Herpes Viruses

Question 1

A 26 year old patient has been diagnosed with genital herpes and is prescribed an appropriate drug for initial therapy. The anti-viral prescribed is a pro-drug, requiring sequential action of a host esterase, a viral kinase, and then host kinases to convert it to its active form. The drug is:

Answer 1

Answer: Valacyclovir

Valacyclovir has higher bioavailability than does acyclovir, but is rapidly hydrolyzed by esterases to acyclovir following absorption. The initial phosphorylation of acyclovir is specifically catalyzed by viral thymidine kinase, and the subsequent conversion to the active triphosphate derivative is catalyzed by mammalian kinases. A is incorrect. Acyclovir does not require initial metabolism by esterases. B is incorrect. Foscarnet is a pyrophosphate analog. None of the metabolic steps listed apply to this drug. C is incorrect. Ganciclovir does not require esterase action, and is used for treatment of CMV, not genital herpes. D is incorrect. Trifluridine does not interact with esterases, and is phosphorylated by host kinases.

Question 2

How many latency programs of EBV are there?

Answer 2

4

Based on expression of latency associated genes, can lead to different disease syndromes.

Question 3

Cytomegalic Inclusions Disease can cause

Answer 3

Pneumonitis, Hepatosplenomegaly, Sensorineural Deafness, Retinitis, Atrophy of eye, Encephalitis

Question 4

HHV-7

Answer 4

is not associated with disease

Question 5

HHV-6 causes

Answer 5

Roseola Infantum

Question 6

HHV-8 causes

Answer 6

Kaposi Sarcoma

Question 7

Herpes Simplex Virus

Answer 7

DNA virus
Enveloped
Replicates in nucleus
Double Stranded Linear

Question 8

Herpes Simplex Histo

Answer 8

Big red, Intranuclear inclusion bodies (Cowdry bodies)

Question 9

Pox Virus Histo

Answer 9

Inclusion bodies in cytoplasm

Question 10

HSV Transmission

Answer 10

1. Sex
2. Saliva
3. Vertical transmission (TORCH)

Question 11

HSV 1

Answer 11

Confined to upper half of body
Acute: Gingivostomatitis (aggressive and painful inflammation of lips and gums, more common in infants)
Chronic: Cold sores, herpes labialis on lips

Question 12

HSV1

Answer 12

Keratoconjunctivitis

Serpiginous corneal ulcers under slit lamp exam

Question 13

HSV1 is associated with

Answer 13

temporal lobe encephalitis: causes hemorrhage and necrosis of inferior and medial temporal lobes
Fever, HA, seizure, AMS w/ Bizarre behavior and olfactory hallucinations
Personality changes

Question 14

HSV1 is most common cause of

Answer 14

sporadic encephalitis in US

Question 15

HSV1 remains latent in

Answer 15

Trigeminal Ganglia

Question 16

HSV1 gets activated by

Answer 16

stress or immunocomprose

Question 17

Appearance of herpes rash

Answer 17

Dew drops on rose petal: Clear vesicles on top of erythematous base

Question 18

Herpetic whitlow

Answer 18

Herpes on finger

Common in dentists

Question 19

Erythema multiforme

Answer 19

Hypersensitivity reaction which causes small target lesions on back of hands and feet that move in centrally. Rash appears 1-2 weeks after infection.

Question 20

HSV 2

Answer 20

Genitals

Question 21

HSV 2 transmission

Answer 21

Sex or birth

Question 22

Herpes Genitalis

Answer 22

painful inguinal lymphadenopathy with clusters of vesicals with a red base

Question 23

Genital Herpes is always

Answer 23

painful and vesicular

Question 24

HSV 2 lies dormant in

Answer 24

sacral ganglia

Question 25

HSV 2 causes

Answer 25

aseptic meningitis in adolescents and adults

Question 26

Test for diagnosis

Answer 26

PCR

Question 27

tzanck smear

Answer 27

look for multinucleated cell bodies

Question 28

HSV 2 Tx

Answer 28

No cure but acyclovir or valcyclovir