Viruses - DNA - Herpes Family Flashcards
TORCHeS Infections
TORCHeS Infections:
Toxoplasmosis
Other (HIV, VZV, Parvovirus B19, enteroviruses, others)
Rubella
Cytomegalovirus
Herpes
Syphilis
Herpes Virus Family
Viruses in the Herpes family
Herpes Virus Family
- Herpes Simplex Virus 1 (HSV1) aka HHV1
- Herpes Simplex Virus 2 (HSV2) aka HHV2
- Varicella Zoster Virus (VZV) aka HHV3
- Epstein–Barr Virus (EBV) aka HHV4
- Cytomegalovirus (CMV) aka HHV5
- Roseola aka HHV6
- Kaposi’s sarcoma-associated herpesvirus (KSHV) aka HHV8
Herpes Virus Family
Are all enveloped or nonenveloped?
Herpes Virus Family
All of the Herpes Virus Family are:
*** Enveloped ***
Herpes Virus Family
The members of the Herpes Virus Family can be found latent in?
(ALL CAN GO LATENT!!!)
Herpes Virus Family
- Herpes Simplex Virus 1 (HSV1) in trigeminal ganglia
- Herpes Simplex Virus 2 (HSV2) in sacral ganglia
- Varicella Zoster Virus (VZV) in dorsal root ganglia
- Epstein–Barr Virus (EBV) in B-cells
- Cytomegalovirus (CMV) in mononuclear** cells** (lymphocytes and macrophages)
- Roseola in monocytes
- Kaposi’s sarcoma-associated herpesvirus (KSHV) in B-cells
Herpes Simplex Virus 1 & 2 (aka HHV1 & 2)
lab tests
Hermes, the god of herpes
- Linear DS DNA
- Enveloped virus
- Replicates in nucleus (like most DNA viruses)
- Cowdry bodies (intranuclear inclusions that look like targets; Large red and eosinophilic)
- Tzanc smear (older test, scrape ulcer base) to look for multinucleated giant cells
- PCR for herpes
Herpes Simplex Virus 1 & 2 (aka HHV1 & 2)
ddx HSV vs. Pox virus inclusion bodies
Hermes, the god of herpes
- HSV:
Cowdry bodies (intranuclear inclusions that look like targets; Large red and eosinophilic)
- ddx vs. Pox virus:
Has similar inclusion bodies but located in the cytoplasm (Guarneri inclusion bodies)
Herpes Simplex Virus 1 & 2 (aka HHV1 & 2)
Source
Hermes, the god of herpes
Transmitted by Sex, saliva, and vertically (TORCHeS infection!)
- HSV 1:
Usually confined to the upper half of the body
- HSV 2:
Usually confined to the genital regions
Herpes Simplex Virus 1 & 2 (aka HHV1 & 2)
HSV 1 (aka HHV1)
(Usually confined to the upper half of the body)
*** 1st infects as gingivostomatitis (AKA Orolabial herpes; inflammation of the oral mucosa and gingiva) ***
Hermes, the god of herpes
- Snake like ulcers
- Herpes rash (rose petal & dew drops; clear vesicles on a erythema base)
- Lip herpes; Cold sores!!!
- Ocular herpes; Keratoconjuctivitis (* fluorescent stained slit lamp exam of cornea)
- Temporal lobe encephalitis*w/bizarre behavior; Hemmorages and necrosis!
- Herpetic whitlow; Herpes on finger (dentists!!!)
- 1-2 weeks after infection can cause an erythema multiforme rash.
* (#1 cause of sporadic encephalitis)
Herpes Simplex Virus 1 & 2 (aka HHV1 & 2)
HSV 2 (aka HHV2)
(Usually confined to the genital regions)
Hermes, the god of herpes
- Painful vesicular lesions w/ inguinal lymphadenopathy
- Can cause aseptic meningitides (mostly in adolescents and adults
- Herpetic whitlow; Herpes on finger (dentists!!!)
- 1-2 weeks after infection can cause an erythema multiforme rash.
Herpes Simplex Virus 1 & 2 (aka HHV1 & 2)
HSV erythema multiforme rash
Hermes, the god of herpes
- 1-2 weeks after infection with HSV 1 or 2 (mostly 1)
- looks like targets!
- Starts on hands and feet and moves inwardly / centrally
- Due to a hypersensitivity rxn.
