HSV Infection: Causes and Symptoms
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Questions and Answers

Which of the following is a common site of HSV infection?

  • Liver
  • Genital mucosa (correct)
  • Brain
  • Lungs

    • What is a major cause of blindness worldwide?

  • HSV keratitis (correct)
  • HSV pneumonia
  • HSV esophagitis
  • HSV encephalitis

    • What is the name of the infection caused by HSV-1 or -2, affecting the fingers?

  • Herpes gladiatorum
  • HSV esophagitis
  • Herpes whitlow (correct)
  • HSV keratitis

    • Which virus is also implicated in the development of Bell palsy?

    <p>Varicella-zoster virus (VZV)</p> Signup and view all the answers

    What is the name of the infection spread through the sport of wrestling?

    <p>Herpes gladiatorum</p> Signup and view all the answers

    What percentage of Bell palsy cases were associated with Human herpesvirus (HHV6)?

    <p>60%</p> Signup and view all the answers

    What is the layer of delicate connective tissue around the myelin sheath of each myelinated nerve fiber?

    <p>Endoneurium</p> Signup and view all the answers

    What is the percentage of Bell palsy cases associated with HSV?

    <p>13%</p> Signup and view all the answers

    What is the typical duration of primary herpetic gingivostomatitis in otherwise normal patients?

    <p>10-14 days</p> Signup and view all the answers

    What is the common symptom of primary herpetic gingivostomatitis before the appearance of oral lesions?

    <p>Fever, loss of appetite, and malaise</p> Signup and view all the answers

    What is the typical location of oral lesions in primary herpetic gingivostomatitis?

    <p>All of the above</p> Signup and view all the answers

    What is a common complication of primary herpetic gingivostomatitis?

    <p>Difficulty with eating</p> Signup and view all the answers

    What is a characteristic of ulcers in primary herpetic gingivostomatitis?

    <p>They have scalloped borders and marked surrounding erythema</p> Signup and view all the answers

    What is the primary route of transmission of primary herpetic gingivostomatitis?

    <p>Through contact with saliva and other secretions</p> Signup and view all the answers

    What is a common scenario where asymptomatic shedding of HSV occurs?

    <p>Following dental treatment</p> Signup and view all the answers

    What is a common site of reactivation of HSV-1?

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

    What is the primary pathogen for herpes encephalitis and herpes pneumonitis?

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

    What is the recommended antiviral therapy for HSV seropositive patients undergoing hematopoietic cell transplantation?

    <p>Acyclovir 400 mg three times a day</p> Signup and view all the answers

    What is the common mutation seen in acyclovir-resistant HSV?

    <p>Mutated virally derived thymidine kinase</p> Signup and view all the answers

    What is the recommended alternative therapy for acyclovir-resistant HSV?

    <p>Foscarnet</p> Signup and view all the answers

    What is the primary infection caused by varicella zoster virus?

    <p>Varicella (chickenpox)</p> Signup and view all the answers

    Where does the varicella zoster virus typically become latent?

    <p>Dorsal root ganglia or ganglia of the cranial nerves</p> Signup and view all the answers

    What is the incubation period of varicella zoster virus?

    <p>2-3 weeks</p> Signup and view all the answers

    Which of the following groups of people is more likely to develop herpes zoster infection?

    <p>Elderly people</p> Signup and view all the answers

    What is a characteristic of ulcers in immunocompromised patients?

    <p>They are larger and often occur on non-keratinized sites</p> Signup and view all the answers

    What is the gold standard test for diagnosing HSV?

    <p>HSV isolation by cell culture</p> Signup and view all the answers

    What is the significance of a four-fold rise in IgG antibody titers?

    <p>It indicates active infection and is seen in 5% of patients</p> Signup and view all the answers

    What is the primary goal of management for primary HSV infection?

    <p>Supportive care and definitive treatment</p> Signup and view all the answers

    Why is biopsy of HSV lesions not performed?

    <p>Because the clinical appearance and history are characteristic, and infection is readily confirmed with a culture or cytology specimen</p> Signup and view all the answers

    What is the percentage of patients undergoing hematopoietic stem cell transplantation who experience reactivation of HSV?

    <p>70%</p> Signup and view all the answers

    What is the significance of elevated IgM titers?

    <p>It indicates primary HSV infection and occurs within days</p> Signup and view all the answers

    What is the advantage of real-time PCR over culture?

    <p>It is more sensitive and highly specific</p> Signup and view all the answers

    What is the duration for which these ulcers heal?

    <p>10-14 days</p> Signup and view all the answers

    Which nerve is involved in palatal lesions of herpes zoster?

    <p>V2</p> Signup and view all the answers

    What is a complication of HZI involving the geniculate ganglion?

