Herpes Simplex Virus (HSV) Overview
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Questions and Answers

What is the most common cause of genital herpes?

  • HSV-2 (correct)
  • Varicella-zoster virus
  • Cytomegalovirus
  • HSV-1
  • What is a common manifestation in neonates infected with herpes simplex virus?

  • Infantile spasms
  • Chronic lung disease
  • Pneumonia with respiratory distress (correct)
  • Congestive heart failure
  • Which complication is most likely to occur with anal and perianal herpes?

  • Intracranial calcifications
  • Hemorrhagic syndrome
  • Vesicle formation on the face
  • Bacterial superinfection (correct)
  • What is the incubation period for the infection?

    <p>2-12 days (B)</p> Signup and view all the answers

    Which of the following symptoms is NOT commonly associated with early infection?

    <p>Fatigue (A)</p> Signup and view all the answers

    What is the mortality rate for neonatal herpes simplex virus infection?

    <p>65-80% (A)</p> Signup and view all the answers

    In which population is gingivostomatitis most commonly seen?

    <p>Children or young adults (D)</p> Signup and view all the answers

    What systemic manifestations can accompany early infection of genital herpes?

    <p>Fever and alteration of the general condition (D)</p> Signup and view all the answers

    What is a possible complication of ocular manifestations of herpes simplex infection?

    <p>Blindness (D)</p> Signup and view all the answers

    Which of the following can occur as a result of primary maternal infection before 28 weeks of gestation?

    <p>Spontaneous abortion (B)</p> Signup and view all the answers

    What characteristic does the vesicular eruption in genital herpes typically have?

    <p>Erythematous base evolving towards ulcerations (C)</p> Signup and view all the answers

    Which condition could result from autoinoculation after touching a herpes lesion?

    <p>Eczema herpeticum (B)</p> Signup and view all the answers

    Which type of herpes virus is primarily responsible for herpetic keratitis?

    <p>HSV-1 (B)</p> Signup and view all the answers

    What factor increases the risk of transmission of herpes simplex virus during delivery?

    <p>Primary infection during late pregnancy (D)</p> Signup and view all the answers

    Which symptom is associated with Herpes simplex encephalitis?

    <p>Hemorrhagic, necrotizing encephalitis (D)</p> Signup and view all the answers

    What is a common trigger for herpes gladiatorum?

    <p>Microabrasions in the skin (A)</p> Signup and view all the answers

    What is the primary site of infection for Herpes Simplex Virus 1 (HSV-1)?

    <p>Oral mucosa (B)</p> Signup and view all the answers

    Which population has the highest prevalence of HSV-2 infection?

    <p>Prostitutes (B)</p> Signup and view all the answers

    Through which method is Herpes Simplex Virus most commonly transmitted?

    <p>Direct contact with secretions (C)</p> Signup and view all the answers

    What immune response is initially triggered by a Herpes Simplex Virus infection?

    <p>IgM antibodies (C)</p> Signup and view all the answers

    What is the role of sensory nerve endings in Herpes Simplex Virus infections?

    <p>They transport the virus to nerve cell bodies. (C)</p> Signup and view all the answers

    What is indicated by the presence of IgM antibodies for HSV-1 and 2 in a serum test?

    <p>Primary infection or reactivation (A)</p> Signup and view all the answers

    Which condition can result due to the invasion of HSV into the central nervous system?

    <p>Herpes simplex encephalitis (B)</p> Signup and view all the answers

    When does viremia associated with Herpes Simplex Virus become more intense?

    <p>In infants born to infected mothers (B)</p> Signup and view all the answers

    Which diagnostic method can confirm the presence of HSV in vesicular lesions?

    <p>Polymerase chain reaction (PCR) (C)</p> Signup and view all the answers

    In what state does HSV reside after causing an initial infection?

    <p>Latent state in sensory ganglia (C)</p> Signup and view all the answers

    What change in cerebrospinal fluid (CSF) is most indicative of HSV encephalitis?

    <p>Lymphocytic pleocytosis (B)</p> Signup and view all the answers

    What is the recommended intravenous dosage of Acyclovir for herpes simplex encephalitis?

    <p>3x5 mg/kg/day (B)</p> Signup and view all the answers

    What is a characteristic finding in the brain MRI of a patient with HSV encephalitis?

    <p>Lesions predominantly in the temporal and frontal lobes (B)</p> Signup and view all the answers

    What is the mechanism of action of Acyclovir in treating HSV infections?