Herpes Simplex Virus 1 & 2 (aka HHV1 & 2)
Treatment
Hermes, the god of herpes
- NO CURE
- Prevent breakouts with Acyclovir and / or valcyclovir
Epstein-Barr Virus (aka HHV4)
lab tests
Ye Olde Epstein Bar
- DS DNA
- Enveloped virus
- Cytotoxic (CD8+) T-cell reactive* lymphocytes
* (Downy cells** AKA **atypical cells; Very large, lots of cytoplasm, have oval, indented, or folded nucleus)
- Monospot Ig* test to diagnose during acute infections → activates B cells to secrete heterophile sheep antibodies that agglutinate sheep or horse RBC’s.
* (IgM for current or recent infection, IgG for prior infections)
Epstein-Barr Virus (aka HHV4)
MOA
Ye Olde Epstein Bar
- EBV envelope (glycoprotein) binds to CD21 receptor (Complement receptor type 2 aka CR2; on the surface of B cells) to infect B cells.
- T-cells proliferate → causing splenomegaly*
- Most are reactive cytotoxic CD8+ T cells (reactive lymphocytosis) aka downy cells or atypical cells but can also be NK cells.
* (Must avoid contact sports due to risk of splenic rupture)
Epstein-Barr Virus (aka HHV4)
Source
Ye Olde Epstein Bar
- Spread through mouth secretions
- “KISSING DISEASE!!!”
- Causes infectious mononucleosis (“mono”)
Epstein-Barr Virus (aka HHV4)
signs and symptoms
Ye Olde Epstein Bar
- Triad of symptoms:
- fever
- pharyngitis (mono pharyngitis often in teens and adults, vs. strep pharyngitis more often in children)
- lymphadenopathy (often tender lymphadenopathy in posterior cervical region)
- Can also see Splenomegaly**
Epstein-Barr Virus (aka HHV4)
EBV ↑ the risk factor for 3 cancers!
Ye Olde Epstein Bar
- Hodgkin’s lymphoma (HL); mixed cellularity
- Non-Hodgkin’s lymphoma (NHL); Burkett lymphoma
- Nasopharyngeal carcinoma (NPC)
- Also ↑ risk of Oral Hairy leukoplakia (but its NOT a precancerous lesion)
Epstein-Barr Virus (aka HHV4)
EBV ↑ the risk factor for 3 cancers!
1) Hodgkin’s lymphoma (HL); mixed cellularity
Ye Olde Epstein Bar
- Weakend immune systems develop B cell lymphoma.
- The cancerous B cells are an abnormal type called Reed-Sternberg cells (giant cells that resemble “owl eyes”).
- Mixed cellularity is the second most common type of HL and is seen mostly in older adults (although it can occur at any age).
- It can start in any lymph node but most often occurs in the upper half of the body.
Epstein-Barr Virus (aka HHV4)
EBV ↑ the risk factor for 3 cancers!
2) Non-Hodgkin’s lymphoma (NHL); Burkett lymphoma*
* (The fastest growing human tumor, associated with impaired immunity and is rapidly fatal if left untreated.)
Ye Olde Epstein Bar
- Burkitt lymphoma is a form of non-Hodgkin’s lymphoma in which cancer starts in B-cells.
- Especially likely to develop in people infected with HIV.
- Common translocation is t8:14
- Endemic (African) Burkitt lymphoma is common in young children who have both malaria and EBV. It usually starts as tumors of the jaw or other facial bones. It also can affect the GI tract, ovaries, and breasts and can spread to the CNS
- The types more common in the U.S. (sporadic and immunodeficiency-associated) usually start in the bowel and form a bulky tumor mass in the abdomen, often with massive involvement of the liver, spleen, and bone marrow.
Epstein-Barr Virus (aka HHV4)
EBV ↑ the risk factor for 3 cancers!
3) Nasopharyngeal carcinoma (NPC)
Ye Olde Epstein Bar
- Commonly in asian people.
- It is most common in males.
- It is a squamous cell carcinoma or an undifferentiated* type
* (Undifferentiated cells are cells that do not have their mature features or functions.)
Epstein-Barr Virus (aka HHV4)
EBV ↑ the risk factor for
Oral Hairy leukoplakia
Ye Olde Epstein Bar
- it is NOT a precancerous lesion
- Primarily affects people whose immune systems have been weakened by disease, especially HIV/AIDS.
- Thickened, white patches on gums, insides cheeks, bottom of mouth and sometimes tongue.
- These patches can’t be scraped off*.
