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MIDTERMS > Herpesviridae mycv > Flashcards

Herpesviridae mycv Flashcards

1
Q
  • Enveloped icosahedral capsid, linear double
    stranded DNA
  • ~120-300nm
  • ____=to creep
  • Virion consists of 4 components: __,___,___,___
  • 3 known subfamilies __,___,___
A

HERPESVIRIDAE
- herpes
- nucleic acid core, capsid, tegument and envelope
- Alphaherpesvirinae-HSV type 1 and 2, VZV
➢ Betaherpesvirinae-CMV, HHV-6, HHV-7
➢ Gammaherpesvirinae-EBV, HHV-8

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2
Q

HUMAN HERPESVIRUS

A
  1. Herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2)
  2. Varicella-zoster virus (VZV)
  3. Epstein-barr virus (EBV)
  4. Cytomegalovirus (CMV)
  5. Human herpesviruses 6 and 7 (HHV-6 and HHV-7
  6. HHV-8, (associated with Kaposi sarcoma)
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3
Q

Hallmark characteristic: ___
* Reactivation can be caused by various stimuli
* Fever, stress, UV exposure, axonal injury, immunosuppression
* Form ____
* ____ was the first human herpesvirus to be recognized

A

HERPESVIRIDAE
- latency
- Cowdry Type A intranuclear inclusion bodies
- Herpes Simplex Virus (HSV)

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4
Q

Alphaherpesvirinae

A

Human herpesvirus 1, 2, 3

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5
Q

Gammaherpesvirinae

A

Human herpesvirus 4 and 8

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6
Q

Betaherpesvirinae

A

Human herpesvirus 5, 6, 7

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7
Q

Human herpesvirus 1
Virus:
Primary target cell:
Site of latency:
Mode of spread

A

Herpes simplex type 1
Mucoepithelial cells
Neuron
Close contact

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8
Q

Human herpesvirus 2
Virus:
Primary target cell:
Site of latency:
Mode of spread

A

Herpes simplex type 2
Mucoepithelial cells
Neuron
Close contact (std)

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9
Q

Human herpesvirus 3
Virus:
Primary target cell:
Site of latency:
Mode of spread

A

Varicella- zoster virus
Mucoepithelial cells
Neuron
Close contact and respiratory contact

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10
Q

Human herpesvirus 4
Virus:
Primary target cell:
Site of latency:
Mode of spread

A

Epstein- Barr virus
Bcells and Epithelial cells
b cell
saliva(kissing dse)

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11
Q

Human herpesvirus 8
Virus:
Primary target cell:
Site of latency:
Mode of spread

A

Kaposi’s sarcoma relaated virus
lymphocyte and other cells
n/a
close contact saliva and std

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12
Q

Human herpesvirus 5
Virus:
Primary target cell:
Site of latency:
Mode of spread

A

-cytomegalovirus
-monocyte, lymphocyte and epithelial cells
- monocyte and lymphocyte
- close contact, transfusions, tissue transplant and congenital

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13
Q

Human herpesvirus 6
Virus:
Primary target cell:
Site of latency:
Mode of spread

A
  • Herpes lymphotropic virus
  • tcells
  • t cells
    -respiratory and close contact
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14
Q

Human herpesvirus 7
Virus:
Primary target cell:
Site of latency:
Mode of spread

A

Human herpesvirus 7
t cells
t cells
n/a

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15
Q
  • Infection of either the skin or genitalia
A

Herpes Simplex Virus
- * HSV type 1 (Human herpes virus type 1 or HHV type 1)
* HSV type 2 (HHV type 2)

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16
Q

is usually isolated from lesions in and around the mouth and is transmitted by direct contact or droplet spread from cases or carriers.
>Infections above the waist

A

HSV type 1 (Human herpes virus type 1 or HHV type 1)

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17
Q

is transmitted sexually or from a maternal genital infection to a new born.
>Infection below the waist

A
  • HSV type 2 (HHV type 2)
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18
Q

PATHOGENESIS
* Initially infect and replicate in mucoepithelial cells and then establish latent infection of the innervating neurons.
* Skin and mucous membranes are the portals of entry in which the
virus also multiplies, causing lysis of cells and formation of vesicles.
* After replication is under way in the skin or a mucous membrane,
virions travel to the root ganglia via the sensory nerves supplying the
area.

