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Herpesviruses Flashcards

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1
Q

Alpha Herpesviruses

A

Herpesvirus 1, 2, 3

1&2 = HSV

3= VZV

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2
Q

Gamma Herpesviruses

A

4 = EBV

**also #8?

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3
Q

Beta Herpesvirinae

A

Herpesvirus 5, 6, 7

5 = CMV

6 = HHV6

7 = HHV7

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4
Q

Herpesvirus genome and structure

A

dsDNA genome

  • Envelope, tegument, and capsid
  • Glycoprotein spikes
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5
Q

Herpesvirus produces proteins in what three phases

A
  1. Immediate Early proteins (alpha) regulate gene transcription
  2. Early proteins (Beta) DNA pol and TF’s
  3. Late Proteins (Gamma) = structural proteins
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6
Q

Herpesvirus envelope is from ______

A

the nucleus

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7
Q

Herpesvirus encodes what two enzymes

A

DNA-dependent DNApol

Thymidine Kinase

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8
Q

80% of Herpesvirus are ______

A

asymptomatic

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9
Q

Oral herpes (acute gingivostomatitis) incubation time

A

One week

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10
Q

Cold sores =

A

herpes labialis

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11
Q

Herpes labialis prevalence?

A

20-40%

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12
Q

Herpes Keratitis most frequent cause of ______

A

blindness

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13
Q

Major signs of herpes keratitis

A
  • Unilateral red eye
  • Vesicular skin rash
  • Folicular conjunctivitis
  • DENDRITIC CORNEAL ULCER (= hallmark sign)
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14
Q

Herpes keratitis Tx

A

Acyclovir cream 3%

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15
Q

Herpes Whitlow caused by

A

HSV 1 or 2

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16
Q

Herpes whitlow incubation period

A

2-20 days

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17
Q

Herpes whitlow infection characteristics (3)

A

Fever

Malaise

Treatmtent is SELF LIMITING

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18
Q

Herpes gladiatorum appearance and treatment

A

Head and neck blister cluster

Treatment is acyclovir

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19
Q

Eczema herpeticum epid, features, incubation, and Tx

A
  • Rare, usually children
  • Severe disseminated disease at pre-existing sites of skin damage
  • Incubation of 5-12 days
  • Tx = Acyclovir and ANTIBIOTICS to prevent 2’ infection
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20
Q