* (ddx with candida which can be scraped off!)
Epstein-Barr Virus (aka HHV4)
Adverse RXN if treated w/ a penicillin!
Ye Olde Epstein Bar
- Intense itchy maculopapular or morbilliform rash.
- Appears on extensor surfaces and pressure points 7 to 10 _days after treatmen_t with beta-lactam antibiotics (such as ampicillin, amoxicillin and cephalosporins).
- This rash indicates a ‘hypersensitivity reaction’ to the antibiotic.
- It is not a true allergy and does not occur if the antibiotic is given later on in the absence of EBV infection.
Epstein-Barr Virus (aka HHV4)
Treatment
Ye Olde Epstein Bar
- No tx!
- rest and fluids
Cytomegalovirus (aka HHV5)
lab tests
Cyto “Mega-Lo” Virus
- DS DNA
- Enveloped virus
- Replicates in nucleus (like most DNA viruses)
- Buffy coat culture with anti-CMV antibodies
- “Owl eye” inclusion bodies
Cytomegalovirus (aka HHV5)
Source
Cyto “Mega-Lo” Virus
Transmitted by:
- Blood
- Sexual contact
- Congenital (TORCHeS infection!); ↑ risk 2nd trimester
- Breast milk
- Saliva
- Urine
- Transplants, immunosuppression, HIV (CD4 < 50)
Cytomegalovirus (aka HHV5)
Congenital presentations of CMV
- Most common fetal** **viral infection!
- Most of the time (80%) asymptomatic!
- #1 cause of Sensory-neural deafness from viral inf.
- #1 cause of mental retardation from viral inf.
Cyto “Mega-Lo” Virus
* TORCHeS infection!
- Congenital cataracts, Sensory-neural Deafness
- Blueberry muffin rash; (thrombocytopenia) (similar rash also seen in Rubella)
- Ventriculomegaly from periventricular** calcifications** (also seen in Toxoplasmosis)
- mental retardation and seizures from the Intracranial calcifications
- Hepatomegaly, jaundice.
- Hydrops fetalis; Heart failure leading to severe edema
Cytomegalovirus (aka HHV5)
signs and symptoms
Cyto “Mega-Lo” Virus
- Transplant pts at ↑ risk for CMV pneumonia!
- CMV retinitis; Full thickness retinal necrosis (“Pizza pie retinopathy”) → Blind spots, flashing lights, vision loss (Typically unilateral but can be bilateral)
- CMV esophagitis and colitis; Ulcerations are singular, deep, and linear (ddx HSV ulcers which are multiple and shallow)
- CMV mononucleosis (similar to reg mono w/ sore throat, lymphadenopathy, and fatigue) but monospot test would be (-)
Cytomegalovirus (aka HHV5)
Treatment
Cyto “Mega-Lo” Virus
Ganciclovir
or
Foscarnet (when UL97 gene mutation makes it resistant to Ganciclovir)
Varicella Zoster Virus (aka HHV3)
lab tests
Varicella “Zeus” ster virus
- DS DNA
- Enveloped virus
- Replicates in nucleus (like most DNA viruses)
- Tzanc smear (older test, scrape) to look for multinucleated giant cells
Varicella Zoster Virus (aka HHV3)
Diseases from VZV
Varicella “Zeus” ster virus
- Congenital Varicella Syndrome (a TORCHeS infection!)
If infected in 1st and 2nd trimesters
- Chickenpox (Varicella)
Spread by respiratory droplets or ruptured vesicles
- Shingles (Herpes Zoster)
Reactivation of previous VZV infection
Varicella Zoster Virus (aka HHV3)
Chickenpox (Varicella) signs and symptoms
Varicella “Zeus” ster virus
- Headache and fever
- Xanthem (“widespread rash”); itchy
- Vesicular rash → Vesicular lesions w/ surrounding erythema (like HSV dew drops on rose petal)
- All rashes are at different stages of healing (vs. smallpox w/ similar looking rash but all at same stage!)
- Adults can get pneumonia (major cause of morbidity & mortality in adults w/ chicken pox)
- Encephalitis
Varicella Zoster Virus (aka HHV3)
Shingles (Herpes Zoster) signs and symptoms
- VZV remains latent in dorsal root ganglia until its reactivated in older individuals (stress or immunocompromised)
Varicella “Zeus” ster virus
- Vesicular rash on erythema base travels down dorsal root (sensory nerves! painful!) in a dermatone pattern*, rarely crossing the midline.
