HSV 1&2

Question 1

What is going on with the HSV when is it latent?

Answer 1

Its genome, but not progeny, exist in trigeminal and/or sacral ganglia; only gene expressed is LAT

Question 2

What is going on with the HSV when is it reactivated?

Answer 2

It produces progeny that infect epithelial cells innervated by the latently-infected neurons

Question 3

4 herpesviruses that are sexually transmitted

Answer 3

HSV 1, HSV 2, CMV, KSHV

Question 4

(T/F): Acyclovir is the curative treatment of choice for HSV-1 and HSV-2 that works by terminating chain elongation.

Answer 4

False - No herpes treatments are curative! The rest of the statement is true.

Question 5

How does HSV get into cells?

Answer 5

Direct fusion with the plasma membrane in a pH-INDEPENDENT manner

Question 6

Immediate early genes

Answer 6

Transcription factors that switch host RNA polymerase to preferential viral gene transcription

Question 7

Early genes

Answer 7

Proteins needed for replications

Question 8

Late genes

Answer 8

Structural proteins

Question 9

Two important HSV early genes

Answer 9

Thymidine kinase, DNA polymerase

Question 10

Where does HSV replicate?

Answer 10

Nucleus of epithelial cells

Question 11

Thymidine kinase mutants are particularly prevalent in what population?

Answer 11

AIDS patients with concurrent HSV infx

causes ACV resistance

Question 12

Where does HSV assembly occur? Why do we care?

Answer 12

Nucleus; forms nuclear inclusion bodies (vacuoles with bugs in them) that are diagnostic

Question 13

Describe the pathogenesis of the multinucleated giant cells seen in Tzanck smears

Answer 13

Same viral glycoproteins that allow HSV to fuse with plasma membranes are expressed on the membrane late in infection, allowing the infected cell to fuse with neighboring cells

Question 14

What type of cells are visualized with Tzanck smears?

Answer 14

Epithelial cells; virus only produces glycoproteins when it’s replicating, and it only replicates in epithelial cells

Question 15

Function of only HSV gene produced during latency?

Answer 15

LAT = produces RNA that silences some cellular genes to prevent apoptosis of the infected cell

Question 16

Is HSV enveloped?

Answer 16

YES! (think: it has to fuse with plasma membrane)

Question 17

If the HSV genome is observed to be extrachromosomal, what is happening?

Answer 17

Latency

Question 18

HSV 1 or 2: cervicitis

Answer 18

2

Question 19

HSV 1 or 2: encephalitis

Answer 19

1

Question 20

HSV 1 or 2: meningitis

Answer 20

2

Question 21

HSV 1 or 2: herpetic whitlow

Answer 21

1

Question 22

HSV 1 or 2: keratitis

Answer 22

2

Question 23

HSV 1 or 2: penile/vulvar vesicles

Answer 23

2

Question 24

HSV 1 or 2: gingivostomatitis

Answer 24

1

Question 25

HSV 1 or 2: herpes labialis

Answer 25

1

Question 26

Who gets disseminated herpes upon reinfection?

Answer 26

Immunocompromised patients

Question 27

Who gets disseminated herpes upon primary infection?

Answer 27

Neonates (think eczema herpeticum)

Question 28

A patients present with small penile vesicles that he has never had before. If this is a primary HSV 2 infection, when did he most likely contract the virus?

Answer 28

2 weeks ago

Question 29

Why are recurrent HSV infections shorter than primary infections?

