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Parasitology/Virology > Herpes Virus > Flashcards

Herpes Virus Flashcards

1
Q

What are the alpha herpesviruses?

A

HSV-1 (HHV-1)
HSV-2 (HHV-2)
VZV (HHV-3)

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2
Q

What are the beta herpesviruses?

A

CMV (HHV-5)
HHV-6
HHV-7

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3
Q

What are the gamma herpesviruses?

A

EBV (HHV-4)

HHV-8

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4
Q

What is a characteristic of alpha herpesviruses?

A

Blistering rash, neurotropic

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5
Q

What is a characteristic of beta herpesviruses?

A

Roseola viruses (CMV is transient)

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6
Q

What are the lymphotropic herpesviruses?

A

EBV, CMV, HHV-6, HHV-7, HHV-8

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7
Q

What is the difference between lymphotropic and neurotropic herpesviruses?

A

Lymphotropic - can infect epithelial cells

Neurotropic - can infect nerve cells

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8
Q

What is contained within the CMV tegument?

A

pp65 and mRNAs

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9
Q

What makes CMV genetic makeup unique compared to other herpesviruses?

A

Contains DNA and RNA

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10
Q

What is the function of immediate early genes of CMV?

A

Function in viral DNA synthesis
Do not require protein synthesis
Detected in nucleus within a few hours

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11
Q

What is the function of early genes of CMV?

A

Function in DNA replication and viral protein modification
Require protein synthesis for expression
Cytoplasmic and nuclear

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12
Q

What is the function of late genes of CMV?

A

Mostly structural gene products (capsid, tegument, envelope)

Cytoplasmic and nuclear

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13
Q

What cells get permissive infection of CMV?

A

Fibroblasts, epithelial cells, macrophages

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14
Q

What cells get latent infection of CMV?

A

Hemopoietic cells (including myeloid/macrophage progenitor cells in the bone marrow and liver)

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15
Q

What cells get persistent infection in CMV?

A

Lymphocytes, endothelial cells, stromal cells of he bone marrow

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16
Q

What is the leading infectious cause of birth defects in the US?

A

CMV

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17
Q

Who will exhibit clinical symptoms of CMV infection?

A

Immunocompromised patients
Older individuals (immunosenescence)
Neonates

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18
Q

What is the mode of transmission of CMV?

A

Bodily fluids

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19
Q

What are the clinical manifestations of CMV in immunocompetent host?

A

Asymptomatic (80-90%)
Mononucleosis (heterophile antibody negative)
Idiopathic thrombocytopenic purpura/hemolytic anemia

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20
Q

What are the clinical manifestations of CMV in immunocompromised host?

A

Retinitis - hemorrhagic
Hepatits
Gastroenteritis - primarily colitis and esophagitis
Pneumonia - diffuse interstitial/alveolar, “snow storm”
Glomerulopathy
Disseminated disease

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21
Q

What are rare manifestations of CMV infection?

A

Periventriculitis
Transverse myelitis/peripheral neuropathy
Cytomegalic inclusion disease of the newborn

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22
Q

How is CMV diagnosed?

A 
Rapid culture (Shell vial method)
Histopathology/immunocytochemistry
PCR
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23
Q

What do you need for a positive diagnosis of CMV?

A

Evidence of viral replication (positive shell vial culture or positive PCR)
AND
Systemic signs of disease (fever, leukopenia, thrombocytopenia, eleveated liver transaminases)

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24
Q

What can be used to prevent CMV infection?

A

Vaccine being developed

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25
Q

What can be used to prevent CMV disease (prevent reactivation of already infected patients)?

A

Antiviral prophylaxis - ganciclovir, valganciclovir

Bolstering cell mediated immunity

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26
Q

What is most important in the immune response to CMV?

A

CD8 cytotoxic T cells

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27
Q

What is the primary treatment of CMV?

A

Ganciclovir

or valganciclovir, foscarnet

28
Q

What cells are infected by EBV?

A

B lymphocytes and oral/nasopharyngeal epithelium

29
Q

How does the DNA persist in cells latently-infected with EBV?

A

Episome

30
Q

How does EBV result in malignant transformation?

A

Viral genome inserted into cell DNA

31
Q

What are clinical manifestations of EBV infection in immunocompetent host?

A

Only 10% of infected persons become symptomatic
Heterophile antibody positive mononucleosis
Autoimmune disease - rash with ampicillin
Pneumonitis
Transverse myelitis/peripheral neuropathy
Some Hodgkin’s lymphoma

32
Q

What is most important in the immune response to EBV?

A

CD8 cytotoxic T cells

33
Q

What is the first antibody response (prior to symptoms) of EBV?

A

IgM/IgG antibodies to early antigens

34
Q

What is the second antibody response (during symptoms) of EBV?

A

IgM antibodies to heterophile antigens

35
Q

What is the subsequent antibody response (resolution) of EBV?