A

Herpes Simplex Virus

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19
Q

a. Most common site is the face—on the cheeks, chin, around the mouth or on the forehead;
b. Napkin rash;
c. ‘fever blister’ or herpes febrilis
d. ___- an infection of the finger;
e. _____ an infection of the body;
f. Eczema herpeticum

A

Herpes Simplex Virus (Cutaneous Infections)
- Herpetic whitlow
- Herpes gladiatorum

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20
Q

Herpes Simplex Virus Oral infection
1
2
3
4
5

A

Acute gingivostomatitis
herpetic stomatitis
pharyngitis
tonsillitis
localized lymphadenopathy

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21
Q

Herpes Simplex Virus Ophthalmic

A

Severe keratoconjunctivitis, follicular conjunctivitis with vesicle formation on the lids,
dendritic keratitis or corneal ulcers or as vesicles on the eyelids, corneal scarring and impairment
of vision

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22
Q

Herpes Simplex Virus Nervous system
1
2
3
4
5

A
  • HSV encephalitis;
  • Sporadic encephalitis;
  • HSV meningitis;
  • Sacral autonomic dysfunction;
  • Rarely transverse myelitis or the Guillain–Barre syndrome and Bell’s palsy
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23
Q

Herpes Simplex Virus Visceral

A

HSV esophagitis;
* Tracheobronchitis and pneumonitis;
* Hepatitis;
* Erythema multiforme;
* Disseminated HSV infection

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24
Q

Genital disease is usually
caused by ___

A

HSV-2

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25
Q

are known to increase
the risk of transmission of infection with human immunodeficiency virus (HIV).

A

Genital herpetic ulcers

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26
Q

Herpes Simplex Virus, in male patients: The lesions typically develop on __,__,

A

the glans or shaft of the penis, urethra

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27
Q

Herpes Simplex Virus, * In female patients: The lesions may be seen on the___,__,__,__,__

A

vulva, vagina, cervix, perianal area, or inner thigh

28
Q

Herpes Simplex Virus, In patients of both sexes

A

Inguinal lymphadenopathy

29
Q

Herpes Simplex Virus, In homosexuals;

A
  • Herpetic proctitis
30
Q
A
31
Q

Transplacental infection with HSV1
or 2 can lead to congenital malformations

A

Neonatal Herpes

32
Q

Herpes Simplex Virus
* Direct Detection

A

Electron microscopy of vesicle fluid -Immunofluorescence of skin scrapings
- PCR

33
Q

Herpes Simplex Virus Virus Isolation - __ AND ___are among the easiest viruses to cultivate. It usually takes only 1 - 5 days for a result to be available

A

HSV-1 and HSV-2

33
Q
A
34
Q

Herpes Simplex Virus, Not that useful in the acute phase because it takes 1-2 weeks for before antibodies appear after infection. Used to document to recent infection

A

Serology

35
Q

rapid result but cannot distinguish
between HSV and VZV

A

Electron microscopy of vesicle fluid

36
Q

can distinguish between HSV and VZV

A

Immunofluorescence of skin scrapings

37
Q

__ - now used routinely for the diagnosis of herpes simplex encephalitis and other herpes simplex infections

A

PCR

38
Q

Herpes Simplex Virus TREATMENT

A

Acyclovir
Famciclovir and valacyclovir –
Other older agents – e.g. idoxuridine, trifluorothymidine, Vidarabine (ara-A)

39
Q

These agents are highly toxic and is suitable for topical use for ophthalmic
infection only

