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HERPESVIRUSES
Herpesviruses
• Members of this family often cause life-long
latent recurring infections which progress
slowly.
• Types:
– Herpes simplex viruses (HSV-1 & HSV-2).
– Varicella-Zoster virus.
– Epstein Barr virus (EBV).
– Cytomegalovirus (CMV).
– Human herpes virus 6, 7, 8.
HSV-1 & HSV-2
Similar in morphology & structure, but:
– HSV-1 lesions: above the waist.
– HSV-2 lesions: below the waist.
Pathogenesis & Clinical Picture
Primary HSV Infections
(Exposure to the virus for the first time)
• Probably transmitted by direct contact.
• Involves the mucous membrane of the mouth, lips,
skin of face, nose, eyes and genital tract.
• Clinically, appears as painful vesicles on an
erythematous base, vesicles rupture and its
contents dry forming crusts which finally heal
(within 7-10 days) without scarring (together
with fever & enlarged lymph nodes).
Pathogenesis & Clinical Picture
Latent Infections
• Replication occurs at the site of the entry of
the virus in the epithelium.
• Virus particles are transported along the
axons to the sensory (dorsal root) ganglion
where some virus particles are able to
establish a latent infection.
• HSV-1 latency is in the trigeminal ganglion
while in HSV-2 latency is in the sacral ganglia.
• Latency remains for the life-time of the host.
Pathogenesis & Clinical Picture
Reactivation & Recurrence
• Reactivation of the latent virus:
– may be restricted to asymptomatic shedding.
– or may produce clinically obvious disease (at any
site innervated by the affected neurons).
• Provoked by various stimuli: fever, UV
exposure, sunlight, trauma, stress, immuno-
suppression and in case of HSV-2 by sexual
intercourse.
Clinical Types of HSV Infection
I- HSV-1 Diseases
• Acute Gingivostomatitis (commonest).
• Recurrent herpes labialis (cold sores).
• Encephalitis (most serious).
• Keratoconjunctivitis: may lead to corneal ulcers,
scarring & blindness.
• Herpetic whitlow (felon) is a pustular lesion of
the distal phalynx of a finger or hand (e.g.
dentists), characterised by pruritis, burning
sensation & pain.
• Disseminated infections: e.g. pneumonia as in
AIDS patients.
Herpetic
Gingivostomatitis
Herpes Labialis
Cold Sores Cycle
Laboratory Diagnosis of HSV Infections
• Isolation of the virus on tissue culture.
• Direct detection of HSV in vesicle fluid by
electron microscopy.
• Detection of viral DNA by PCR.
• Detection of viral antigen by direct
immunofluorescence or ELISA.
• Serological diagnosis to detect IgM antibodies
that indicates recent infection or reactivation.
Treatment
• Idoxuridine (IDU) topically is used in the
treatment of eye and skin infections.
• Acyclovir & vidarabine: inhibit viral DNA
synthesis. Acyclovir (Zuvirax) is available for
topical, oral and I.V. use.
• Foscarnet:
– inhibit HSV DNA polymerase.
– Used in treating acyclovir-resistant HSV
infections.
VARICELLA-ZOSTER VIRUS
(VZV)
VARICELLA-ZOSTER VIRUS
(VZV)
• Infection with VZV presents in two
clinical forms:
–The primary infection; varicella
(chickenpox) is a generalized eruption.
–The reactivation infection; zoster
(shingles) is a localized form.
Pathogenesis & Clinical Features 1
1. Varicella (Chickenpox)
• The virus enters by droplet infection (IP: 2 weeks).
• The typical rash of varicella appears first on the
trunk then spread to the face & limbs.
• The skin rash is initially macular & rapidly evolves
through papules to clear vesicles.
• The vesicles changes to pustules which dry to form
scabs which heal without scar formation.
• Oral lesions: consist of small ulcers surrounded by
erythema. Vesicles rupture & are rarely noticed.
Varicella (Chickenpox)
Pathogenesis & Clinical Features 3
2. Zoster (Shingles)
• It’s a peripheral nerve cell infection with an eruption in
the overlying epidermis.
