Condition- Herpes Simplex Virus

Question 1

How is he herpes simplex virus transmitted?

Answer 1

• Via close contact with an individual shedding the lesion (kissing, sexual intercourse)
• The herpes virus enters the host through a break in their skin

Question 2

What tends to be the genreal distribution of HSV1 and HSV2 symptoms?

Answer 2

• HSV-1 causes symptoms above the waist (oral herpes, herpes encephalitis)
• HSV-2 causes symptoms below the waist (genital herpes)

Question 3

State and describe the two phases of a herpes virus life cycle

Answer 3

• Lytic phase: HSV enters epithelial cell, inserts DNA, and replicates in cell, lysing it as the new viruses leave the cell
• Latent phase: HSV enters sensory nerves and remains dormant in sensory ganglion

Question 4

List three factors which can cause a dormant herpes virus to reactivate and become symptomatic

Answer 4

• stress
• viral infection
• Break in skin
• Immunocompromised

Question 5

In which ganglion does the HSV causing recurrent oral and genital herpes remain dormant?

Answer 5

• Oral Herpes- remains dormant in trigeminal ganglion
• Genital Herpes- remains dormant in sacral ganglion

Question 6

List some of the manifestations of primary infection of HSV

Answer 6

• Oral Herpes
• Genital Herpes
• HSV meningitis/ encephalitis
• Herpes Keratoconjunctivitis
• Herpes Whitlow
• Eczema herpeticum
• Herpes gladiatorum
• Disseminated infection

Question 7

Describe the presentation of Oral Herpes

Answer 7

• Primary infection (in children): fluid-filled vesicles on lips, gums, palatte, tongue
• Primary infection in adults: Pharyngitis
• Recurrent infection: prodrome =>crusty, red cold sores on vermillion border

Question 8

Describe the ocular manifestations of herpes

Answer 8

• Causes Keratoconjunctivitis
  
  • Cornea: blurry vision, branching dendritic lesions
  • Conjuctiva: red, painful, tears, photophobia

Question 9

Which infection causes this sign?

Answer 9

HSV infection causing HSV keratoconjunctivits

Can see dendritic ulcers = classic sign

Question 10

Describe the CNS manifestations of HSV

Answer 10

• Herpes Encephalitis: headache, fever, confusion, seizures
• Herpes meningitis: signs of meningismus

Question 11

What would you see on an LP of someone with HSV encephalitis/ meningitis?

Answer 11

• High protein
• High WCC

Question 12

State the term given for herpes infection of the nail.

Answer 12

Herpes Whitlow

easily spread= autoinoculation

Question 13

What is herpes gladiatorum? Describe its distribution

Answer 13

Herpes on trunk, extremities and head

Often seen in wrestler’s due to close skin-skin contact

Question 14

How does herpes get transmitted from a pregnant woman to her child?

Answer 14

During childbirth through vaginal secretions

Question 15

Descirbe the manifestation of HSV in neonates

Answer 15

1. Skin, mucose, eyes
2. CNS => irritability, seizures
3. Disseminated infection => sepsis, multi-organ failure

Question 16

Which investigations could you offer to someone with HSV

Answer 16

• Based on clinical diagnosis
• Can send fluid for PCR or viral culture
• If Herpes Encephalitis/ meningitis: might do LP, CT/MRI, EEG