DNA Viruses - Herpesviridae Flashcards
Which Sketchy image represents the Herpes simplex virus (types 1 and 2)?
Of what family is this virus a member?
Herpesviridae
Which Sketchy image represents the Epstein-Barr virus?
Of what family is this virus a member?
Herpesviridae
Which Sketchy image represents Cytomegalovirus?
Of what family is this virus a member?
Herpesviridae
Which Sketchy image represents the Varicella-zoster virus?
Of what family is this virus a member?
Herpesviridae
Which Sketchy image represents the HHV-6 (roseola)?
Of what family is this virus a member?
Herpesviridae
Which Sketchy image represents the HHV-8 (Kaposi’s sarcoma)?
Of what family is this virus a member?
Herpesviridae
Identify as many of the marked points in this image as you can.
Note: this image represents the Human simplex virus (types 1 and 2).
Identify as many of the marked points in this image as you can.
Note: this image represents the Epstein-Barr virus.
Identify as many of the marked points in this image as you can.
Note: this image represents Cytomegalovirus.
Identify as many of the marked points in this image as you can.
Note: this image represents the Varicella-zoster virus.
Identify as many of the marked points in this image as you can.
Note: this image represents HHV-6 (roseola).
Identify as many of the marked points in this image as you can.
Note: this image represents HHV-8 (Kaposi’s sarcoma).
Herpes simplex virus types 1 and 2 are _______ viruses in the Herpesviridae family.
Herpes simplex virus types 1 and 2 are DNA viruses in the Herpesviridae family.
Are HSV1 and HSV2 naked viruses?
No;
they are enveloped
True/False.
HSV-1 and HSV-2 are single-stranded, circular, enveloped DNA viruses.
False.
HSV-1 and HSV-2 are double-stranded, linear, enveloped DNA viruses.
_________ bodies are _____philic intranuclear inclusions that can be found in cells infected with HSV (as well as CMV and VZV).
Cowdry bodies are eosinophilic intranuclear inclusions that can be found in cells infected with HSV (as well as CMV and VZV).
Cowdry bodies are eosinophilic intranuclear inclusions that can be found in cells infected with what virus(es)?
HSV;
CMV;
VZV
True/False.
HSV-1 and HSV-2 can be transmitted vertically and are ToRCHeS infections.
True.
HSV-1 and HSV-2 can be transmitted vertically and are ToRCHeS infections (HSV is the “He” in “ToRCHeS”)
The initial outbreak of HSV-1 often presents as ___________itis (vesicular lesions and ulcerations of the oral cavity and perioral area).
The initial outbreak of HSV-1 often presents as gingivostomatitis (vesicular lesions and ulcerations of the oral cavity and perioral area).
Describe the lesions caused by the initial presentation of HSV-1 in the form of gingivostomatitis:
_________ lesions and __________s of the oral cavity and perioral area.
Describe the lesions caused by the initial presentation of HSV-1 in the form of gingivostomatitis:
_vesicular_ lesions and _ulceration_s of the oral cavity and perioral area.
Herpes _______ (or cold sores) presents on the lips and is typically caused by HSV-___.
Herpes labialis (or cold sores) presents on the lips and is typically caused by HSV-1.
__________itis caused by HSV (typically type 1) presents with serpiginous corneal ulcers seen on fluorescein slit lamp exam.
Keratoconjunctivitis caused by HSV (typically type 1) presents with serpiginous corneal ulcers seen on fluorescein slit lamp exam.
Keratoconjunctivitis caused by HSV (typically type 1) presents with _________ (description) ______ (location / tissue type) ulcers seen on fluorescein slit lamp exam.
Keratoconjunctivitis caused by HSV (typically type 1) presents with serpiginous corneal ulcers seen on fluorescein slit lamp exam.
HSV (typically type ____) can cause hemorrhagic _______ lobe _________itis.
HSV (typically type 1) can cause hemorrhagic temporal lobe encephalitis.
_______ is the number one cause of sporadic encephalitis in the US.
HSV-1 is the number one cause of sporadic encephalitis in the US
Where does HSV-1 (and sometimes HSV-2) typically lie dormant?
The trigeminal ganglia
HSV lesions are typically described as having what appearance?
