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Virology > Herpesviruses > Flashcards

Herpesviruses Flashcards

1
Q

Alpha Herpesviruses

A

Herpesvirus 1, 2, 3

1&2 = HSV

3= VZV

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2
Q

Gamma Herpesviruses

A

4 = EBV

**also #8?

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3
Q

Beta Herpesvirinae

A

Herpesvirus 5, 6, 7

5 = CMV

6 = HHV6

7 = HHV7

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4
Q

Herpesvirus genome and structure

A

dsDNA genome

  • Envelope, tegument, and capsid
  • Glycoprotein spikes
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5
Q

Herpesvirus produces proteins in what three phases

A
  1. Immediate Early proteins (alpha) regulate gene transcription
  2. Early proteins (Beta) DNA pol and TF’s
  3. Late Proteins (Gamma) = structural proteins
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6
Q

Herpesvirus envelope is from ______

A

the nucleus

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7
Q

Herpesvirus encodes what two enzymes

A

DNA-dependent DNApol

Thymidine Kinase

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8
Q

80% of Herpesvirus are ______

A

asymptomatic

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9
Q

Oral herpes (acute gingivostomatitis) incubation time

A

One week

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10
Q

Cold sores =

A

herpes labialis

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11
Q

Herpes labialis prevalence?

A

20-40%

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12
Q

Herpes Keratitis most frequent cause of ______

A

blindness

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13
Q

Major signs of herpes keratitis

A
  • Unilateral red eye
  • Vesicular skin rash
  • Folicular conjunctivitis
  • DENDRITIC CORNEAL ULCER (= hallmark sign)
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14
Q

Herpes keratitis Tx

A

Acyclovir cream 3%

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15
Q

Herpes Whitlow caused by

A

HSV 1 or 2

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16
Q

Herpes whitlow incubation period

A

2-20 days

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17
Q

Herpes whitlow infection characteristics (3)

A

Fever

Malaise

Treatmtent is SELF LIMITING

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18
Q

Herpes gladiatorum appearance and treatment

A

Head and neck blister cluster

Treatment is acyclovir

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19
Q

Eczema herpeticum epid, features, incubation, and Tx

A
  • Rare, usually children
  • Severe disseminated disease at pre-existing sites of skin damage
  • Incubation of 5-12 days
  • Tx = Acyclovir and ANTIBIOTICS to prevent 2’ infection
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20
Q

Genital Herpes systemic effects

A

Fever, flu-like symptoms, swollen lymph nodes

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21
Q

Genital HSV2 lasts about _______

A

one month

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22
Q

HSV encephalitis usually caused by

A

HSV1

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23
Q

HSV accounts for __% of all encephalitic viral infections

A

10-20%

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24
Q

HSV encephalitis phases

A

Prodrome = fever and nausea

Encephalopathy = either acute or subacute

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25
Q

HSV encephalitis has a predilection for edema and hemorrhage in ______

A

temporal lobe

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26
Q

CSF appearance in HSV encephalitis

A

Glucose and protein = mostly normal

Elevated WBC (mostly lymphocytes)

RBC found becaue of hemorrhage

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27
Q

HSV meningitis mostly caused by ____

A

HSV2

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28
Q

50% of HSV meningitis cases are _____ and 50% are _____

A

Primary and Secondary

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29
Q

HSV enceph vs. meningitis – CSF appearance

A

Enceph has way higher RBC

Meningitis has higher WBC and Protein

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30
Q

Neonatal herpes caused mostly by

A

HSV2

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31
Q

Neonatal HSV can be transmitted…

A
  1. vertically from mom
  2. from another neonate
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32
Q

Symptoms of neonatal HSV (after vs before birth infections)

A

After Birth = Many confined to skin, eye, and mouth. Encephalitis in 35%. Disseminated in 25%.

