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Microbiology Exam IV > HSV/HPV > Flashcards

HSV/HPV Flashcards

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1
Q

Herpes Simplex Virus: Genital Herpes (Characteristics)

A
  • Lesion progression from macules, papules, vesicles, pustules, to ulcers
  • Often fever, inguinal adenopathy, malaise
  • Lesion duration is ~3 weeks
  • Symptoms more severe in WOMEN
  • Common lesion sites: vulva, cervix, peritoneum, penis, thighs, buttocks

PRIMARY infection will be MORE SEVERE; i.e. first time patient has seen the infection

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2
Q

Herpes Simplex Virus: Genital Herpes (Recurrent Lesions)

A

3-5 Discreet lesions
Vulvar irritation
Prodrome –> Tingling and Pain
Heal within 7-10 days

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3
Q

Herpes Simplex Virus: Other Diseases

A

1) Herpetic Whitlow (Ulcer on finger; most commoly seen in healthcare field)
2) Herpes labialis (cold sore)
3) Herpes simplex keratitis
4) Herpes simplex encephalitis (Rare but most serious outcome)

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4
Q

Neonatal Herpes Infection

A

Highest risk is infants born to mothers experiencing PRIMARY infection at time of delivery

Rarely asymptomatic and often lethal

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5
Q

Neonatal Herpes Infection (Localized to Skin, Eyes, and Mouth)

A
  • Not lethal (Least severe, even without treatment)
  • Present at 10-11 days following birth
  • Recurrences in first 6 months
  • ~30% untrated have more serious consequences: BLINDNESS, MICROCEPHALY, SPASTIC QUADRIPLEGIA
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6
Q

Neonatal Herpes Infection (Encephalitis)

A

May or may not have skin lesions with this
1/3 of nenoate infections
Neurologic symptoms (bulging fontanel, temp instability, poor feeding)
Can be improved with anti-herpes agents

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7
Q

Neonatal Herpes Infection (Disseminated Infection)

A

Lesions in visceral organs and skin

Symptoms: irritability, seizures, respiratory distress, jaundice, bleeding diathesis, shock

Complications: HSV pneumonitis, Disseminated Intravascular Coagulation (DIC)

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8
Q

Neonatal Herpes Infection (Prevention and Treatment)

A

Prevention:
Physical exam for lesions
C. section
Healthcare workers: Herpetic whitlow (do not work during active lesion); Orolabial lesions (wear mask while working)

Treatment:
IV administration of antivirals for all neonate herpes cases

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9
Q

Herpes Simplex Virus (Virology)

A

Herpesvirus family member
Enveloped
dsDNA genome
***Encodes many of its own enzymes for genome replication
-HSV POLYMERASE is a target of ANTI-VIRALS

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10
Q

Herpes Simplex Virus (Infection and Spontaneous Reactivation)

A

Infection: HSV attack –> Virus replication in peripheral epithelial tissue –> Retrograde transport –> Latency established in ganglia

Spontaneous Reinfection (due to UV light, trauma, hormones): Virions produced –> Anterograde transport to epithelium –> Virus replication in peripheral epithelial tissues –> HSV shedding –> Recurrent lesions

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11
Q

Herpes Simplex Virus (Clinical)

A 
HSV-1 = Oral lesions
HSV-2 = Genital lesions

90% of adults are seropositive for HSV-1 or HSV-2

Primary infection:
HSV-1 before age 4 (via contact with lesions or saliva)
HSV-2 sexual activity

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12
Q

Herpes Simplex Virus (Diagnosis)

A

Clinical appearance of lesions
1-2 mm diameter groups, vesicles –> pustules –> ulcers

TZANCK SMEAR = cells scraped from border of lesion, staining is used to look for CYTOPATHIC EFFECT and LARGE MULTINUCLEATED CELLS (syncytia formation)

Virological Tests (can distinguish between HSV-1 and HSV-2):

  • PCR to detect genome
  • Immunochemistry to detect antigens
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13
Q