- Postherpetic neuralgia: pain after shingles!
- Herpes Zoster opthalmicus if VZV infects the V1 branch of trigeminal nerve → vision loss
* If rash crosses the midline it is Disseminated VCV and is a red flag of immunocompromisation! test for HIV if no Hx!!!
Varicella Zoster Virus (aka HHV3)
Congenital Varicella Syndrome signs and symptoms
(a TORCHeS infection!)
Varicella “Zeus” ster virus
- Limb hypoplasia
- Cutaneous scarring** in a **dermatomal pattern
- Blindness
Varicella Zoster Virus (aka HHV3)
Vaccine
Varicella “Zeus” ster virus
- Live attenuated Chickenpox (Varicella) vaccine
- Shingles (Zoster) vaccine*, is simply a larger-than-normal dose of the vaccine used against chickenpox.
* Shingles (Zoster) vaccine recommended for adults over 60; HIV pts can get if CD4 > 200
Varicella Zoster Virus (aka HHV3)
Treatment
Varicella “Zeus” ster virus
For chickenpox (Varicella):
Acyclovir
For shingles (Herpes Zoster):
Acyclovir or Famc_ycl_ovir or Valcyclovir
Roseola (aka HHV6)
lab tests
AKA: 6th disease, Exanthema subitum (sudden rash)
A roseola by any other name would smell as sweet
- DS DNA
- Enveloped virus
Roseola (aka HHV6)
signs and symptoms
AKA: 6th disease, Exanthema subitum (sudden rash)
A roseola by any other name would smell as sweet
- Occurs between 6 months and 2 years of age.
- Starts with high fever (over 104º) often lasting 3-4 days → can cause febrile seizures
- After 3-4 days* pt develops diffuse maculopapular lacy rash that spares the face*.
* (ddx measles which has a fever and rash together, and does not spare the face!)
Roseola (aka HHV6)
MOA
AKA: 6th disease, Exanthema subitum (sudden rash)
A roseola by any other name would smell as sweet
- Roseola infects CD4+ cells (helper t cells)
- the infection kills the CD4+ cells
- Causing immunosuppression**
Roseola (aka HHV6)
Treatment
AKA: 6th disease, Exanthema subitum (sudden rash)
A roseola by any other name would smell as sweet
- NO tx
- keep pt. cool and give fluids
Kaposi’s sarcoma-associated herpesvirus (aka HHV8)
lab tests
Ring around the kaposi
- DS DNA
- Enveloped virus
- Lymphocytic infiltrates (ddx Bartonella hensleae and bacillary angiomatosis w/ a neutrophil infiltrate!)
Kaposi’s sarcoma-associated herpesvirus (aka HHV8)
MOA
Ring around the kaposi
- Causes the dysregulation of vascular endothelial growth factor (VEGF) → aberrant angiogenesis
Kaposi’s sarcoma-associated herpesvirus (aka HHV8)
3 populations with ↑ risk for KS
Ring around the kaposi
1) AIDs pts (and immunocompromised):
- AIDS defining illness
2) Elderly russian men
- often have lower extremity lesions
3) Endemic areas of Africa:
- Adults will have classic presentation with palatal lesions. In children it can be fatal.
Kaposi’s sarcoma-associated herpesvirus (aka HHV8)
Source
Ring around the kaposi
- Sexual contact
- Kissing
*** especially M to M ***
Kaposi’s sarcoma-associated herpesvirus (aka HHV8)
signs and symptoms
Ring around the kaposi
- Erythematous violaceous lesions on nose, extremities, and mucous membranes.
- The hard palate is frequently affected by lesions, followed by the gums.
- May be present as a plaque, patch, macule, or nodule! (rise from primitive mesenchymal cells involving angiogenesis causing the violaceus color)
- Intraintestinal lesions (mucous membranes!)
Kaposi’s sarcoma-associated herpesvirus (aka HHV8)
HHV8 can cause a B cell lymphoma called?
Ring around the kaposi
- HHV8 can cause a B cell lymphoma called primary enfusion lymphoma (PEL)
- Primary enfusion lymphoma is a rare HIV-associated non-Hodgkin’s lymphoma (NHL)
Kaposi’s sarcoma-associated herpesvirus (aka HHV8)
Treatment
Ring around the kaposi
- If HIV (+) and not yet on tx, give AIDs therapy (should help shrink lesions)