A

idoxuridine, trifluorothymidine, Vidarabine (ara-A)

40
Q

___ – this the drug of choice for most situations at present. It is available in a number of formulations

A

Acyclovir
-I.V. (HSV infection in normal and immunocompromised patients)
* Oral (treatment and long term suppression of mucocutaneous herpes and
prophylaxis of HSV in immunocompromised patients)
* Cream (HSV infection of the skin and mucous membranes)
* Ophthalmic ointment

41
Q

___ and ___ – oral only, more expensive than acyclovir.

A

Famciclovir and valacyclovir

42
Q

___—causing Chicken Pox (Bulutong)-1° infection
* ___—Shingles-2° infection
* Classic disease of childhood with the highest prevalence occurring in
the 4-10 years old age group
* Highly communicable-attack rate of 90% in close contacts
* MOT: Respiratory droplet, Direct contact with lesion.
* Gain entry via the respiratory tract and spreads to the lymphoid
system
* Incubation period: 14 days
* Following the primary infection, the virus remains latent in the
sensory ganglia

A

Varicella-Zoster Virus
- Varicella
- Zoster

43
Q

Primary infection
* Incubation period: ___
* Presents fever, lymphadenopathy. a widespread vesicular rash.
* The features are so characteristic that a diagnosis can usually be made on clinical grounds alone.
* Complications are rare but occurs more frequently and with greater
severity in adults and immuno compromised patients.
* Most common complication is secondary bacterial infection of the vesicles.
* Severe complications which may be life threatening include ____, ___ and ___

A

VARICELLA
- 14-21 days
- viral pneumonia, encephalitis, and hemorrhagic chickenpox

44
Q

mainly affect a single area of the skin.
* It may occur at any age but the vast majority of patients are more than 50 years of age.
* The latent virus reactivates in a sensory ganglion and tracks down the sensory nerve to the appropriate segment.
* eruption of vesicles in the skin often accompanied by intensive pain which may last for months
_____
* Complications include
1
2
3

A

HERPES ZOSTER (Shingles)
- (postherpetic neuralgia)
- Ophthalmic zoster
* Generalized zoster
* Ramsay Hunt Syndrome

45
Q

Varicella-Zoster Virus TREATMENT
1
2
3

A
  • Self-limiting
  • Acyclovir
  • For Herpes zoster: Famciclovir and Valacyclovir
46
Q

PREVENTION of Varicella-Zoster Virus
* Chicken pox: ____
* Zoster: __
* Prophylaxis: ____

A
  • Live attenuated vaccine (2 doses)-Varivax®, ProQuad®
  • Zostavax, Shingrix (for adults > 50 y.o)
  • Passive immunization of Varicella-zoster immunoglobulin (VZIg)
47
Q

____
* MOT: saliva and sexual contact, hence the name “kissing disease”
* Common in younger children and sexually active adolescents
* Site of latency: __
* infected B-cells are transformed so that they become capable of
continuous growth in vitro
* Associated with various infections

A

Epstein-Barr Virus (EBV)
- Human herpesvirus 4
- memory B-cells

48
Q

Epstein-Barr Virus
CLINICAL MANIFESTATIONS

A
  1. Infectious Mononucleosis
  2. Burkitt’s lymphoma
  3. Nasopharyngeal carcinoma
  4. Lymphoproliferative disease and lymphoma in the immuno suppressed.
  5. X-linked lymphoproliferative syndrome
  6. Chronic infectious mononucleosis
  7. Oral leukoplakia in AIDS patients
  8. Chronic interstitial pneumonitis in AIDS patients
49
Q

“mono”
* Occurs in adolescents and
young adults
* Symptoms: Fatigue, fever,
sore throat, swollen lymph
nodes and splenomegaly
* Treatment: Self-limiting, most
cases resolve on their own

