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Microbiology > Herpes And Pox Viruses > Flashcards

Herpes And Pox Viruses Flashcards

1
Q

Give a brief description of the herpesviridae family

A

Enveloped dsDNA viruses

MW: 80-150,000kD

Latent infection after initial entry

Reactivation to produce recurrent infections

Some are associated with cancer
Eg EBV with nasopharyngeal carcinoma and Burkitt’s lymphoma

Human Herpes virus 8 with Kaposi sarcoma

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2
Q

Classify herpes viruses

A

HHV1- Herpes Simplex virus type 1

HHV2- Herpes Simplex virus type 2

HHV3- Varicella Zoster virus

HHV4- Epstein-Barr virus

HHV5- Human cytomegalovirus

HHV6- Human Herpes virus 6

HHV7- Human Herpes virus 7

HHV8- Kaposi sarcoma associated herpes virus

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3
Q

HHV1, 2, 3 (VSV) have their site of latency in the sensory nerve ganglia

True or false

A

True

HSV1- Trigeminal ganglion
HSV2- Sacral ganglion

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4
Q

HHV4 (EBV) has its site of latency where❓

A

B-lymphocytes

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5
Q

HHV5 (CMV) has its site of latency where❓

A

Epithelial cells

Leukocytes

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6
Q

Which HHVs have their site of latency in T lymphocytes❓

A

HHV6

HHV7

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7
Q

HHV8 (KSHV) has its site of latency in❓

A

B lymphocytes

Epithelial cells

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8
Q

In most developing countries, 90% of population have HSV1 antibody by the age of 30

A

True

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9
Q

The detection of HSV-2 antibody before puberty is a usual occurrence

True or false

A

False, it’s unusual

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10
Q

What is the prevalence of HSV-2 antibody in Africa❓

A

51-68%

More common in women

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11
Q

How is HSV-1 transmitted❓

How is HSV-2 transmitted❓

A

1.
Kissing
Direct contact with infected saliva
Respiratory droplets

  1. Sexual transmission
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12
Q

Is the primary infection of HHV is usually asymptomatic or symptomatic❓

Is the reactivation of HHV symptomatic or asymptomatic❓

A

Asymptotic or mild; painful blistering rash 1-3days post exposure

Asymptomatic; symptoms are less severe

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13
Q

Is viraemia more common in HSV-2 or HSV-1

A

HSV-2, usually occurs in immunocompromised patients

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14
Q

What are the stimuli for the reactivation of HHV❓

A

Fever

Stress

Sunlight

Immunosuppression

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15
Q

Oropharyngeal Herpes is characterized by❓

It is usually seen in what age group❓

How long does it last❓

It is usually seen in what category of HHV❓

A

1.
Fever blisters/Cold sores

Gingivostomatitis: ulcerative lesions involving the buccal mucosa, tongue, gums, pharynx

  1. Children <5 years
  2. Lasts 5-12 days

4.
HSV-1

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16
Q

Genital herpes, a very common sexually transmitted infection, is caused by❓

The efficiency of sexual transmission is greater from which sex❓

A

1.
HSV-1
HSV-2

2.
Men➡️Women

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17
Q
  1. In the primary infection of HSV-1 and HSV-2, what’s the incubation period of the virus❓
  2. How long does the primary infection last❓
  3. How would you identify it❓
  4. What course does it follow❓
  5. Is the primary infection more severe than the recurrent or vise versa❓
  6. Is a symptomatic viral shedding greater in HSV1/HSV2 ❓
A

5days

11-12days

  • Multiple painful vesicopustular lesions, bilateral and extensive
  • Bilateral enlarged tender inguinal lymph nodes
4. 
Papules
  ⬇️
 Vesicles 
  ⬇️
 Pustules 
  ⬇️
 Ulcers 
  ⬇️
 Crusts 
  ⬇️
 Healed
  1. The primary infection is more severe; recurrent is mild and of short duration
  2. HSV2
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18
Q

A recurrent symptomatic infection with genital herpes is usually mild and short in duration

