Lecture 7: Herpes Virus

Question 1

Human herpesviruses all have 3 phases of disease

Answer 1

1. Primary infection
2. Latency
3. Reactivación
   a person may never experience or notice reactivation
   all human herpesviruses infect for life**

Question 2

Which human herpevirus establish latency in neurons

Answer 2

HSV-1
HSV-2
VZV

Question 3

Which human herpes virus establish latency in B lymphocytes

Answer 3

HHV-4 = EBV
HHV-8

Question 4

Herpetic gingivostomatitis
-herpes type
-manifestations
-reactivation

Answer 4

HSV-1
Sores on lips, gums, tongue, cheeks (inflamed gums)
Reactivates as herpes labiales

Question 5

Herpes labialis
-type of herpes
-latency where

Answer 5

Cold sores (fever blisters)
Reactivated from HSV-1 or HSV-2
Latency-trigeminal ganglion

Question 6

HSV in immunocompromised

Answer 6

Can manifest as chronic, necrotic ulcers with hemorrhagic crusts
-can become bilateral
-aggressive

Question 7

Genital herpes
-types of human herpes virus
-latency

Answer 7

Mostly due to HSV-2
Latency is established at the sacral ganglia

Question 8

Neonatal herpes
-type of human herpes virus

Answer 8

HSV-2
-can be acquired during birth
-primary infection in 3rd trimester

Question 9

Herpes diagnosis

Answer 9

Serology: (indirect way because measuring anti-bodies (IgM & IgG)
Elisa or western blot= differentiation between HSV-1 and HSV-2
PCR=
Differentiation between HSV-1 and HSV-2
TZANCK SMEAR shows CPE’s
CPE seen in HSV and VZV = inclusion bodies (“crowdy bodies) & syncytia

Question 10

Herpes treatment and prevention

Answer 10

-acyclovir
-Valcyclovir
-sun avoidance

Question 11

Human herpes virus-3
Also known as VZV
-genome
-capsule
-envelope
-reactivation

Answer 11

-genome: dsDNA
-Capsule: icosohedral
-envelope: yes
-reactivation: shingles (zoster)

Question 12

VZV pathogenesis
-initial
-latency
-reactivation

Answer 12

-chicken Pox
-sensory neuronal cells
-shingles (herpes zoster)

Question 13

Chickenpox manifestations

Answer 13

Maculopapular rash after 14 days post-infection
-begins in trunk-> face and extremities
Oral manifestation without scarring

Question 14

Herpes zoster/shingles (VZV)
-reactivation
-manifestations

Answer 14

-REACTIVATION after age of 60 from chickenpox (varicela = HHV-3)
-bilateral (only on one side of the body)
-severe pain, itching, and numbness followed by bilateral rash

Question 15

Herpes zoster (shingles) clinical presentation

Answer 15

Zoster refers to the characteristics localization of skin lesions = dermatome
Each dermatome is Innervated by a single sensory nerve

Question 16

Treatment for VZV
-Chickenpox
-shingles

Answer 16

Chickenpox = acyclovir within 24 hours
Shingles = acyclovir within 72 hours

Question 17

VZV prevention
-chickenpox
-shingles

Answer 17

Vaccines
Chickenpox= varivax
Shingles= shingrix (>50 y/o)

Question 18

Infectious mononucleosis
-which type of Human herpes virus
-capsule
-genome
-envelope

Answer 18

(Kissing disease)
(Epstein-Barr virus= EBV)
-TYPE= HHV-4
-icosahedral
-dsDNA
-envelope: yes

Question 19

Describe the EBV pathogenesis
(Infectious mononucleosis) and where is establishes latency

Answer 19

-infects B cells and epithelial cells of oropharynx
This obviously will cause your T cells to attack your infected B cells and kill them… resulting in symptoms of MONO.

-latency = memory B cells or sensory ganglion ????????? (See hong PowerPoint)

Question 20

EBV manifestations

Answer 20

-marked fatigue- lasts for weeks (up to 6 months)
-lymphadenopathy
-hepatosplenomegaly
-enlarged tonsils can obstruct the airway
-pharyngitis
rarely reactivates

HSV-4

Question 21

oral symptoms of EBV (infectious mono)

Answer 21

-halitosis (bad breath)
-pharyngitis with membrane formation
-petechiae on soft palate (this point was grabbed from photo)

Question 22

Oral hairy leukoplakia Is caused by which herpes?
What are the manifestations?

Answer 22

-happens from HHV-4 (EBV) most common in immunocompromised = AIDS
-White lesions on sides of tongue (often bilateral)!

Question 23

EBV is a virus of B cells linked to several forms of cancers, which are?

Answer 23

-gastric carcinoma
-Hodgkin’s disease

Question 24

CMV
-type of HHV
-Capsule
-genome
-Envelope

Answer 24

-HHV-5
-icosahedral
-dsDNA
-yes

Question 25

T/F: Most people become infected with CMV during their lifetime What about the Clinical disease of CMV?

Answer 25

True >90% of adults in most of the world are seropositive -Clincial disease: generally occurs in the immunocompromised (newborns, AIDS, organ transplants)

Question 26

CMV transmission -shedding -torch -most common route of transmission

Answer 26

Shedding = bodily fluids/secretions (urine, saliva, breast milk, semen, vaginal secretions, blood) Crosses the Placenta (TORCH) Most common: congenital, oral, sexual, organ transplant, blood transfusion

Question 27

Reactivation of CMV and its manifestations

Answer 27

**usually occurs in context of immuno suppression** -Oral CMV ulcers = painful solitary penetrating ulcers -CMV sialadentis = rare = painful swelling of major salivary glands, bilateral, decreased saliva, xerostomia *this makes sense since CMV establishes latency in salivary glands*

Question 28

CMV diagnosis

Answer 28

Direct microscopic observation Looking for CPE of “OWLS EYE” -perinuclear inclusion bodies and cytomegaly *this can be compared to the CPE of EBV which will have CPE of “Downey cells”*

Question 29

Diagnosing EBV

Answer 29

-About 10% of lymphocytes are atypical showing CPE of “Downey cells” = enlarged, mis-sharpen nuclei with increased cytoplasm -Heterophile antibodies elevated in cases of IM patients caused by EBV

Question 30

Kaposi’s sarcoma -capsid -genome -envelope

Answer 30

Kaposi’s sarcoma = HHV-8 -dsDNA -yes enveloped

Question 31

-Kaposi’s Sarcoma often is found in associate with? -can nonsexual transmission occur?

Answer 31

-found in association with HIV infection -Nonsexual transmission can also occur mostly through organ transplant

Question 32

Kaposi’s Sarcoma manifestations

Answer 32

-rare and malignant neoplasm of blood/blood vessels in Immunocompromised individuals -cancer -patches of abnormal tissue grow under the skin or mucous membranes (mouth, nose, anus) **lesions may be RED, PURPLE, BROWN, OR BLACK**

Question 33

Kaposi’s sarcoma oral manifestations

Answer 33

*Aside from patches of abnormal tissue growing under the skin, they can also grow in mucosa membranes.* **can occur in the absence of skin lesions** -oral manifestations (mucous membrane) occur on the hard palate or gingivae… if it happens on the soft palate then it is an advanced state of Kaposi’s sarcoma Color = RED OR PURPLE vascular lesions