herpesvirus infections Flashcards
herpes infection of the mouth and lips and in the eye is generally associated with….
HSV1
genital infection is most often associated with
HSV2, and also HSV1
what is prodromal phase
early signs or symptoms of an illness or health problem that appear before the major signs or symptoms
what to do if you suspect ocular herpes simplex infection
refer for urgent same day specialist referral
can you initiate treatment whilst awaiting review by specialist in pt suspected to have ocular herpes simplex
no, do not give treatment
specialist urgent same day referral
what do you do if same day review is not possible for a pt with suspected ocular herpes simplex infection
seek specialist advice
may include topical antiviral treatment in primary care
what to do if herpes simple infection in pregnancy
refer or seek specialist advice for treatment
what is a neonate
0-28 days
varicella (chickenpox) is caused by which virus
varicella zoster
management of chickenpox in neonates
seek specialist advice due to high er risk of severe disease and complications
is antiviral treatment recommended in children with chickenpox
no, not routinely as it is generally self limiting and complications are rare
who is chickenpox more severe in? (age)
adolescents (ages 14 and over) and adults
would you consider antivirals in pt 14 and over and adults who have chickenpox
chickenpox is more severe in this age range
antiviral treatment started within 24h of onset of rash may be considered, esp if severe infection or risk of complications
seek specialist advice on diagnosis and management of chickenpox in immunocompromised pt
treatment of chickenpox during pregnancy
immediate specialist advice
pregnant females with severe chickenpox may be at risk of complications, esp varicella pneumonia
Pregnant females who develop severe chickenpox may be at risk of complications, especially
varicella pneumonia
shingles is caused by this virus
herpes zoster
what is herpes zoster (shingles)
viral infection of individual nerve and the skin surface affected by the nerve
shingles infection is caused by reactivation of
varicella zoster virus (chickenpox virus)
what pt with shingles need oral antiviral treatment (4)
- immunocompromised
- non-truncal involvement (neck, limbs, perineum)
- moderate to severe pain
- rash
consider oral antiviral treatment for shingles for pt over 50 to reduce risk of
post herpetic neuralgia
consider oral antiviral treatment in this age range to reduce the risk of post herpetic neuralgia
over 50
when should you start treatment for shingles
within 72h of onset of rash
which patients with shingles would you admit to hospital or seek specialist advice?
- immunocompromised with severe or widespread infection
- severely immunocompromised
- shingles in ophthalmic distribution of trigeminal nerve
a patient presents to the pharmacy with this. they say they felt tingling to begin with a few days and now have what appears to be a rash. they also have a headache. you diagnose them as having shingles and refer them because of the region it can affected. which nerve has been affected?
trigeminal nerve
where does shingles rash typically present
Usually you get the shingles rash on your chest and tummy, but it can appear anywhere on your body including on your face, eyes and genitals.
describe shingles rash
The rash appears as blotches on your skin, on 1 side of your body only.
A rash on both the left and right of your body is unlikely to be shingles.
The blotches become itchy blisters that ooze fluid.
A few days later, the blisters dry out and scab.
Skin remains painful until after the rash is gone
first signs of shingles
a tingling or painful feeling in an area of skin
a headache or feeling generally unwell
chronic pain which persists after the rash has healed is known as
post herpetic neuralgia (needs specific treatment)
who is the shingles vaccine recommended for
70-79 yr olds
a patient presents with an painful rash on their back. they are pregnant. what is it and what do you do
shingles
if you’re pregnant and get shingles, it’s mostly mild and there’s usually no risk to you or your baby.
But a GP should arrange for a specialist to advise on whether you need treatment.
who is post exposure prophylaxis to attenuate varicella zoster disease and reduce risk of complications (e.g. pneumonitis) recommended for
- increased risk of severe chickenpox e.g. neonates (esp in first 7 days of life)
- children under one year
- pregnant
- immunosuppressed
(who have had a significant exposure to varicella-zoster virus during the infectious period and who are susceptible to the virus.)
post exposure prophylaxis (VZ) with this antiviral drug is recommended for most at risk individuals (except certain susceptible neonates and for individuals for whom antivirals are contra-indicated or otherwise unsuitable (e.g. if there are significant concerns about renal impairment or intestinal malabsorption))
acyclovir
post exposure prophylaxis (VZ) with this drug is recommended for certain susceptible neonates and for individuals for whom antivirals are contra-indicated or otherwise unsuitable (e.g. if there are significant concerns about renal impairment or intestinal malabsorption)
varicella zoster immunoglobulin VCIG
Prophylactic intravenous aciclovir [unlicensed use] should also be considered in addition to VZIG for neonates whose mothers develop chickenpox 4 days before and up to 2 days after delivery as….