Genital Herpes systemic effects

A

Fever, flu-like symptoms, swollen lymph nodes

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21
Q

Genital HSV2 lasts about _______

A

one month

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22
Q

HSV encephalitis usually caused by

A

HSV1

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23
Q

HSV accounts for __% of all encephalitic viral infections

A

10-20%

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24
Q

HSV encephalitis phases

A

Prodrome = fever and nausea

Encephalopathy = either acute or subacute

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25
HSV encephalitis has a predilection for edema and hemorrhage in \_\_\_\_\_\_
temporal lobe
26
CSF appearance in HSV encephalitis
_Glucose and protein_ = mostly normal Elevated _WBC_ (mostly *lymphocytes*) _RBC_ found becaue of hemorrhage
27
HSV meningitis mostly caused by \_\_\_\_
HSV2
28
50% of HSV meningitis cases are _____ and 50% are \_\_\_\_\_
Primary and Secondary
29
HSV enceph vs. meningitis -- CSF appearance
Enceph has way higher RBC Meningitis has higher WBC and Protein
30
Neonatal herpes caused mostly by
HSV2
31
Neonatal HSV can be transmitted...
1. vertically from mom 2. from another neonate
32
Symptoms of neonatal HSV (after vs before birth infections)
_After Birth_ = Many confined to skin, eye, and mouth. **Encephalitis** in 35%. Disseminated in 25%. _Before birth_ = **Premature** birth, low **birthweight**, microcephaly, hydrocephalus, chorioretinitis, vesicular skin lesions
33
* HSV replicates in ______ cells. * Hangs out in the ______ and\_\_\_\_\_\_ ganglia. * Establishes \_\_\_\_\_\_\_\_
* epithelial * trigeminal and sacral * latency
34
HSV1 and 2 cause 3 types of infections:
1. **Lytic** (replication in mucoepithelial cells, disease @ lesion site) 2. **Latent** (neuronal) 3. **Persistent** (in lymphocytes and MQ
35
Cell death during HSV infection can result from \_\_\_\_\_, \_\_\_\_\_, or \_\_\_\_\_\_\_
1. Virus induced inhibition of cell molecules 2. DNA degradation 3. Cytoskeleton disruption
36
Other cellular hallmarks of HSV infection
* COWDRY bodies (acidophilic intranuclear inclusion) * Syncitia
37
Innate ___________ may be sufficient to limit HSV infection
innate protection by interferon
38
Antivirals for HSV
* Anything ending in "cyclovir" (A, Pen, Val, Fam) * Adenosine Arabinoside * Iodo-deoxyuridine * Trifluridine
39
Varicella is a result of _______ infection of VZV
primary
40
Varicella Pox appearance
vesicle, pustule, crust, scabbed lesions Lesions appear for 3-5 days
41
Varicella incubation period
about 2 weeks
42
When is chickenpox contagious?
**_2-3 days before rash appears_**
43
\_\_\_\_\_\_\_\_\_\_ can be observed during the course of chickenpox infection
ALL stages of lesions
44
Varicella rash characteristics and associated diseases?
* more prevalent on trunk * SCALP presence distinguishes it from other rashes * May cause **Interstitial PNA** in 20-30% of adults (from inflammatory rxn at site of lesion)
45
Herpes Zoster is a _______ infection of __________ Varicella
**recurrent** infection of **latent** VZV
46
Shingle rash is usually ________ and forms a \_\_\_\_\_\_\_\_\_\_
_unilateral_ forms a "_dermatomal pattern"_
47
VZV transmission via \_\_\_\_\_\_\_\_, rarely \_\_\_\_\_
_Inhalation_ Rarely _transplacental_
48
VZV initially infects the _________ and spreads to ________ by VIREMIA
respiratory tract RE system
49
Syncitia and intracellular inclusions occur in VZV because the virus...
is spread cell to cell
50
VZV is latent isn _________ or \_\_\_\_\_\_\_\_\_\_
DRG or Cranial nerve ganglia
51
Who is given VZV immunoglobulin? (3)
* IC patients * Exposed staff * neonates from infected mothers
52
VZV vaccine = \_\_\_\_\_\_\_
Live attenuated
53
VZV vax can be effective when given...
**post exposure** | (*antibodies* and *CMI* are stimulated)
54
VZV vaccination in adults is an effective means to...
**boost antibodies** to reduce onset of zoster
55
Epstein Barr Virus: Family/Herpesvirus type
Gammaherpesvirinae | (HHV-4)
56
EBV genomem, shape, and surface proteins
