Intro to Herpes

Question 1

4 components of the herpesviridae viruses

Answer 1

Core (linear dsDNA)
Capsid
Tegument
Envelope

Question 2

3 viruses in the alphaherpesviridae family

Answer 2

HSV 1 (HHV1)
HSV 2 (HHV2)
VZV (HHV3)

Question 3

HSV 1

Answer 3

Infection of the lips and oral mucosa
Possible genitalia, liver and lung infections
Latency established in the trigeminal sensory ganglion
Person to person transmission (contact with lesion or oral/genital secretions)
Primary infection can be asymptomatic, mild, or worst episode
Reactivation typically at lower vermillion border

Question 4

The #1 cause of fatal sporadic encephalitis is…

Answer 4

HSV

Question 5

Symptoms of HSV encephalitis and how is it diagnosed

Answer 5

Fever
Headache
Seizures
Neurologic deficits
Decreases consciousness
Diagnosed with PCR

Question 6

Acyclovir

Answer 6

Inhibits HSV 1/2, VZV, and some EBV
Nucleoside analog to dGTP
Results in early DNA chain termination
Gets phosphorylated by thymidine kinase enzyme (viral), which allows it to be specific but also allows for resistance
Can be given IV or PO
Main problem is renal toxicicity

Question 7

HSV 2

Answer 7

Infection of the genitalia
Latency established in the sacral ganglia
Transmitted person to person (contact with lesion or oral/genital secretions)
Transmission more likely when asymptomatic

Question 8

Symptoms of primary HSV 1 infection

Answer 8

Most asymptomatic or mildly symptomatic, can also be worst episode
Gingivostomatitis
Pharyngitis
Constitutional symptoms (fever)
Longer lesion duration and longer shedding

Question 9

Symptoms of primary HSV 2 infection

Answer 9

Most asymptomatic or mildly symptomatic, can also be worst episode
Painful ulcers
Fever
Dysuria (urinary retention)
Lymphadenopathy
Headache

Question 10

Neonatal HSV disease

Answer 10

Major morbidity and mortality
Usually HSV 2
Can be acquired intrauterine, perinatal, or postnatal
Presentations include skin/eyes/mouth vs CNS (encephalitis) vs disseminated disease

Question 11

VZV

Answer 11

Primary (varicella - chicken pox) and secondary (herpes zoster - shingles) syndrome
Airborne transmission (highly contagious) or contact with vesicular fluid

Question 12

Herpes zoster

Answer 12

Prodromal neuritis (severe pain)
Then you get the rask
Erythematous papules to grouped vesicles
Limited to 1/2 dermatomes

Question 13

Complications of herpes zoster

Answer 13

1. Post herpetic neuralgia
Pain beyond 4 months of rash
Dysesthesias, allodynia, numbness also possible
More likely if older or immuocompromised
2. Herpes zoster opthalmicus
3. Herpes zoster oticus

Question 14

Treatment of VZV

Answer 14

No treatment for young with uncomplicated varicella
Need higher doses than with HSV when you do use acyclovir, etc
For immunocompromised, >50 yo, or severe presentations

Question 15

2 Zoster vaccines

Answer 15

Zostavax (live virus)

Shingrex (inactive subunit vaccine)

Question 16

CMV

Answer 16

Infection of lymphocytes but can effect other cells
Latency in monocytes, macrophages, DCs
Shed in urine, blood, throat, cervix, semen, stool, tears, breast milk
Transmitted via contact with secretions, blood or tissue transmission, or neonatal

Question 17

Treatment for CMV

Answer 17

Ganciclovir or valganciclovir

Question 18

EBV

Answer 18

Infection of B and T cells primarily (latency in these cells too)
Primary infection causes malaise, headache, fever, can get tonsillitis, etc
Morbilliform rash with amoxicillin
Can get splenic rupture