    <p>Ramsay Hunt syndrome</p> Signup and view all the answers

    What is a laboratory method used to confirm a diagnosis of VZV infection?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of using direct fluorescent antibody testing?

    <p>To increase the sensitivity of the test</p> Signup and view all the answers

    What is a complication of HZI in patients with HIV disease?

    <p>Both A and B</p> Signup and view all the answers

    What is the goal of management of oral lesions of varicella and HZI?

    <p>All of the above</p> Signup and view all the answers

    What is a component of supportive care in the management of oral lesions of varicella and HZI?

    <p>Hydration</p> Signup and view all the answers

    Study Notes

    HSV Infection

    • Recurrent HSV results from reactivation at latent sites, traveling centripetally to mucosa or skin, causing localized vesicles or ulcers
    • Common sites of infection: oral, genital mucosa, and eye; HSV-1 above the waist, HSV-2 below the waist
    • Infections can cause:
      • Keratitis (major cause of blindness worldwide)
      • Herpes whitlow (infection of the fingers)
      • Herpes gladiatorum (infections of the skin spread through wrestling)
      • Herpes encephalitis
      • HSV esophagitis and pneumonia
      • Neonatal and disseminated infection
    • HSV is an etiologic agent in erythema multiforme
    • HSV has been recovered in the endoneurial fluid of patients with Bell palsy

    Primary Gingivostomatitis

    • Majority of primary HSV-1 infections are subclinical, occurring in children, teenagers, and young adults
    • Clinical manifestations:
      • 1-3 day prodrome of fever, loss of appetite, malaise, and myalgia
      • Oral pain leading to poor oral intake, requiring hospitalization for hydration
      • Disease is self-limiting in otherwise normal patients, resolving within 10-14 days
    • Oral findings:
      • Erythema and clusters of vesicles/ulcers on keratinized mucosa of hard palate, attached gingiva, and dorsum of the tongue
      • Vesicles break down to form ulcers that coalesce to form larger ulcers with scalloped borders and marked surrounding erythema
      • Gingiva is often erythematous, and the mouth is extremely painful, causing difficulty with eating
      • Pharyngitis causes swallowing difficulties

    Recrudescent Oral HSV Infection

    • Reactivation of HSV may lead to asymptomatic shedding of HSV in saliva and other secretions, an important risk factor for transmission
    • Reactivation of HSV-1 on the oral mucosa is common and usually asymptomatic
    • Ulcers are painful and similar to those seen in immunocompetent patients, except that they may be larger and occur on non-keratinized sites
    • Presence of 1-2 mm vesicles or satellite ulcers at the edges of the main ulcer is a helpful sign

    Laboratory Diagnosis

    • HSV isolation by cell culture is the gold standard test for diagnosis
    • Single swab of oral ulcers is performed
    • PCR from swabs detects HSV antigen 3-4 times more often than culture
    • Real-time PCR is highly sensitive and specific
    • Primary HSV infection is associated with elevated IgM titers that occur within days
    • Followed by permanent IgG titers that indicate previous infection but confer no protection against reactivation
    • Recurrent infection is associated with a rise in IgG antibody titer in acute and convalescent sera, but a four-fold rise is seen in only 5% of patients
    • Assay for HSV IgM is not particularly reliable for diagnostic purposes

    Management

    • Primary HSV infection:
      • Directed toward pain control, supportive care, and definitive treatment
    • HSV in immunocompromised patients:
      • Should be treated with systemic antivirals to prevent dissemination to other sites (e.g., HSV esophagitis) or systemically
      • Antiviral therapy such as acyclovir or valacyclovir at suppressive doses should be initiated for all patients who are HSV seropositive
      • Acyclovir-resistant HSV is most frequently seen in this group of patients, where the virally derived thymidine kinase that activates acyclovir is mutated
      • In such cases, foscarnet or cidofovir is effective

    Varicella-Zoster Virus Infection

    • Primary infection with varicella-zoster virus (VZV) leads to varicella (chicken pox)
    • The virus then becomes latent, usually in the dorsal root ganglia or ganglia of the cranial nerves
    • Reactivation produces herpes zoster infection (HZI), commonly called shingles
    • Incidence of HZI increases with age and the degree of immunosuppression
    • Involvement of V results in blisters and ulcers on the mandibular gingiva and tongue
    • Uncommon complications of HZI:
      • Ramsay Hunt syndrome (Bell palsy, vesicles of the external ear, and loss of taste sensation in the anterior two-thirds of the tongue)
      • Resorption and exfoliation of teeth and osteonecrosis of the jawbones, especially in patients with HIV disease

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    Description

    This quiz covers the recurrent HSV infection, its causes, symptoms, and common sites of infection. Learn about HSV-1 and HSV-2 and their impact on the body.

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