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Parasitology/Virology > Herpes Virus > Flashcards

Herpes Virus Flashcards

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1
Q

What are the alpha herpesviruses?

A

HSV-1 (HHV-1)
HSV-2 (HHV-2)
VZV (HHV-3)

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2
Q

What are the beta herpesviruses?

A

CMV (HHV-5)
HHV-6
HHV-7

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3
Q

What are the gamma herpesviruses?

A

EBV (HHV-4)

HHV-8

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4
Q

What is a characteristic of alpha herpesviruses?

A

Blistering rash, neurotropic

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5
Q

What is a characteristic of beta herpesviruses?

A

Roseola viruses (CMV is transient)

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6
Q

What are the lymphotropic herpesviruses?

A

EBV, CMV, HHV-6, HHV-7, HHV-8

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7
Q

What is the difference between lymphotropic and neurotropic herpesviruses?

A

Lymphotropic - can infect epithelial cells

Neurotropic - can infect nerve cells

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8
Q

What is contained within the CMV tegument?

A

pp65 and mRNAs

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9
Q

What makes CMV genetic makeup unique compared to other herpesviruses?

A

Contains DNA and RNA

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10
Q

What is the function of immediate early genes of CMV?

A

Function in viral DNA synthesis
Do not require protein synthesis
Detected in nucleus within a few hours

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11
Q

What is the function of early genes of CMV?

A

Function in DNA replication and viral protein modification
Require protein synthesis for expression
Cytoplasmic and nuclear

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12
Q

What is the function of late genes of CMV?

A

Mostly structural gene products (capsid, tegument, envelope)

Cytoplasmic and nuclear

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13
Q

What cells get permissive infection of CMV?

A

Fibroblasts, epithelial cells, macrophages

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14
Q

What cells get latent infection of CMV?

A

Hemopoietic cells (including myeloid/macrophage progenitor cells in the bone marrow and liver)

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15
Q

What cells get persistent infection in CMV?

A

Lymphocytes, endothelial cells, stromal cells of he bone marrow

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16
Q

What is the leading infectious cause of birth defects in the US?

A

CMV

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17
Q

Who will exhibit clinical symptoms of CMV infection?

A

Immunocompromised patients
Older individuals (immunosenescence)
Neonates

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18
Q

What is the mode of transmission of CMV?

A

Bodily fluids

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19
Q

What are the clinical manifestations of CMV in immunocompetent host?

A

Asymptomatic (80-90%)
Mononucleosis (heterophile antibody negative)
Idiopathic thrombocytopenic purpura/hemolytic anemia

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20
Q

What are the clinical manifestations of CMV in immunocompromised host?

A

Retinitis - hemorrhagic
Hepatits
Gastroenteritis - primarily colitis and esophagitis
Pneumonia - diffuse interstitial/alveolar, “snow storm”
Glomerulopathy
Disseminated disease

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21
Q

What are rare manifestations of CMV infection?

A

Periventriculitis
Transverse myelitis/peripheral neuropathy
Cytomegalic inclusion disease of the newborn

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22
Q

How is CMV diagnosed?

A 
Rapid culture (Shell vial method)
Histopathology/immunocytochemistry
PCR
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23
Q

What do you need for a positive diagnosis of CMV?

A

Evidence of viral replication (positive shell vial culture or positive PCR)
AND
Systemic signs of disease (fever, leukopenia, thrombocytopenia, eleveated liver transaminases)

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24
Q

What can be used to prevent CMV infection?

