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MSK Week 1 > Viral Skin Infections > Flashcards

Viral Skin Infections Flashcards

1
Q

What type of nucleic acids do we have in Herpes viruses

A

Double stranded DNA

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2
Q

How can we distinguish the herpes viruses under microscopy?

A

You can’t

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3
Q

What are herpes viruses susceptible to generally?

A

Susceptible to drying, inactivation by heat, mild detergent and solvents because of their membrane envelope

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4
Q

Where do herpesviruses replicate?

A

Nucleus

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5
Q

Types of Herpes Viruses?

A

Alpha Beta Gamma

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6
Q

What viral types fall into the Alpha category?

A

HSV-1 HSV-2 VZV

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7
Q

Presentation of HSV-1

A

Labial lesions (cold sores), fever blister, keratitis, encephalitis

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8
Q

Presentation of HSV-2

A

Genital lesions, severe CNS disease in neonates (congenital herpes infection)

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9
Q

Presentation of VZV

A

Herpes Zoster - Chicken pox, shingles - Transmitted by respiratory droplets

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10
Q

Where do alpha herpes viruses stay latent?

A

Sensory ganglia/neurons

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11
Q

What viral types fall into the Beta category?

A

CMV HHV-6 HHV-7

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12
Q

Which category, Alpha or Beta, has the longest replicative phase?

A

Beta Alpha’s is short

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13
Q

Where do Beta viruses stay latent?

A

Monocytes/macrophages Lymphocytes Endothelial cells

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14
Q

Monospot test result for CMV?

A

Negative

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15
Q

Histological finding for CMV?

A

“Owl-eye” inclusions

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16
Q

HHV-6 is associated with what symptoms? How is it transmitted?

A

Roseola Transmitted by saliva

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17
Q

Roseola?

A

High fevers for several days that can cause seizures followed by diffuse macular rash.

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18
Q

What viral types fall into the Gamma category?

A

EBV (HHV-4), KSHV (HHV-8)

Karposi’s sarcomma-associated herpesvirus: these viruses cause Karposi’s sarcoma, a cancer common in AIDs patients

Epstein-Barr virus: cause of infectious mononucleosis (glandular fever). Infants are susceptible to EBV after their maternal antibody protection dissapears

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19
Q

What cells are infected by Gamma category viruses?

A

Epithelial cells and lymphocytes

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20
Q

What cells do gamma category viruses stay latent in?

A

Lympocytes and endothelial cells

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21
Q

Mononucleosis

A

Flu-like symptoms caused by HHV-4 (EBV)

Fever, hepatosplenomegaly, pharyngitis

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22
Q

Besides EBV, what virus type causes mononucleosis?

A

CMV (HHV-5)

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23
Q

What cells does EBV target specifically?

A

B cells

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24
Q

EBV monospot test result?

A

Positive

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25
Q

HHV-8 is associated with what?

A

A Kaposi sarcoma, a neoplasm of endothelial cells. Seen in HIV/AIDS patients and transplant patients. Dark, violaceous, flat but nodular skin lesions

26
Q

How is HHV-8 transmitted?

A

Sexually

27
Q

Life Cycle of Herpes

A
  1. Lytic Replication 2. Latency 3. Reactivation
28
Q

Lytic Phase, generally:

A

In epithelial cells, viruses take over cellular machineries for replication, synthesis of macromolecules and virus assembly, and eventually leads to cell death

29
Q

Proteins made by viruses do what, generally:

A

Proteins are produced that prevent premature programmed cell death or apoptosis and evade immune responses

30
Q

What DNA replication enzymes can herpes viruses make?

A

All herpesviruses encode enzymes used in DNA replication: 1. ribonucleotide reductase 2. thymidine kinase 3. primase/helicase 4. DNA polymerase

31
Q

What are the immediate early genes?

A

Transcriptional regulatory factors that turn on delayed early gene expression

32
Q

What are the delayed early genes?

A

DNA replication enzymes

33
Q

What occurs during the DNA replication phase?