as they are at the highest risk of fatal outcome despite VZIG prophylaxis
this combination should be considered for neonates whose mothers develop chickenpox 4 days before and up to 2 days after delivery, as they are at the highest risk of fatal outcome despite VZIG prophylaxis.
prophylactic intravenous aciclovir [unlicensed use] should also be considered in addition to VZIG
alternative to aciclovir for post exposure prophylaxis (VZ)
valaciclovir (unlicensed use)
post exposure prophylaxis for individuals on long term acyclovir or valaciclovir (VZ)
may require dose to be temporarily increased
Individuals who develop chickenpox despite post-exposure prophylaxis require treatment with ..
antiviral
During outbreaks in nurseries and pre-school settings where chickenpox is co-circulating with group A streptococcus infections (such as scarlet fever), post-exposure prophylaxis with ….. can be given to certain non immune individuals in these settings
chickenpox varicella-zoster vaccine
this antiviral drug is active against herpesvirus but does not eradicate them
acyclovir
uses of aciclcovir include
systemic treatment of varicella-zoster
the systemic and topical treatment of herpes simplex infections of the skin and mucous membranes
acyclovir eye ointment is license for
HSV infections of the eye
famciclovir is a prodrug of
penciclovir
famciclovir is a prodrug of
penciclovir
femciclovir is a prodrug or penciclovir and is similar to this drug
aciclovir
femciclovir is a prodrug of penciclovir and is similar to acyclovir and may be used in the treatment of (2)
herpes zoster
genital herpes
valaciclovir is an ester of this drug
aciclvoir
valaciclovir may be used in the treatment of
herpes zoster and herpes simplex infections of the skin and mucous membranes (including genital herpes)
this antiviral is licensed for preventing cytomegalovirus disease following solid organ transplantation.
valaciclovir
IV foscarnet sodium is licensed for
mucocutaneous herpes simplex virus infection unresponsive to aciclovir in immunocompromised patients
oral ionising pranobex is licensed for
mucocutaneous infections due to the herpes simplex virus.
is cytomegalovirus a member of which virus group
member of the herpesvirus group
in immunocompetent patients, cytomegalovirus infection is often…
asymptomatic and self-limiting therefore treatment is not always required.
in immunocompromised pt e.g. AIDS and transplant recipients, cytomegalovirus manifests
more severely causing diseases associated with greater morbidity and mortality
these is a possibility of resistance with this antiviral drug in those who have repeatedly have a poor treatment response or when viral excretion continues despite treatment (for CMV infection)
ganciclovir
does CMV infection cause symptoms
usually asymptotic and self limiting therefore treatment not usually required (in immunocompetent patients)
which high risk drug does aciclovir and valaciclovir severely interact with and what is the interaction
theophylline/aminotheophylline - aciclovir increases exposure, monitor and adjust dose
acyclovir is …. toxic
nephrotoxic
when using antivirals in renal impairment, ensure pt maintain…
adequate hydration
aciclvoir dose for treatment of non genital Herpes simplex
200 mg 5 times a day usually for 5 days (longer if new lesions appear during treatment or if healing incomplete).
what is this
cold sore
what is this
cold sore, they can appear anywhere on the face
what is this
cold sore which has burst and crusted over into a scab
describe cold sore
A cold sore usually starts with a tingling, itching or burning feeling.
Over the next 48 hours one or more painful blisters will appear on your face.
Usually small and filled with fluid. The blisters burst and crust over into a scab.
Can appear anywhere on the face
How long do cold sores usually take to heal
within 10 days
state some things that can trigger cold sore
illness, sunshine or being on your period.
are cold sores contagious
Cold sores are contagious from the moment you first feel tingling or other signs of a cold sore coming on to when the cold sore has completely healed.
They can easily spread to other people and other parts of your body.
advice on how to spread cold sore spreading
wash your hands with soap and water whenever you touch your cold sore
do not kiss anyone while you have a cold sore
do not have oral sex until your cold sore completely heals as you could give your partner genital herpes
Zovirax Cold Sore Cream/aciclovir 5% OTC age
adults and children
Zovirax Cold Sore Cream/aciclovir 5% OTC how to use & how often & duration
Apply the cream liberally to completely cover the whole of the affected area.
Apply to the affected area 5x a day at approximately 4 hourly intervals for 4 days. If your cold sore has not healed after this time, you can use the cream for up to 10 days in total.
where should you not use otc zovirax/aciclovir?
Do not use in eyes, on genitals or in the mouth or nose.
where can you use OTC aciclovie cream ?
lips and face
at what stage can you use OTC aciclovir cream for sold sore of face or lips
at tingle or at blister
true or false - cold sores are contagious from the moment you get tingling, burning, itching sensation which is usually before onset of blister
TRUE
