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Human Diseases > Herpes Virus > Flashcards

Herpes Virus Flashcards

1
Q

How many herpes viruses are there?

A

8

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2
Q

Name the herpes viruses that affect humans?

A 
Herpes simplex 1
Herpes simplex 2
varicella Zoster virus
Cytomegalovirus
Epstein Barr Virus
Human herpes virus 6
Human herpes virus 7
Human herpes virus 8 (karposis sarcoma associated herpes virus)
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3
Q

How are herpes virus transmitted?

A

Saliva in asymptomatic and symptomatic individuals

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4
Q

Why are herpes virus often presented to you as a dentist?

A

Most can present as oral lesions

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5
Q

Describe herpes virus structure

A

Enveloped acquired from host cell

DS DNA

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6
Q

What are the 2 stages of herpes virus infection? describe each

A

Lytic infection and latent infection
Lytic - actively replicating new viruses produced causing host cell to burst and die
Latent = dormant in host cell - no active replication

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7
Q

Describe general life cycle of herpes simplex virus 1 and 2

A
  1. During primary infection the virus is exposed to epithelial cells where is attaches
  2. Capsid containing double stranded DNA is released into cytoplasm
  3. DS DNA moves in nucleus where new prodigy viruses are produced
  4. new viruses released from cell during lysis
  5. released in vesicles contains highly infectious fluid (also found in saliva)
  6. when the infection is under control from immune system some prodigy viruses will travel up sensory neurones to the spinal ganglia where they sit dormant until reactivated and they travel back to epithelial cells
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8
Q

Describe primary infection?

A

First infection with either HSV1 or 2 causing active viral replication in mucosal tissues.
Normally symptomatic but can be asymptomatic

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9
Q

Describe latency?

A

Virus sits in nerve cell bodies in spinal cord with no viral replication

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10
Q

Describe reactivation?

A

Latent virus reactivates and active viral replication in mucosal tissues resumes

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11
Q

At what age do most primary infections occur in UK?

A

Before 5

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12
Q

What is the seroprevalence of HSV1 and HSV2 in UK?

A 
1 = 50-70%
2 = 10%
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13
Q

How is HSV spread?

A

Oral - close contact e.g. kissing
Genitals - sexual contact
From mother to baby

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14
Q

Describe oral manifestion of primary HSV infection?

a) what virus
b) symptoms - sytemically
c) symptoms - orally
d) complications

A

a) Most commonly HSV1 but can be HSv2
b) usually asymptomatic
c) severe gingivostomatitis
d) may require hospitalisation due to dehydration or pain

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15
Q

Oral reactivation of HSV1?

A

Cold sores - rarely intra-oral

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16
Q

Oral reactivation of HSV2?

A

Generally doesn’t reactivate

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17
Q

Oral reactivation of HSV

a) cause
b) triggers
c) sensation
d) duration

A

a) unknown
b) stress, fever, menstruation, cold, UV
c) tingling or itching
d) 5-12 days

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18
Q

HSV genital disease

a) primary infection
b) reactivation agent
c) primary vs reactivation severity

A

a) HSV1 or HSV2
b) HSV2 only
c) primary is more severe, reactivation is usually asymptomatic

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19
Q

Why can HSV genital disease be spread unknowingly?

A

Reactivation is often asymptomatic

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20
Q

Main complications of HSV?

A

Secondary bacterial infection - rash destroys epithelia so bacteria can penetrate
Corneal ulcers - loss of vision, risk of scarring
Meningitis - self limiting, HSV2, can be recurrent (mollarets meningitis)
Herpes simplex encephalitis, life-threatening, usually HSV1
Neonatal hepres simplex - life threatening
Life threatening infection in immunocompromised

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21
Q

What is herpetic whitlow?

A

Lesions on thumb or fingers due to herpes simplex virus

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22
Q

What type of people are susceptible to herpetic whitlow?

A

Thumb suckers - infected saliva penetrates skin

Occupational health hazard when correct PPE not used

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23
Q

How can HSV affect the eye?

A

Occular infection - corneal ulcers - need to be treated promptly or scarring and loss of vision

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24
Q

What causes neonatal infection?

