Herpetic stomatitis & Infectious Esophagitis Flashcards
Mention the similar structures of all HSV family
- Large viruses with Icosahedral core surrounded by lipoprotein envelope
- linear double stranded DNA
- No polymerase
- Has tegument :
- that is located between nucleocapsid & envelope
- play role in viral replication by regulatory proteins ( transcription & translation factors )
Mention the important properties of HSV family
- Replicate in nucleus & form intranuclear inclusions
- Budding from nuclear membrane let it obtain an envelope
- Cause Latent infection:
1. Acute disease —-> asymptomatic period (latent state)
- Provoking agent or immunosuppression —> reactivation of HSV replication——> cause disease
- After HSV infects neurons ——> latency-associated transcripts are synthesized——-> suppress viral replication ——> initiate & maintain latent state
What is the mode of transmission of Herpes Simplex Virus-1 ?
- Saliva ( mostly primary infection occur during childhood )
- oral- genital sex
During latency in HSV 1 where is the viral DNA located ?
Cytoplasm ( NOT integrated into
nuclear DNA)
Explain the pathogenesis of HSV 1
Virus replicates in skin or mucous membrane at initial site of infection ——> migrates up neuron by retrograde axonal flow ——-> latent in trigeminal ganglia
What factors reactivate HSV 1 ?
- sunlight
- hormonal changes
- trauma
- stress
- fever
How do HSV 1 reactivation occur ?
Previous factors will migrate down neuron ——> replicates in skin —-> lesions
Describe the lesion of HSV 1
- Skin lesion contains vesicles filled of serous fluid with virus particles & cell debris
- Multinucleated giant cells : base of herpesvirus lesions
- Cell-mediated immunity: limiting herpesviruses
What happens if the vesicles of HSV 1 ruptures ?
virus can be transmitted to other individuals
State all the clinical findings / diseases caused by HSV 1
1- Gingivostomatitis
2- Herpes labialis
3- Keratoconjunctivitis
4- Encephalitis
5- Herpetic whitlow
6- Herpes gladiatorum ( on fingers & fingertips)
7- Eczema herpeticum (Kaposi’s varicelliform eruption)
8- Disseminated infections
9- Erythema multiforme
A patient has vesicles on his upper lip at the mucocutaneous junction . What is the clinical finding & it’s caused by which virus ?
Herpes labialis
Caused by HSV 1
- Note : Milder & recurrences frequently reappear at the same site
Corneal ulcers & lesions of conjunctival epithelium ; that could cause blindness due to reoccurrence
Keratoconjunctivitis
What is Gingivostomatitis?
- Cause Fever, irritability & vesicular lesions in mouth
- Primarily in children and many of them are asymptomatic
- Primary disease is more severe & lasts longer than recurrences
- Lesions heal spontaneously in 2 to 3 weeks
Which HSV 1 finding cause :
Esophagitis & depressed T-cell pneumonia function ?
Disseminated infections
What is Kaposi’s varicelliform eruption ?
It’s another name for Eczema herpeticum ; caused by HSV 1
It’s determined by its Vesicular lesions at site of atopic dermatitis
(eczema) in children
Vesicular lesion found on the head, neck & trunk
Herpes gladiatorum
Herpes gladiatorum occurs to which group of people?
Wrestlers & others who have close body contact
A physician developed Pustular lesion in her hand after contact with patient’s lesions. What is the clinical finding?
Herpetic whitlow
Mention the indications of Encephalitis
- Fever, headache , nausea & vomiting
2- altered sense of smell & loss of vision, memory loss
3- hemiparesis, ataxia, hyperreflexia
- Point #2 & 3 are examples of Focal neurological deficits affecting medial temporal lobe
4- Seizures , Altered mental status & Behavioral changes
5- Meningeal signs —-> nuchal rigidity & photophobia
What is the CSF analysis of Encephalitis due to HSV 1
- High protein level
- Lymphocytic pleocytosis
- Normal glucose levels
State features of Erythema multiforme
- “ target” or “bull’s eye” lesion ( rash a central red ring ) due to immune-mediated reaction to HSV antigens
- Macular or papular lesions on the trunk , hand & feet symmetrically occurring
What are all the diagnosis that could be done for HSV 1 ?
1- Cell culture
2- Tzanck smear
3- PCR
4- Diagnosis of neonatal herpes
- Viral cultures or PCR assay
5- Neutralization test ( Serologic test)
Which test is useless to diagnose HSV 1 and why ?