A

Infectious Mononucleosis

50
Q

Epstein-Barr Virus (EBV) Hematologic approach

A
  • Absolute lymphocytosis—30% Atypical lymphocytes/Downy Cells
51
Q

LABORATORY DIAGNOSIS

A

A Hematologic approach
B Immunologic approach
1 Specific Antibody Test
2 Non-specific Antibody Test
C EBV DNA molecular assays using whole blood

52
Q

Specific Antibody Test

A
  • EBV Virus Capsid Antigen (VCA) Antibody (Current or past infection)
  • EBV Nuclear Antigen (EBNA) Antibody (Past infection)
  • EBV Early Antigen (EA) antibody (acute infection especially in
    immunosuppressed)
53
Q

Non-specific Antibody Test
_____- positive only for 2-3 weeks after exposure

A

Heterophile Antibody Test/ Monospot test (early diagnosis of IM)-

54
Q

TREATMENT AND PREVENTION
* No antiviral drug
* Self-limiting for 2-3 weeks
* No vaccine
* Avoid sharing personal items like utensils, drinking glasses etc.

A

Epstein-Barr Virus (EBV)

55
Q
  • Has the largest genome of the human herpesvirus
  • Replicates only in human cells
    >Fibroblasts, epithelial cells, granulocytes, macrophages and others
  • Establish latency in ___,___
  • Acquired from blood, tissue and body secretions
  • MOT: depends on the time, development and population
A

Cytomegalovirus
- T-cells, macrophages

56
Q

Cytomegalovirus Early Life

A

1 During pregnancy (transplacental)
2 During birth (passage to birth canal)
3 After birth (breastfeeding)

57
Q

Cytomegalovirus Childhood

A
  • Saliva (kissing)
58
Q

Cytomegalovirus Adult

A
  • Sexual transmission
  • Blood transfusion
  • Organ transplantation
59
Q
  • Incubation period: 3-6 weeks
  • Causes lifelong infection
  • May cause asymptomatic shedding
A

Cytomegalovirus

60
Q

Cytomegalovirus
Symptoms vary:
A
B
C
D

A

A. Immunocompetent persons-mild or asymptomatic
B. Immunocompromised patients
* HIV/AIDS: retinitis, colitis, and encephalitis
* Transplant recipient: severe/fatal disease
C. Congenital and perinatal
* Cytomegalic inclusion disease, fetal death
D. Neonates
* Microcephaly, seizure, deafness, mental retardation, jaundice,
purpura, hepatitis

61
Q

Cytomegalovirus LABORATORY DIAGNOSIS
1
2
3
4
5

A
  • NAAT (PCR, RT-PCR)-blood, urine, saliva, CSF
  • Serological assays (CMV IgM, IgG, pp65 antigen)
  • Viral culture
  • Direct enzyme-linked fluorescent antibody (DEAFF) test
  • Direct microscopic examination of lung, liver and kidney biopsy (Owl’s
    eye inclusion body)
62
Q

Cytomegalovirus TREATMENT AND PREVENTION
1
2
3
4
* Prevention is indicated only in high risk cases.
* Screening of blood and organ donors and administration of CMV
immunoglobulins have been employed in prevention.
* No vaccine is available

A
  • Ganciclovir-retinitis and pneumonia
  • Valganciclovir
  • Foscarnet
  • Cidofovir
63
Q

Are ubiquitous and are Found worldwide
- They are transmitted mainly through contact with saliva and through breast feeding
- infection are acquired rapidly after the age of 4 months when the effect of maternal antibody wears off
- remains latent in the body after primary infection and reactivates from time to time

A

HHV-6 and HHV-7

64
Q

Roseola Infantum-fever and rash in
babies

A

HHV-6

65
Q

Originally isolated from cells of ____ as well as some lesser known malignancies such as __ AND ____
* MOT: sharing utensils, kissing or close
contact with infected individual, blood
transfusion, organ transplantation, needle
sharing, sexual transmission

A

HHV-8
- Kaposi’s sarcoma (KS)
- Castleman’s disease and primary effusion lymphomas

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