Answer 29

Neutralizing antibodies developed after the primary infection will be present

Question 30

Primary oral HSV 1 or 2

Answer 30

Gingivostomatitis

Question 31

Recurrent oral HSV 1 or 2

Answer 31

Herpes labialis

Question 32

Manifestation of primary HSV 1 or 2 infection in females

Answer 32

Internal or external vesicles, mucopurulent cervicitis, vaginitis, rarely urethritis

Question 33

Pattern of recurrence in HSV 2 infections

Answer 33

More frequent soon after primary infection then diminish in frequency over time

Question 34

More frequent recurrence: HSV 1 or HSV 2 genital lesions

Answer 34

HSV 2

Question 35

Genital HSV prodrome

Answer 35

Flu-like sx, itching/burning in infected areas, leg/buttocks muscle aches

Question 36

Cause of HSV encephalitis in neonates

Answer 36

Primary HSV 2

Question 37

Cause of HSV encephalitis in adults

Answer 37

Recurrent HSV 1

Question 38

Sx of HSV encephalitis

Answer 38

Fever, HA, confusion, seizures

Question 39

70% mortality if untreated

Answer 39

Herpes encephalitis

Question 40

Cause of HSV meningitis

Answer 40

Primary HSV 2

Question 41

Incidence of HSV meningitis

Answer 41

10% of primary HSV 2 infections

Question 42

Sx of HSV meningitis

Answer 42

HA, stiff neck, fever, vomiting

Question 43

Mortality of HSV meningitis

Answer 43

Usually resolves in 1 week

Question 44

You were worried that your OB patient with a primary HSV 2 infection may transmit the virus during delivery despite ACV treatment (C/S was contraindicated). A couple days after delivery the mother states she is relieved that her baby didn't get the virus as he has not developed any herpetic signs. You inform her that:

Answer 44

Neonatal herpes doesn't present until 1-2 weeks after delivery and the infant has a 30% chance of being infected so be on the lookout for a rash

Question 45

75% morbidity/mortality

Answer 45

Severe neonatal herpes

Question 46

Manifestations of neonatal herpes

Answer 46

Zoster-form rash, encephalitis, disseminated infection leading to organ failure

Question 47

More common: adult or neonatal HSV encephalitis

Answer 47

Neonatal

Question 48

You notice your OB patient has a primary HSV infection at the time of labor. What do you do?

Answer 48

C-section!

Question 49

Rate of transmission of primary HSV infection during delivery

Answer 49

30%

Question 50

Rate of transmission of secondary HSV infection during delivery

Answer 50

2-3%

Question 51

Incidence of neonatal HSV transmitted transplacentally

Answer 51

5%

Question 52

Incidence of neonatal HSV transmitted during vaginal delivery

Answer 52

95%

Question 53

Dx of oral herpes

Answer 53

Clinical

Question 54

Dx of genital herpes

Answer 54

1. Culture and look for cytopathic effect 2. Fluorescent antibody screening of virus culture 3. PCR 4. Tzank smear 5. Serology to detect anti-glycoprotein G Abs

Question 55

Which diagnostic tests for genital herpes can differentiate between HSV 1 and HSV 2?

Answer 55

PCR and serology

Question 56

Which diagnostic test for genital herpes only tells you the patient has had a herpes infection at some point and why?

Answer 56

Serology; you're detecting anti-glycoprotein G Abs, so you know patient was exposed to HSV at one point but not that there is an active infection

Question 57

Dx keratitis

Answer 57

Slit lamp to look for corneal damage | can you tell apart syphilis from HSV?

Question 58

Dx HSV meningitis

Answer 58

Culture CSF to look for cytopathic effect

Question 59

Main point of diagnosing HSV meningitis

Answer 59

Rule out bacterial meningitis, which is more severe than the self-resolving aseptic (viral) meningitis

Question 60

Dx HSV encephalitis

Answer 60

PCR + Southern blot of CSF | EEG to rule it out if normal

Question 61

Tests that are no good for dx HSV encephalitis

Answer 61

1. Culture of CSF - rarely positive | 2. Antibody tests - don't develop for 1-2 weeks and need to treat ASAP

Question 62

Dx disseminated HSV in neonate

Answer 62

Liver enzymes + other diagnostic methods mentioned

Question 63

Rules out HSV encephalitis

Answer 63

Normal EEG

Question 64

Why does ACV not attack host DNA polymerase?

Answer 64

The first phosphate must be added by viral thymidine kinase

Question 65

DOC for ACV treatment failure

Answer 65

Foscarnet because it doesn't have to be phosphorylated