A “dew drop on a rose petal” appearance
Herpetic _________ is caused by HSV and is characterized by painful lesions on one or more fingers (this is more common in ________).
Herpetic whitlow is caused by HSV and is characterized by painful lesions on one or more fingers (herpetic whitlow is more common in dentists).
Erythema __________ is a hypersensitivity reaction associated with certain infections (such as HSV) that presents with small _______ lesions on the back of the hands and feet that move centrally.
Erythema multiforme is a hypersensitivity reaction associated with certain infections (such as HSV) that presents with small target lesions on the back of the hands and feet that move centrally.
Erythema multiforme is a hypersensitivity reaction associated with certain infections (such as HSV) that presents with small target lesions on the back of the ______ and ______ that move ______ly.
Erythema multiforme is a hypersensitivity reaction associated with certain infections (such as HSV) that presents with small target lesions on the back of the hands and feet that move centrally.
Pain___ ________ lymphadenopathy is associated with HSV (typically type 2).
Painful inguinal lymphadenopathy is associated with HSV (typically type 2).
HSV (typically type 2) lies dormant in where?
The sacral ganglia
HSV (typically type ___) can lead to aseptic _________ in both adolescents and adults.
HSV (typically type 2) can lead to aseptic meningitis in both adolescents and adults.
Infection with HSV (typically type ___) can lead to hemorrhagic temporal lobe encephalitis.
Infection with HSV (typically type ___) can lead to aseptic meningitis.
Infection with HSV (typically type 1) can lead to hemorrhagic temporal lobe encephalitis.
Infection with HSV (typically type 2) can lead to aseptic meningitis.
What can be used to visualize multinucleated giant cells infected with HSV, which aids in diagnosis?
A Tzanck smear
What medication(s) can be used to prevent HSV breakouts?
Valacyclovir;
acyclovir
Epstein-Barr virus is a _____ virus in the Herpesviridae family.
Epstein-Barr virus is a DNA virus in the Herpesviridae family.
Epstein-Barr virus is primarily transmitted via what?
Saliva
________ + painful lymphadenopathy in the ________ ________ region + splenomegaly + pharyngitis are some of the classic features of Epstein-Barr virus-induced mononucleosis.
Fever + painful lymphadenopathy in the posterior cervical region + splenomegaly + pharyngitis are some of the classic features of Epstein-Barr virus-induced mononucleosis.
Epstein-Barr virus infection causes peripheral lymphocytosis and the presence of atypical lymphocytes (abnormally large reactive CD___+ T-cells with abundant cytoplasm) and _________ cells (atypical lymphocytes with strongly basophilic cytoplasm pathognomonic of EBV infection).
Epstein-Barr virus infection causes peripheral lymphocytosis and the presence of atypical lymphocytes (abnormally large reactive CD8+ T-cells with abundant cytoplasm) and Downey cells (atypical lymphocytes with strongly basophilic cytoplasm pathognomonic of EBV infection).
Fever + __________ __________ in the posterior cervical region + __________ + pharyngitis are some of the classic features of Epstein-Barr virus-induced mononucleosis.
Fever + painful lymphadenopathy in the posterior cervical region + splenomegaly + pharyngitis are some of the classic features of Epstein-Barr virus-induced mononucleosis.
Epstein-Barr virus remains latent in what cell type?
B cells
To initiate infection, the Epstein-Barr virus envelope glycoprotein binds to the _____ membrane protein of _____ cells.
To initiate infection, the Epstein-Barr virus envelope glycoprotein binds to the CD21 membrane protein of B cells.
The four basic S/Sy of EBV mononucleosis are:
The four basic S/Sy of EBV mononucleosis are:
Fever
Pharyngitis
Painful lymphadenopathy (posterior cervical)
Splenomegaly
Pharyngitis with production of _________ _________ is a common feature of Epstein-Barr virus-induced mononucleosis.
pharyngitis with production of tonsillar exudate is a common feature of Epstein-Barr virus-induced mononucleosis.
Patients with Epstein-Barr virus infections who are mistakenly treated with ________ or ________ (due to suspicion of streptococcal pharyngitis) can develop a maculopapular rash.
patients with Epstein-Barr virus infections who are mistakenly treated with penicillin or amoxicillin (due to suspicion of streptococcal pharyngitis) can develop a maculopapular rash.