A

Vaccine being developed

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25
What can be used to prevent CMV disease (prevent reactivation of already infected patients)?
Antiviral prophylaxis - ganciclovir, valganciclovir | Bolstering cell mediated immunity
26
What is most important in the immune response to CMV?
CD8 cytotoxic T cells
27
What is the primary treatment of CMV?
Ganciclovir | or valganciclovir, foscarnet
28
What cells are infected by EBV?
B lymphocytes and oral/nasopharyngeal epithelium
29
How does the DNA persist in cells latently-infected with EBV?
Episome
30
How does EBV result in malignant transformation?
Viral genome inserted into cell DNA
31
What are clinical manifestations of EBV infection in immunocompetent host?
Only 10% of infected persons become symptomatic Heterophile antibody positive mononucleosis Autoimmune disease - rash with ampicillin Pneumonitis Transverse myelitis/peripheral neuropathy Some Hodgkin's lymphoma
32
What is most important in the immune response to EBV?
CD8 cytotoxic T cells
33
What is the first antibody response (prior to symptoms) of EBV?
IgM/IgG antibodies to early antigens
34
What is the second antibody response (during symptoms) of EBV?
IgM antibodies to heterophile antigens
35
What is the subsequent antibody response (resolution) of EBV?
IgM/IgG antibodies to EBNA
36
What are clinical manifestations of EBV infection in immunocompromised host?
PTLD (post transplant lymphoproliferative disorder) Hairy oral leukoplakia Burkitt's lymphoma
37
How is EBV diagnosed?
Evidence of high EBV DNA by quantitative PCR Positive immunocytochemistry PLUS Systemic signs of disease - fever, pharyngitis, lymphadenopathy
38
How is EBV disease prevented (reactivation prevented in previously infected patients)?
Acyclovir Ganciclovir Valganciclovir
39
What is the treatment for EBV mononucleosis?
Supportive treatment | Corticosteroids for severe case
40
What is the treatment for EBV pneumonitis or EBV hairy leukoplakia?
Acyclovir
41
What is the treatment for Burkitt's lymphoma/nasopharyngeal carcinoma from EBV?
Chemotherapy/excision
42
What is the treatment for PTLD (post transplant lymphoproliferative disorder)?
Acyclovir, ganciclovir, non-specific immunoglobulin, alpha interferon Anti-CD20 Rituximab
43
Is VZV lymphotropic or neurotropic?
Neurotropic - reactivation associated with pain or paresthesias
44
What cells does VZV infect?
Epithelial cells - vesicular (blistering) rash
45
What are the stages of VZV infection?
``` Primary infection - chicken pox Latency (90% dorsal root or cranial nerve ganglia, 10% anterior horn cells) Reactivated infection (shingles) ```
46
Who is most susceptible to VZV complications?
Most frequent in immunocompromised patients | Also frequent in immunocompetent adults
47
What are complications of chicken pox?
Most commonly involve CNS, lungs, or liver Reye's syndrome - associated with aspirin Hemorrhagic chicken pox in immunocompromised host
48
What is shingles?
Vesiculopustular rash involving 1-2 contiguous dermatomes | Prodromal paresthesias or pain
49
What are complications of shingles in immunocompetent host?
Post-herpetic neuralgia Decreased vision/blindness (5th cranial nerve) Encephalitis associated with 5th cranial nerve Ramsey-Hunt syndrome (geniculate ganglion)
50
What are complications of shingles in immunocompromised host?
Disseminated disease
51
How is VZV diagnosed?
Physical diagnosis/history | If doubt after physical: Pap smear of skin lesion, direct fluorescent antibody (DFA) of skin lesion, PCR of CSF
52
How is VZV infection/disease prevented?
Oka vaccine (live/attenuated) - Prevent chicken pox in nonimmune children and adults - Prevent shingles in elderly VZIG - Prevention of chicken pox in nonimmune immunocompromised patients (newborns of mothers with chicken pox)
53
What is the treatment for chicken pox/shingles in immunocompetent host?
Acyclovir | within 24 hrs for chicken pox, within 72 hrs for shingles
54
What is the treatment for chicken pox/shingles in immunocompromised host?
Acyclovir IV
55
What cells does HHV-6 infect?
Lymphocytes, epithelial cells, and monocytes/macrophages
56
What is the clinical presentation of HHV-6?
Exanthem subitum (roseola) - in children In adults and children: - Mononucleosis (heterophile antibody negative) - Meningitis, encephalitis, pneumonitis, hepatitis - Bone marrow suppression - delayed bone marrow engraftment in BMT patients
57
How is a diagnosis of HHV-6 disease made?
Characteristic rash (Exanthem subitum - roseola) immediately after 1-2 days of high fever Serology PCR
58
What is the treatment of HHV-6 disease?
Ganciclovir, foscarnet, and cidofovir
59
What cells does HHV-8 infect?
Urogenital and gastrointestinal epithelial cells
60
What differentiates HHV-8 from other lymphotrophic herpes viruses?
Also angiotrophic
61
What form is the DNA in latent HHV-8 infection?
Episome
62
What are clinical manifestations of HHV-8?
Kaposi's sarcoma Primary effusion lymphoma (PEL) Multicentric Castleman's disease (MCD)/B cell lymphoma
63
What immunologic response is important in HHV-8?
T cell mediated immune response
64
How is HHV-8 diagnosed?
Serology | PCR
65
What is treatment of cutaneous Kaposi's sarcoma from HHV-8?
Ganciclovir, valganciclovir, foscarnet
66
What is treatment of visceral Kaposi's sarcoma or lymphoma from HHV-8?
Chemotherapy and irradiation
67
What is treatment of other manifestations of HHV-8?
Improve cell mediated immunity

Parasitology/Virology (19 decks)

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