Before birth = Premature birth, low birthweight, microcephaly, hydrocephalus, chorioretinitis, vesicular skin lesions

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33
Q
  • HSV replicates in ______ cells.
  • Hangs out in the ______ and______ ganglia.
  • Establishes ________
A
  • epithelial
  • trigeminal and sacral
  • latency
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34
Q

HSV1 and 2 cause 3 types of infections:

A
  1. Lytic (replication in mucoepithelial cells, disease @ lesion site)
  2. Latent (neuronal)
  3. Persistent (in lymphocytes and MQ
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35
Q

Cell death during HSV infection can result from _____, _____, or _______

A
  1. Virus induced inhibition of cell molecules
  2. DNA degradation
  3. Cytoskeleton disruption
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36
Q

Other cellular hallmarks of HSV infection

A
  • COWDRY bodies (acidophilic intranuclear inclusion)
  • Syncitia
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37
Q

Innate ___________ may be sufficient to limit HSV infection

A

innate protection by interferon

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38
Q

Antivirals for HSV

A
  • Anything ending in “cyclovir” (A, Pen, Val, Fam)
  • Adenosine Arabinoside
  • Iodo-deoxyuridine
  • Trifluridine
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39
Q

Varicella is a result of _______ infection of VZV

A

primary

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40
Q

Varicella Pox appearance

A

vesicle, pustule, crust, scabbed lesions

Lesions appear for 3-5 days

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41
Q

Varicella incubation period

A

about 2 weeks

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42
Q

When is chickenpox contagious?

A

2-3 days before rash appears

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43
Q

__________ can be observed during the course of chickenpox infection

A

ALL stages of lesions

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44
Q

Varicella rash characteristics and associated diseases?

A
  • more prevalent on trunk
  • SCALP presence distinguishes it from other rashes
  • May cause Interstitial PNA in 20-30% of adults (from inflammatory rxn at site of lesion)
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45
Q

Herpes Zoster is a _______ infection of __________ Varicella

A

recurrent infection of latent VZV

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46
Q

Shingle rash is usually ________ and forms a __________

A

unilateral

forms a “dermatomal pattern”

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47
Q

VZV transmission via ________, rarely _____

A

Inhalation

Rarely transplacental

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48
Q

VZV initially infects the _________ and spreads to ________ by VIREMIA

A

respiratory tract

RE system

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49
Q

Syncitia and intracellular inclusions occur in VZV because the virus…

A

is spread cell to cell

50
Q

VZV is latent isn _________ or __________

A

DRG or Cranial nerve ganglia

51
Q

Who is given VZV immunoglobulin? (3)

A
  • IC patients
  • Exposed staff
  • neonates from infected mothers
52
Q

VZV vaccine = _______

A

Live attenuated

53
Q

VZV vax can be effective when given…

A

post exposure

(antibodies and CMI are stimulated)

54
Q

VZV vaccination in adults is an effective means to…

A

boost antibodies to reduce onset of zoster

55
Q

Epstein Barr Virus: Family/Herpesvirus type

A

Gammaherpesvirinae

(HHV-4)

56
Q

EBV genomem, shape, and surface proteins

A

dsDNA

icosahedral

gp350/220 + gp110

57
Q

EBV gp350 surface protein forms _________, and binds to _____ receptor on B cells

A

Glycoprotein complex I

CD21 (CR2) on B cells

58
Q

EBV internalization occurs by ______

A

Cytoplasmic vesicles

59
Q

Three potential outcomes for EBV infection

A
  1. Replicate in B cells or epithelial cells
  2. latent infection of B cells
  3. Stimulate and immortalize B cells
60
Q

EBV transcription and translation start with _________ genes

A

Immediate-Early

61
Q

Two types of EBV cellular infections

A
  1. Permissive (Epithelial and B cell)
  2. Nonpermissive (B cell)
62
Q

Viral capsid and glycoproteins that are synthesized by EBV (3) during a Permissive Epithial & B cell infection

A
  1. Early antigen (EA)
  2. Viral Capsid Antigen (VCA)
  3. Glycoproteins of the membrane antigen (MA)
63
Q

EBV: Three viral genes that are expresed depending on the state of the B cell

**This is part of what type of B cell infection??**

A
  1. **EBNA’s ** = E-B nuclear antigens
  2. LMP’s = Latent membrane proteins
  3. LP’s = Latent proteins

**Non-permissive B cell infection**

64
Q

What are EBNA’s and LP’s?

