L72

Question 1

Both strain of herpes:
Small or large?
DNA or RNA?
Envelope or no?

Answer 1

Large
DNA
Enveloped
Immune ok pts - more severe if IC

Question 2

How does herpes replicate in the host?

Answer 2

Glycoprotein receptors (gD) engaged with host cells
Capsid enters cell
Synthesize viral DNA & proteins @ host nucleus
Assemble new viruses in host nucleus
Bud off host

Question 3

What population is most likely to get HSV1 infections?

Answer 3

Kids!

Question 4

What population is most likely to get HSV2 infections?

Answer 4

Women

Age not a limiting factor - throughout life

Question 5

Herpes transmission

Answer 5

Infected mucosal surface shedding
HSV1 - oral or genital
HSV2 - genital
To infants during birth

Question 6

Are condoms protective?

Answer 6

Partly - not 100% b/c of general groin infection

Question 7

Describe the pathogenesis of herpes.

Answer 7

Into mucosal surface
Infect & replicate in epidermis & dermis
Infection moves into sensory & motor nerve endings
Moves up to ganglia and DORMANT here

Question 8

Describe the pathogenesis of herpes reactivation.

Answer 8

IC, UV light, trauma, stress - induce reactivation

Virus moves out of ganglia –> down nerves –> cause mucosal lesions

Question 9

Describe primary HSV 1 infection

Answer 9

ASYMPTOMATIC 
Probably a kid - older more likely to be symptomatic: 
- Fever
- "Feeling sick"
- Mouth/lip PAINFUL lesions

Question 10

What is the primary HSV1 infection in kids?

Answer 10

Gingivostomatitis

- Mouth, lips, tongue

Question 11

What are the 6 primary HSV1 infection in adults?

Answer 11

1. Acute herpetic pharyngotonsillitis
2. Herpetic Whitlow (fingers)
3. Herpes galditorum (abraded skin)
4. Ocular herpes
5. Herpes hepatitis
6. Bell’s palsy (CN 7)

Question 12

How do you differentiate between acute herpetic pharyngotonsillitis and other pharynx/tonsillar diseases?

Answer 12

Can only differentiate this from other things by PCR but you probably won’t b/c self-limited

Question 13

Which form of ocular herpes are you most worried about?

Answer 13

Acute retinal necrosis

• Necrotizing!!!
• Rapid progression –> blindness

Question 14

Which form of ocular herpes causes dendritic lesions on the cornea?

Answer 14

HSV keratitis

Question 15

What is a commonality for reactivation with HSV1 and HSV2?

Answer 15

If your initial infection was symptomatic, then you’re likely to reactivate

Question 16

What is unique about HSV1 reactivation?

Answer 16

Can have prodromal stage (tingling)

Question 17

What are 3 the reactivation diseases for HSV1?

Answer 17

1. Oral-facial (aka mouth herpes is back)
2. Encephalitis
3. Esophagitis that presents with PAINFUL swallowing + small, shallow lesions

Question 18

What is unique in diagnosis to help you determine HERPES encephalitis?

Answer 18

High RBCs in CSF from lumbar puncture

MRI = necrotization of temporal lobe

Question 19

What is the presentation for primary HSV2 infection?

Answer 19

ASYMPTOMATIC

PAINFUL genital ulcers

Question 20

How do babies get herpes? What is the presentation?

Answer 20

During birth from infected mothers
Skin-eyes-mouth (SEM)
High mortality if disseminated
High morbidity (cog defect) if neuro

Question 21

How might HSV2 recur?

Answer 21

Ano-genital

Often with thymidine kinase resistant strains

Question 22

Diagnose herpes

Answer 22

Clinical
PCR - especially if CSF involvement
Direct fluorescence Ab - antigen-Ab complex if virus present

Question 23

Treat severe primary infection

Answer 23

Valacyclovir 1000mg PO 2x day

Question 24

Chronic suppressive therapy

Answer 24

Pt with recurrence 6+ times per year

Vala 500mg PO daily

Question 25

Serious herpes infection treatment

Answer 25

IV acyclovir nephrotoxic

Question 26

Treatment if serious herpes infection is resistant to acyclovir

Answer 26

Resistant due to TK deficient virus

Foscarnet!!