Herpesviruses HSV-1 and HSV-2, VZV

Herpes Simplex Encephalitis 2 cases/1,000,000 people in US, ______ are children, _______ adults older than 50, this is probably because the CTL response is ________ Almost all with cases are with _________ (90%) Herpes simplex virus travels up __________ or __________ nerves to the temporal or frontal lobes of brain. This is happen during a primary infection or during a _____________ of the virus. The virus replicates causing _________ of brain tissue. Prompt treatment is needed with __________ given intravenously. Without acyclovir, ______ die, with acyclovir, ______ die. but an have neurological deficits in the survivors. Can reoccur.

1/3 50% waning HSV-1 trigeminal or olfactory reactivation necrosis acyclovir 70% 10%

______ age 14-49 are infected with genital herpes (HSV-2)

16%

HSV and HSV02 share _________ genetic identity A person can be infected with both strain of virus In _________, the virus expresses a range of suppressive _________ but no proteins. These suppress viral lytic gene expression.

50% latency miRNA

While ______ of all genital herpes is caused by HSV-2, ______ is caused by HSV-1 (and this number is increasing). Why is this? It used to be that almost everyone got HSV-1 in childhood _______ they became sexually active and oral HSV-1 protects against acquiring _________ HSV-1. Now only 18%-35% of 5 year old are _________ for HSV-1 and by 30 years old 60% are positive. ________ is a big spreader of HSV-1 to the genital tract.

70% 30% before genital positive Oral sex

Varicella Zoster Virus Very communicable-_______ of susceptible in house hold will contract chicken pox Major spread ______________, lesions are also contagious. Varicella can be more serious in __________, with most common risk being _______. Defining is vesicular _____, lesions are present in all stages from just erupted to crusted over. Usually latent in _________, cranial nerves, and ___________ nervous system ganglia.

90% respiratory droplets adults, pneumonia rash dorsal root, autonomic

Really need to know that _____-_____ response in all herpes infections is critical to keeping the virus in check.

CD8-CTL

Remember ______ and ________ will go up the nerve retrograde axial transport to lay dormant-__________-no virus produced.

HSV VZV latent

Herpes Simplex Virus-HSV There are two types of HSV, _______ and __________ Both infect _______________ cells, cause lesions, and become latent in ____________ for oral and _______________ for genital

HSV-1, HSV-2 mucosal epithelial nerve ganglia/trigeminal ganglia Sacral ganglia

Genital herpes 40 million are seropositive for ______, all most all for genital infection. ______ of infected don't know they are. ___________ infections are common. It is most common to get HSV-2 from asymptomatic ________ Infection and lesions are present in _______ epithelium also some upper ______ and anal area. As in primary oral infections the primary infection is the _______ can result in ___________ swelling, fever, and more sores then will be present in reactivation events.

HSV-2 2/3 Asymptomatic Shedding genital thighs worst lymph node

______ tends to cause more recurrences and asymptomatic heading then __________

HSV-2 HSV-1

Varicella in Pregnancy can cause severe congenital ________ if are pregnant in the ________ trimester Also bad if get varicella _______ delivery. Both are very rare.

defects first before

Herpes Whitlow Can be common in _________-usually get from oral herpes, 5-8% of children and 1-2% of adults secrete herpes in saliva without visible sores. Herpes can be easily spread to others by someone who has _____________. Recurrences in ________ of cases. Gloves and hand washing are useful in prevention. Topical __________ or oral __________ are reduce symptoms

dentists herpetic whitlow 20%-50% acyclovir (x2)

Herpesviruses ________ linear, icosahedral, ___________ inactivated: detergents, acid, drying can have _______ and _______ infections

dsDNA enveloped lytic latent

has three parts to its replication cycle ________ _______ _______ _____________ stop viral DNA replication in the early/middle stage

early, middle, late or immediate early, early, late antivirals

Primary Ginvivostomatitis This is the _______ infection with oral HSV-1 (primary) HSV-1 is much more ____________ than HSV-2. It infects _____________, then travels up to the trigeminal ganglion and remain latent.

first common mucosal epithelium

Herpes labials-recurrent oral herpes Any reactivation/recurrent oral herpes after the primary infection are termed _____________. Usually less _______, lesions appear in same place as original lesions. Recurrence triggered by _______, _________ menstruation and can be triggered by __________, ___________ and root canal. Generally less severe and no _______ and lymph node swelling.

herpes labials severe stress, UV light dental procedures, oral surgery fever

Neonatal herpes Spreads from _______ to ________, most cases are due to primary infection while __________. Most cases cause by ________ but cases ______ are rising. Can also be caused by reactivation of existing infection. _________ of babies form with neonatal herpes are from woman and partner who don't have history for past genital herpes infection. Use of acyclovir can drastically reduce mortality.

mother, baby pregnant HSV-2, HSV-1 60-80%

It used to be taught that HSV-1 caused ___________ and HSV-2 caused _________. This is no longer true. For oral herpes the vast majority is caused by HSV-1. HSV-2 can cause oral herpes but it is rarely reactivates.

oral herpes genital herpes

Ocular herpes Ocular herpes can caused by ____________ oral herpes going to the eye or spread by _________ the eye and contaminating with HSV. Mot of the time resolves without problem. But can cause more serious infection that scar the cornea. The infection can also recur in ______ of the cases. Treatment is ___________ eye drops or oral _____________

reactivating touching 50% antiviral acyclovir

Herpes Zoster-Shingles Herpes Zoster/Shingles is caused by ______________ of varicella virus along ____________, usually 1 to 3 adjacent, thoracic, ophthalmic, and cervical most common. Can be very ________, lesions can be infectious, will cause the primary infection _____________ About _____ that have shingles can also have post _____________. This is where you continue to have mild to severe pain after resolution of lesions. This may last weeks, mouths and sometimes years. Greatest risk is people over _______. This is when the CTL response seems to be waning.

reactivation dermatomes painful chicken pox 1/3 herpetic neuralgia 50

Primary Ginvivostomatitis Symptoms include gingivitis and vesicle on buccal mucosa, also on the __________, ________, ________, lips and face. Vesicles break down into _______ or crust over on lips and face but usually don't scar. Last one to two weeks, an be very ________ and children may become dehydrated. There is often _______, and enlarged lymph nodes

tongue, hard palate, gingivae ulcers painful fever

The _____________ antivirals need to be activated by a protein found in an infected cell, a __________. They should only act on cells that are infected by the virus. _____________-is just a prodrug of acyclovir. It is metabolized in the body to acyclovir. It is used because it has a longer 1⁄2 life in the body. ___________ is the oral prodrug of penciclovir which is a topical ointment. ____________ is really just used for CMV infections and it also has a prodrug that has a longer 1⁄2 life in the body Valgancyclovir.

acyclovir viral kinase Valacyclovir Famciclovir Gancyclovir

For both oral and genital recurrent herpes sores-________ can be taken prophylactically or at first sings of outbreak _______, ________, and ____________ _________, and __________ can also be taken daily to help prevent outbreaks and transmission.

antivirals acyclovir, valacyclovir, famciclovir acyclovir, valacyclovir

Vaccine/Varicella IgG There is an _____________ now recommended for all children. Need ____ shots for complete prevention Also use the same shot for people over _______ just stronger to help prevent ______. But for herpes zoster the vaccine works only __________. Post exposure the vaccine can be given, if early enough, for some protection, but if contraindicated for the __________ vaccine, varicella IgG can be given for some protection.

attenuated vaccine two 60 shingles partially live-attenuated