Herpes

Question 1

Most common route of transmission

Answer 1

Saliva, fluids

Question 2

What is their family

Answer 2

Herpesviridae

Question 3

Basic structure

Answer 3

Enveloped, double stranded 150KB- QUITE SMALL

Question 4

Method of infection

Answer 4

Lytic infection with a latent phase

Question 5

HSV Primary infection

Answer 5

Infects epithelial cells, causing shedding and infecting nerves

Question 6

HSV Reccurent infection

Answer 6

Virus was stored is spinal ganglion, travels down sensory neuron and causes shedding

Question 7

What growth state is the virus in when symptoms are visible?

Answer 7

Active- multiplying in mucosal tissue

Question 8

Virus responsible for primary oral herpes

Answer 8

HSV1 and HSV2

Question 9

Symptoms of primary oral herpes

Answer 9

Usually Asymptomatic in children

Can lead to severe gingivostomatitis in children and hospitalisation due to pain and nil by mouth

Question 10

Virus responsible or oral reactivation

Answer 10

Most commonly HSV1

Question 11

Symptoms of oral reactivation

Answer 11

Usually asymptomatic

Can cause cold sores on the vermilion of lip, rarely intraoral

Question 12

Reasons and characteristics for reactivation

Answer 12

Mostly random with non specific triggers
usually indicated with tingling and itching before active vesicles
lasts 5-10 days

Question 13

Virus responsible for primary genital herpes

Answer 13

HSV1 or HSV2

Question 14

Virus responsible for genital reactivation

Answer 14

HSV2

Question 15

Minor complications of HSV

Answer 15

Secondary bacterial infections (strep/staph)
Corneal Ulcers- scarring and loss of vision
Self limiting Meningitis

Question 16

What is Mollaret’s Meningitis

Answer 16

Recurring, asymptomatic meningits

Question 17

Major complications of HSV

Answer 17

Herpes simplex encephalitis- usually HSV1
Neonatal Herpes Simplex
Opportunistic infection in immunocompromised.

Question 18

What is Herpes simplex encephalitis?

Answer 18

very rare, general and focal signs of cerebral dysfunction.
Temporal lobe oedema
Prescribe aciclovir

Question 19

what is herpetic whitlow

Answer 19

caused in finger and thump sucking, heretic lesion and digits through contact
OF OCCUPATIONAL RELEVANCE

Question 20

Neonatal herpes

Answer 20

More probable if mother acquires primary herpes during pregnancy
If recurrent, low risk due to immunity

Question 21

Diagnosis of HSV

Answer 21

Direct Viral Detection via PCR

Question 22

Treatment of HSV

Answer 22

Aciclovir- oral but low bioabalibility for 5xday dose

Valaciclovir- Prodrug but expensive

Question 23

Risks of Herpes Simplex encephalitis and treatment

Answer 23

Must be treated with intravenous Aciclovir for min 10 days. High risk of relapse so repeated lumbar puncture recommended

Question 24

life cycle of Varicella Zoster

Answer 24

Replication in lymph nodes–> Primary viraemian–>Replication in liver/spleen–>secondary viraemia–> dissemination to skin

Question 25

How is Varicella Zoster spread?

Answer 25

Spread via secretions and fluid from vesicles. Infection via respiratory mucosa

Question 26

Progression of Varicella Zoster to Shingles

Answer 26

Latency period in the Dorsal ganglion of spine--> presentation in dermatomal pattern.

Question 27

Characteristics of VZV primary infection

Answer 27

CHICKEN POX prodrome of fever leading to centripetal distribution of lesions. ORALLY, can present before rest of body

Question 28

Progression of Chicken pox lesions

Answer 28

Macules (alteration of skin colour) Papule (Solid elevated lesion) Vesicle (elevation containing clear fluid, BLISTERS) Pustule (Elevation containing purulent exduate) ALL AT THE SAME TIME!

Question 29

How contagious is Chicken pox?

Answer 29

Attack rate in household 90% with significant contact of 15 min in same room Incubation period avg 14 days but infectious 2 DAYS PRIOR TO RASH

Question 30

Opthalmic Zoster

Answer 30

Nasocillary branch of trigeminal nerve | Can effect both side

Question 31

Post Exposure Prophlaxis of VZV

Answer 31

Retained for pregnant women and Immunocompromised IF significant contact occurs. 7 day delay before aciclovir treatment

Question 32

Varicella and Shingle vaccine

Answer 32

Both live attenuated so DON'T give to immunosuppresed Varicella in USA, boosts IgG VZV Shingles for all over 70s

Question 33

Cytomegalovirus (CMV)

Answer 33

relatively benign with a seroprevalence of 40% Spread through direct secretion contact. Primary CAN cause gladular fever

Question 34

Concerns of CMV

Answer 34

Although generally benign, severe diseases in the compromised Congenital infection risk at any stage, especially primary infection-->Hearing loss

Question 35

Characteristics of Epstein-Barr Virus

Answer 35

characteristic of mononucleosis infection- general icky feeling Young children- at most sore throat Adolescents- glandular fever WARNING- ONCOGENIC

Question 36

Developments of EBV

Answer 36

latent in lympocytes transmission via saliva and sex ORAL HAIRY LEUKPLAKIA IN IMMUNOSUPPRESED

Question 37

Roseola Infantum?

Answer 37

A rash presentation Herpes 6 and 7 6 is a particular issue in transplant patients as it can cause rejection

Question 38

What is Human Herpes Virus 8 associated with

Answer 38

Karposi's sarcoma | Highly associated with HIV and myeloproliferative cancers