Herpes Simplex Virus (Treatment Goals)

A

Anti-herpetic drugs DO NOT act on the latent stage of infection

Goal: SHORTERN time to lesion healing and INCREASE time between outbreaks

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14
Q

Herpes Simplex Virus (Treatment Drugs)

A

Acyclovir, Famciclovir, and Valacyclovir

Inhibit Viral DNA polymerase

MUST be activated by VIRAL THYMIDINE KINASE

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15
Q

Herpes Simplex Virus (Foscarnet)

A

Nonnucleoside inhibitor

  • No HSV tk phosphorylation needed
  • Used in cases of ACYCLOVIR-RESISTANT HSV infections

Common in someone who is immune suppressed and under long-time anti-herpetic treatment

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16
Q

HPV: Genital Warts (condyloma acuminatum)

A 
Hyperkeratotic, firm, exophilic papules
1 mm - 2 cm diameter
Symptoms:
-75% asymptomatic
-Itching, pain, burning
Cervical Warts:
-Exophilic, endophilic, flat
-Identified with 3-5% acetic acid (turns wart tissue WHITE to be identified)
17
Q

HPV: Respiratory Papillomatosis/Laryngeal Papillomas

A

Seen in Children
-Nodules on the ciliated and squamous epithelial junction of the larynx
Symptoms:
-altered cry
-hoarseness
-stridor
-respiratory distress

Treatment = SURGICAL REMOVAL (however, will grow back)
-C. section not proven to be effective

18
Q

Human Papillomavirus (HPV) (Virology)

A

Papovaviridae family member
Non-enveloped
dsDNA genome
Replication is closely tied to the DIFFERENTIATION STATUS of the tissue it infects

19
Q

HPV Genome and Cancer

A

E2 is a gene that negatively regulates expression of genes E6 and E7

E2 expression is dysregulated in CANCER and leads to INCREASED expression of E6 and E7

E6 inhibits p53 and E7 inhibits Rb, both of which normally suppress tumor cells between G1 and S phase; however, when these are inhibited you get increased replication and chance of CANCER

20
Q

Human Papillomavirus (HPV) (Transmission and Diagnosis)

A

Transmission:

  • Genital warts are sexually transmitted
  • Cuts and abrasions provide route of entry for the virus
  • Incubation period is 3-4 MONTHS

Diagnosis:
-Clinical appearance is usually sufficient
(Hyperkeratosis and Koilocytes are histological markers)
-HPV types can be ID’d using PCR
(e.g. HIGH risk types: 16, 18, 31, 33)

21
Q

Human Papillomavirus (HPV) (Diagnosis: Pap Smears)

A

Cervical smear looks for specific markers

e.g. Koilocytes: enlarged keratinocytes that contain irregular hyperchromatic nuclei surrounded by a characteristic HALO

22
Q

Human Papillomavirus (HPV) (Treatment)

A

Genital Warts:

  • Cryotherapy
  • CO2 laser

Pre-malignant and Malignant Cervical Neoplasms:

1) Low grade lesions:
- Cauterization
- Cryotherapy
- CO2 laser therapy
- Loop excision
2) High grade lesions/cancer treatment may include:
- Hysterectomy
- Radiation
- Chemotherapy

23
Q

Human Papillomavirus (HPV) (Prevention)

A
  • Papanicolaou stained cervical smears
  • Reduce high risk behavior
  • HPV vaccines*
  • Made in YEAST
  • Prepared from VIRAL CAPSID PROTEINS (L1)
  • Three doses
  • GARDASIL (Quadrivalent)
  • **Protects against HPV 6, 11, 16, and 18
  • CERVARIX (Bivalent)
  • **Protects against HPV 16 and 18
24
Q

HPV Vaccine Recommendations

A

Girls (age 11-12): Universal vaccination with either Quadrivalent or Bivalent vaccine

Boys (age 11-12): Universal vaccination with Quadrivalent

Microbiology Exam IV (6 decks)

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