Herpesvirus infections Flashcards
Which strain of herpes simplex virus is generally associated with oral lesions (cold sores)?
Herpes simplex virus serotype 1 (HSV-1)
Which strain of herpes simplex virus is most associated with genital lesions?
Herpes simplex virus serotype 2 (HSV-2)
But HSV-1 can also cause genital lesions
What is the management of uncomplicated herpes simplex virus infection of the lips (herpes labialis or cold sores) or herpetic gingivostomatitis? (2)
- Oral paracetamol +/- ibuprofen for pain and fever*
- Topical antiviral treatment is not routinely recommended BUT may be helpful when used from the onset of the prodromal phase
* other treatments that may be considered for symptoms relief include topical anaesthetics or analgesics, and mouthwashes
What is the route of antiviral treatment for severe, frequent or persistent oral herpes simplex virus infection?
Oral
A patient presents to primary care with suspected ocular herpes simplex virus, what should the GP do?
Refer for urgent, same-day specialist referral
DO NOT initiate treatment whilst awaiting review
** If same-day review is NOT possible, specialist advice should be sought, which may include topical antiviral treatment in primary care
Chickenpox is caused by which virus?
Varicella-zoster virus
If a pregnant woman who is 20 weeks of gestation or less is exposed to varicella-zoster virus and is NOT immune, what is the management (post-exposure prophylaxis)?
Varicella-zoster immunoglobulin (VZIG) as soon as possible
** VZIG is effective up to 10 days post exposure
From passmed notes
If a pregnant woman who is more than 20 weeks gestation is exposed to varicella-zoster virus and NOT immune, what is the management (post-exposure prophylaxis)?
Either:
- Varicella-zoster immunoglobulin (VZIG) OR
- Antivirals (aciclovir or valaciclovir)
Given 7 to 4 dyas after exposure
From passmed
Shingles (herpes zoster) is a viral infection caused by the (?) of the varicella-zoster virus
Reactivation
Which patients with shingles (herpes zoster) should be offered oral antiviral treatment? (4)
- Immunocompromised
- Non-truncal involvement (e.g. neck, limbs, perineum)
- Moderate to severe pain or rash
- Patients aged over 50 years to reduce the risk of post-herpetic neuralgia (consider)
How soon after the onset of the rash in shingles (herpes zoster) should oral antiviral treatment be started?
72 hours
Which patients with shingles (herpes zoster) should be admitted to hospital or specialist advice sought? (3)
- Immunocompromised patients with severe or widespread infection
- Severe immunocompromised
- Shingles in the ophthalmic distribution of the trigeminal nerve
What is the name of the chronic pain that persists after the rash from shingles (herpes zoster) has healed?
Post-herpetic neuralgia
Is aciclovir active against herpesviruses?
Yes but does not eradicate them
Aciclovir enters herpes-infected cells and inhibits the herpes-specific DNA polymerase, stopping further viral DNA synthesis and therefore replication
Aciclovir stops the virus from growing but does not clear the virus from the body completely
What are the common side effects of aciclovir is used topically in the eye? (2)
Eye inflammation
Eye pain
What are the common side effects when aciclovir is used IV route? (4)
Nausea
Photosensitivity reaction
Skin reactions
Vomiting
What are the common side effects when oral aciclovir is used? (10)
Abdominal pain Diarrhoea Dizziness Fatigue Fever Headache Nausea Photosensitivity reaction Skin reactions Vomiting
Which viruses is aciclovir indicated for use in treatment? (2)
Herpes simplex virus
Varicella-zoster virus
Famiciclovir is a prodrug of (?)
peniciclovir
(?) is a prodrug of peniciclovir
Famiciclovir
Famiciclovir is indicated for use in the treatment of which viruses? (2)
Herpes simplex virus (Genital herpes; non-genital in immunocompromised patients)
Varicella-zoster virus (herpes zoster/shingles)
Valaciclovir is an ester of (?)
aciclovir
(?) is an ester of aciclovir
Valaciclovir
Valaciclovir is indicated for use in the treatment/prevention of which viruses? (3)
Varicella-zoster virus (herpes zoster/shingles)
Herpes simplex virus
Prevention of cytomegalovirus following solid organ transplantation (when valganciclovir or ganciclovir cannot be ued)
Foscarnet sodium (IV) and inosine pranobex (oral) are both licensed for use in which infection due to herpes simplex virus?
Mucocutaneous infections due to herpes simplex virus
Which antiviral drug is considered if an immunocompromised patient has mucocutaneous herpes simplex virus infection that is unresponsive to aciclovir?
Foscarnet sodium (IV) - 40 mg/kg every 8 hours for 2-3 weeks or until lesions heal
What are the two indications for use of foscarnet sodium (IV)?
Cytomegalovirus
Mucocutaneous herpes simplex virus infections unresponsive to aciclovir in immunocompromised patients
Can men who are trying to conceive children take foscarnet sodium?
NO
Men should avoid fathering a child during and for 6 months after treatment
Which electrolytes need to monitors if a patient is taking foscarnet sodium? (2)
Calcium
Magnesium
Monitor serum creatinine every second day during induction and every week during maintenance
Cytomegalovirus (CMV) is a member of the (?)virus group
herpes
In which patients does cytomegalovirus (CMV) manifest more severely causing diseases associated with greater morbidity and mortality?
Immunocompromised patients (e.g. AIDS and transplant recipients)
Do immunocompetent patients with cytomegalovirus (CMV) infections routinely require treatment?
NO
- often asymptomatic and self-limiting
Name 6 antiviral drugs that are licensed for use in the management of cytomegalovirus (CMV) infection
Ganciclovir Cidofovir Foscarnet sodium Letermovir Valaciclovir Valganciclovir
Which drug licensed for use in cytomegalovirus (CMV) infections is associated with possible resistance?
Ganciclovir
There is a possibility of ganciclovir resistance in those who repeated have a poor treatment response or when viral excretion continues despite treatment
Ganciclovir is contraindicated in patients who are hypersensitive to which other antiviral drug?
Valganciclovir
Valganciclovir is a pro-drug of ganciclovir
Why must you be cautious when prescribing inosine pranobex to patients with a history of gout?
Metabolised to uric acid
Which two antiviral drugs do you need to use with caution in elderly patients?
Aciclovir
Valciclovir
- risk of neurological reactions
If herpesviruses are treated with aciclovir, why are recurrent infections common?
Aciclovir stops the virus from growing but does not clear the virus from the body completely
Aciclovir enters herpes-infected cells and inhibits the herpes-specific DNA polymerase, stopping further viral DNA synthesis and therefore replication
If a patient is to use topical aciclovir for cold sores, when should they apply the cream?
As soon as they notice symptoms (e.g. tingling)