dsDNA icosahedral **gp350/220** + **gp110**
57
EBV gp350 surface protein forms \_\_\_\_\_\_\_\_\_, and binds to _____ receptor on B cells
Glycoprotein complex I **CD21** (CR2) on B cells
58
EBV internalization occurs by \_\_\_\_\_\_
Cytoplasmic vesicles
59
Three potential outcomes for EBV infection
1. **Replicate** in **B cells** or **epithelial** cells 2. **latent infection** of B cells 3. Stimulate and **immortalize B cells**
60
EBV transcription and translation start with _________ genes
Immediate-Early
61
Two types of EBV cellular infections
1. Permissive (Epithelial and B cell) 2. Nonpermissive (B cell)
62
Viral capsid and glycoproteins that are synthesized by EBV (3) during a **Permissive Epithial & B cell infection**
1. Early antigen (EA) 2. Viral Capsid Antigen (VCA) 3. Glycoproteins of the **membrane antigen** (MA)
63
EBV: Three viral genes that are expresed depending on the state of the B cell \*\*This is part of what type of B cell infection??\*\*
1. **EBNA's ** = E-B nuclear antigens 2. **LMP's** = Latent membrane proteins 3. **LP's** = Latent proteins \*\*Non-permissive B cell infection\*\*
64
What are EBNA's and LP's?
**DNA binding proteins** establish and maintain infection
65
What are LMP's?
Membrane proteins with oncogenic-like activity (stimulate and immortalize B cell)
66
EBV establishes latency in \_\_\_\_\_\_\_\_\_
**Memory B cells** in which only the **EBNA** and **LMP** are expressed
67
Purpose of the DNA binding protiens and LMPs (overall)
maintaining the genome in the B cells but **minimizing chance of immune recognition** of the infected cells
68
Permissive epithelial and B cell infection results in \_\_\_\_\_\_\_\_\_\_\_\_
Heterophile Antibody-Positive Infectious Mononucleosis (Mono)
69
Sx of infectious mononucleosis
lymphadenopathy, splenomegaly exudative pharyngitis (w **HIGH FEVER**)
70
Serious complications with mono:
* Laryngeal **obstruction** or splenic **rupture** * **_Meningoencephalitis_**
71
Anti EA and Anti VCA antobidies occur within \_\_\_\_\_\_\_\_\_\_, while anti EBNA antibodies are formed at about \_\_\_\_\_\_\_\_\_\_
One week 2 months
72
EBV incubation period is roughly \_\_\_\_\_\_\_\_\_
2 months
73
3 diseases from Non-Permissive B cell infection:
1. EBV-induced Lymphoproliferative Disease 2. Burkitt's Lymphoma 3. Nasopharyngeal Carcinoma
74
_EBV induced Lymphoproliferative disease_ characteristics (3) (CBC, immune response, and who is most likely to get it)
* **High B cell** lymphocytes * **Lack of T cell response** d/t immunosuppressive drugs * occur at **higher rates in heart and lung transplant** patients than those getting bone marrow or kidney/liver
75
Burkitt's lymphoma definition =
Agressive **monoclonal B cell lymphoma** of the jaw and face Affects children, **associated with HIV** (AIDS-associated malignancy)
76
NP carcinoma endemic in \_\_\_\_\_\_. Proliferation of _______ cells. Symptoms?
* **Asia + N. Africa** * **Epithelial cells** * Nasal discharge, nosebleed, PT tube obstruction, **Metastasis** to other organs
77
EBV transmitted by (3)
saliva, oral contact, fomites
78
Clinically, EBV causes _____ or ______ infections
Acute or latent
79
Acute EBV infection pathogenesis (three steps)
replication in **NP** cells spread to **Salivary** gland **VIREMIA** and **infection of RE system**
80
EBV latent infection: 1. Virus is present as _____ in B cell and epithelial cells. 2. Viral ______ rate is low 3. What cellular interaction causes this to occur?
* _Episome_ * _reactivation_ rate is low * happens from **NP cells** infecting **passing B cells**
81
B cell proliferation in EBV infection causes increase in \_\_\_\_\_\_\_\_\_\_
heterophile antibody
82
T cell activation during EBV infection results in \_\_\_\_\_\_\_\_\_\_
atypical lymphocytes called **DOWNEY CELLS** \*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*
83
What is a Downey Cell?
large lymphocye **due to antigen stimulation** Have basophilic cytoplasmic rim
84
Heterophile antibody results from activation of \_\_\_\_\_\_\_\_\_ When can it be detected/how long does it last?
_B cells_ detected at 1st week, can last several months