True or false

A

True

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19
Q

Is asymptomatic viral shedding greater in HSV-1/HSV-2❓

A

HSV-2

20
Q

What is the mortality of Neonatal Herpes❓

What is usually the sequelae in those who survive❓

A

60%

Neurologic

21
Q

Is viral encephalitis usually seen in HSV1/HSV2❓

Is meningitis usually seen in HSV1/HSV2❓

A

HSV-1, may also present with ocular infections (keratoconjunctivitis)

Meningitis is usually seen in HSV-2

22
Q
  1. a. In using Tzanck test to diagnose HSV, what would you watch out for❓
    b. Is this test sensitive and specific❓

2.
a. If the type specific serological test is positive for HSV2, what would that denote❓

b. Does the type specific serological test positive for HSV1 distinguish between an anogenital and orolabial infection❓

A

1.
a. Intranuclear inclusions/multinucleated giant cells

b. This test is insensitive and nonspecific for HSV

2.
a. An anogenital infection

b. A +ve HSV1 can’t distinguish btwn an anogenital and orolabial infection

23
Q

How would you diagnose a case of HSV-1 / HSV-2❓

A

Viral culture

PCR

Antigen detection

Type specific serological test

Tzanck

24
Q

How would you treat a case of HSV-1 / HSV-2❓

Would it eradicate the latent virus❓

A
  1. Acyclovir 400mg orally 7-10days

Valacyclovir 1g orally 7-10days

Famciclovir

Episodic and suppressive treatments ⬇️fq of recurrence by 70-80% in px w recurrence >6 per year

  1. No, it wouldn’t eradicate the latent virus
25
Q

Varicella zoster virus VZV…

  1. Is transmitted by❓
  2. Is a highly contagious childhood disease, T/F❓
  3. Has an incubation period of❓
  4. Is presented clinically as❓
  5. Describe the disease progression
A
  1. Respiratory droplets
  2. T, it’s a highly contagious childhood dx
  3. Incubation period: 11-21 days
  4. Generalized vesiculopapular rashes
5. 
Macules 
⬇️
Papules 
⬇️
Vesicles 
⬇️
Pustules 
⬇️
Crust
25
Q

Herpes zoster (Shingles)…

  1. Occurs by reactivation of❓
  2. Is most common in the elderly, T/F❓
  3. Is presented clinically as❓
  4. What is it’s complication❓
A 
1. 
Reactivation of latent VZV
⬇️ 
multiplication with a sensory ganglion 
⬇️
Travels down the sensory nerve to the skin
  1. T, most common in the elderly
  2. Vesicular lesions on the skin
  3. Post herpetic neuralgia
25
Q
  1. What methods can be used to prevent and control VZV❓
  2. How would you diagnose a case of VZV❓
  3. What treatment will you give❓
A
  1. Use of Varicella Immune Globulin
    Use of attenuated varicella/shingle vaccine
    Isolation
  2. Viral culture
    Antigen detection (immunoflourescence antibody staining)
    PCR
  3. Acyclovir for >18yrs
    children w severe dx
25
Q

CMV…

  1. Is transmitted via what routes❓
  2. Causes which infections❓
A 
1. 
Intra-uterine
Perinatal 
Blood transfusion
Organ transplantation
  1. Pneumonia
    Ocular infections
25
Q

What do you know about CMV❓

A
  • Most individuals are infected with in the first few years of life
  • Rarely causes disease in healthy pple
  • It is an infectious mononucleosis-like syndrome, with subclinical infections
  • Establishes lifelong latent infections
  • Viral shedding through pharynx and urine, months to years after primary infection
26
Q

What diseases can occur in a CMV infected immunocompromised pt❓

A

Intestinal pneumonia (most common)

Retinitis

Enteritis

Disseminated infection

27
Q

How would you diagnose a case of CMV❓

What treatment will you give❓

How can you control it❓

A
  1. PCR

Isolation of virus (human fibroblasts)

Antigen detection; pp65 assay (immunoflourescence)

Antibody detection (IgG past infection, IgM new infection)

  1. Ganciclovir
  2. Isolation of newborn

Screening of transplant donors and recipients for CMV antibody

28
Q

What do you know about EBV❓

A

Most pple are infected by adulthood

Causes immortalization of infected cell lines

Viral shedding occurs through saliva

29
Q

EBV/Infectious mononucleosis/Glandular Fever…

  1. Is transmitted via❓
  2. Initiates infection in the❓
  3. Is replicated in the❓
  4. Is reactivated by❓
  5. Has an incubation period of❓
  6. Presents clinically as❓
  7. Last for how long❓
A
  1. Close contact/Kissing
  2. Oropharynx
  3. Epithelial cells/surface B lymphocytes of pharynx and salivary gland
  4. Immunosuppression