• It results from reactivation of latent varicella infection in
the neurons.
• The disease usually occurs in older people.
• It manifests as painful vesicular eruption, unilateral &
confined to one dermatome, usually thoracic or lumbar.
• Oral zoster: affect the anterior half of the tongue, soft
palate & cheek with very painful ulcers with
eryhthematous borders.
Zoster (Shingles)
Treatment
• Acyclovir (IV) is effective in the
treatment of varicella & zoster.
• It is not used for all cases, but
indicated in the following conditions:
– Immunocompromised patients.
– Ophthalmic zoster (to avoid corneal
scarring).
– Varicella complicated by pneumonia.
– Neonatal infection.
Prevention & Control
• Acyclovir & interferon: are
given to immune deficient children.
• VZ immune globulin (VZIG):
should be given to contacts of cases.
• Live attenuated varicella
vaccine (Varivax): given as one
S.C. dose for children 1-12 years of
age.
EPSTEIN-BARR VIRUS (EBV)
• Widespread & mostly asymptomatic.
• The virus is excreted & transmitted via
the saliva & multiply in the
oropharyngeal mucosa.
EBV Diseases
• Infectious mononucleosis (glandular
fever).
• Others:
– Nasopharyngeal carcinoma.
– Burkitt’s lymphoma.
– Oral hairy leukoplakia (in AIDS patients).
– Hodgkin’s disease.
– T-cell lymphoma.
Infectious Mononucleosis
(Glandular Fever)
Pathogenesis & Clinical Features
• Incubation period: 30-50 days.
• Fever, sore throat, skin rash & cervical
lymphadenopathy which becomes generalized
with or without hepatosplenomegaly.
• Oral lesions:
– Early, throat is painful & congested.
– Petechial hemorrhages may be seen on the palate.
– Oral mucosa may show white pseudomembrane then oral
ulceration may occur with submandibular lymphadenitis & mild
fever.
Laboratory Diagnosis
1.Blood picture: A high total leucocytic count (up to
25,000/cmm) with predominant monocytes & atypical
lymphocytes.
2.Detection of heterophil antibodies: which
agglutinate sheep or horse RBCs (Paul Bunnell test or
monopost test).
3.Definitive diagnosis requires the demonstration of
IgM to EBV capsid antigen or rising titre of IgG to
both viral capsid antigen (VCA) or EB nuclear antigen
(EBNA).
4.Detection of EBV nucleic acids in patient’s saliva or
throat washing (e.g. by PCR).
Prevention & Control
A subunit vaccine
is under trial.
CYTOMEGALOVIRUS (CMV)
– The name “cytomegalovirus“ was chosen on
account of the swollen state of virus-infected
cells.
– The virus is widespread.
Transmission of CMV
– Transplacental (congenital).
– Other methods:
• Close contact
• Sexual intercourse
• Breast feeding
• Blood transfusion
• Organ transplantation
Human Herpes Virus 6 (HHV6)
• HHV6 is the cause of a common disease
of infancy called roseola infantum.
• It is characterized by high fever & skin
rash.
Human Herpes Virus 7 (HHV7)
• HHV7 is associated with:
– persistent salivary glands infection
– & may cause fatal encephalitis.
Human Herpes Virus 8 (HHV8)
HHV8 causes
Kaposi’s
sarcoma in
patients with
AIDS.
Coxsakieviruses (A & B)
• They cause:
– Aseptic meningitis.
– Herpangina (sore throat with papulovesicular lesions on
the palate, dysphagia, anorexia & stiff neck).
– Hand-foot & mouth disease.
Mumps
• Acute disease of children.
• Transmitted by droplets.
• Characterised by parotitis.
• Prevention: LAV (either singly or included
in MMR vaccine).
Measles
• Acute highly infectious disease of children.
• Transmitted by droplets.
• Characterised by fever, sneezing, coughing, ocular
pain & Koplik’s spots (bluish-white spots on the inside of
cheeks opposite the lower molar teeth) & maculopapular
skin rash.
