Herpes Simplex Viruses 1 and 2 Flashcards

1
Q

As a family, herpesviruses are

A

Large, double-strand DNA viruses whose icosahedral capsids are surrounded by lipid envelopes.

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2
Q

Herpesviruses are complex, encoding over 90 proteins that supply:

A

Attachment and fusion glycoproteins of the envelope; transcriptional regulators that redirect host RNA polymerase to viral genes; a viral DNA polymerase and associated enzymes for replication of the virus genome; capsomeres; and still other envelope glycoproteins required for virus spread from cell to cell.

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3
Q

A hallmark of herpesviruses is their ability to?

A

Establish latent infections in which the virus genome, but not virus progeny, is maintained in a quiescent state for the remainder of the host’s life.

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4
Q

Once infected with a herpesvirus?

A

A patient is infected for life and subject to recurrent infections when the latent virus reactivates to produce progeny once again.

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5
Q

Herpes simplex virus (HSV) serotypes 1 and 2 can be transmitted?

A

Sexually-transmitted viruses

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6
Q

HSV 1 and 2 replicate in?

A

Epithelial cells and reside latently in the trigeminal or sacral ganglia hence, they are termed neurotropic herpesviruses.

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7
Q

While HSV 2 principally causes?

A

Genital lesions, HSV 1 can too, and both viruses cause additional ailments.

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8
Q

Once attached, HSV directly fuses with the plasma membrane in a

A

pH-independent manner and the released nucleocapsid migrates to the cell’s nucleus where the genome is released.

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9
Q

Initial transcription/translation (“immediate early” expression) produces proteins that act

A

As transcriptional regulators that modify host RNA polymerase so that it preferentially transcribes viral genes over host genes.

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10
Q

“early” proteins whose roles are

A

To replicate the virus genome to produce progeny genomes.

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11
Q

Prominent “early” proteins include

A

A thymidine kinase and components of a virally-encoded DNA polymerase.

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12
Q

The thymidine kinase is important clinically for two reasons?

A

First, it is required to phosphorylate (and hence activate) acyclovir (ACV) and derivatives, the drugs of choice to treat most HSV infections. Second, thymidine kinase mutants are a problem during treatment because their spontaneous occurrence renders HSV resistant to ACV.

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13
Q

HSV resistant to ACV is particularly a problem in

A

AIDS patients dually infected with HSV.

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14
Q

The “late” class of proteins is produced; these encode the?

A

Capsomeres, envelope glycoproteins, and other structural proteins.

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15
Q

Virus assembly occurs in the?

A

Nucleus and the virus buds from the plasma membrane during release.

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16
Q

Because the same viral glycoproteins responsible for the initial fusion (entry) event are?

A

Also present in the plasma membrane of infected cells late in infection, infected cells may fuse with adjacent, uninfected cells.

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17
Q

HSV can spread from cell to cell without?

A

The formal release of virus progeny from one cell and subsequent attachment and penetration of a nearby cell leading to the formation of syncitia: giant cells with more than one nucleus.

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18
Q

Virus assembly in the nucleus and syncitium formation are the basis of?

A

A diagnostic test for HSV: the Tzanck smear, in which smears of cells taken from an ulcerous lesion (vesicle) are viewed under a microscope.

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19
Q

Nuclear assembly leads to the formation of?

A

Inclusion bodies in the nucleus.

20
Q

If a Tzanck smear reveals multinucleated giant cells with nuclear inclusion bodies?

A

The infection is caused by a herpesvirus, presumably HSV.

21
Q

Soon after primary infection in epidermal cells, HSV?

A

Establishes latency in peripheral sensory neurons.

22
Q

Once latency established, the entire virus genome is?

A

Maintained extrachromosomally in neurons in 10-100 copies per cell, much like a plasmid in bacteria.

23
Q

The only HSV gene expressed during the maintenance of latency is called?

A

LAT (latency-associated transcript) whose product is an RNA species that silences a subset of cellular genes to prevent apoptosis of the infected neuron.

24
Q

Because only LAT is expressed?

A

No virus particles are produced during the maintenance of latency.

25
A decline in cell-mediated immunity allows the virus to?
Reactivate from latency and begin a productive, lytic replication cycle.
26
Reactivation of the latent virus in neurons leads to?
A recurrent infection in epithelial cells innervated by the latently-infected neurons.
27
Frequent sufferers of cold sores will often complain of numbness at the site after many years of recurrences.
Reactivation apparently kills the neuron
28
HSV 1 Diseases:
``` Gingivostomatitis Herpes labialis (fever blister) Herpetic whitlow (finger vesicle) *Keratitis* Conjunctivitis Blepharitis *Encephalitis* ```
29
HSV 2 Diseases:
*Cervicitis* *Vulvular vesicles* Vaginal vesicles Urethritis (rarely) *Penile vesicles* Perianal vesicles *Meningitis* Encephalitis
30
As with most viral infections, HSV infections are generally?
self-limiting.
31
Skin, ocular, and urogenital infections can be caused by?
Either virus, thus HSV 1 is not strictly limited to “above the belt” nor HSV 2 limited to “below the belt.”
32
Disseminated disease is a problem among?
Immunocompromised patients, often from reactivation. Neonates are also at risk can be severe or fatal.
33
A significant percentage of primary HSV infections are?
Asymptomatic.
34
When infections are symptomatic?
Multiple blisters form on the infected skin (oral, genital, or perianal) about two weeks following infection.
35
The blisters soon rupture producing?
Mildly to somewhat severely painful open vesicles (ulcers) which will take up to two weeks to heal during a primary infection.
36
Recurrent infections occur during lapses in?
Cell-mediated immunity and the resulting cold sores or genital lesions are limited in size and duration due to the presence of neutralizing antibody.
37
Transmission:
Both HSV 1 and 2 can be transmitted sexually although HSV 2 is the more frequent genital infection.
38
Epidemiology HSV 1:
Up to 60% of the adult US population has been infected with HSV 1.
39
Epidemiology HSV 2:
Most HSV 2 infections are diagnosed between the ages of 20 and 29; rates are 10% in adult males, 20% in adult females, and 10% in young adults.
40
If a mother presents with herpetic lesions at delivery?
The baby should be taken by C-section.
41
Diagnosis of oral herpes is generally by?
Clinical appearance.
42
Diagnosis Genital herpes:
``` Culturing virus from lesions; Fluorescent antibody (FA) screening PCR screening Serology: Tzanck smear: ```
43
Once individuals are infected with HSV?
They are infected for life. There are no curative treatments, but fortunately, there are several good antiviral treatments to lessen disease episodes.
44
There are four major groupings of anti-HSV drugs:
Acyclovir (ACV): drugs of choice Vidarabine and trifluoridine Foscarnet (Phosphonoformate) Docosanol
45
Vidarabine and trifluoridine mechanism:
DNA base analogs that inhibit the viral DNA polymerase.
46
Foscarnet (Phosphonoformate) mechanism:
Pyrophosphate analog that blocks the pyrophosphate-exchange site preferentially on the viral DNA polymerase.
47
Docosanol mechanism:
Modifies the host cell membrane so that the virus envelope cannot fuse with the plasma membrane, thus limiting the spread of the reactivated virus.