Herpetic viral infections

Question 1

Name 8 herpes viruses?

Answer 1

1) HSV1
2) HSV2
3) EBV
4) VZV
5) CMV
6) HHV6
7) HHV7
8) HHV8 (associated with kaposis sarcoma in HIV patients)
Hallmark: Latency established after primary infection and long term persistence of virus in the host in a dormant state.

Question 2

How does herpes simplex virus get transmitted?

Answer 2

1) Enters through mucous membranes and skin:
HSV1: Lip and skin lesions
HSV2: Genital lesions

Question 3

Gingivosomatitis brief:

Answer 3

• affects 10 months to 3 years
• lasts up to 2 weeks
• vesicular lesions on lips, gums and anterior surface of tongue
• painful ulcerations with bleeding
• HIGH FEVER
• pain on eating and drinking - dehydration.

Tx - Aciclovir and IV fluids

Question 4

Skin problems with HSV:

Answer 4

• Cold sores on lip with HSV1
• Vesicular lesions on eczematous skin - Eczema Herpeticum
• Herpetic Whitlows - Painful erythematous oedematous white putues on broken skin of fingers - (when adults kiss kids hands)

Question 5

Eye problems with HSV:

Answer 5

• Blepharitis or conjunctivitis
• Can involve cornea (dendritic ulceration) leading to corneal scarring and vision loss eventually.
• Any child with herpetic lesions near eyes need ophthalmic investigation with SLIT LAMP.

Question 6

Chicken Pox (primary VZV) clinical presentation?

Answer 6

1) 200-500 lesions on head and trunk progressing to the peripheries
2) Crops of papsules - vesicles with surrounding erythema and pustules at different times - can crust for up to 7 days.
3) Itchy and scratchy
4) Fever
5) lesions for over 10 days - DEFECTIVE CELLULAR IMMUNITY
6) Child with fever and chicken pox whose fever settles then recurs few days later -SECONDARY BACTERIAL INFECTION.

Question 7

Complications of VZV/chicken pox?

Answer 7

1) Secondary bacterial infection
2) Encephalitis
3) Purpura fulminan - due to vasculitis in skin and subcutaneous tissues

Question 8

Management of VZV/chicken pox?

Answer 8

1) Symptomatic
2) Immunocompromised - IV acyclovir
3) Adolescents and adults - Valciclovir
4) Prevention Varicella Zoster immunoglobulin (VZIG) fo those who are immunosuppressed and have contact with chicken pox.

Question 9

What conditions do EBV cause?

Answer 9

EBV can cause:

1) Infectious mononucleosis
2) Burkitt lymphoma
3) Lymphoproliferative disease in immunocompromised
4) Nasopharyngeal carcinoma

Question 10

Infectious mononucleosis (with EBV) presentation?

Answer 10

Clinical features for 1-3 months then self-resolving.
1) Fever/malaise
2) Tonsillopharyngitis (often severe and limiting fluid and food ingestion)
3) Lymphadenopathy (prominent cervical lymph nodes)
Others:
- Petechiae on soft palate
- Splenomegaly (50%) and hepatomegaly
- Maculopapular rash
- Jaundice

Question 11

Diagnosing infectious mononucleosis? (EBV)

Answer 11

• Atypical lymphocytes on blood film (really large)

- Positive monospot test - heterophile antibodies present

Question 12

Management of EBV infectious mononucleosis?

Answer 12

1) Symptomatic
2) SEVERE - corticosteroids
3) DO NOT GIVE Abs + DO NOT OPEN MOUTH.
4) Ampicillin or amoxicillin can cause maculopapular rash in kids with EBV (AVOID!!!!!)

Question 13

CMV transmission, Sx, Dx, Tx?

Answer 13

1) Transmitted via saliva, secretions, rarely blood products, organ transplants.
2) Mononucleosis syndrome (pharyngitis and lymphadenopathy) not as severe as EBV - less severe EBV glandular fever.
3) Monitor after transplant with PCR (if they’ve had an organ transplant)
4) Negative monospot test - atypical lymphocytes but no heterophile antibodies (NOT EBV infectious)
5) Treatment - Ganciclovir or foscernet (side effects)

Question 14

HHV6 + HHV7 brief:

Answer 14

• HHV6 more prevalent
• Oral secretions of family members, most infected with these by 2 years.
• CHARACTERISTIC: Exanthem subitem (roseola infantum= sudden onset high fever few days, followed by generalised macular rash as fever wanes
• Exanthum subitem misdiagnosed as measles or rubella - check serology