HSV Flashcards

1
Q

Define herpes simplex virus.

A

Disease resulting from HSV1 or HSV2 infection.

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2
Q

What is HSV1 AKA and what does it cause?

A

Cold sores

  • Herpes labialis - lips
  • Herpetic whitlow - painful infection on fingers
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3
Q

What is HSV2 AKA and what does it cause?

A

Genital herpes

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4
Q

How is HSV1 spread?

A

Respiratory droplets

Saliva

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5
Q

How does HSV1 present?

A
  • Gingivostomatitis, cold sores (herpes labialis)
  • Herpetic whitlow
  • Eczema herpeticum
  • Herpes simplex meningitis, encephalitis
  • Systemic infection
  • Keratoconjunctivitis
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7
Q

How does HSV2 present?

A
  • Genital herpes (chronic-life long)
  • flu-like prodrome
  • vesicles/papules around genitals, anus
  • shallow ulcers
  • urethral discharge
  • dysuria
  • fever and malaise
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8
Q

How common is HSV1?

A

Very common

90% of adults seropositive for HSV1 by age 30yrs (can be asymptomatic)

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10
Q

How is HSV2 spread?

A
  • Sexual contact
  • Perinatal
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11
Q

What is the aetiology of HSV1 and 2?

A
  • Virus becomes dormant following primary infection - trigeminal/sacral root ganglia
  • Reactivation may occur in response to stress or immunosuppression
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12
Q

List the herpesvirus classification.

A
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13
Q

What kind of viruses are HSV1 and 2?

A

Large, enveloped, double-stranded DNA viruses.

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14
Q

What are the two phases of HSV?

A

Has a latent and lytic phase:

Latent phase - chronic infection where infectious virons are not produced –> asymptomatic

Lytic phase - viral replication and transport of virus to skin and mucosal surfaces–> active infection

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16
Q

Describe the pathophysiology of herpes simplex virus.

A
  • Acquired at mucosal surfaces or breaks in the skin
  • Virus replicates in epidermis then infects sensory or autonomic nerve ending and travels via retrograde axonal transport to sensory ganglia.
  • It then enters latent phase, evading the immune system to cause lifelong infection
  • Periodic reactivation of the virus produces lytic replication when the virus travels by anterograde transport doen axons to the mucosal or cutaneous surface.
  • Reactivation may lead to asymptomatic shedding of virus –> neuropathic tingling and burning to recurrent ulceration
  • Timing and source is often diffucult to determine because virus is asymptomatic in when acquired
  • HSV is associated with CD4+ and CD8+ T cells and antibodies.
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17
Q

What investigations would you do fos HSV infection?

A

Usually clinical diagnosis

May consider viral culture and HSV PCR, glycoprotein G based type specific serology.

  • Viral culture - highest yield if vesicles can be unroofed and the base of an ulcer can be scraped with a Dacron swab
  • HSV PCR - as above; higher sensitivity than viral culture
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18
Q

How do you manage HSV infection?

A
  • oral aciclovir, valaciclovir or famciclovir *
  • symptomatic treatment - paracetamol, lidocaine 5% topical,
  • topical antiviral - docosanol topical 10%

*IV if there is disseminated visceral involvement (pneumonitis, hepatitis or SN involvement)

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19
Q

What is most likely to predict future eye involvement?

A
  • Involvement of the tip of nose