Patients with Epstein-Barr virus infections who are mistakenly treated with penicillin or amoxicillin (due to suspicion of streptococcal pharyngitis) can develop what?
A maculopapular rash
EBV is associated with what malignancies?
B cell malignancies
(Hodgkin’s + non-Hodgkin’s + Burkitt lymphomas)
EBV is associated with what B cell malignancies?
Hodgkin’s,
non-Hodgkin’s,
and Burkitt lymphomas
EBV infection may be associated with the development of Hodgkin’s lymphoma, which is characterized by what characteristic cells?
Reed-Sternberg cells
(classically described as having an “owl eye” appearance)
EBV is associated with which form of Burkitt lymphoma?
African (or endemic) Burkitt lymphoma
(often presents with a large jaw lesion and/or jaw swelling)
EBV is associated with a higher risk for development of __________ carcinoma, which is more commonly seen in patients with Asian ancestry.
EBV is associated with a higher risk for development of nasopharyngeal carcinoma, which is more commonly seen in patients with Asian ancestry.
Epstein-Barr virus is associated with a higher risk for development of what oral lesion that occurs most commonly in HIV patients?
Hairy leukoplakia
What can be used to rapidly diagnose acute Epstein-Barr virus infection?
The monospot test
(utilizes horse or sheep RBCs, which will agglutinate when mixed with patient serum due to production of anti-horse/sheep blood IgM antibodies induced by the presence of Epstein-Barr virus)
How does the monospot test identify acute cases of EBV?
It utilizes horse or sheep RBCs, which will agglutinate when mixed with patient serum due to production of anti-horse/sheep blood IgM antibodies induced by the presence of Epstein-Barr virus.
Patients with what viral infection should avoid contact sports due to risk of splenic rupture?
Infectious mononucleosis
Patients with EBV infection should avoid contact sports due to risk of what?
Splenic rupture
Cytomegalovirus is a(n) _____ virus in the _____viridae family.
Cytomegalovirus is a DNA virus in the Herpesv**iridae family.
Cytomegalovirus can remain latent in what cell types?
Mononuclear WBCs
(i.e. lymphocytes, monocytes, and macrophages)
True/False.
Cytomegalovirus can remain latent in any of the following:
B-cells or T-cells or macrophages
True.
Cytomegalovirus can reactivate and cause disease, most commonly in what population?
Immunosuppressed patients
Is CMV a ‘ToRCHeS’ infection?
Yes.
Congenital cytomegalovirus infection can present with a characteristic “_______________” rash.
congenital cytomegalovirus infection can present with a characteristic “blueberry muffin” rash.
(Note: also seen in a few other infections, such as rubella.)
Congenital cytomegalovirus infection can present with _______________megaly and resultant ___________ (cutaneous finding).
Congenital cytomegalovirus infection can present with hepatosplenomegaly and resultant jaundice.
Congenital cytomegalovirus infection is a cause of which form of hearing loss:
Conductive or sensorineuronal?
Unilateral or bilateral?
Sensorineuronal;
either unilateral or bilateral
Congenital cytomegalovirus infection can result in structural abnormalities in the brain, including ________megaly and peri________ _________s.
Congenital cytomegalovirus infection can result in structural abnormalities in the brain, including ventriculomegaly and periventricular calcifications.
The changes in brain structure caused by congenital cytomegalovirus infection can lead to what major S/Sy?
Developmental delay and/or seizures
What percentage of newborns with congenital cytomegalovirus infection are asymptomatic?
90%
Intrauterine CMV infection can result in _______ _______, which is characterized by fluid accumulation in multiple compartments of the fetus.
Intrauterine CMV infection can result in hydrops fetalis, which is characterized by fluid accumulation in multiple compartments of the fetus.
Which ToRCHeS infection can result in hydrops fetalis, which is characterized by fluid accumulation in multiple compartments of the fetus?
CMV
_________ is the number one cause of sensorineural hearing loss in children.
CMV is the number one cause of sensorineural hearing loss in children.
What is the most common congenital viral infection?
CMV
CMV is associated with organ transplantation, predisposing transplant recipients to what CMV presentation(s)?
CMV pneumonia;
as well as CMV hepatitis, gastritis, colitis, and/or encephalitis
What population should be given prophylactic antiviral medications for protection against CMV?
