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Lect 3 - Herpes viruses hsv


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Lect 3 - Herpes viruses hsv

  1. 1. Herpesviruses
  2. 2. • Are a leading cause of human viral diseases; second only to influenza and cold viruses • The name herpes comes from the Greek word herpein which means to creep: creeping or spreading nature of the skin lesions • Can cause active disease or remain silent lifelong to be reactivated during periods of immunosuppression Herpesviruses
  3. 3. 1. Alphaherpesviruses  Herpes simplex virus (HSV-1 & 2)  Varicella zoster virus (VZV) 2. Betaherpesviruses  Cytomegalovirus (CMV)  Human herpes virus-6 (HHV-6 & 7) 3. Gammaherpesviruses  Epstein bar virus (EBV)  Human herpes virus-8 (HHV-8) Herpesviruses: subfamilies
  4. 4. Herpesvirus Particle • Enveloped double stranded DNA viruses (Linda Stannard, University of Cape Town, S.A.) Fried-egg appearance
  5. 5. Herpes Simplex Viruses (HSV)
  6. 6. Properties • Are very large viruses • Types: HSV-1 & HSV-2 • Man is the only natural host
  7. 7. Epidemiology • The virus is shed in saliva, tears, genital and other secretions: Spreads by: Kissing Sexual contact Use of utensils contaminated with saliva Mother to child during birth and postnatal Mother to fetus in utero
  8. 8. Replication of HSV
  9. 9. Replication of HSV
  10. 10. Primary infection • Is usually subclinical in most individuals • Generally HSV-1 causes infection above the waist and HSV-2 below the waist  40% of genital sores are due to HSV-1  5% of facial herpes are due to HSV-2 • HSV spreads locally and a short-lived viraemia occurs Pathogenesis
  11. 11. Pathogenesis
  12. 12. Latency in ganglia
  13. 13. Pathogenesis Reactivation occurs due to: Physical or psychological stress Infection Fever Irradiation including sunlight Menstruation • 45% of oral lesions • 60% of genital herpes
  14. 14. Clinical Manifestations 1. Acute gingivostomatitis 2. Herpes Labialis (cold sore) 3. Ocular Herpes 4. Herpes Genitalis 5. Other forms of cutaneous herpes 6. Meningitis 7. Encephalitis 8. Neonatal herpes
  15. 15. Sites of HSV 1 & 2 Infection Almost any human cell type can be infected by HSV
  16. 16. Oral-facial Herpes Acute Gingivostomatitis • The commonest manifestation of primary herpetic infection • Pain and bleeding of the gums • Ulcers with necrotic bases • Usually a self limiting disease which lasts around 13 days.
  17. 17. Herpes labialis (cold sore) • Is a recurrence of oral HS in about 45% of individuals • A prodrome of tingling, warmth or itching at the site • About 12 hours later, redness appears followed by papules and then vesicles Oral-facial Herpes
  18. 18. Ocular Herpes Mild superficial lesions of the external eye, to severe sight-threatening diseases of the inner eye. • Keratitis – dendritic ulcers • Conjunctivitis • Iridocyclitis, chorioretinitis
  19. 19. Genital Herpes • May be primary or recurrent • Infection sites can be the external genitalia, vagina, cervix, bladder, the sacral nerve routes • Redness on the external genitalia followed by itching papules and then vesicles • The lesions are prone to secondary infection e.g. S. aureus, Streptococcus and Candida albicans
  20. 20. Genital Herpes
  21. 21. Herpes Simplex Encephalitis (HSE) A serious complications • Global involvement of the brain • The brain is almost liquefied • The mortality rate approaches 100% • IV acyclovir is given in all cases of suspected HSE
  22. 22. Other Cutaneous Manifestations Eczema Herpeticum • A potentially serious disease that occurs in patients with eczema Herpetic Whitlow • Arise from implantation of the virus into the skin and typically affect the fingers Herpes Gladiatorum • This is contracted by wrestlers. • Spreads by direct contact from skin lesions on one wrestler to the other Herpetic Whitlow Herpetic Whitlow
  23. 23. Lab Diagnosis • Culture: requires a 3-7 days for result; has limitations • ELISA & IF to detect virus specific glycoproteins: same day result; can differentiate between HSV 1 & HSV 2 • ELISA & IF to detect antibodies: not useful in recurrent infections • PCR for HSV-DNA particularly in CSF in herpes encephalitis • Tzanck Smear: cells from base of ulcer are stained with Giemsa stain: Presence of multinucleated giant cells suggests HSV
  24. 24. Cytopathic Effect of HSV in cell culture: Note the ballooning of cells. Positive immunofluorescence test for HSV antigen in epithelial cell.
  25. 25. Management Only a few indications of antiviral chemo­therapy:  Severe primary infection  Sight­threatening ocular herpes  Herpes simplex encephalitis Acyclovir • I.V, Oral, Cream, Ophthalmic ointment