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. Varicella-zoster (VZV)
2. HHV (6 & 7)
Alpha-subfamily latency location?
Sensory nerve ganglia
1. HSV1 (cold sore) : trigeminal ganglion
2. HSV2 (genital herpes) : sacral ganglion
Beta-subfamily latency location?
Monocyte & lymphocyte
Gamma-subfamily latency location?
1. Gingivostomatitis (cold sore)
2. Herpetic keratitis of eye --> corneal blindness
4. Genital herpes
5. Neonatal herpes
6. Herpetic whitlow
Which Herpes virus cause Encephalitis?
Passage fetus through infected birth canal
TORCHES cross blood-placenta barrier
1. Acyclovir 2. Valacyclovir 3. Famciclovir 4. Trifluridine eye drops (HSV1) --> corneal infection 5. Condom use (HSV2)
1. Tzanck prep 2. Viral culture 3. PCR 4. Serology 5. Direct Fluorescent Antibodies
Reveals multinucleated giant cells & intranuclear inclusion bodies
Direct Fluorescent Antibodies?
Ulcer base scrapings tested with antibodies against HSV. --> Antibodies attach HSV if present & fluoresce
1. Highly contagious * Aerosolized respiratory secretion (coughing, sneezing) * Contact ruptured vesicles 2. Zoster: reactivation from sensory ganglion
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
Other complications of immunocompromised pt with VZV?
Pneumonia & encephalitis
1. Acyclovir (48-72 hours)
2. Chickenpox vaccine
3. Zoster immune globulin --> reducing severity high risk individuals (4 days after)
1. Dew drops on rose petal
2. Tzanck prep --> multinucleated giant cells
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
Herpes Zoster opthalmicus
1. one-sided forehead
2. Blindness --> corneal involvment
Chicken pox vaccine?
1. Live attenuated 2. Two-dose series, subcutaneously * 12-15 months * 4-6 year age
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
1. Chronic burning, itching, shooting pain --> sensitivity to touch
Distinguish shingles & herpes?
1. Direct fluorescent antibody
2. VZV & HSV PCR
3. Viral culture
* VZV grows slowly vs. HSV grows readily
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
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
CMV Primary infection Symptoms?
1. Asymptomatic (latent phase)
2. Congenital disease (TORCHES) --> cross placenta
CMV complication in immunocompromised pt?
CMV can infect most organs
4. Disseminated disease
CMV complication in AIDS vs. transplant pt?
Marrow Transplant = CMV pneumonitis
AIDS = CMV retinitis
Congenital CMV syndrome
1. Skin rash --> blueberry muffin spots
5. Mental impair
CMV Diagnosis-Serology (IgG & IgM)
IgG & IgM
-/- : never had CMV
-/+ : primary CMV
+/- : previous infection (dormant)
+/+ : recurrent CMV
1. Serology (IgG & IgM)
2. Viral culture
* easy to grow BUT several days
4. Direct fluorescence test
CMV Diagnosis-Tissue Histology
* Intranuclear inclusion bodies
* Intracytoplasmic inclusions (smaller, multiple)
CMV treatment (immunocompromised pt)
1. Gancyclovir for CMV retinitis and infants
2. CMV-IG for pregnant women
3. No vaccine available
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
When should we use CMV-IG?
To treat pregnant women
Why there is currently no protection against CMV?
There is no vaccine available
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
Which herpes virus target mucosal epithelium?
1. HSV 1/2
Which herpes virus target B lymphocyte epithelia? (1)
Which herpes virus resides in B-cell during its latency period? (2)
Which herpes virus transmits through contacts? (5)
1. HSV 1
2. HSV 2
5. HHV 6
Which herpes virus results into central nervous system lymphoma in immunodeficiency pt? (1)
How herpes encephalitis occurs? (2)
1. blood-borne (hematogenous) spread
2. neuronal transmission
Which diseases rarely seen in HSV2? (3)
2. Herpetic Whitlow
3. Herpes Keratitis
Compare & Contrast HSV1 vs. HSV2 clinical manifestations
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
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
For pt suffering genital herpes, who has multiple partners, which treatment is recommended to prevent future complication?
Oral antiviral suppressive therapy
Which is the most common secondary complication seen in chicken pox?