MICRO: Herpes

Question 1

Human Herpes Virus Types?

Answer 1

Question 2

Herpes viruses that set up latent infection in Sensory Nerve Ganglia?

Answer 2

HSV1
HSV2
Varicella Zoster (HHV3)

Question 3

Herpes viruses that set up a latent infection in B Lymphocytes?

Answer 3

EBV (HHV4)

CMV (HHV5)

Kaposi Sarcoma (HHV8)

Question 4

Herpes viruses that set up a latent infection in T Lymphocytes?

Answer 4

HHV6

HHV7

Question 5

Herpes viruses that set up a latent infection in Epithelial Cells?

Answer 5

EBV (HHV4)

CMV (HHV5)

Question 6

Examples/Characteristics of Alphaherpes Viruses?

Answer 6

HSV 1 / 2, VZV (HHV3)

Rapid growth in cell culture

Neuronal latency

Question 7

Examples/Characteristics of Betaherpes Viruses?

Answer 7

CMV (HHV5), HHV6

Slow growth

Affinity for CD4 lymphocytes

Question 8

Examples/Characteristics of Gammaherpes Viruses?

Answer 8

EBV

Grow only in lymphoblastoid cell lines

Affinity for B lymphocytes

Question 9

Structure of Herpes Virus?

Answer 9

Linear double stranded DNA virus

Question 10

Host Factors Influence on HSV Severity

Answer 10

Congenital deficiencies in humoral immunity do not appear to be significant risk factors for serious primary or recurrent HSV disease

Congenital and some acquired deficiencies in cell-mediated immunity are associated with severe HSV disease- severe and prolonged HSV infections occur in transplant recipients and individuals infected with HIV

Question 11

Manifestations of Primary HSV1 Infection

Answer 11

Question 12

Manifestations of Primary HSV2 Infection

Answer 12

Question 13

Three major patterns of disease in neonatal HSV Infection?

Answer 13

– Lesions of skin, eyes, and mouth

– CNS disease with/without SEM

– Disseminated disease (involving multiple organs) with/without vesicles (most severe)

Untreated mortality exceeds 80% in disseminated disease, and 50% in CNS disease

Question 14

Treatment of HSV Infection

MOA?

Answer 14

Acyclovir: Converted by viral thymidine kinase to active acyclovir monophosphate; cellular enzyme catalase converts acyclovir monophosphate => acyclovir triphosphate => competitively inhibits viral DNA polymerase

Resistance: uncommon. generally only seen in immunocompromised patients after long duration of acyclovir treatment. Consider Foscarnet or Cidofovir

Question 15

Herpes Infection affecting the Skin/Face?

Answer 15

Herpes Gladiatorum

Question 16

________ is the causative agent of varicella (_________) and zoster (____________)

Answer 16

HHV3 is the causative agent of varicella (chicken pox) and zoster (shingles)

Question 17

Pathogenesis of VSV

Answer 17

Question 18

Primary VZV Infection (Incubation, Rash Development, Infectious)

Answer 18

Question 19

Complications of VSV Infection?

Answer 19

Question 20

Varicella in Pregnancy?

Answer 20

Question 21

VZV Reactivation

Answer 21

Question 22

What is Post-herpetic Neuralgia a complication of?

Answer 22

Question 23

Otological complication of VZV reactivation, due to reactivation of latent virus in the geniculate ganglion with spread of infection to the 8th cranial nerve?

Triad of Presentation?

Treatment?

Answer 23

Ramsay Hunt Syndrome

Triad of:

• ipsilateral facial paralysis
• ear pain
• vesicles in the auditory canal or on the auricle

Early treatment (acyclovir and steroids) should be instigated to avoid complications (permanent facial nerve dysfunction)

Question 24

Neonates that should receive post-exposure prophylaxis to VZV?

Answer 24

Question 25

Immunization against VSV?

Answer 25