4-7 weeks

6. 
Fever/Malaise 
Lymphadenopathy 
Sore throat 
Hepatosplenomegaly

2-4 weeks

30
Q

Which cancers can be caused by EBV❓

A

Nasopharyngeal ca

Burkitt’s lymphoma

Hodgkin’s disease

Non-Hodgkin’s lymphoma

Gastric ca

Oral hairy leukoplakia (esp on AIDS)

Lymphoproliferative disorders

31
Q

What tests will you order for if you suspect a case of EBV❓

A

PCR

Isolation of virus

Antibody detection (IgG/IgM/EBNA)

Heterophile antibody test/monospot

32
Q

List:

  1. Latent Phase antigens
  2. Late phase antigens

for EBV

A
  1. Latent Phase:
    EBNA (EBV nuclear antigens)
    LMP (late membrane proteins)
  2. Late Phase:
    VCA (Viral capsid antigens)
    Viral glycoproteins
33
Q

70-80% of pt with acute IM develop heterophil antibodies that agglutinate sheep RBCs

True or false

A

True

34
Q

Roseola/exanthem subitum

  1. Is caused by which HHV❓
  2. Is characterized by❓
  3. Reactivated by❓
A
  1. HHV6
  2. Fever (3days)
    Maculopapular rash from trunk➡️extremities
  3. Immunosuppression
35
Q

Give a brief description of the pox viruses

A
  • Large, complex structure
  • Brick-shaped/ovoid
  • dsDNA-carrying virions
  • 200 * 300nm
  • Envelope is not acquired by budding and not essential for infectivity
  • Replication occurs in the cytoplasm
36
Q

Small pox (orthopoxvirus)….

  1. Was eradicated in❓
  2. Presents clinically as❓
  3. Is a potential bioterrorist weapon, T/F❓
A

1979

Uniform papulovesicular rash that evolves to pustules over 1-2weeks

True

37
Q

Molluscum contagiosum (molluscipoxvirus)…

  1. Is transmitted via❓
  2. Has an incubation period of❓
  3. An infection presents clinically as❓
  4. Can be treated by❓
A

Direct skin to skin contact

2-8 weeks

2 to 10mm, benign, painless, nodular, pale, firm lesions in the epidermis

Curettage/careful removal of the central core w forceps

38
Q

Orf/Parapoxvirus of goat and sheep…

  1. Is acquired by❓
  2. Has a duration of infection of❓
  3. Presents clinically as❓
  4. Can be diagnosed using❓
A
  1. Close contact with infected animal
    Inoculation through cuts/abrasions
  2. About 35 days
  3. Begins as a vesicle
    Evolved into nodular mass
    Develops central necrosis
4. 
Clinical appearance 
Occupational history 
Serology 
Electron microscopy
39
Q
  1. Describe the epidemiology of monkeypox
  2. It’s similar to smallpox but milder, T/F❓
  3. Is transmitted by❓
  4. Has an incubation period of❓
  5. Clinical presentation❓
  6. Prodrome lasts for how long❓
  7. How would you treat Monkeypox❓
A

1.
Rare
Occurs in Central and West Africa

  1. True
  2. Contact w cutaneous/mucosal lesions of infected animals
    Contact with blood/body fluids of infected humans

5-21 days

5. 
Fever/malaise 
Headache 
Lymphadenopathy 
Enanthem on tongue and mouth

1-5days

  1. Isolation
    No specific treatment available
    Vaccine against smallpox (85% effective)
40
Q

A seeming presentation w monkeypox could also be❓

A 
Smallpox 
Chickenpox 
Measles
Bacterial skin infections
Scabies
Secondary syphilis
Drug related allergies
41
Q

Would tests would you request for to diagnose monkeypox❓

A 
Clinical presentation 
ELISA
Antigen detection tests 
PCR
Virus isolation

Microbiology (11 decks)

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