Herpes Viruses: HZV, EBV, CMV, Kaposi's Sarcoma, Herpes Simplex 1-2

Question 1

Chicken pox

• pattern of infection
• presentation
• cause
• management

Answer 1

Primary VZV infection

• resp spread
• infectious period - 4 days pre rash - 5 days post rash
• incubation period - 2-3wks

Presentation

• fever, mild systemic upset
• itchy bilateral maculopapular over trunk, face, limbs => vesicular

Mainly supportive
-calamine lotion - itch
-school exclusion until blisters crust
If IC/neonate/peripartum exposure => VZIG
-give IV aciclovir if symptomatic

Question 2

Chicken pox

-complications

Answer 2

Common complication - bacterial infection of lesions
-risk increased by NSAIDs
Rare
-pneumonia
-encephalitis
-disseminated hemorrhagic chickenpox

Question 3

Shingles

• differences between shingles and chicken pox
• most common location
• risk factors
• presentation

Answer 3

Reactivation of VZV from dorsal root/cranial nerve ganglia => acute unilateral painful vesicular rash
-most common T1-L2

Risk factors

• age
• HIV, IC

Prodrome - severe burning pain of dermatome
-fever, systemically unwell
Rash - limited to dermatome
-macular => vesicular

Question 4

Shingles

• management
• complications

Answer 4

Conservative

• avoid pregnant, IC
• cover blisters until crusty

Analgesia - paracetamol/NSAIDs
2nd line - amytriptyline

Antivirals - aciclovir within 1st 3 days (reduce PHN risk)

MOST COMMON - PHN
-self limiting
HZ opthalmicus - CN5 affected
Ramsey Hunt - CN7 affected 
-facial paralysis, ear pain/vertigo/tinnitus => aciclovir + CS

Question 5

Zoster vaccinations

• varicella
• shingles

Answer 5

Varicella - LAIV

• non immune HCW
• contacts of IC patients

Shingles - LAIV to 70-79

Question 6

EBV

• most common infection, presentation. diagnosis and management
• other conditions

Answer 6

MOST COMMON - mono in young adults
-sore throat, fever, systemically unwell
-lymphadenopathy, splenohepatomegaly
Symptoms resolve in 2-4wks

Diagnosis - FBC + monospot test in 2nd week to confirm

Supportive

• rest, fluids, simple analgesia
• avoid contact sports for 4wks => reduce splenic rupture risk

Malignancies

• Burkitt, Hodgkin, HIV CNS lymphoma
• nasopharyngeal carcinoma

Question 7

CMV

• exposure pattern
• possible presentations of illness

Answer 7

50% of people thought to be exposed to virus but only symptomatic in IC

Congenital CMV - growth retardation, blueberry muffin skin lesions, hepatosplenomegaly

CMV mono - in IC

CMV retinitis, encephalitis - in low CD4 counts in HIV

CMV pneumonitis, colitis

Question 8

Kaposi’s sarcoma

• presentation
• management

Answer 8

HIV associated

• purple plaques on skin, mucosa => ulcerate
• resp involvement - haemoptysis, pleural effusion

Management - radiotherapy + resection

Question 9

Herpes simplex virus

• presentation
• management

Answer 9

HSV1, 2

• severe gingivostomatitis, cold sores
• painful genital ulceration

Management
-TO/PO aciclovir, chlorhexidine mouthwash

Complications

• HS encephalitis
• HS keratitis

Question 10

HS encephalitis

• causative organism
• presentation
• investigations
• management

Answer 10

HSV1 most common
Neuro and temporal lobe signs
-fever, headache, psych symptoms, seizures, vomiting
-aphasia

Investigations

• CSF - high lymphocytes, protein
• PCR - HSV
• CT, MRI - temporal, inf frontal changes
• EEG

Management - aciclovir

Question 11

HS keratitis

• presentation
• investigation
• management

Answer 11

Red, painful eye
Photophobia, teary
Reduced visual acuity

Fluoroscein stain - epithelial ulcer
Viral culture

URGENT OPTHALMOLOGY REFEERRAL
-aciclovir