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Herpes Simplex
I and II
Dr.T.V.Rao MD
Dr.T.V.Rao MD 1
Herpesviridae
• The Herpesviridae are a large family
of DNA viruses that cause diseases in
animals, including humans The f...
Herpes Viruses
DNA group
• Most important Human
Pathogens
• Wide Host cell range
• Life Long Infection –
Periodic reactiva...
• Alphaherpesvirinae
– Herpes simplex virus type 1 HSV-1
– Herpes simplex virus type 2 HSV-2
– Varicella-zoster virus VZV
...
Infecting Humans.
Herpes Simplex virus 1 and 2
Varicella Zoster Viruses
Cytomegalovirus virus
Epstein Barr virus
Human Her...
Properties of Herpes
Viruses.
• Spherical in Shape
• Icosahedral 150
to 200 nm in size
• Genome – Double
stranded DNA
Line...
Out Standing Characteristics
• Encode many
enzymes.
• Cause Latent
Infections.
• Indefinite
persistence.
• Relation in
Imm...
Herpes Virus
Dr.T.V.Rao MD 8
Classification of Human Herpes
virus
• Subfamily –
Alpha
Neurons
Herpes
simplex 1,2
Dr.T.V.Rao MD 9
Subfamily Beta
Glands and
Kidney
Cytomegalovir
us
Lymphoid
tissues
Herpes 6,7
Dr.T.V.Rao MD 10
Subfamily - Gamma
• Lymphoid tissue
( Herpes 5 )
Epstein Barr
virus
Kaposi Sarcoma
(Virus Herpes 8)
Dr.T.V.Rao MD 11
Intranuclear infection of
infected cells
Dr.T.V.Rao MD 12
Herpes Virus Replication
Replicates in Host Cell Nucleus
Form Cow dry A Type inclusion
bodies.
More than 50 different t...
Herpes Simplex
1 and 2
Dr.T.V.Rao MD 14
Human Herpes Virus 1 and 2
• They are also called Human Herpes Virus
1 and 2 (HHV-1 and HHV-2) and are
neurotropic and neu...
Herpes 1and 2
• HSV-1 is commonly
associated with
herpes outbreaks of
the face known as
cold sores or fever
blisters, wher...
Infections in Humans.( Herpes
Simplex 1 and 2 )
• Wide spread in Humans
• Broad Host Ranges.
• Replicate in Many types of ...
HERPES SIMPLEX VIRUS (HSV)
• HSV 1 infect the upper part of the
body
- mouth and the face
• HSV 2 infect the lower part of...
Properties of Herpes Simplex VirusesProperties of Herpes Simplex Viruses
Type 1 andType 1 and 22
• Similar in Organization...
Out characters of Herpes
group of viruses
• Out standing characters
• 1 Encode many
enzymes
• Latent infections are
common...
HSV 1 differs from HSV 2
• HSV 1
• Monoclonals differs
• On CAM HSV 2 larger
pocks
• Replicate well on Chick
embryo fibrob...
Virus Grows in the following.
• Primary and Continues Cell lines.
• Monkey and Rabbit Kidney,
• Human Amnion
• Syncytial f...
Sources of infection
- Saliva
- Skin lesions
-Oropharyngeal
lesions
- Carriers
Dr.T.V.Rao MD 23
Pathogenesis.
• Most Common Human Viral Infection
• Causes catalytic effect causes the
necrosis of cells.
• Infects Skin a...
Pathogenesis
Entry by skin or mucous membranes
viral multiplication sensory nerve
lysis of cells root ganglia
vesicles lat...
TransmissionTransmission
• Close contact
• Skin and epithelial contact,
• Defects in Mucosal membrane
• Multiples Locally,...
Predisposition of Latent
Infection in
• Ganglion
• Trigeminal HSV 1
• Sacral HSV 2
• Immunity.
• Cell Mediated ( CMI )
• P...
Dr.T.V.Rao MD 28
Dr.T.V.Rao MD 29
Clinical Manifestations
• Oropharyngeal Disease Buccal
Gingival Mucosa Incubation 3 to 5
days
• May last for 2-3 weeks
• G...
Recurrent Blisters in Herpes
simplex 1
Dr.T.V.Rao MD 31
Herpes lesions in the oral
cavity
Dr.T.V.Rao MD 32
Eye Infections
and Genital Infections.
• Corneal ulcerations pacifications
• Blindness
• Vesiculo ulcerative Lesions
penis...
Herpes simplex 1 infecting eye
Dr.T.V.Rao MD 34
Herpes 2 producing
Genital Lesions
Dr.T.V.Rao MD 35
Skin InfectionsSkin Infections
• Infect abrasions
• Dentists,
( Herpetic
Whitlow) Health
care workers,
• Eczema , Burns
Dr...