A

DNA binding proteins

establish and maintain infection

65
Q

What are LMP’s?

A

Membrane proteins with oncogenic-like activity

(stimulate and immortalize B cell)

66
Q

EBV establishes latency in _________

A

Memory B cells in which only the EBNA and LMP are expressed

67
Q

Purpose of the DNA binding protiens and LMPs (overall)

A

maintaining the genome in the B cells but minimizing chance of immune recognition of the infected cells

68
Q

Permissive epithelial and B cell infection results in ____________

A

Heterophile Antibody-Positive Infectious Mononucleosis (Mono)

69
Q

Sx of infectious mononucleosis

A

lymphadenopathy, splenomegaly

exudative pharyngitis (w HIGH FEVER)

70
Q

Serious complications with mono:

A
  • Laryngeal obstruction or splenic rupture
  • Meningoencephalitis
71
Q

Anti EA and Anti VCA antobidies occur within __________, while anti EBNA antibodies are formed at about __________

A

One week

2 months

72
Q

EBV incubation period is roughly _________

73
Q

3 diseases from Non-Permissive B cell infection:

A
  1. EBV-induced Lymphoproliferative Disease
  2. Burkitt’s Lymphoma
  3. Nasopharyngeal Carcinoma
74
Q

EBV induced Lymphoproliferative disease characteristics (3)

(CBC, immune response, and who is most likely to get it)

A
  • High B cell lymphocytes
  • Lack of T cell response d/t immunosuppressive drugs
  • occur at higher rates in heart and lung transplant patients than those getting bone marrow or kidney/liver
75
Q

Burkitt’s lymphoma definition =

A

Agressive monoclonal B cell lymphoma of the jaw and face

Affects children, associated with HIV (AIDS-associated malignancy)

76
Q

NP carcinoma endemic in ______.

Proliferation of _______ cells.

Symptoms?

A
  • Asia + N. Africa
  • Epithelial cells
  • Nasal discharge, nosebleed, PT tube obstruction, Metastasis to other organs
77
Q

EBV transmitted by (3)

A

saliva, oral contact, fomites

78
Q

Clinically, EBV causes _____ or ______ infections

A

Acute or latent

79
Q

Acute EBV infection pathogenesis (three steps)

A

replication in NP cells

spread to Salivary gland

VIREMIA and infection of RE system

80
Q

EBV latent infection:

  1. Virus is present as _____ in B cell and epithelial cells.
  2. Viral ______ rate is low
  3. What cellular interaction causes this to occur?
A
  • Episome
  • reactivation rate is low
  • happens from NP cells infecting passing B cells
81
Q

B cell proliferation in EBV infection causes increase in __________

A

heterophile antibody

82
Q

T cell activation during EBV infection results in __________

A

atypical lymphocytes called DOWNEY CELLS

****************

83
Q

What is a Downey Cell?

A

large lymphocye due to antigen stimulation

Have basophilic cytoplasmic rim

84
Q

Heterophile antibody results from activation of _________

When can it be detected/how long does it last?

A

B cells

detected at 1st week, can last several months

85
Q

Heterophile is a great indication for whom?

A

Adults (not reliable in children)

86
Q

What is a Paul and Bunnel test?

A

MonoSpot test

detects Antibodies that cause agglutination of RBC’s from another species (horse)

87
Q

___% of adults have been infected with EBV by age 40

88
Q

Infants are susceptible to EBV when?

A

When mom’s antibody protection wears off

89
Q

EBV diagnostic tests (4)

A
  1. Physical exam (look at SPLEEN)
  2. CBC/CMP
  3. MonoSpot test
  4. Microscopy for Downey Cells
90
Q

Explain the blood test to determine the stage of EBV infection.