85
Heterophile is a great indication for whom?
Adults (not reliable in children)
86
What is a Paul and Bunnel test?
MonoSpot test detects Antibodies that cause **agglutination of RBC**'s from another species (horse)
87
\_\_\_% of adults have been infected with EBV by age 40
95%
88
Infants are susceptible to EBV when?
When mom's antibody protection wears off
89
EBV diagnostic tests (4)
1. Physical exam (look at SPLEEN) 2. CBC/CMP 3. MonoSpot test 4. Microscopy for Downey Cells
90
Explain the blood test to determine the stage of EBV infection. (4 stages)
1. No VCA antibodies = **susceptible** 2. IgM to VBA but no EBNA = **Primary infection** 3. VCA and EBNA antibodies = **Past infection** 4. Elevation of antibodies to EA in presence of EBNA antibodies = **REACTIVATION**
91
CMV family member (and class)
HHV5 Betaherpesvirinae
92
Three infections from CMV
1. Congenital CMV 2. Heterophile-negative mononucleosis 3. Diseases of Immunocompromised patients
93
Congenital CMV: _____ infection from mom is spread to placenta. \_\_\_\_\_\_\_ infection in mom rarely causes congenital abnormalities
Primary Reactivation
94
CMV may cause ________ or ________ symptoms Give some examples of both.
Temporary (liver, spleen, lung, seizure) Permanent (Hearing/vision loss, Microcephaly, Mental disability)
95
Heterophile-negative mono is similar to IM except for...
Paul-Bunnell test is **negative**
96
CMV diseases in immunocompromised patients include
pneumonia gastroenteritis **RETINITIS** encephalitis
97
CMV cellular hallmark
Cowdry bodies
98
What are Cowdry bodies?
giant **multinucleated** cells in CMV infection found in **Parotid** gland OWLS EYE appearance
99
CMV causes ______ infection in salivary, breasts, kidneys, and peripheral blood leukocutes. This leads to \_\_\_\_\_\_\_\_\_\_\_\_\_
Persistent infection Leads to chronic excretion by the organ involved.
100
CMV incubation period
4-6 weeks
101
CMV main sites of replication
**Salivary glands** and **Kidneys**
102
CMV control
no treatments, drugs possess many sides Drugs = **Ganciclovir**, valganciclovir, Foscarnet, cidofovir
103
HHV6 and HHV7, also known as...
Betaherpesvirinae (roseolovirus)
104
HHV6 infects what cells? Where does it replicate
lymphocytes, monocytes, epithelial and endothelial cells Replicates in salivary glands \*\*\*\*These are both similar to CMV\*\*\*\*
105
Roseola (6th disease) due to ____ more than \_\_\_\_\_\_
HHV6 more than HHV7
106
Roseola is a common _____________ disease affecting \_\_\_\_\_
acute febrile infants
107
When/where does Roseola rash appear?
After three days (after fever) appears on **neck, trunk, thighs**
108
\_\_\_\_\_ infections of Roseola (HHV6) can cause other complications, such as... What about IC patients?
_Primary_ infections can cause **encephalitis, lymphadenopathy,** and **hepatitis** \*\*May cause these things in Immunocompromised patients upon **reactivation**.
109
Another name for infantile Roseola
Exanthem subitum
110
Infection with HHV6 and 7 occur mainly during \_\_\_\_\_\_\_\_
childhood
111
Seroprevalence of HHV6 in 2 year olds approaches...
80%
112
HHV7 antibody prevalence in adults reaches \_\_\_\_%
98%
113
What is HHV8
Kaposi's Sarcoma-associated Herpes
114
HHV8 causes ____ or _______ infections It infects ____________ cells but multiplies in ________ cells
**latent** or **lytic** Infects **peripheral blood lymphocytes** but multiplies in **endo**/**epithelial** cells and **monocytes**
115
Kaposi's sarcoma is a ___ tumor form ______ lineage
**spindle cell tumor** derived from **endothelial cell** lineage
116
Kaposi Sarcoma locations
under skin, in oral lining, nose, and throat
117
Kaposi sarcoma can be limited to _____ or may...
mucocutaneous lesions or may spread to other otgans
118
Kaposi sarcoma cancer spreads to ___ or ____ causing bleeding and function issues
GI or lungs
119
HHV8 is a defining illness for what?
HIV/AIDS
120
HHV8 may be spread via what routes?
Sexual or Nonsexual nonsexual = poorly understood
121
HHV8 treatments (2)
1. Tumor **surgical excision** 2. **Irradiation**

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