Neonatal Herpes.
• In Uterus
• At Birth
• After Birth.
• Delivery By
Caesarean
Section
Reduces the
Infection
Dr.T.V.Rao MD...
Neonatal Infection –
Normal delivery
Dr.T.V.Rao MD 38
OtherManifestations.
• Meningitis,
• Encephalitis
• Multi organ
Involvement
• Increased incidence
in Immune
compromised AI...
Recurrent infections in HSV 1 andRecurrent infections in HSV 1 and
22
Dr.T.V.Rao MD 40
Immunity
• Mothers Ig G protects for 6 months.
• Primarily Ig M Later Ig g produced.
Main Participants in Immunity.
C M I ...
Laboratory Diagnosis
• Microscopy,
• Antigen
Detection
• DNA detection
PCR.
• Viral Isolation.
• Serology
Dr.T.V.Rao MD 42
Dr.T.V.Rao MD 43
Microscopy,
• Tzanck Smear
• Intranuclear
Type A Inclusion
Bodies
• Electron
Microscopy
• Fluorescent
Antibody Dr.T.V.Rao ...
Specimens for Diagnosis.
•Saliva.
•CSF
•Vesicle
fluid.
Dr.T.V.Rao MD 45
Viral Isolation
• Chick embryo
• In Tissue
Cultures
Primary
Embryonic
Kidney
Human Amnion
Dr.T.V.Rao MD 46
Serology,
•ELISA Test
• Neutralization
Tests
• Complement
Fixation
Tests
Dr.T.V.Rao MD 47
Chemotherapy
• Idoxuridine used topically in eye and skin
infections – first successful antiviral
agent.
• Acyclovir and v...
Epidemiology.
• World Wide Distribution
• HSV 1 early in life 6 months to 3 years.
• 70% to 90% Adults have Antibodies
• P...
• Programme Created by
Dr.T.V.Rao MD for Medical and
Paramedical Students for Global
education on Infectious Diseases
• Em...
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Herpes Simplex I and II

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Herpes Simplex I and II

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Herpes Simplex I and II

  1. 1. Herpes Simplex I and II Dr.T.V.Rao MD Dr.T.V.Rao MD 1
  2. 2. Herpesviridae • The Herpesviridae are a large family of DNA viruses that cause diseases in animals, including humans The family name is derived from the Greek word herpein ("to creep"), referring to the latent, re-occurring infections typical of this group of viruses. Herpesviridae can cause latent or lytic infections. Dr.T.V.Rao MD 2
  3. 3. Herpes Viruses DNA group • Most important Human Pathogens • Wide Host cell range • Life Long Infection – Periodic reactivation • Immunocompromised • Large number of genes, • Some viruses susceptible to treatment. Dr.T.V.Rao MD 3
  4. 4. • Alphaherpesvirinae – Herpes simplex virus type 1 HSV-1 – Herpes simplex virus type 2 HSV-2 – Varicella-zoster virus VZV • Betaherpesvirinae – cytomegalovirus CMV – Human herpesvirus type 6 HHV-6 – Human herpesvirus type 7 HHV-7 • Gammaherpesvirinae – Epstein-Barr virus EBV CLASSIFICATION (Human pathogens) Dr.T.V.Rao MD 4
  5. 5. Infecting Humans. Herpes Simplex virus 1 and 2 Varicella Zoster Viruses Cytomegalovirus virus Epstein Barr virus Human Herpes viruses 6, 7. Kaposi's Sarcoma associated Viruses Dr.T.V.Rao MD 5
  6. 6. Properties of Herpes Viruses. • Spherical in Shape • Icosahedral 150 to 200 nm in size • Genome – Double stranded DNA Linear • Envelope contains Glycoprotein's Dr.T.V.Rao MD 6
  7. 7. Out Standing Characteristics • Encode many enzymes. • Cause Latent Infections. • Indefinite persistence. • Relation in Immunocompromised • Relation to Cancers. Dr.T.V.Rao MD 7
  8. 8. Herpes Virus Dr.T.V.Rao MD 8
  9. 9. Classification of Human Herpes virus • Subfamily – Alpha Neurons Herpes simplex 1,2 Dr.T.V.Rao MD 9
  10. 10. Subfamily Beta Glands and Kidney Cytomegalovir us Lymphoid tissues Herpes 6,7 Dr.T.V.Rao MD 10
  11. 11. Subfamily - Gamma • Lymphoid tissue ( Herpes 5 ) Epstein Barr virus Kaposi Sarcoma (Virus Herpes 8) Dr.T.V.Rao MD 11
  12. 12. Intranuclear infection of infected cells Dr.T.V.Rao MD 12
