Herpesviridae Flashcards Preview

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Flashcards in Herpesviridae Deck (52):
1

Transmission of HSV-1/HSV-2?

1. Direct contact

2. Sexually transmitted (HSV-2)

3. Sensory nerve --> sensory nerve ganglia --> sensory nerve --> skin lesions

2

Alpha-subfamily?

1. HSV1/HSV2
2. Varicella-zoster (VZV)

3

Beta-subfamily?

1. CMV

2. HHV (6 & 7)

4

Gamma-subfamily?

1. EBV

2. KSHV

5

Alpha-subfamily latency location?

Sensory nerve ganglia

1. HSV1 (cold sore) : trigeminal ganglion

2. HSV2 (genital herpes) : sacral ganglion

6

Beta-subfamily latency location?

Monocyte & lymphocyte

7

Gamma-subfamily latency location?

B cells

8

HSV1/HSV2 clinical?

1. Gingivostomatitis (cold sore)

2. Herpetic keratitis of eye --> corneal blindness

3. Encephalitis

4. Genital herpes

5. Neonatal herpes

6. Herpetic whitlow

9

Which Herpes virus cause Encephalitis?

1. HSV1/2

2. CMV

3. VZV

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10

Neonatal herpes?

Passage fetus through infected birth canal

11

TORCHES cross blood-placenta barrier

TO-Toxoplasmosis

R-Rubella

C-Cytomegalovirus

HE-Herpes, HIV

S-Syphilis

12

Treatment HS1/HS2?

1. Acyclovir 2. Valacyclovir 3. Famciclovir 4. Trifluridine eye drops (HSV1) --> corneal infection 5. Condom use (HSV2)

13

HS1/HS2 Diagnostics?

1. Tzanck prep 2. Viral culture 3. PCR 4. Serology 5. Direct Fluorescent Antibodies

14

Tzanck prep?

Reveals multinucleated giant cells & intranuclear inclusion bodies

15

Direct Fluorescent Antibodies?

Ulcer base scrapings tested with antibodies against HSV. --> Antibodies attach HSV if present & fluoresce

16

VZV transmission?

1. Highly contagious * Aerosolized respiratory secretion (coughing, sneezing) * Contact ruptured vesicles 2. Zoster: reactivation from sensory ganglion

17

VZV clinical (incubation, signs & symptoms, course of infection)

1. 10-21 days incubation period

2. Fever, headache, malaise

3. Rash: trunk & face --> then entire body (including mucous membrane)

4. Crops eruption (one forms one scabs over)

5. Last 7 days

18

Other complications of immunocompromised pt with VZV?

Pneumonia & encephalitis

19

VZV treatment?

1. Acyclovir (48-72 hours)

2. Chickenpox vaccine

3. Zoster immune globulin --> reducing severity high risk individuals (4 days after)

 

20

VZV diagnostic

1. Dew drops on rose petal

2. Tzanck prep --> multinucleated giant cells

21

Zoster (Shingles) clinical (reactivation VZV infection)

Painful eruption vesicles isolated to single dermatome --> Not crossing mid-line --> vesicles dry up and form crust --> painful in elderly

22

Herpes Zoster opthalmicus

1. one-sided forehead

2. Blindness --> corneal involvment

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23

Chicken pox vaccine?

1. Live attenuated 2. Two-dose series, subcutaneously * 12-15 months * 4-6 year age

24

VZV unique in comparison with other herpesvirus?

1. NO asymptomatic viral shedding --> Only shed from shingles lesions

2. Occurs in waves (crop) --> multiple stages at once

25

Post-herpetic neuralgia

1. Chronic burning, itching, shooting pain --> sensitivity to touch

2. Elderly 

26

Distinguish shingles & herpes?

1. Direct fluorescent antibody

2. VZV & HSV PCR

3. Viral culture

* VZV grows slowly vs. HSV grows readily

27

Treatment of Shingles and its complications

1. Shingles: acyclovir (48-72 hours)

2. Zoster/Shingles vaccine (age > 60): live attenuated vaccine

3. PHN: ibuprofen and/or corticosteroids --> pain control

28

CMV transmission

1. Infected body fulid:

* Milk, saliva, urine & tears

* Blood & organ transplant

* Mother to child

2. Prolonged exposure (eg: children in day care)

3. Sexual tranmission

29

CMV Primary infection Symptoms?

1. Asymptomatic (latent phase)

2. Congenital disease (TORCHES) --> cross placenta

30

CMV complication in immunocompromised pt?

CMV can infect most organs

1. Pneumonia

2. Retinitis

3. Esophagitis

4. Disseminated disease

31

CMV complication in AIDS vs. transplant pt?

Marrow Transplant = CMV pneumonitis

AIDS = CMV retinitis

32

Congenital CMV syndrome

1. Skin rash --> blueberry muffin spots

2. Hepatomegaly

3. Jaundice

4. Chorioretinitis

5. Mental impair

33

CMV Diagnosis-Serology (IgG & IgM)

IgG & IgM

-/- : never had CMV

-/+ : primary CMV

+/- : previous infection (dormant)

+/+ : recurrent CMV

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34

CMV Diagnosis

1. Serology (IgG & IgM)

2. Viral culture

* easy to grow BUT several days

3. PCR

4. Direct fluorescence test

35

CMV Diagnosis-Tissue Histology

Owl eye

* Intranuclear inclusion bodies

* Intracytoplasmic inclusions (smaller, multiple)

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36

CMV treatment (immunocompromised pt)

1. Gancyclovir for CMV retinitis and infants

2. CMV-IG for pregnant women

3. No vaccine available

37

When should we use Gancyclovir as treatment?

1. Which disease?

2. List two targeting populations 

1. Gancyclovir for CMV

2. Patients with retinitis and infants

38

When should we use CMV-IG?

To treat pregnant women

39

Why there is currently no protection against CMV?

There is no vaccine available

40

Compare viral culture of CMV, HSV and VZV?

1. HSV: readily grow

2. CMV: will grow but take some time

3. VZV: take a long time to grow

41

Which herpes virus target mucosal epithelium?

1. HSV 1/2

2. VZV

42

Which herpes virus target B lymphocyte epithelia? (1)

1. EBV

43

Which herpes virus resides in B-cell during its latency period? (2)

1. EBV

2. KSHV

44

Which herpes virus transmits through contacts? (5)

1. HSV 1

2. HSV 2

3. VZV

4. CMV

5. HHV 6

45

Which herpes virus results into central nervous system lymphoma in immunodeficiency pt? (1)

EBV

46

How herpes encephalitis occurs? (2)

1. blood-borne (hematogenous) spread

2. neuronal transmission

47

Which diseases rarely seen in HSV2? (3)

1. Encephalitis

2. Herpetic Whitlow

3. Herpes Keratitis

48

Compare & Contrast HSV1 vs. HSV2 clinical manifestations

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49

List 3 groups of HSV infections that should be treated with IV acyclovir

1. Patients with neonatal herpes

2. Herpes infection in immunocompromised host

3. Pts with encephalitis or meningoencephalitis

50

When should oral antiviral suppressive therapy is used to treat HSV Prophylaxis?

1. Pts with frequent painful oral/genital herpes recurrences

2. Pts with genital herpes: sexually active with uninfected partner

51

For pt suffering genital herpes, who has multiple partners, which treatment is recommended to prevent future complication?

Oral antiviral suppressive therapy

52

Which is the most common secondary complication seen in chicken pox?

Cellulitis