    <p>Inhibiting viral DNA polymerase (D)</p> Signup and view all the answers

    Which of the following treatments is recommended for severe skin and mucosa reactivations of HSV?

    <p>5 days of Valaciclovir (D)</p> Signup and view all the answers

    What long-term treatment is advised for patients with multiple HSV reactivations per year?

    <p>Valaciclovir or Famciclovir chemoprophylaxis (C)</p> Signup and view all the answers

    Flashcards

    HSV Infection Types

    HSV-1 (oral herpes) and HSV-2 (genital herpes) are infections of the skin, mucous membranes, and can sometimes affect the central nervous system.

    HSV-1 Prevalence

    HSV-1 is a very common infection worldwide, with a high percentage of adults having antibodies.

    HSV-2 Prevalence

    HSV-2 infection is less common than HSV-1, with a lower percentage of adults having antibodies. Risk factors include multiple sexual partners and prostitution.

    HSV Transmission

    HSV spreads via contact with oral secretions (e.g., kissing, shared utensils), genital secretions (sexual contact, oral sex), or mucocutaneous lesions; also, mother-to-child during pregnancy.

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    HSV Replication Pathways

    HSV replicates initially at entry points, then travels to nerve cell bodies in ganglia, and spreads throughout the body via the nervous system.

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    HSV Latency

    HSV stays inactive in the sensory ganglia. Reactivation can occur due to immune system weakness.

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    HSV-CNS Involvement

    HSV can invade the central nervous system (CNS) causing potentially life-threatening encephalitis, mainly through the nerve pathways.

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    HSV Immune Response

    The body initially fights HSV with IgM antibodies, followed by IgG; cellular immunity plays a vital role, especially in preventing reactivation of the infection.

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    HSV-1 vs HSV-2

    HSV-1 is typically associated with oral herpes (cold sores), while HSV-2 is primarily linked to genital herpes.

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    Neonatal HSV Infection

    This occurs when a newborn comes into contact with infected vaginal secretions during delivery. It can also happen transplacentally or postpartum.

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    HSV Reactivation

    The virus can become active again, causing symptoms even after a period of dormancy. This happens due to weakened immune systems.

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    HSV Symptoms

    Symptoms vary depending on location and infection stage. They can include fever, skin lesions (vesicles, ulcers), pain, dysuria, and neurological issues in severe cases.

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    HSV Treatment

    Antiviral medications are used to manage symptoms and reduce viral shedding. There is no cure for HSV infections.

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    HSV Complications

    Severe complications can include encephalitis, pneumonia, hepatitis, and neurological sequelae.

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    HSV Diagnosis

    Usually diagnosed based on clinical presentation and sometimes confirmed by laboratory tests.

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    Incubation Period

    The time between exposure to the HSV virus and the onset of symptoms can range from 2 to 12 days.

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    Early HSV Symptoms

    Early HSV infection can be asymptomatic or involve skin and mucous membrane lesions, sometimes accompanied by fever, body aches, and general weakness.

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    Gingivostomatitis / Herpetic Pharyngitis

    These infections are common in children and young adults, mostly caused by HSV-1, and involve sores in the mouth and throat.

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    Oro-Labial Herpes (Herpes Labialis)

    This is the most common form of recurrent herpes infection, marked by blisters around the mouth, often preceded by itching or burning.

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    Herpetic Whitlow (Herpes Panaritium)

    This infection affects fingers, particularly the index finger of the dominant hand, causing vesicles, swelling, redness, and pain.

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    Herpes Gladiatorum

    This infection is common in contact sports, caused by skin-to-skin contact with an infected person, resulting in blisters on various areas of the body.

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    Eczema Herpeticum

    This occurs when HSV infection affects someone with eczema, leading to widespread herpes lesions.

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    Herpetic Keratitis

    HSV can infect the cornea, resulting in potential blindness, characterized by pain, light sensitivity, and red eye.

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    HSV Diagnosis: Giant Cells

    Tzanck smears from vesicular (blister) lesions show giant cells with intranuclear inclusions, a characteristic of HSV infection.

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    HSV Diagnosis: Serum Antibodies

    Serum IgM antibodies against HSV-1 or 2 indicate a primary infection or reactivation. IgG antibodies indicate chronic infection, not necessarily current disease.

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    HSV Diagnosis: Viral Culture

    HSV can be grown in cell cultures, where it causes characteristic changes (cytopathic effect), confirming the presence of the virus.

