Herpesviridae

Question 1

What are the types of viruses in the herpesviridae family?

Answer 1

Herpes simplex-1 - cold sores and STD
Herpes Simplex Virus-2: STD
Varicella-Zoster Virus: Chickenpox and shingles
Epstein-Barr virus: mononucleosis
CMV: asymtomatic disease - birth defects
HHV-6 & HHV-8: Roseola and AIDS related

Question 2

What is the structure of a herpes virus.

Where is HSV-1 latent?

Answer 2

• Linear, double stranded DNA, icosahedral, envelope

- HSV-1 in the trigeminal

Question 3

Where is HSV-2 latent?

Where is VZV latent?

Answer 3

HSV-2 is latent in the sacral root ganglia

VZV is latent in the dorsal root ganglia

Question 4

Where is EBV, CMV, and HHV-6 latent?

Answer 4

• in the white blood cells;

Question 5

What is the average incubation period of HSV-1 and HSV-2?

What are primary infections like in HSV-1 and HSV-2?

Answer 5

• average time is 6 days
• The lesion (aka “dew drop on a rose petal”) are painful, itch and contain LOTS of virus. After primary infection the virus persistis in the host for the entire lifetime of host.

Question 6

What are HSV-1 and HSV-2 recurrent infections like?

What initiates it?

Answer 6

• milder and shorter in duration

- A stressor (trauma, stress, UV-irradiation, hormones)

Question 7

What are the disease manifestations of HSV-1?

Answer 7

• Primary orofacial (gingivostomatitis), recurrent stomatitis (cold sores), herpes gladitorium/whitlow, encephalitis, ocular herpes.

Question 8

What are the disease manifestations of HSV-2?

Answer 8

• STD, herpetic whitlow, and encephalitis

Question 9

How often is HSV-1 symptoms recur?

Answer 9

1-2 times a year but healing is rapid and complete (8-10 days)

Question 10

How can HSV-1 effect the eye?

What is the #1 cause of viral encephalitis?

Answer 10

• one of the leading causes of blindness in the world, contains dendritic ulcerations (branching)
• HSV-1 in the post-natal period, and HSV-2 in the neonatal period (except no orbitofrontal or temporal lobe localization)

Question 11

What is Herpes Gladiatorum?

Where is HSV viral encephalitis isolated to?

Answer 11

• HSV-1 dermatitis - most commonly in wrestlers and rugby players
• in one hemisphere

Question 12

What are the classical symptoms of HSV-2 in females?
What are the classical symptoms of HSV-2 in males?
What are some constitutional symptoms?

Answer 12

Perfuse watery discharge, dewdrops on a severe pain - 50% are asymptomatic.
-vesicales on glans penis or penile shaft, constitutional symptoms.
Constitutional sym: fever, dysuria, localized inguinal adenopathy, malaise, stiff neck ,headache, and photophobia.

Question 13

Are constitutional symptoms present upon reactivation?

What’s Herpetic Whitlow?

Answer 13

• NO

- Either HSV1 or HSV2 of the fingers - think dentists.

Question 14

What is the primary infection of varicella zoster virus called?
How is it transmitted?

Answer 14

• Chicken Pox

- Respiratory of aerosolized particles from skin lesions.

Question 15

Where does VZV replicate?

Is chicken pox more severe in adulthood or childhood?

Answer 15

• in the respiratory epithelial cells, spreads through lymphatics.
• more severe in childhood

Question 16

What are the symptomatic rash of VZV like?

Answer 16

• maculopapular lesions begin on scalp and spread to the trunk and extremities. Progresses to vesicular, ALL 3 lesion types can be found simultaneously.

Question 17

What do you not wanna give to children with chickenpox?

What is the reactivation of the chicken pox called?

Answer 17

Aspirin’s because of Reye’s

- Shingles

Question 18

Is there a respiratory component to shingles?

What is the pattern of the rash in shingles?

Answer 18

• No; activation (in the dorsal root ganglion) due to a stressor
• along the dermatome - very painful

Question 19

What types of vaccinations are available?