• Prevention: LAV (either singly or included in MMR
vaccine), human Igs for susceptible contacts.
Human Papilloma Virus (HPV)
د حاتم البيطار استشاري وجراح الفم والاسنان 01005684344 اتصل للحجز بالعيادة محاضر طبي Dr.Hatem EL-Bitar

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  • 2. Herpesviruses • Members of this family often cause life-long latent recurring infections which progress slowly. • Types: – Herpes simplex viruses (HSV-1 & HSV-2). – Varicella-Zoster virus. – Epstein Barr virus (EBV). – Cytomegalovirus (CMV). – Human herpes virus 6, 7, 8.
  • 3. HSV-1 & HSV-2 Similar in morphology & structure, but: – HSV-1 lesions: above the waist. – HSV-2 lesions: below the waist.
  • 4. Pathogenesis & Clinical Picture Primary HSV Infections (Exposure to the virus for the first time) • Probably transmitted by direct contact. • Involves the mucous membrane of the mouth, lips, skin of face, nose, eyes and genital tract. • Clinically, appears as painful vesicles on an erythematous base, vesicles rupture and its contents dry forming crusts which finally heal (within 7-10 days) without scarring (together with fever & enlarged lymph nodes).
  • 5. Pathogenesis & Clinical Picture Latent Infections • Replication occurs at the site of the entry of the virus in the epithelium. • Virus particles are transported along the axons to the sensory (dorsal root) ganglion where some virus particles are able to establish a latent infection. • HSV-1 latency is in the trigeminal ganglion while in HSV-2 latency is in the sacral ganglia. • Latency remains for the life-time of the host.
  • 6. Pathogenesis & Clinical Picture Reactivation & Recurrence • Reactivation of the latent virus: – may be restricted to asymptomatic shedding. – or may produce clinically obvious disease (at any site innervated by the affected neurons). • Provoked by various stimuli: fever, UV exposure, sunlight, trauma, stress, immuno- suppression and in case of HSV-2 by sexual intercourse.
  • 7. Clinical Types of HSV Infection I- HSV-1 Diseases • Acute Gingivostomatitis (commonest). • Recurrent herpes labialis (cold sores). • Encephalitis (most serious). • Keratoconjunctivitis: may lead to corneal ulcers, scarring & blindness. • Herpetic whitlow (felon) is a pustular lesion of the distal phalynx of a finger or hand (e.g. dentists), characterised by pruritis, burning sensation & pain. • Disseminated infections: e.g. pneumonia as in AIDS patients.
  • 10. Laboratory Diagnosis of HSV Infections • Isolation of the virus on tissue culture. • Direct detection of HSV in vesicle fluid by electron microscopy. • Detection of viral DNA by PCR. • Detection of viral antigen by direct immunofluorescence or ELISA. • Serological diagnosis to detect IgM antibodies that indicates recent infection or reactivation.
  • 11. Treatment • Idoxuridine (IDU) topically is used in the treatment of eye and skin infections. • Acyclovir & vidarabine: inhibit viral DNA synthesis. Acyclovir (Zuvirax) is available for topical, oral and I.V. use. • Foscarnet: – inhibit HSV DNA polymerase. – Used in treating acyclovir-resistant HSV infections.
  • 13. VARICELLA-ZOSTER VIRUS (VZV) • Infection with VZV presents in two clinical forms: –The primary infection; varicella (chickenpox) is a generalized eruption. –The reactivation infection; zoster (shingles) is a localized form.
  • 14. Pathogenesis & Clinical Features 1 1. Varicella (Chickenpox) • The virus enters by droplet infection (IP: 2 weeks). • The typical rash of varicella appears first on the trunk then spread to the face & limbs. • The skin rash is initially macular & rapidly evolves through papules to clear vesicles. • The vesicles changes to pustules which dry to form scabs which heal without scar formation. • Oral lesions: consist of small ulcers surrounded by erythema. Vesicles rupture & are rarely noticed.
