Herpesvirus infections

Question 1

Which strain of herpes simplex virus is generally associated with oral lesions (cold sores)?

Answer 1

Herpes simplex virus serotype 1 (HSV-1)

Question 2

Which strain of herpes simplex virus is most associated with genital lesions?

Answer 2

Herpes simplex virus serotype 2 (HSV-2)

But HSV-1 can also cause genital lesions

Question 3

What is the management of uncomplicated herpes simplex virus infection of the lips (herpes labialis or cold sores) or herpetic gingivostomatitis? (2)

Answer 3

1. Oral paracetamol +/- ibuprofen for pain and fever*
2. 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

Question 4

What is the route of antiviral treatment for severe, frequent or persistent oral herpes simplex virus infection?

Answer 4

Oral

Question 5

A patient presents to primary care with suspected ocular herpes simplex virus, what should the GP do?

Answer 5

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

Question 6

Chickenpox is caused by which virus?

Answer 6

Varicella-zoster virus

Question 7

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)?

Answer 7

Varicella-zoster immunoglobulin (VZIG) as soon as possible

** VZIG is effective up to 10 days post exposure

From passmed notes

Question 8

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)?

Answer 8

Either:
- Varicella-zoster immunoglobulin (VZIG) OR
- Antivirals (aciclovir or valaciclovir)
Given 7 to 4 dyas after exposure

From passmed

Question 9

Shingles (herpes zoster) is a viral infection caused by the (?) of the varicella-zoster virus

Answer 9

Reactivation

Question 10

Which patients with shingles (herpes zoster) should be offered oral antiviral treatment? (4)

Answer 10

1. Immunocompromised
2. Non-truncal involvement (e.g. neck, limbs, perineum)
3. Moderate to severe pain or rash
4. Patients aged over 50 years to reduce the risk of post-herpetic neuralgia (consider)

Question 11

How soon after the onset of the rash in shingles (herpes zoster) should oral antiviral treatment be started?

Answer 11

72 hours

Question 12

Which patients with shingles (herpes zoster) should be admitted to hospital or specialist advice sought? (3)

Answer 12

1. Immunocompromised patients with severe or widespread infection
2. Severe immunocompromised
3. Shingles in the ophthalmic distribution of the trigeminal nerve

Question 13

What is the name of the chronic pain that persists after the rash from shingles (herpes zoster) has healed?

Answer 13

Post-herpetic neuralgia

Question 14

Is aciclovir active against herpesviruses?

Answer 14

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

Question 15

What are the common side effects of aciclovir is used topically in the eye? (2)

Answer 15

Eye inflammation

Eye pain

Question 16

What are the common side effects when aciclovir is used IV route? (4)

Answer 16

Nausea
Photosensitivity reaction
Skin reactions
Vomiting

Question 17

What are the common side effects when oral aciclovir is used? (10)

Answer 17

Abdominal pain 
Diarrhoea
Dizziness
Fatigue
Fever
Headache
Nausea
Photosensitivity reaction 
Skin reactions
Vomiting

Question 18

Which viruses is aciclovir indicated for use in treatment? (2)

Answer 18

Herpes simplex virus

Varicella-zoster virus

Question 19

Famiciclovir is a prodrug of (?)

Answer 19

peniciclovir

Question 20

(?) is a prodrug of peniciclovir

Answer 20

Famiciclovir

Question 21

Famiciclovir is indicated for use in the treatment of which viruses? (2)

Answer 21

Herpes simplex virus (Genital herpes; non-genital in immunocompromised patients)

Varicella-zoster virus (herpes zoster/shingles)

Question 22

Valaciclovir is an ester of (?)

Answer 22

aciclovir

Question 23

(?) is an ester of aciclovir

Answer 23

Valaciclovir

Question 24

Valaciclovir is indicated for use in the treatment/prevention of which viruses? (3)

Answer 24

Varicella-zoster virus (herpes zoster/shingles)

Herpes simplex virus

Prevention of cytomegalovirus following solid organ transplantation (when valganciclovir or ganciclovir cannot be ued)

Question 25

Foscarnet sodium (IV) and inosine pranobex (oral) are both licensed for use in which infection due to herpes simplex virus?

Answer 25

Mucocutaneous infections due to herpes simplex virus

Question 26

Which antiviral drug is considered if an immunocompromised patient has mucocutaneous herpes simplex virus infection that is unresponsive to aciclovir?

Answer 26

Foscarnet sodium (IV)
- 40 mg/kg every 8 hours for 2-3 weeks or until lesions heal

Question 27

What are the two indications for use of foscarnet sodium (IV)?

Answer 27

Cytomegalovirus

Mucocutaneous herpes simplex virus infections unresponsive to aciclovir in immunocompromised patients

Question 28

Can men who are trying to conceive children take foscarnet sodium?

Answer 28

NO

Men should avoid fathering a child during and for 6 months after treatment

Question 29

Which electrolytes need to monitors if a patient is taking foscarnet sodium? (2)

Answer 29

Calcium
Magnesium

Monitor serum creatinine every second day during induction and every week during maintenance

Question 30

Cytomegalovirus (CMV) is a member of the (?)virus group

Answer 30

herpes

Question 31

In which patients does cytomegalovirus (CMV) manifest more severely causing diseases associated with greater morbidity and mortality?

Answer 31

Immunocompromised patients (e.g. AIDS and transplant recipients)

Question 32

Do immunocompetent patients with cytomegalovirus (CMV) infections routinely require treatment?

Answer 32

NO

- often asymptomatic and self-limiting

Question 33

Name 6 antiviral drugs that are licensed for use in the management of cytomegalovirus (CMV) infection

Answer 33

Ganciclovir
Cidofovir
Foscarnet sodium
Letermovir
Valaciclovir
Valganciclovir

Question 34

Which drug licensed for use in cytomegalovirus (CMV) infections is associated with possible resistance?

Answer 34

Ganciclovir

There is a possibility of ganciclovir resistance in those who repeated have a poor treatment response or when viral excretion continues despite treatment

Question 35

Ganciclovir is contraindicated in patients who are hypersensitive to which other antiviral drug?

Answer 35

Valganciclovir

Valganciclovir is a pro-drug of ganciclovir

Question 36

Why must you be cautious when prescribing inosine pranobex to patients with a history of gout?

Answer 36

Metabolised to uric acid

Question 37

Which two antiviral drugs do you need to use with caution in elderly patients?

Answer 37

Aciclovir
Valciclovir

• risk of neurological reactions

Question 38

If herpesviruses are treated with aciclovir, why are recurrent infections common?

Answer 38

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

Question 39

If a patient is to use topical aciclovir for cold sores, when should they apply the cream?

Answer 39

As soon as they notice symptoms (e.g. tingling)