A

IgM/IgG antibodies to EBNA

36
Q

What are clinical manifestations of EBV infection in immunocompromised host?

A

PTLD (post transplant lymphoproliferative disorder)
Hairy oral leukoplakia
Burkitt’s lymphoma

37
Q

How is EBV diagnosed?

A

Evidence of high EBV DNA by quantitative PCR
Positive immunocytochemistry
PLUS
Systemic signs of disease - fever, pharyngitis, lymphadenopathy

38
Q

How is EBV disease prevented (reactivation prevented in previously infected patients)?

A

Acyclovir
Ganciclovir
Valganciclovir

39
Q

What is the treatment for EBV mononucleosis?

A

Supportive treatment

Corticosteroids for severe case

40
Q

What is the treatment for EBV pneumonitis or EBV hairy leukoplakia?

A

Acyclovir

41
Q

What is the treatment for Burkitt’s lymphoma/nasopharyngeal carcinoma from EBV?

A

Chemotherapy/excision

42
Q

What is the treatment for PTLD (post transplant lymphoproliferative disorder)?

A

Acyclovir, ganciclovir, non-specific immunoglobulin, alpha interferon
Anti-CD20 Rituximab

43
Q

Is VZV lymphotropic or neurotropic?

A

Neurotropic - reactivation associated with pain or paresthesias

44
Q

What cells does VZV infect?

A

Epithelial cells - vesicular (blistering) rash

45
Q

What are the stages of VZV infection?

A 
Primary infection - chicken pox
Latency (90% dorsal root or cranial nerve ganglia, 10% anterior horn cells)
Reactivated infection (shingles)
46
Q

Who is most susceptible to VZV complications?

A

Most frequent in immunocompromised patients

Also frequent in immunocompetent adults

47
Q

What are complications of chicken pox?

A

Most commonly involve CNS, lungs, or liver
Reye’s syndrome - associated with aspirin
Hemorrhagic chicken pox in immunocompromised host

48
Q

What is shingles?

A

Vesiculopustular rash involving 1-2 contiguous dermatomes

Prodromal paresthesias or pain

49
Q

What are complications of shingles in immunocompetent host?

A

Post-herpetic neuralgia
Decreased vision/blindness (5th cranial nerve)
Encephalitis associated with 5th cranial nerve
Ramsey-Hunt syndrome (geniculate ganglion)

50
Q

What are complications of shingles in immunocompromised host?

A

Disseminated disease

51
Q

How is VZV diagnosed?

A

Physical diagnosis/history

If doubt after physical: Pap smear of skin lesion, direct fluorescent antibody (DFA) of skin lesion, PCR of CSF

52
Q

How is VZV infection/disease prevented?

A

Oka vaccine (live/attenuated)

  • Prevent chicken pox in nonimmune children and adults
  • Prevent shingles in elderly

VZIG
- Prevention of chicken pox in nonimmune immunocompromised patients (newborns of mothers with chicken pox)

53
Q

What is the treatment for chicken pox/shingles in immunocompetent host?

A

Acyclovir

within 24 hrs for chicken pox, within 72 hrs for shingles

54
Q

What is the treatment for chicken pox/shingles in immunocompromised host?

A

Acyclovir IV

55
Q

What cells does HHV-6 infect?

A

Lymphocytes, epithelial cells, and monocytes/macrophages

56
Q

What is the clinical presentation of HHV-6?

A

Exanthem subitum (roseola) - in children
In adults and children:
- Mononucleosis (heterophile antibody negative)
- Meningitis, encephalitis, pneumonitis, hepatitis
- Bone marrow suppression - delayed bone marrow engraftment in BMT patients

57
Q

How is a diagnosis of HHV-6 disease made?

A

Characteristic rash (Exanthem subitum - roseola) immediately after 1-2 days of high fever
Serology
PCR

58
Q

What is the treatment of HHV-6 disease?

A

Ganciclovir, foscarnet, and cidofovir

59
Q

What cells does HHV-8 infect?

A

Urogenital and gastrointestinal epithelial cells

60
Q

What differentiates HHV-8 from other lymphotrophic herpes viruses?

A

Also angiotrophic

61
Q

What form is the DNA in latent HHV-8 infection?

A

Episome

62
Q

What are clinical manifestations of HHV-8?

A

Kaposi’s sarcoma
Primary effusion lymphoma (PEL)
Multicentric Castleman’s disease (MCD)/B cell lymphoma

63
Q

What immunologic response is important in HHV-8?

A

T cell mediated immune response

64
Q

How is HHV-8 diagnosed?

A

Serology

PCR

65
Q

What is treatment of cutaneous Kaposi’s sarcoma from HHV-8?

A

Ganciclovir, valganciclovir, foscarnet

66
Q

What is treatment of visceral Kaposi’s sarcoma or lymphoma from HHV-8?

A

Chemotherapy and irradiation

67
Q

What is treatment of other manifestations of HHV-8?

A

Improve cell mediated immunity

Parasitology/Virology (19 decks)

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