Answer 19

• live attenuated vaccine, while a passive immunization is more useful for immunocompromised.

Question 20

What diseases are associated with Epstein Barr virus?

Answer 20

• infectious mononucleosis
• Burkitt’s lymphoma
• Nasopharyngeal carcinoma
• Chronic EBV
• Lymphoproliferative disease

Question 21

Where are the sites of latency for EBV?

What are the target cells for EBV?

Answer 21

• in B cells

- the epithelial cells within the oropharynx become persistently infected (lytic infection)

Question 22

What is the prodrome in EBV? What occurs afterward?

Answer 22

• low-grade fever, chills, anorexia, fatigue, malaise, myalgia, retro-orbital headache, fullness; and acute mononucleosis occurs afterwards.

Question 23

How is EBV transmitted?

Answer 23

• Adolescents and adults - transmission occurs through kissing; among young children occurs when sharing objects contaminated with saliva

Question 24

What are the clinical manifestations of infectious mononucleosis?
How does EBV use B cells?

Answer 24

• Profound Fatigue**,Pharyngitis, Cervical lymphadenopathy (mostly unilateral), fever, splenomegaly.
• Uses them to proliferative (using the CD21 to hide) produce IgM (produce heterophile antibodies)

Question 25

What is diagnostic for EBV?

Why don’t you want to give ampicillin to EBV patients?

Answer 25

• heterophile antibodies**, atypical lymphocytes, Downey cells (T-cells), also and increase in MONOcytes
• normally rash in only 5-10% of patients - if given ampicillin then 100% get rash

Question 26

What is the cause of Burkitt’s Lymphoma?

Where are tumors normally seen in these patients?

Answer 26

• EBV + malaria = lymphoma

- Tumors can be seen in the jaw

Question 27

What are the symptoms of a nasopharyngeal carcinoma?

What population of people are typical for a nasopharyngeal carcinoma?

Answer 27

• cervical lymphadenopathy, blood in the saliva, or a bloody discharge from nose
• in asian descent specifically Chinese

Question 28

What is the EBV lymphoproliferative Disease?

What other disease can be associated with EBV?

Answer 28

Usually occurs in people with T cell immunodeficiency, transplant recipients.
- Hodgkin’s lymphoma

Question 29

How common is CMV?

How does CMV get transmitted in infancy or in reproductive years?

Answer 29

• 40-100% - leading congenital infection in the US, most common viral cause of birth defects
• infancy: congenitally of perinatally
• adult: sex, blood transfusion, organ transplant

Question 30

What is used to differentiate between Mono and EBV.

What are the sources of CMV?

Answer 30

EBV is heterophile + and Mono is heterophile -

- oropharyngeal secretions, urine, cervical and vaginal secretions, sperm, breast milk, etc.

Question 31

What puts pregnant women most at risk?

What are population at greatest risk?

Answer 31

• going into a DAYCARE FACILITY (shed tons of virus) for a SERONEGATIVE pregnant women places the fetus at the greatest risk of infection.
• immunocompromised, especially in AIDS (causes: Pneumonia, Retinitis, and possible death)

Question 32

CMV infections represent the leading cause what?

What type of rash is possible for infants in CMV?

Answer 32

• Mental retardation due to congenital infection

- thrombocytic purpura (blueberry muffin babies)

Question 33

What is diagnostic for CMV with a mononucleosis-like syndrome?

Answer 33

• heterophil antibody negative, Owls’ eye inclusions.

Question 34

What is classic of an HHV-6 infection?

Answer 34

High fever (can’t bring it down)for several days followed by a rash; found in some cases of roseola.

Question 35

What is classically associated with HHV-8?

Answer 35

Kaposi’s sarcoma- HIV

Question 36

What are the 5 xantham?

Answer 36

HHV-6 & HHV-7, B19 (parvovirus), measles, rubella.

Question 37

What are Tzanck test positive?

Answer 37

1) Herpes simplex
2) CMV
3) Varicella and herpes zoster
4) Rubeola