AIDS patients with a CD4+ count <50
A common manifestation of CMV infection in AIDS patients is CMV _______, which is sometimes described as “pizza pie” _____pathy.
A common manifestation of Cytomegalovirus infection in AIDS patients is CMV retinitis, which is sometimes described as “pizza pie” retinopathy.
CMV is a common cause of HIV-associated ________itis and is likely to present with singular, deep, and linear ________ ulcerations.
CMV is a common cause of HIV-associated esophagitis and is likely to present with singular, deep, and linear esophageal ulcerations.
How do the lesions seen in CMV esophagitis in HIV+ patients typically appear?
Singular, deep, linear ulcerations
CMV colitis is likely to present with ulcerations on the walls of the ______ (as well as the esophagus).
CMV colitis is likely to present with ulcerations on the walls of the colon (as well as the esophagus).
“____________” inclusions can be seen upon microscopic examination of CMV-infected cells.
“Owl’s eye” inclusions can be seen upon microscopic examination of CMV-infected cells.
CMV lines with the ______ gene mutation require treatment with foscarnet (the ______ gene mutation confers resistance to ganciclovir).
CMV lines with the UL97 gene mutation require treatment with foscarnet (the UL97 gene mutation confers resistance to ganciclovir).
CMV lines with the UL97 gene mutation require treatment with _______ (the UL97 gene mutation confers resistance to ganciclovir).
CMV lines with the UL97 gene mutation require treatment with foscarnet (the UL97 gene mutation confers resistance to ganciclovir).
CMV infection in immunocompetent patients often presents how?
Sore throat, lymphadenopathy, and fatigue
(symptoms are similar to those seen in EBV infection)
A patient presents with sore throat, fatigue, and lymphadenopathy. You suspect a viral cause and wish to differentiate between EBV and CMV.
What test do you use?
The monospot test
(+ in EBV;
- in CMV)
What medication is effective against CMV?
(Note: strains without the UL97 gene mutation, which are treated with Foscarnet)
Ganciclovir
Varicella-zoster virus is a _____ virus in the ______viridae family.
Varicella-zoster virus is a DNA virus in the _Herpes_viridae family.
True/False.
The Varicella-zoster virus is enveloped.
True.
What virus causes chickenpox (a pruritic rash with small, fluid-filled blisters)?
Varicella-zoster virus
True/False.
Chickenpox may present with fever after development of the itchy, fluid-filled lesions and headache.
False.
Chickenpox may present with fever before development of the itchy, fluid-filled lesions and headache.
How is varicella-zoster virus transmitted?
Via respiratory droplets
How are the lesions seen in chickenpox typically described?
Pruritic, fluid-filled vesicles
(“dew drops on a rose petal” appearance)
True/False.
The vesicular lesions of chickenpox are typically found in various stages of development and healing.
True.
What smear can be used to visualize multinucleated giant cells infected with varicella-zoster virus, which aids in diagnosis?
a Tzanck smear
True/False.
Patients who contract varicella-zoster virus in childhood have a higher likelihood of developing pneumonia.
False.
Patients who contract varicella-zoster virus in adulthood** have a higher likelihood of developing pneumonia.
What is a major complication of varicella-zoster virus infection?
Encephalitis
What patient populations are at a higher risk of developing varicella pneumonia or encephalitis?
Immunocompromised patients
The vaccine for varicella-zoster virus is a __________ vaccine typically administered in childhood.
The vaccine for varicella-zoster virus is a live-attenuated vaccine typically administered in childhood.
________ is an effective treatment for varicella-zoster virus infection in children ages 12+, adults, and immunocompromised patients.
Acyclovir is an effective treatment for varicella-zoster virus infection in children ages 12+, adults, and immunocompromised patients.
Where does varicella-zoster virus remains latent?
The dorsal root ganglia
What are some predisposing factors that might lead to shingles (VZV reactivation)?
Stress, aging, or immunosuppression
Herpes _______ (shingles) presents with a “dew drop on a rose petal” appearing rash within a ____________ distribution.
Herpes zoster (shingles) presents with a “dew drop on a rose petal” appearing rash within a dermatomal distribution.
True/False.
Herpes zoster (shingles) is typically relatively painless.
False.
Herpes zoster (shingles) is typically extremely painful.
