

Answer 19

Not as long and without systemic symptoms of primary outbreak - so no fever malaise

Question 20

Which virus (1 or 2 ) asx sheds more often

Answer 20

HSV 2&raquo_space;>HSV 1

Question 21

How often does HSV 2 shedding occur?

Answer 21

every 10 days for 2-12 hours

Question 22

What 3 antivirals are used to reduce shedding, transmission and recurrences? how often dosed?

Answer 22

acyclovir, valacyclovir, or famciclovir

Daily

Question 23

When do you have to take oral acyclovir, valacyclovir or famciclovir to reduce symptoms of recurrence

Answer 23

prodromal stage.

Question 24

Which HSV is spread through sex

Answer 24

both

Question 25

over half of genital herpes is what type

Answer 25

HSV 1

Question 26

both viruses express what in latency?

Answer 26

LAT (Latency Associated Transcripts)

Question 27

The risk of acquiring HIV infection is higher if you have what location of what type of HSV infx

Answer 27

genital HSV-2

Question 28

which HSV is MC cause of herpetic whitlow

Answer 28

HSV-1

Question 29

which HSV is MC cause of herpetic gladitorum

Answer 29

HSV -1

Question 30

which HSV is MC cause of ocular herpes

Answer 30

HSV-1

Question 31

The number 1 cause of infectious blindness in developed countries

Answer 31

Herpes Keratitis

Question 32

Sx of herpes keratitis

Answer 32

Staining of the eye shows dendritic lesion, areas of ulceration

Question 33

tx to avoid in herpes keratits

Answer 33

steroids

Question 34

Which eye infx of herepes is less common in primary infx but MC in recurrences?

Answer 34

Stromal Keratitis

Question 35

What is tx for ocular herpes (2)

Answer 35

antiviral eye drops, and/or oral acyclovir

Question 36

Which HSV is MC cause of temporal/frontal lobe encephalitis

Answer 36

HSV-1

Question 37

What are 2 ways to dx HSV encephalitis?

Answer 37

PCR of CSF (may be negative in early infx) | MRI

Question 38

tx for temporal/frontal lobe encephalitis

Answer 38

IV acyclovir as early as possible

Question 39

Which herpes virus is a TORCH vinfx

Answer 39

HSV-2

Question 40

What is risk of transmission to baby if primary infx occurs < 12 weeks before birth

Answer 40

40%

Question 41

What is risk of transmission to baby if primary infx occurs MORE THAN 12 weeks before birth or with RECURRENT infx

Answer 41

1-2%

Question 42

What is tx for pregnant woman having any Herpes lesions in pregnancy. (drug and # of weeks given and the procedure) - so 2 things

Answer 42

Acyclovir suggested at 36 weeks C-sections reduce but do not abolish risk

Question 43

Dx of neonatal Herpes (3 tests you must do all three)

Answer 43

1) Surface cultures 2) If vesicles are present: scrapings/swabs with culture 3) PCR of CSF

Question 44

What are the main means of spread of varicella (2)

Answer 44

respiratory droplets, lesions

Question 45

Complications Varicella infection (4)

Answer 45

secondary bacterial infx of skin Reyes syndrome - with ASA use CNS manifestations PNA-

Question 46

3 CNS manifestations of VZV infx

Answer 46

1) Cerebellar ataxia 2) Meningitis Encephalitis

Question 47

infection of a pregnant woman in first 20 weeks of pregnancy carries risk of?

Answer 47

Congenital varicella syndrome. = birth defects

Question 48

If get varicella < 5 days before delivery increased risk of ?

Answer 48

congenital varicella zoster = disseminated, systemic disease

Question 49

What are the MC sites of Shingles? (3)

Answer 49

thoracic, ophthalmic and cervical most common.

Question 50

What are the two main complications of Shingles?,

Answer 50

postherpetic neuralgia | herpes zoster ophthalmicus and treatments

Question 51

Tx for shingles

Answer 51

Acyclovir, Famciclovir, Valacyclovir treatment best started < 72 hours after first lesion

Question 52

What is Hutchinson’s sign? what does it portend? =

Answer 52

Herpes lesions on tip of nose--> higher chance of ocular involvement (herpes zoster ophthalmicus)

Question 53

Tx for herpes zoster ophthalmicus

Answer 53

cyclovirs, topical steroids

Question 54

What are the 1st and 2nd MC viruses that cause Bell's Palsy?

Answer 54

``` #1 - HSV-1 #2 - VZV ```

Question 55

What kind of vaccine is the VZV vaccine

Answer 55

Live, Attenuated virus vaccine

Question 56

When it should VZV vaccine be given for varicella and when it should be given for zoster

Answer 56

varicella (chickenpox)- First dose 12-14 months, second dose 4-6 years Zoster -(Shingles) - over 60 years old