Herpeseviruses (CMV, EBV, VZV, HHV-6, HHV-8)

Question 1

unique contents of CMV tegument

Answer 1

carries mRNA and pp65(diagnostic protein)

interesting that it is a dsDNA virus, but carries mRNA

Question 1

VZV tropism

Answer 1

permissive in mucoepithelial cells(skin)

latent in neurons

Question 2

malignancies caused by EBV

Answer 2

Burkitt’s lymphoma

nasopharyngeal carcinoma

post-transplant lymphoproliferative disorder

some hodgkins lymphomas

Question 3

treatment for HHV-6

Answer 3

ganciclovir, foscarnet

indicated for exanthem subitum(roseala)

Question 4

clinical manifestation of VZV(reactivation)

complications?

Answer 4

shingles/zoster

VZV reactivates from latent DRG; vesiculopapular rash in dermatomal distribution

complications:

• ramsey-hunt syndrome(reactivation from geniculate ganglion) - vesicles in external auditory meatus
• guillan-barre syndrome: ascending bilateral paralysis;

Question 4

shingles complications in immuncompromised

Answer 4

pneumonitis, hepatitis, meningoencephalitis

longer lasting rash and dissemination

Question 6

describe the tropism of CMV during:

permissive

latent

and persistent infections

Answer 6

permissive = epithelial cells, fibroblasts, macrophages

latent = infects hematopoeitic cells

persistent = lymphocytes, endothelial cells, BM stroma

Question 7

treatment/prophylaxis for CMV

specific treatment for CMV pneumonitis, retinitis

Answer 7

ganciclovir(BM toxicity)

foscarnet(renal toxicity)

hyperimmune globulin w/ganciclovir OR foscarnet for CMV pneumonitis in BMT pts

valganciclovir for retinitis

Question 7

clinical manifestation of HHV-8

Answer 7

kaposi’s sarcoma

primary effusion lymphoma - b lymphocyte infection

multicentric calstleman’s disease - b cell lymphoma

Question 8

lymphotrophic AND angiotrophic herpesevirus

Answer 8

HHV-8

kaposi’s

Question 9

treatment for VZV

Answer 9

for chickenpox: acyclovir (use IV is immunocompromised)

for shingles, can bump it up to famciclovir, valacyclovir(still use IV for immunocompromised)

Question 9

HHV-8 transmission, treatment

Answer 9

sexually transmitted

ganciclovir, valganciclovir, foscarnet

Question 10

clinical manifestation of VZV(primary)

complications?

Answer 10

chickenpox - resp. tract infected; spread to blood/lyph; eventually reticuloendothelial cells; then skin

complications: acute cerebellar ataxia, meningoencephalitis, pneumonitis, hepatitis

• reyes syndrome: kids taking aspirin during chickenpox; fatty liver and encephalopathy

Question 11

neurotropic herpesviruses

Answer 11

HSV-1, HSV-2, VZV

Question 13

describe permissive, latent, persistent infections

Answer 13

permissive = lytic; producing infectious viral progeny

latent = silent genome persistence; nonlytic

persistent = low lvl of viral prgeny, nonlytic on cell level

Question 15

CMV diagnosis

Answer 15

shell rapid CMV culture(uses IE and E antigens, pp65) - 12-24hrs

owl’s eye cell - cytomegalic inclusions

Question 16

clinical manifestation of EBV?

manifestations of EBV in immunocompromised ?

Answer 16

• heterophile positive mononucleosis; virus in saliva, kissing disease
• autoimmune disease(ITP, hemolytic anemia)
• RASH w/AMPICILLIN; mono has exudative pharyngitis, making it look like GAStrep infection; Ampicillin is perscribed and if a rash forms, EBV is almost pathopneumonic

Immunocompromised

• post transplant lyphoproliferative disorder - solid organ and BMT recipients
• hairy oral leukoplakia - white patches on lateral surface of tongue in AIDS pts
• Burkitt’s lymphoma

Question 17

prophylaxis for EBV

Answer 17

acyclovir, ganciclovir, valganciclovir

Question 19

manifestation of CMV in immunocompetent, immunocompromised

Answer 19

immunocompetent: 80-90% asymptomatic - heterophile negative mononucleosis - idiopathic thrombocytopenic purpura

hemolytic anemia

immunocompromised: primary OR reactivated -

• retinitis(especially AIDS)
• pneumonia(especcialy BM recipients)
• hepatitis, gastroenteritis, glomerulopathy
• disseminated disease

Question 20

tissue tropism for EBV

Answer 20

permissive and latent infections pursue lymphocytes(mostly B), and oral/nasopharyngeal epithelium

Question 21

leading infectious cause of birth defects in US

Answer 21

cytomegalovirus

Question 22

clinical manifestation of HHV-6

Answer 22

exanthem subitum: roseola rash(fever then maculopapular rash)

heterophile negative mononucleosis(like CMV)

BM suppression; delayed engraftment in BMT recipients

Question 23

how does CMV evade immune system?

Answer 23

downregulation of MHCI,II antigens

inactivation of interferon genes

Question 24

general structure of herpesviruses

Answer 24

enveloped dsDNA w/icosahedral, capsule, tegument, and IE, E and L proteins

Question 25

lymphotrophic herpesviruses

Answer 25

EBV, CMV, HHV6

maculopapular rash, causes of ITP, mononucleosis w/atypical lymphocytosis