  • 16. Pathogenesis & Clinical Features 3 2. Zoster (Shingles) • It’s a peripheral nerve cell infection with an eruption in the overlying epidermis. • It results from reactivation of latent varicella infection in the neurons. • The disease usually occurs in older people. • It manifests as painful vesicular eruption, unilateral & confined to one dermatome, usually thoracic or lumbar. • Oral zoster: affect the anterior half of the tongue, soft palate & cheek with very painful ulcers with eryhthematous borders.
  • 18. Treatment • Acyclovir (IV) is effective in the treatment of varicella & zoster. • It is not used for all cases, but indicated in the following conditions: – Immunocompromised patients. – Ophthalmic zoster (to avoid corneal scarring). – Varicella complicated by pneumonia. – Neonatal infection.
  • 19. Prevention & Control • Acyclovir & interferon: are given to immune deficient children. • VZ immune globulin (VZIG): should be given to contacts of cases. • Live attenuated varicella vaccine (Varivax): given as one S.C. dose for children 1-12 years of age.
  • 20. EPSTEIN-BARR VIRUS (EBV) • Widespread & mostly asymptomatic. • The virus is excreted & transmitted via the saliva & multiply in the oropharyngeal mucosa.
  • 21. EBV Diseases • Infectious mononucleosis (glandular fever). • Others: – Nasopharyngeal carcinoma. – Burkitt’s lymphoma. – Oral hairy leukoplakia (in AIDS patients). – Hodgkin’s disease. – T-cell lymphoma.
  • 22. Infectious Mononucleosis (Glandular Fever) Pathogenesis & Clinical Features • Incubation period: 30-50 days. • Fever, sore throat, skin rash & cervical lymphadenopathy which becomes generalized with or without hepatosplenomegaly. • Oral lesions: – Early, throat is painful & congested. – Petechial hemorrhages may be seen on the palate. – Oral mucosa may show white pseudomembrane then oral ulceration may occur with submandibular lymphadenitis & mild fever.
  • 23. Laboratory Diagnosis 1.Blood picture: A high total leucocytic count (up to 25,000/cmm) with predominant monocytes & atypical lymphocytes. 2.Detection of heterophil antibodies: which agglutinate sheep or horse RBCs (Paul Bunnell test or monopost test). 3.Definitive diagnosis requires the demonstration of IgM to EBV capsid antigen or rising titre of IgG to both viral capsid antigen (VCA) or EB nuclear antigen (EBNA). 4.Detection of EBV nucleic acids in patient’s saliva or throat washing (e.g. by PCR).
  • 24. Prevention & Control A subunit vaccine is under trial.
  • 25. CYTOMEGALOVIRUS (CMV) – The name “cytomegalovirus“ was chosen on account of the swollen state of virus-infected cells. – The virus is widespread.
  • 26. Transmission of CMV – Transplacental (congenital). – Other methods: • Close contact • Sexual intercourse • Breast feeding • Blood transfusion • Organ transplantation
  • 27. Human Herpes Virus 6 (HHV6) • HHV6 is the cause of a common disease of infancy called roseola infantum. • It is characterized by high fever & skin rash.
  • 28. Human Herpes Virus 7 (HHV7) • HHV7 is associated with: – persistent salivary glands infection – & may cause fatal encephalitis.
  • 29. Human Herpes Virus 8 (HHV8) HHV8 causes Kaposi’s sarcoma in patients with AIDS.
  • 30. Coxsakieviruses (A & B) • They cause: – Aseptic meningitis. – Herpangina (sore throat with papulovesicular lesions on the palate, dysphagia, anorexia & stiff neck). – Hand-foot & mouth disease.
  • 31. Mumps • Acute disease of children. • Transmitted by droplets. • Characterised by parotitis. • Prevention: LAV (either singly or included in MMR vaccine).
  • 32. Measles • Acute highly infectious disease of children. • Transmitted by droplets. • Characterised by fever, sneezing, coughing, ocular pain & Koplik’s spots (bluish-white spots on the inside of cheeks opposite the lower molar teeth) & maculopapular skin rash. • Prevention: LAV (either singly or included in MMR vaccine), human Igs for susceptible contacts.