Sketchy Micro: Varicella Zoster Virus

Question 1

What kind of virus is VZV?

Answer 1

An enveloped dsDNA virus that is part of the herpesviridae family

(Think of the blue overtones and Hermes in the tree.)

Question 2

What is exanthum?

Answer 2

A widespread rash

Question 3

What symptoms are characteristic of primary herpes infection?

Answer 3

Headache, fever, and exanthum

Think of the kids sweating and holding their heads.

Question 4

VZV is transmitted by _______________.

Answer 4

respiratory droplets (like the kid spraying drops into the other kid’s mouth with a squirt gun)

Question 5

The rash caused by varicella is often described as ______________.

Answer 5

a cluster of vesicular rashes with erythematous bases (“dew drops on roses”) at different stages of healing

Question 6

Peripheral smears of a patient with VZV might show _______________.

Answer 6

multinucleated giant cells (the Tzank test)

Think of the kid with the toy tank in the audience.

Question 7

What symptoms might develop in an immunocompromised adult with VZV?

Answer 7

Encephalitis and pneumonia

Think of the man on the stage coughing with a red turban. He’s got a cane.

Question 8

What kind of vaccine is the VZV vaccine?

Answer 8

Live attenuated

Think of the “LIVE show” sign that is in the shape of a needle… it’s next to the kids.

Question 9

Who should receive treatment for VZV?

Answer 9

Immunocompromised patients and those older than 12 should receive acyclovir.

(Think of the blue recycling container.)

Question 10

VZV lies dormant in _______________.

Answer 10

the dorsal root ganglia (just like the person sleeping on the roots that are extending backward)

Question 11

What rash is characteristic of shingles?

Answer 11

Again, shingles presents with vesicles on an erythematous base

Question 12

If a young person presents with shingles and has no history of immunosuppression, what should you do?

Answer 12

Test them for HIV

Question 13

What is herpes zoster ophthalmicus?

Answer 13

Herpes of the V1 branch of the trigeminal nerve

This can lead to blindness.

(Think of the guy with the red eye patch.)

Question 14

The herpes zoster vaccine is a _____________ vaccine.

Answer 14

live attenuated

Think of the “LIVE show” sign next to the elderly people beneath the roof shingles.

Question 15

True or false: shingles vaccine cannot be given to AIDS patients.

Answer 15

False. Provided their CD4s are greater than 200, AIDS patients can be given shingles vaccine.

(Think of the “maximum occupancy 200” sign on the roof shingles.)

Question 16

What drugs can treat shingles?

Answer 16

Acyclovir, valacyclovir, and famciclovir

Think of the blue recycling bin, the violet recycling bin, and the FAMily wearing recycling shirts.

Question 17

What are signs of congenital varicella syndrome?

Answer 17

Limb hypoplasia (doll with short limbs) 
Cutaneous scarring in a dermatomal pattern (doll with stuffing coming out in a dermatomal pattern) 
Blindness (chicken pulling eye off doll) 

(There is a pregnant woman watching the chicken attack the little doll.)