Flashcards in L72 Deck (26)
Both strain of herpes:
Small or large?
DNA or RNA?
Envelope or no?
Immune ok pts - more severe if IC
How does herpes replicate in the host?
Glycoprotein receptors (gD) engaged with host cells
Capsid enters cell
Synthesize viral DNA & proteins @ host nucleus
Assemble new viruses in host nucleus
Bud off host
What population is most likely to get HSV1 infections?
What population is most likely to get HSV2 infections?
Age not a limiting factor - throughout life
Infected mucosal surface shedding
HSV1 - oral or genital
HSV2 - genital
To infants during birth
Are condoms protective?
Partly - not 100% b/c of general groin infection
Describe the pathogenesis of herpes.
Into mucosal surface
Infect & replicate in epidermis & dermis
Infection moves into sensory & motor nerve endings
Moves up to ganglia and DORMANT here
Describe the pathogenesis of herpes reactivation.
IC, UV light, trauma, stress - induce reactivation
Virus moves out of ganglia --> down nerves --> cause mucosal lesions
Describe primary HSV 1 infection
Probably a kid - older more likely to be symptomatic:
- "Feeling sick"
- Mouth/lip PAINFUL lesions
What is the primary HSV1 infection in kids?
- Mouth, lips, tongue
What are the 6 primary HSV1 infection in adults?
1. Acute herpetic pharyngotonsillitis
2. Herpetic Whitlow (fingers)
3. Herpes galditorum (abraded skin)
4. Ocular herpes
5. Herpes hepatitis
6. Bell's palsy (CN 7)
How do you differentiate between acute herpetic pharyngotonsillitis and other pharynx/tonsillar diseases?
Can only differentiate this from other things by PCR but you probably won't b/c self-limited
Which form of ocular herpes are you most worried about?
Acute retinal necrosis
- Rapid progression --> blindness
Which form of ocular herpes causes dendritic lesions on the cornea?
What is a commonality for reactivation with HSV1 and HSV2?
If your initial infection was symptomatic, then you're likely to reactivate
What is unique about HSV1 reactivation?
Can have prodromal stage (tingling)
What are 3 the reactivation diseases for HSV1?
1. Oral-facial (aka mouth herpes is back)
3. Esophagitis that presents with PAINFUL swallowing + small, shallow lesions
What is unique in diagnosis to help you determine HERPES encephalitis?
High RBCs in CSF from lumbar puncture
MRI = necrotization of temporal lobe
What is the presentation for primary HSV2 infection?
PAINFUL genital ulcers
How do babies get herpes? What is the presentation?
During birth from infected mothers
High mortality if disseminated
High morbidity (cog defect) if neuro
How might HSV2 recur?
Often with thymidine kinase resistant strains
PCR - especially if CSF involvement
Direct fluorescence Ab - antigen-Ab complex if virus present
Treat severe primary infection
Valacyclovir 1000mg PO 2x day
Chronic suppressive therapy
Pt with recurrence 6+ times per year
Vala 500mg PO daily
Serious herpes infection treatment
IV acyclovir *nephrotoxic*