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Microbiology > Human Herpes Viruses > Flashcards

Human Herpes Viruses Flashcards

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0
Q

What kind of Genomic material is associated with the herpes viruses?

A

Large double stranded DNA genome.

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1
Q

How many herpes viruses are there that infect humans? Name them.

A 
Herpes simplex virus 1 and 2
Varicella-zoster virus
Cytomegalovirus
Epstein-Barr virus
Human herpes virus 6 and 7 and 8
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2
Q

Structure of a herpes virus particle?

A

Lipid belayer envelope
Tegument- amorphous layer of proteins
Icosahedral nucleocapsid

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3
Q

What is a characteristic of all herpes viruses?

A

Following primary infection > latent infection > virus may reactivate at any stage.
*reactivation associated with further disease normally

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4
Q

What kind of lesions do herpes simplex viruses 1 and 2 cause?

A

Painful vesicles on the skin at site of inoculation.

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5
Q

What is a vesicle?

A

Small, circumscribed elevation of the epidermis containing serous fluid.

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6
Q

What is HSV1 associated with?

A

Oro-facial lesions?

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7
Q

What is HSV2 associated with?

A

Genital lesions.

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8
Q

What two clinical patterns of disease do HSV show?

A

Primary infection

Reactivation

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9
Q

Characteristics of a primary infection?

A

Most are asymptomatic.

Or may present with a painful blistering rash.

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10
Q

How long does said painful blistering rash take to develop?

A

1-3 days post-exposure.

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11
Q

Characteristic of said vesicles?

A

They can spread to other areas of the skin and mucous membranes via auto-inoculation.

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12
Q

What are symptoms due to primary infection determined by?

A

The site of inoculation.

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13
Q

What five clinical presentations are associated with primary infection with herpes simplex virus?

A 
Gingivo-stomatitis
Eczema herpeticum
Herpetic whitlow 
Conjunctivitis + keratitis
Genital herpes
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14
Q

What is an ulcer?

A

A local defect or excavation of the surface of an organ or tissue produced by slouching off of necrotic inflammatory tissue.

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15
Q

Signs of Gingivo-stomatitis?

A

Vesicles inside mouth on the bucchal mucosa and gums as well as the lips and skin around the mouth.

  • vesicles inside mouth ulcerated and become covered with grayish slough.
  • lesions may be on head and neck.
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16
Q

Symptoms of Gingivo-stomatitis?

A

Fever

Cervical lymphadenopathy

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17
Q

How does one normally get Gingivo-stomatitis?

A

Kissing

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18
Q

How long do the vesicles of Gingivo-stomatitis take to heal?

A

Within 14 days.

*illness is self-limiting

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19
Q

What is eczema herpeticum?

A

Superinfection of eczema tours skin with HSV.

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20
Q

What is herpetic whitlow?

A

Inoculation of virus into the fingers.

*hazard of doctors, nurses and dentists

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21
Q

How do HSV affect the eyes?

A

Conjunctivitis. Also edema of lids.

Keratitis.

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22
Q

What is keratitis?

A

Inflammation of the cornea.

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23
Q

What is a herpetic lesion of the cornea called?

A

Dendritic ulcer.

*has a branching appearance.

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24
Q

How long do eye lesions due to HSV (conjunctivitis and keratitis) normally take to heal?

A

Lesions usually heal within 3 weeks.

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25
Q

What are features of a dendritic ulcer?

A

Pain

Photophobia

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26
Q

Which HSV virus is genital herpes due to?

A

Mainly HSV2 but 20-30% of cases are due to HSV1.

27
Q

Features of genital herpes?

A

Vesicles in genital or peri-anal area.

*infection may be confined to the cervix in females

28
Q

How long do the vesicles in genital herpes last?

A

14-21 days.

29
Q

What is genital herpes associated with?

A

Aseptic meningitis.

30
Q

What flows primary infection?

A

Latency.

31
Q

Where does the virus go during latency?

A

Virus enters sensory nerve endings at the site of inoculation > travels up axon > latent infection in ganglion supplying that area of skin.

32
Q

What is a ganglion?

A

Is a nerve cell cluster or a group of nerve cell bodies located in the peripheral nervous system.

33
Q

Which ganglion/ganglia are involved in latent infection?

A

Genital area - sacral ganglia

Oro-facial area - trigeminal ganglion

34
Q

How does the virus persist in the neuron?