A

DNA replicates as covalently closed circle, followed by the rolling circle mechanism

34
Q

What are the late genes?

A

Structural proteins

35
Q

General description of the Assembly/egress phase for viruses

A

Capsid generated around created proteins, primary envelopment (nuclear membrane envelops it), leave nuclear membrane, enveloped by golgi (secondary envelopment), exits

36
Q

What is occurring during the latency phase?

A

Circular viral genome (episome) maintained in neurons without replication; expresses LAT transcript, which plays a role in latency establishment and evades immune detection

37
Q

Reactivation of HSV-2 - Triggers

A

Stress, sunlight, trauma, menstruation

38
Q

Triggers for VZV reactivation

A

Immune suppression, depressed cell-mediated immunity (age)

39
Q

Reactivation process for HSV-2

A

Involved limited viral replication in neurons, transport of viral capsid to axonal terminals and egress to regions innervated by specific neurons. Asymptomatic reactivation facilitates virus spread to naive hosts.

40
Q

Clinical features of HSV primary infection?

A

Accompanied by systemic symptoms such as fever and malaise

41
Q

Clinical features of HSV reactivation

A

Accompanied by prodromal symptoms like pain, numbness, itchiness, tingling sensation

42
Q

Clinical features of HSV acute infection

A

Direct destruction of tissues or induction of immunopathologic response 1. Characteristic skin lesions are vesicles with an erythematous base 2. Usually grouped at a single anatomic site

43
Q

HSV Type, Age, and outcome for: Ocular Herpes

A

1 All ages Resolution with occasional visual impairment

44
Q

HSV Type, Age, and outcome for: Oral herpes

A

Usually 1 All ages Just resolves

45
Q

HSV Type, Age, and outcome for: Genital herpes

A

Usually 2 Adolescents and adults Just resolves

46
Q

HSV Type, Age, and outcome for: Neonatal herpes

A

Usually 2 Age: 0-4 weeks Leads to development impairment

47
Q

HSV Type, Age, and outcome for: Meningoencephalitis

A

2 Adolescents, adults Just resolves

48
Q

HSV Type, Age, and outcome for: Encephalitis

A

1 All ages Leads to severe neurological impairment and death

49
Q

HSV Type, Age, and outcome for: Disseminated herpes

A

Usually 1 All ages Can resolve or kill you

50
Q

How to diagnose Herpes infections

A
  1. viral culture 2. Tzanck smear (Smear of an opened skin vesicle to detect mononucleated giant cells) 3. serology 4. PCR
51
Q

How does Herpes Thymidine Kinase Anti-Herpes Therapy work?

A

DNA chain terminator, specifically activated by the viral TK. Incorporates into the viral DNA and terminates the DNA replication of viruses

52
Q

Acyclovir

A

A TK antiherpes that inhibits viral DNA polymerase and chain terminates

53
Q

Ganciclovir

A

CMV does not have a viral TK but can be inhibited by ganciclovir. A viral protein kinase homologue is involved in activating ganciclovir

54
Q

Treatment for CMV?

A

Ganciclovir

55
Q

Foscarnet?

A

Used in the treatment of CMV retinitis in AIDS patients receiving AZT therapy. Has renal side effects and must be administered by IV continuously

56
Q

How does Foscarnet work?

A

Binds directly to the pyrophosphate-binding sites of RNA or DNA polymerases. Does not need to be activated by cellular or viral kinases

57
Q

Varivax?

A

Live-Attenuated VZV vaccine

58
Q

Who is Varivax recommended for?

A
  • Kids - Non pregnant women of child bearing age - Those with humoral immunodeficiencies - HIV+ children with age specific CD4+counts greater than or equal to 25%
59
Q

Varivax not recommended for?

A
  • Pregnant women - HIV+ persons or persons with other cellular immunodeficiencies - People receiving immunosuppressive therapy, steroids, etc.
60
Q

Which is more severe? Primary infection or Recurrent?

A

Primary - No immunity yet

61
Q
A

MSK Week 1 (14 decks)

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