Serological tests such as Neutralization test
Because many adults already have circulating antibodies & recurrences rarely cause rise in antibody titer
Rapid diagnosis for herpes encephalitis is …..
PCR ; it detects HSV DNA in spinal fluid
How is cell culture performed for HSV 1 ?
Virus is identified by :
1- Fluorescent antibody staining of infected cells
2- Enzyme-linked immunosorbent assay (ELISA): virus glycoproteins
How many days does it take for the Cytopathic effect of isolated virus from a lesion ?
1 to 3 days
How to distinguish between HSV 1 & HSV 2
ELISA test ——> by using monoclonal antibody against glycoprotein G
Which test detects multinucleated giant cells using
Giemsa stain in HSV 1 ?
Tzanck smear
State the main properties of Cytomegalovirus
- It’s Structurally & morphologically similar to other herpesviruses
- It is antigenically different than other herpesviruses
- Single serotype
- Natural hosts: Humans
- Giant cells are formed ——-> cytomegalo
How CMV is transmitted in young children?
Via saliva
How CMV is transmitted later in life ?
- Sexually ( semen & cervical secretions)
- Blood transfusions
- Organ transplants
How CMV is transmitted early in life ?
- Across placenta
- Birth canal
- Breast milk
What is cytomegalic inclusion disease ?
- A fetus infection by CMV characterized by multinucleated giant cells with intranuclear inclusions
- Many organs are affected
- Widespread congenital abnormalities
How cytomegalic inclusion disease occur ?
When primary infection occurs in pregnant woman who has no antibodies to neutralize virus before it infect fetus
- If pregnant woman has antibodies against virus then the fetus will NOT be infected
When & how does the congenital abnormalities appear in fetus with cytomegalic inclusion disease ?
When : During 1st trimester
How: development of organs occurs
& death of precursor cells result in ——> congenital defects
CMV enters latent state in monocytes & reactivated when ……………..?
When cell - mediated immunity is decreased
Reactivation of CMV from latent state in cervical cells will cause …?
Infection of newborn during passage through the birth canal
CMV can persist for years in which organ/s ?
Kidneys
What are the mechanisms pulled by CMV to maintain longer latent state ?
- CMV encode MicroRNAs:
——> binds to & prevent translation of cell’s mRNA for class 1 MHC
——> prevents viral proteins from being displayed on infected cell & not killed by cytotoxic T cells - Assembly of MHC class I ——> the viral peptide complex is unstable in CMV infected cells —-> viral antigens is not displaced on cell surface & not killed by cytotoxic T cells
- Also encodes protein that function as chemokine receptor —-> preventing chemokines from serving as signal for host immune cells to migrate to site of CMV infection
- Has immunosuppressive effect that —-> inhibits T cells
What are the clinical findings for infants during gestation with CMV infection?
- microcephaly
- seizures
- deafness
- thrombocytopenia
- jaundice
- Purpura “ blueberry muffin “
- Hepatosplenomegaly
- Excrete CMV in urine for several years
What are the clinical findings of CMV in Immunocompetent adults ?
- heterophil- negative mononucleosis fever
- Lethargy
- Abnormal lymphocytes in peripheral blood smears
What are the clinical findings of CMV In immunocompromised patients?
Eg.Renal & bone marrow transplants
Systemic CMV infection——> eg. pneumonitis esophagitis & hepatitis
What does CMV cause for AIDS patients ?
- CMV infects intestinal tract—-> colitis with diarrhea
* CMV causes retinitis ——> blindness
What are all the diagnosis performed for CMV ?
- Culturing
- Fluorescent antibody & Histologic staining
- Fourfold or greater rise in antibody titer
- PCR
- CMV antigenemia ( by immunofluorescence assay)
Which protein in immunofluorescence assay test identifies CMV ?
pp65 protein ( located in nucleocapsid of CMV) it’s identified in blood leukocytes
Which fluids are obtained to examine the DNA & RNA of CMV ?
PCR test is used to identify the DNA or RNA in tissue or body fluids
For CMV fluids are obtained from spinal fluid & amniotic fluid
What does the Fluorescent antibody & Histologic staining identify?
Basophilic intranuclear inclusions oval
“owl’s eye” in giant cells in urine & tissue
How is culturing performed for CMV diagnosis?
- Culturing is coupled with the use of immunofluorescent antibody
- used to determine susceptibility to ganciclovir
- diagnosis in 72 hours is preferred