A

Directly through birthing process - if mother infected with HSV, could be secreted in vaginal fluid and infect the baby
Or infected family ember kissing baby shortly after birth

25
Q

How can neonatal infection present?

A

Oral, eye, skin lesions

CNS and disseminated organ involvement

26
Q

What is the most common cause of viral encephalitis?

A

HSV encephalitis

27
Q

How does HSV encephalitis present?

A

Fever, headaches, odd behaviour

28
Q

Why can HSV encephalitis be more problematic in older patients?

A

Symptoms (fever, heachahe, odd behaviour) can be misdiagnosed - leads to late diagnosis = high mortality rate

29
Q

How is HSV diagnosed?

A

PCR - polymerase chain reaction (lesion or cerebrospinal fluid swab)

30
Q

Treatment for HSV?

A

Acicilovir and valaciclovir - inhibit viral polymerase

31
Q

How are HSV treatments selective for infected cells?

A

Needs to be activated by viral enzyme (thymidine kinase)

32
Q

Why is valaciclovir better thank aciclovir?

A

Better oral bioavailability - less dosage but more expensive

33
Q

How does varicella zoster virus present?

A

Chicken pox

34
Q

How is varicella zoster virus transmitted?

A

Oral or respiratory route, can be aerosolised

35
Q

Where does replication of varicella zoster virus occur and what does this cause?

A

Lymph nodes

Primary viraemia - virus enters the blood stream and travels to liver and spleen

36
Q

When VZV reaches liver and spleen what occurs?

A

Replication of virus and secondary viraemia - causing spread of virus to skin

37
Q

Can VZV become latent?
Where?
Reactivation?

A

Yes
In dorsal route ganglion
Reactivation as shingles (zoster)

38
Q

Describe primary chickenpox infection?

a) causative virus
b) symptoms before rash
c) where is the rash found?
d) development of vesicles
e) oral manifestation

A

a) VZV
b) fever
c) centripetal - head, neck trunk
d) macules, papules, vesicles, pustules
e) oral vesicles - extremely painful

39
Q

Seroprevalance of VZV in UK?

A

90%

40
Q

When is VZV infectious?

A

2 days before rash until full crusting of vesicles

41
Q

How can shingles present?

A

Dermatomal - one area
opthalmic
oral

42
Q

Diagnosis of VZV?

A

Clinical or PCR

43
Q

When is treatment for chicken pox required?

A

Increased risk - pregnant women, immunocompromised, severe disease involving lungs

44
Q

How can chicken pox be treated?

A

Zoster immunoglobulin - bag of antibodies

45
Q

When is zoster immunoglobulin used?

A

Early pregnancy when exposed and not immune

46
Q

Why can varicella vaccine not be given to pregnant ladies or immunocompromised?

A

Live attenuated vaccine

47
Q

Indications for varicella vaccine in UK?

A

Healthcare workers, immunocompromised child

48
Q

Shingles vaccine - when is it given, why?

A

aim to boost immunity and prevent reactivation

given to over 70 year olds who have been exposed to chicken pox

49
Q

Transmission of cytomegalovirus (CMV)?

A

Direct contact with infected secretions (saliva, genital)

50
Q

Primary infection CMV?

A

Usually asymptomatic, occasionally cause glandular fever like picture

51
Q

CMV concerns?

A

Congenital infection

Severe disease in immunocompromised

52
Q

Epstein Barr virus presentation?

A

Young children - asymptomatic or sore throat
Adolescents - glandular fever
Often associated with lymphomas or cancer

53
Q

Where does EBV become latent?

A

B lymphocytes

54
Q

EBV transmission?

A

Saliva or sexual contact

55
Q

How can EBV reactivate?

A

Oral hairy leukoplakia

56
Q

What does oral hairy leukoplakia suggest of the patient?

A

Sign of immunosuppression or HIV infection

57
Q

How does Human Herpes virus 6 and 7 present?

A

48 hour non specific rash in infants (roseola infantum)

58
Q

How does HHV 8 present? What is it related to?

A

Kaposi’s sarcoma associated virus

Associated with HIV

Human Diseases (37 decks)

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