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MS2 - Infectious Disease > Herpesviruses > Flashcards

Herpesviruses Flashcards

1
Q

All herpes infections begin with ___________.

A

primary infection

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2
Q

After primary infection, herpes viruses can do one of two things: _____________.

A

lytic replication or latency

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3
Q

Lytic replication can manifest as _____________.

A

disease or asymptomatic shedding

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4
Q

What structure do herpes viruses (all of them) have?

A

Enveloped dsDNA with outer glycoproteins that allow infection

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5
Q

Herpes viruses can present with _____________ inclusions.

A

nuclear and cytoplasmic

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6
Q

Briefly describe the three subgroups of herpes viruses.

A

Alpha: establish latent infections in neurons (HSV1, HSV2, and VZV)

Beta: establish latent infections in myeloid cells (CMV, HH6, and HHV7)

Gamma: establish latent infections in B cells and myeloid cells (EBV, KSV)

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7
Q

What shape does the herpes capsid have?

A

It is icosahedral.

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8
Q

The viral capsid is ______ to the envelope.

A

deep

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9
Q

The fastest herpes virus subgroup (that is, fastest to develop) is ______________.

A

alpha (12 - 24 hours)

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10
Q

Alpha herpes viruses (HSV1, HSV2, and VZV) reside in _____________ neurons.

A

sensory ganglia

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11
Q

What part of the virus stimulates adaptive immunity?

A

The envelope glycoprotein

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12
Q

_________ is the only herpes virus to be transmitted via respiratory secretions.

A

VZV

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13
Q

Herpes viruses transcribe proteins in three stages: _______________.

A
  • Immediate early: proteins that help create a favorable intracellular environment
  • Early: proteins needed for replication (e.g., viral DNA polymerase)
  • Late: structural proteins
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14
Q

What mechanism allows for very fast replication of viral genomes?

A

Rolling circle replication –a process like unraveling toilet paper

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15
Q

Acyclovir requires ___________ to become active.

A

thymidine kinase (as such, organisms such as beta herpes viruses – like CMV – that do not use thymidine kinase are resistant to acyclovir)

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16
Q

Ganciclovir requires _______ to become active.

A

UL97

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17
Q

Why are cidofovir and foscarnet more toxic?

A

They are activated by cellular kinases and thus inhibit host DNA as well.

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18
Q

True or false: the viral envelope comes from the nuclear envelope.

A

False. Viruses do acquire an envelope at the nucleus, but they lose it and regain another in the Golgi.

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19
Q

What is the difference between Cowdry bodies and CMV inclusions?

A

Cowdry bodies are eosinophilic – pink –and CMV bodies are basophilic.

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20
Q

HSV1 is typically latent in _______________, while HSV2 is typically latent in ______________.

A

the trigeminal ganglion; the sacral ganglia

There are, of course, exceptions.

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21
Q

Once an HSV lesion ____________, it is no longer infectious.

A

scabs over

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22
Q

By age 50, ________ percent of people are seropositive for HSV1.

A

90

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23
Q

Severe primary infection with HSV or immuno- compromisation can lead to a painful oral symptom: _____________

A

gingivostomatitis (swelling of the gingiva)

24
Q

Because of ______________, secondary HSV is not as severe –often presenting with cancre sores.

A

T-cell memory

25
Q

A patient presents with _____________ and you say “I know, they have herpetic encephalitis!”

A

fever, confusion, focal neurologic findings, and mononuclear cells in their CSF

26
Q

HSV2 often presents with ___________ superinfection.

A

candida

27
Q

Explain the clinical terminology for VZV.

A

Primary: chickenpox
Reactivation: zoster

28
Q

Where does primary VZV replicate?

A

In lymph nodes

29
Q

What is the classic description of primary VZV infection?

A

Crops of vesicles of varying age

30
Q

What are some complications of VZV?

A
  • Bacterial superinfection (most common problem)
  • Severe adult infection (including pneumonia and sepsis)
  • Encephalitis
  • Congenital
31
Q

What is Hutchinson sign?

A

Reactivation of VZV in the V1 dermatome of the face that leads down to the tip of the nose

Note: if you see this, consult an ophthalmologist because the V1 also enters the eye.

32
Q

How can shingles be treated?

A

Acyclovir is effective if given in the first 3 or 4 days of symptoms.

33
Q

What complications can result from shingles?

A
  • Motor deficits
  • Encephalitis
  • Eye involvement
  • Post-herpetic neuralgia
34
Q

Part of why the elderly are at increased risk of shingles is ____________.

A

decreased T-cell immunity

35
Q

The shingles vaccine is recommended for those ___________.

A

60 and older

36
Q

Beta herpesviruses infect _________-positive cells.

A

CD34 (hematopoietic stem cells)

37
Q

Most neonatal CMV results from __________.

A

breast milk

38
Q

CMV in adolescents can cause ______________.

A

a mononucleosis-type syndrome

39
Q

How should CMV be treated?

A

With ganciclovir or foscarnet (if the virus has UL97 mutations)

40
Q

The “slapped-cheek” disease is caused by __________ and has two names: ____________.

A

parvovirus B19; 5th disease and erythema infectiosum

41
Q

A mother tells you her child had a fever yesterday and a rash today. What virus is this? What is the most common pattern of virus?

A

Roseola; a maculopapular rash that starts on the trunk and moves to the face

42
Q

The most important gamma herpesvirus is _____________.

A

EBV

43
Q

What do EBVNA1 and EBVNA2 do?

A

EBVNA1: links EBV DNA to host genome
EBVNA2: activates viral genes and c-myc (hence Burkitt)

44
Q

What is the pathogenesis of EBV?

A

B cells get infected in the tonsils and spread throughout the body. T cells kill the B cells, and the inflammation from that causes systemic symptoms.

45
Q

Why do heterophile antibodies develop from EBV infection?

A

EBV stimulates B cells to proliferate regardless of antigen presentation. As such, the blood of someone actively infected with EBV will display agglutination to random antigens.

46
Q

How sensitive is the monospot test?

A

~85%

47
Q

What virus causes Kaposi’s sarcoma?

A

HHV8 (gamma herpes virus)

48
Q

The virus that causes Kaposi’s sarcoma resides latent in ________________.

A

B cells

49
Q

Why do herpesviruses typically require close contact?

A

Because they are easily killed in the environment

50
Q

The envelope around herpesviruses (all of them) is derived from _____________.

A

the host cell’s Golgi apparatus

51
Q

When the rash from a herpesvirus has __________, it is usually not contagious anymore.

A

crusted over

52
Q

True or false: primary herpes infections are most often asymptomatic.

A

True. Only about 20% of cases present with symptoms.

53
Q

Even people without herpes symptoms can ______________.

A

spread the virus to others

54
Q

A classic finding of CMV infection in an adult is ______________.

A

interstitial pneumonia

Remember the lung stains on the butcher’s apron.

55
Q

The acute test for EBV tests ________, while _________ will appear after an infection.

A

IgM; IgG

56
Q

It takes about __________ days for VZV to present as chickenpox.

A

10-20

57
Q

The two most common congenital herpes infections are ___________________.

A

CMV (40,000 per year) and HSV (1,200 per year)

MS2 - Infectious Disease (57 decks)

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