(4 stages)

A
  1. No VCA antibodies = susceptible
  2. IgM to VBA but no EBNA = Primary infection
  3. VCA and EBNA antibodies = Past infection
  4. Elevation of antibodies to EA in presence of EBNA antibodies = REACTIVATION
91
Q

CMV family member (and class)

A

HHV5

Betaherpesvirinae

92
Q

Three infections from CMV

A
  1. Congenital CMV
  2. Heterophile-negative mononucleosis
  3. Diseases of Immunocompromised patients
93
Q

Congenital CMV: _____ infection from mom is spread to placenta.

_______ infection in mom rarely causes congenital abnormalities

A

Primary

Reactivation

94
Q

CMV may cause ________ or ________ symptoms

Give some examples of both.

A

Temporary (liver, spleen, lung, seizure)

Permanent (Hearing/vision loss, Microcephaly, Mental disability)

95
Q

Heterophile-negative mono is similar to IM except for…

A

Paul-Bunnell test is negative

96
Q

CMV diseases in immunocompromised patients include

A

pneumonia

gastroenteritis

RETINITIS

encephalitis

97
Q

CMV cellular hallmark

A

Cowdry bodies

98
Q

What are Cowdry bodies?

A

giant multinucleated cells in CMV infection

found in Parotid gland

OWLS EYE appearance

99
Q

CMV causes ______ infection in salivary, breasts, kidneys, and peripheral blood leukocutes.

This leads to _____________

A

Persistent infection

Leads to chronic excretion by the organ involved.

100
Q

CMV incubation period

101
Q

CMV main sites of replication

A

Salivary glands and Kidneys

102
Q

CMV control

A

no treatments,

drugs possess many sides

Drugs = Ganciclovir, valganciclovir,

Foscarnet, cidofovir

103
Q

HHV6 and HHV7, also known as…

A

Betaherpesvirinae (roseolovirus)

104
Q

HHV6 infects what cells? Where does it replicate

A

lymphocytes, monocytes, epithelial and endothelial cells

Replicates in salivary glands

****These are both similar to CMV****

105
Q

Roseola (6th disease) due to ____ more than ______

A

HHV6 more than HHV7

106
Q

Roseola is a common _____________ disease affecting _____

A

acute febrile

infants

107
Q

When/where does Roseola rash appear?

A

After three days (after fever)

appears on neck, trunk, thighs

108
Q

_____ infections of Roseola (HHV6) can cause other complications, such as…

What about IC patients?

A

Primary infections can cause encephalitis, lymphadenopathy, and hepatitis

**May cause these things in Immunocompromised patients upon reactivation.

109
Q

Another name for infantile Roseola

A

Exanthem subitum

110
Q

Infection with HHV6 and 7 occur mainly during ________

111
Q

Seroprevalence of HHV6 in 2 year olds approaches…

112
Q

HHV7 antibody prevalence in adults reaches ____%

113
Q

What is HHV8

A

Kaposi’s Sarcoma-associated Herpes

114
Q

HHV8 causes ____ or _______ infections

It infects ____________ cells but multiplies in ________ cells

A

latent or lytic

Infects peripheral blood lymphocytes but multiplies in endo/epithelial cells and monocytes

115
Q

Kaposi’s sarcoma is a ___ tumor form ______ lineage

A

spindle cell tumor derived from endothelial cell lineage

116
Q

Kaposi Sarcoma locations

A

under skin, in oral lining, nose, and throat

117
Q

Kaposi sarcoma can be limited to _____ or may…

A

mucocutaneous lesions or may spread to other otgans

118
Q

Kaposi sarcoma cancer spreads to ___ or ____ causing bleeding and function issues

A

GI or lungs

119
Q

HHV8 is a defining illness for what?

120
Q

HHV8 may be spread via what routes?

A

Sexual or Nonsexual

nonsexual = poorly understood

121
Q

HHV8 treatments (2)

A
  1. Tumor surgical excision
  2. Irradiation

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