A

In an episcopal (plasmid) form in the NUCLEUS of the neuron.

35
Q

How does reactivation occur?

A

Virus travels down the axon > re-infect skin/mucous membrane in area supplied by that nerve.

36
Q

Stimuli that may provoke reactivation?

A 
Sunlight
Stress
Febrile illnesses
Menstruation
Immunosuppression
37
Q

What are the clinical manifestations associated with reactivation?

A

Cold sores
Recurrent genital herpes
Aseptic meningitis
Keratitis

38
Q

How do cold sores differ to Gingivo-stomatitis?

A

Lesions more localized.

Lesions heal faster. (7-10 days)

39
Q

What often precedes eruption of cold sores?

A

Parasthesia.

40
Q

How does recurrent genital herpes differ from primary infection of genital herpes?

A

Lesions less extensive.
Lesions heal faster.
*recurrence more common with HSV2

41
Q

What syndrome is HSV2 rarely associated with upon reactivation?

A

Mollarets syndrome:

Aseptic meningitis associated with HSV2 reactivation.

42
Q

Reactivation in cornea of eye via which nerve?

A

Ophthalmic branch of the trigeminal nerve.

43
Q

How does recurrent keratitis differ to primary infection keratitis?

A

Dendritic ulcer heals faster.

44
Q

Name three life-threatening syndromes caused by HSV.

A

Acute necrotizing encephalitis.
Neonatal infection.
Disseminated HSV infection in adults.

45
Q

What is acute necrotizing encephalitis?

A

Infection of the brain by HSV.

46
Q

What part of the brain is involved in acute necrotising encephalitis and what happens to it?

A

Temporal lobe.

Necrosis of said tissue.

47
Q

Clinical features of acute necrotising encephalitis?

A

Fever.
Headache.
Confusion.
Alteration in personality.

48
Q

At which stage of HSV infection can acute necrotising encephalitis occur?

A

Primary infection or following reactivation of latent virus.

49
Q

Prognosis of acute necrotising encephalitis?

A

Mortality is high.

Neurological impairment in survivors is invariable.

50
Q

Why is neonatal infection with HSV such a serious condition?

A

Neonate shave poor cell-mediated immunity and are therefore at more risk of disseminated infection.

51
Q

How can neonate acquire a neonatal infection?

A

If they are exposed to HSV in the peri-natal period.

*is a rare condition

52
Q

How may a baby be exposed to HSV?

A

During birth - only risk if primary infection.

If the baby is handled by people with herpetic lesions.

53
Q

What three forms may neonatal infection take?

A

Cutaneous.
Generalized infection.
Encephalitis.

54
Q

Features of cutaneous neonatal infection?

A

Lesions are confined to skin. GOOD PROGNOSIS

55
Q

What happens in generalized infection in neonatal infection?

A

Virus disseminates throughout organs. POOR PROGNOSIS.

56
Q

Clinical features of generalized infection in a neonate?

A 
Jaundice.
Hepatosplenomegaly.
Thrombocytopenia.
Pneumonia.
Encephalitis.
57
Q

What is encephalitis regarding to a neonatal infection?

A

Infection of brain tissue by HSV.

POOR PROGNOSIS.

58
Q

Features of disseminated HSV infection in adults?

A

Sometimes occurs in apparently health adults.

Disease follows fulminant course > patients die before diagnosis is made.

59
Q

Clinical manifestations of disseminated HSV infection in adults?

A

Fulminant hepatitis.
Pneumonitis.
Multi-organ failure.
Encephalitis.

60
Q

Ways to detect HSV in the lab?

A

Direct detection:
- Electron microscopy/immunoflourescence
Cell culture:
- monitor for development of characteristic cytoplasmic effect
Serology:
- IgG = immunity (past exposure)
- IgM = marker of primary or recurrent infection (not reliable)
PCR:
- PCR of CSF best for detecting HSV encephalitis

61
Q

Drug of choice for treating HSV infections?

A

Acyclovir

62
Q

What is acyclovir?

A

A nucleoside analogue of guanosine.

*acts like nucleoside guanosine during DNA synthesis

63
Q

Drug activity?

A

Active against replicating virus but not latent virus.

64
Q

What formulations of acyclovir are available?

A

Oral.
Topical.
IV formulations.

Microbiology (18 decks)

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