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    HSV Detection: PCR

    Viral DNA can be detected in the fluid from blisters using a polymerase chain reaction (PCR) test, which amplifies viral DNA.

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    HSV Encephalitis: CSF Analysis

    Examining the cerebrospinal fluid (CSF) reveals increased white blood cells (lymphocytes) - a sign of inflammation, sometimes with red blood cells indicating bleeding in the brain.

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    HSV Encephalitis: CSF Changes

    In HSV encephalitis, protein levels in the CSF are moderately increased, while glucose levels remain normal, distinguishing it from other infections.

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    HSV Treatment: Acyclovir

    Acyclovir is an antiviral medicine that inhibits viral DNA polymerase, preventing the virus from replicating. It is used orally or intravenously depending on the severity of the infection.

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    HSV Prevention: Chemoprophylaxis

    Long-term treatment with Valaciclovir or Famciclovir is used to prevent recurrent outbreaks in people with frequent infections or those with weakened immune systems.

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    Study Notes

    Herpes Simplex Virus (HSV) Infections

    • HSV-1 and HSV-2 are alpha herpesviruses infecting skin, mucous membranes, and sometimes the central nervous system.
    • HSV-1 typically affects the head, while HSV-2 affects the genitals. Both can affect orofacial and genital areas.
    • The majority of adults have antibodies to HSV-1.
    • HSV-2 infection is less common, but prevalence in some high-risk groups is high (up to 90%).
    • Humans are the only reservoir for HSV.
    • Infection can be symptomatic or asymptomatic (subclinical), with viral shedding (saliva, genital secretions).
    • Transmission occurs through contact with oral secretions, genital fluids, or mucocutaneous lesions, including mother-to-child transmission.

    Pathogenesis

    • Mucosal surfaces or skin are the main entry points for HSV.
    • Viral replication occurs in the nerve endings, eventually traveling to nerve cell bodies in ganglia.
    • The virus spreads to other mucosal sites via sensory nerves.
    • HSV establishes latency in sensory ganglia.
    • Reactivation occurs due to immunodeficiency.

    Clinical Manifestations

    • Early Infection: May be asymptomatic or involve fever, malaise, myalgia, and skin/mucosal lesions.
    • Gingivostomatitis/Herpetic Pharyngitis: Often in children/young adults, presenting with fever, malaise, and oropharyngeal lesions (mouth ulcers).
    • Oro-Labial Herpes (Herpes Labialis): Common recurrent form, characterized by vesicles on the lips.
    • Herpetic Whitlow: Vesicles on fingers, often in individuals who practice contact sports.
    • Herpes Gladiatorum: Skin vesicles in individuals who participate in sports with close contact.
    • Eczema Herpeticum: HSV infection on eczema-prone skin.
    • Ocular Manifestations: Keratitis, with potential for blindness.
    • Herpes Simplex Encephalitis: Rare but severe, characterized by lesions often in the temporal and frontal lobes, potentially causing significant neurological damage.

    Visceral Herpes Infections

    • These involve internal organs (e.g., pneumonia, hepatitis, esophagitis).
    • More common in immunocompromised patients.

    Neonatal Herpes

    • Most commonly caused by HSV-2.
    • Transmission can occur during delivery through direct contact with maternal fluids or rarely across the placenta.
    • Severe illness, with potential for encephalitis, pneumonia, keratitis, sepsis, and high mortality/significant neurological sequelae in survivors.

    Congenital Herpes

    • Infrequent and often occurs before the 28th week of pregnancy.
    • Symptoms can involve birth defects and/or delays (central nervous system, sensory organs) or miscarriage.

    Diagnosis

    • Tzanck smears (giant cells), IgM antibodies (primary infection).
    • PCR for viral DNA.
    • CSF analysis (for HSV encephalitis).

    Treatment

    • Acyclovir (oral or intravenous) is the mainstay treatment. Treatment duration depends on severity, and complications.
    • Topical acyclovir creams may be used for cutaneous/mucosal infections.
    • Prevention strategies involve avoiding contact with infected individuals, as well as sexual precautions, and pregnancy management if indicated.

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    Description

    Explore the intricacies of Herpes Simplex Virus (HSV) infections, including HSV-1 and HSV-2, their transmission routes, and pathogenesis. This quiz covers key aspects of how the virus affects the body and the prevalence among different populations.

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