DNA Viruses 2: Herpesviruses

Question 1

What are some human infections the herpesvirus can cause?

Answer 1

chicken pox
mononucleosis
birth defect
cancer

Question 2

What are the primary infection, reactivation, and treatment of HSV-1?

Answer 2

Primary: Mouth or eye sores (can have genital sores)
Reactivation: cold sores, etc
Treatment: Acyclovir

Question 3

What are the primary infection, reactivation, and treatment of HSV-2?

Answer 3

Primary: Genital sores (can have mouth or eye sores)
Reactivation: Genital sores
Treatment: Acyclovir

Question 4

What are the primary infection, reactivation, and treatment of Varicella Zoster Virus (VZV)?

Answer 4

Primary: Chicken Pox
Reactivation: Shingles
Treatment: Acyclovir, vaccines

Question 5

What are the primary infection, reactivation, and treatment of Epstein Barr Virus (EBV)?

Answer 5

Primary: Mononucleosis
Reactivation: Lymphoma (in immunocompromised)
Treatment: Oncotherapy

Question 6

What are the primary infection, reactivation, and treatment of Cytomegalovirus (CMV)?

Answer 6

Primary: Mononucleosis (less common)
Reactivation: Systemic disease (in immunocompromised)
Treatment: Ganciclovir

Question 7

What are the primary infection, reactivation, and treatment of HSV-6, 7?

Answer 7

Primary: Roseola
Reactivation: Systemic Disease
Treatment: None

Question 8

How is herpesvirus classified?

Answer 8

DNA virus

Question 9

How does the herpesvirus egress?

Answer 9

exocytosis

Question 10

What is a major barrier to vaccines for herpes?

Answer 10

genomes are maintained throughout life

Question 11

What does herpes latency mean?

Answer 11

genome is present in cell, but not infectious virions are present

Question 12

Where is herpes latency established?

Answer 12

neurons

Question 13

What do HSV-1 (And HSV-2) primary infections often cause? what are the symptoms?

Answer 13

Meningitis

still neck, headache

Question 14

What do HSV-1 (And HSV-2) recurrent infections often cause? what are the symptoms?

Answer 14

encephalitis

fever, neurologic symptoms

Question 15

Which HSV is usually above the waist? Which is usually below the waist?

Answer 15

HSV-1 above the waist

HSV-2 below the waist

Question 16

what is prodrome?

Answer 16

In recurrent herpesviruses - itching and tingling at lesion site a day before the outbreak

Question 17

Can HSV be transmitted in the asymptomatic phase?

Answer 17

yes - periodic shedding

Question 18

How are HSV1 and 2 distinguished?

Answer 18

PCR or serology

Question 19

What are two drugs used for chemoprophylaxis for herpes?

Answer 19

Valtrex

Famvir

Question 20

How is the varicella zoster virus spread?

Answer 20

aerosol - highly contagious

Question 21

Where is the vericella zoster virus latent?

Answer 21

dorsal root ganglia neurons

Question 22

What are complications with the varicella zoster virus?

Answer 22

hepatitis
encephalitis
pneumonitis
bacterial infections of the lesions (MRSA, strep)

Question 23

What are complications of recurrent varicella zoster virus (shingles)?

Answer 23

Bell’s palsy
postherpetic neuralgia
retinitis

Question 24

What is herpes zoster ophthalmicus? What is a serious complication?

Answer 24

shingles on the face

can destroy retina

Question 25

What is the diagnosis of varicella zoster virus?

Answer 25

distinctive clinical signs | PCR, antigen, serology kits

Question 26

What is the treatment of varicella zoster virus?

Answer 26

not required if uncomplicated only effective first three days of outbreak Acyclovir - marginally effective

Question 27

What is the prevention of the varicella zoster virus?

Answer 27

live attenuated virus vaccine Varivax - varicella - age 1-50 Zostavax - zoster - age 50+

Question 28

How is the EBV transmitted?

Answer 28

saliva

Question 29

What cells does EBV infect? Where is it latent?

Answer 29

infects oral epithelial cells and B cells | latency in B cells

Question 30

How does EBV present in kids vs older teens?

Answer 30

kids - asymptomatic | teens - mono

Question 31

How many cases of EBV per year? How many hospitalized?

Answer 31

170,000 cases | 15% hospitalized

Question 32

What malignancies do EBV recurrences cause? In what population does this usually occur?

Answer 32

``` immunosupressed populaiton hodgkin lymphoma AIDS-associated non-Hodgkin Lymphoma Post-transplant lymphoproliferative disease Burkitt lymphoma Nasopharyngeal carninoma oral hairy leukoplakia ```

Question 33

How is infectious mono from EBV diagnosed?

Answer 33

clinical signs serology for heterophile antibodies blood smear for elevated WBCs and atypical lymphocytes

Question 34

How are malignancies from EBV treated?

Answer 34

treat symptoms alleviate immunosuppression oncotherapy

Question 35

What are antivirals and prevention of EBV recurrence?

Answer 35

none

Question 36

What are usual symptoms of cytomegalovirus?

Answer 36

asymptomatic | can have infection like mono

Question 37

What distinguishes symptomatic cytomegalovirus from mono?

Answer 37

no sore throat, have rash

Question 38

When is the risk for congenital cytomegalovirus highest?

Answer 38

When pregnant mother has primary infection

Question 39

what are transient outcomes of cytomegalovirus?

Answer 39

hepatomegaly, splenomegaly, jaundice, petechia and purpura, pneumonitis, fetal growth retardation, seizure

Question 40

What are permanent outcomes of cytomegalovirus?

Answer 40

microcephaly, vision loss, hearing loss, mental retardation, motor disabilities, seizures, death

Question 41

What groups of people are at highest risk of CMV?

Answer 41

immunosuppressed AIDS patients prior to antiretroviral therapy transplant recipients

Question 42

What herpes virus is a common cause of transplant failure and transplant patient mortality?

Answer 42

CMV

Question 43

How is CMV diagnosed?

Answer 43

serology, culture, PCR | some pregnant women are screened

Question 44

How is CMV treated?

Answer 44

antiviral drugs | ganciclovir, foscarnet, cidofir

Question 45

what is the prevention of CMV?

Answer 45

none | vaccine is highest priority in Institute of Medicine

Question 46

What do HSV 6,7 cause?

Answer 46

Roseola infantum (exanthem subitum)

Question 47

What is the age of peak incidence for infection with HSV 6,7?

Answer 47

infant - 7-13 months

Question 48

What are symptoms of infection with HSV 6,7?

Answer 48

3 day fever, faint rash on trunk

Question 49

what cells does HSV 6,7 infect? Where is it latent?

Answer 49

CD4+ T cells (both)

Question 50

How is roseola diagnosed?

Answer 50

clinical manifestations | rule out drug allergy

Question 51

What is the treatment for roseola?

Answer 51

none | avoid giving antibiotics

Question 52

What is the prevention for roseola?

Answer 52

none normal hygiene child may attend day care