___________ __________ is a complication of shingles, which presents as burning pain in the nerve fibers and skin long after the shingles rash has cleared.
Postherpetic neuralgia is a complication of shingles, which presents as burning pain in the nerve fibers and skin long after the shingles rash has cleared.
What complication develops when varicella-zoster virus reactivates in V1 (the ophthalmic division of the trigeminal nerve) and can lead to vision loss?
Herpes zoster ophthalmicus
The live attenuated varicella-zoster vaccine is recommended for adults over what age?
60
HIV patients with a CD4+ count of _____ may receive the varicella-zoster vaccine.
HIV patients with a CD4+ count of >200 may receive the varicella-zoster vaccine.
What medication(s) are effective against varicella-zoster shingles infection?
Famciclovir;
valacyclovir
True/False.
Although a member of the Herpesviridae family, varicella-zoster virus cannot be transmitted vertically and is NOT a TORCHeS infection.
False.
VZV falls in the ‘other’ category of ToRCHeS infections (e.g. VZV, Zika, Parvovirus, etc.)
Congenital varicella syndrome can develop if varicella-zoster virus is contracted during the which trimesters of pregnancy?
The first or second
Congenital varicella syndrome can develop if varicella-zoster virus is contracted during the first two trimesters of pregnancy and can result in cutaneous dermatomal _________, _____ness, and ______ ______plasia.
Congenital varicella syndrome can develop if varicella-zoster virus is contracted during the first two trimesters of pregnancy and can result in cutaneous dermatomal scarring, blindness, and limb hypoplasia.
HHV-6 is a _____ virus in the Herpesviridae family that is associated with _______ (what disease)?
HHV-6 is a DNA virus in the Herpesviridae family that is associated with roseola.
What are some other names for roseola (infection with HHV-6)?
‘Sixth disease’
‘Exanthem subitum’
HHV-6 infects what cell type in particular?
CD4+ helper T-cells
HHV-6 infects CD4+ helper T-cells, which can lead to what immediate result?
Immunosuppression
Roseola is characterized by a fever generally lasting ___________ and a ________ that develops after the fever has subsided.
Roseola is characterized by a fever generally lasting 4 days and a rash that develops after the fever has subsided.
Due to the fever, children with roseola can develop what?
Febrile seizures
Describe the rash associated with HHV-6 infection (roseola) in terms of appearance and parts of the body affected.
Diffuse, lacy, body rash that spares the face
Roseola affects children of what ages?
6 - 24 months
True/False.
The course of roseola is usually self-limiting.
True.
HHV-8 is a ______ virus in the Herpesviridae family.
HHV-8 is a DNA virus in the Herpesviridae family.
What AIDS-defining illness is caused by infection with HHV-8?
Kaposi sarcoma
_________ sarcoma is characterized by violaceous lesions on the nose, extremities, and mucous membranes.
Kaposi sarcoma is characterized by violaceous lesions on the nose, extremities, and mucous membranes.
Kaposi sarcoma causes __________ proliferation.
Kaposi sarcoma causes vascular proliferation.
HHV-8 dysregulates __________________, leading to aberrant angiogenesis.
HHV-8 dysregulates vascular endothelial growth factor (VEGF), leading to aberrant angiogenesis.
The lesions of Kaposi sarcoma are most commonlu found where?
The hard palate
(also, mucus membranes, the extremities, etc.)
True/False.
Kaposi sarcoma lesions can be found within the GI tract.
True.
HHV-8 can infect B cells, which may result in what?
Primary effusion lymphoma
HHV-8 is endemic to areas of what region(s)?
Africa
Kaposi sarcoma lesions have a similar appearance to _________ _________ (caused by Bartonella henselae) and differentiation requires microscopic examination of tissue (Kaposi sarcoma lesions have _________ infiltrate).
Kaposi sarcoma lesions have a similar appearance to bacillary angiomatosis (caused by Bartonella henselae) and differentiation requires microscopic examination of tissue (Kaposi sarcoma lesions have lymphocytic infiltrate).
Bacillary angiomatosis and Kaposi sarcoma can be differentiated because Kaposi sarcoma has a __________ infiltrate.
Bacillary angiomatosis and Kaposi sarcoma can be differentiated because Kaposi sarcoma has a lymphocytic infiltrate.
