Human herpesvirus

Question 1

HSV [human herpesvirus 1+2] (1)
1) What is the hallmark of infection with HSV 1 or 2?
2) After an initial infection, where does the virus typically become latent with cold sores?
3) After an initial infection, where does the virus typically become latent with genital herpes?

Answer 1

1) Vesicles or ulcers
2) Trigeminal nerve ganglion
3) Sacral nerve ganglion

Question 2

HSV [human herpesvirus 1+2] (2)
1) What is herpes labialis?
2) Is it predominantly associated with HSV 1 or HSV 2?
3) Is genital herpes predominantly associated with HSV 1 or HSV 2?
4) What are the features of gingivostomatitis?
5) What is herpetic whitlow?
6) What is herpes encephalitis?
7) Is it predominantly associated with HSV 1 or HSV 2?
8) Which lobes does it typically affect?
9) Name 2 features of herpes encephalitis

Answer 2

1) Cold sore lesion at the lip border
2) HSV1
3) HSV2
4) Fever, sore throat that’s followed by tender oropharyngeal vesicles
5) Painful vesicles on the distal phalanx due to inoculation through a break in the skin
6) Inflammation of the brain due to transfer of the virus from the periphery to the brain
7) HSV1
8) Temporal
9) Fever, headache, psychiatric symptoms, seizures, vomiting and focal features i.e. aphasia

Question 3

HSV [human herpesvirus 1+2] (3)
1) How is HSV 1 and 2 treated?
2) How is genital herpes caused by HSV 1 normally contracted?
3) How is genital herpes caused by HSV 2 normally contracted?
4) Name 2 ways genital herpes can present
5) What is the main issue with genital herpes during pregnancy?
6) When is cesarean section recommended in the context of pregnancy and genital herpes?

Answer 3

1) Acyclovir
2) Orogenital sex
3) Sexually transmitted disease
4) Ulcers or blistering lesions affecting the genital area, neuropathic type pain (tingling, burning or shooting), flu-like symptoms, dysuria
5) Neonatal herpes simplex infection contracted during labour and delivery which has a high morbidity and mortality
6) Primary genital herpes contracted after 28 weeks gestation

Question 4

VZV (human herpesvirus 3)
1) How is it spread?
2) What does infection with VZV cause?
3) Where does the virus lay dormant?
4) What does reactivation of the latent virus cause?
5) How is it treated?

Answer 4

1) Respiratory droplets
2) Chickenpox
3) Sensory nerve roots
4) Shingles
5) Acyclovir

Question 5

EBV (human herpesvirus 4)
1) What cells does EBV target?
2) Name 2 features of EBV infection
3) What would a full blood count show?
4) What antibody test can be used?
5) Name a malignancy associated with EBV infection

Answer 5

1) Circulating B cells
2) Fever and malaise, sore throat, transient macular rash, lymphadenopathy in the neck, mild hepatosplenomegaly
3) Lymphocytosis (raised lymphocytes)
4) Heterophile antibody test
5) Burkitt’s lymphoma, Hodgkin’s lymphoma, nasopharyngeal carcinoma, HIV-associated central nervous system lymphomas

Question 6

Cytomegalovirus (human herpesvirus 5)
1) Name a feature of congenital CMV
2) In which patients is CMV encephalopathy and retinitis most often seen in?
3) What is the treatment of choice for CMV retinitis?

Answer 6

1) Growth retardation, microcephaly, sensorineural deafness, encephalitis, hepatosplenomegaly
2) HIV patients with a low CD4 count (< 50)
3) IV ganciclovir