  13. 13. Herpes Virus Replication Replicates in Host Cell Nucleus Form Cow dry A Type inclusion bodies. More than 50 different types proteins in infected cell. Large number of enzymes in DNA synthesis Dr.T.V.Rao MD 13
  14. 14. Herpes Simplex 1 and 2 Dr.T.V.Rao MD 14
  15. 15. Human Herpes Virus 1 and 2 • They are also called Human Herpes Virus 1 and 2 (HHV-1 and HHV-2) and are neurotropic and neuroinvasive viruses; they enter and hide in the human nervous system, accounting for their durability in the human body. HSV-1 is commonly associated with herpes outbreaks of the face known as cold sores or fever blisters, whereas HSV-2 is more often associated with genital herpes. Dr.T.V.Rao MD 15
  16. 16. Herpes 1and 2 • HSV-1 is commonly associated with herpes outbreaks of the face known as cold sores or fever blisters, whereas HSV-2 is more often associated with genital herpes. Dr.T.V.Rao MD 16
  17. 17. Infections in Humans.( Herpes Simplex 1 and 2 ) • Wide spread in Humans • Broad Host Ranges. • Replicate in Many types of Cells. • Produce cytolytic effects • Most Common Diseases. • Gingival stomatitis, Keratoconjunctivitis • Encephalitis Genital diseases, • New Born Infections, Latent Infections in Nerve Cells, • Recurrence. Dr.T.V.Rao MD 17
  18. 18. HERPES SIMPLEX VIRUS (HSV) • HSV 1 infect the upper part of the body - mouth and the face • HSV 2 infect the lower part of the body - genital infections • There is little cross protection • Therefore, one can get both the infections Dr.T.V.Rao MD 18
  19. 19. Properties of Herpes Simplex VirusesProperties of Herpes Simplex Viruses Type 1 andType 1 and 22 • Similar in Organization • Restriction Enzyme Differentiates • H S V 1 contact with Saliva. • H S V 2 Sexual • Maternal infection ( Genital Infection spreads to New Born ) • Replicates in 8-16 hours. Dr.T.V.Rao MD 19
  20. 20. Out characters of Herpes group of viruses • Out standing characters • 1 Encode many enzymes • Latent infections are common • Persist indefinitely in infected hosts. • Frequent reactivation in infected hosts • Some care cancer causing. Dr.T.V.Rao MD 20
  21. 21. HSV 1 differs from HSV 2 • HSV 1 • Monoclonals differs • On CAM HSV 2 larger pocks • Replicate well on Chick embryo fibroblast • More neurovirulent • Type 2 strains are more antiviral resistant • Restriction endonulease analysis diffentiates • HSV 2 • Monoclonal's differentiate • Smaller • No • Lesser • Lesser Dr.T.V.Rao MD 21
  22. 22. Virus Grows in the following. • Primary and Continues Cell lines. • Monkey and Rabbit Kidney, • Human Amnion • Syncytial formation and Giant cell formations • Multiplies in Chorio Allontoic membrane • Monoclonal Antibodies differentiates Type 1 and 2 types. Dr.T.V.Rao MD 22
  23. 23. Sources of infection - Saliva - Skin lesions -Oropharyngeal lesions - Carriers Dr.T.V.Rao MD 23
  24. 24. Pathogenesis. • Most Common Human Viral Infection • Causes catalytic effect causes the necrosis of cells. • Infects Skin and Mucous membrane • Cowdry type A inclusions are produced • Multinucleated Giant cells are demonstrated Dr.T.V.Rao MD 24
  25. 25. Pathogenesis Entry by skin or mucous membranes viral multiplication sensory nerve lysis of cells root ganglia vesicles latency ulcers REACTIVATION COLD FEVER SURGERY UNKNOWN Dr.T.V.Rao MD 25
  26. 26. TransmissionTransmission • Close contact • Skin and epithelial contact, • Defects in Mucosal membrane • Multiples Locally, • Enters through cutaneous nervefibers • Intraaxonally to Ganglion • Centrifugal Migration • Recurrent manifestation in Skin and Mucosa. Dr.T.V.Rao MD 26
  27. 27. Predisposition of Latent Infection in • Ganglion • Trigeminal HSV 1 • Sacral HSV 2 • Immunity. • Cell Mediated ( CMI ) • Predisposing Factors Axonal Injury Physical and Emotional stress U V light 80% Adults harbour Antibodies to HSV Dr.T.V.Rao MD 27
  28. 28. Dr.T.V.Rao MD 28
  29. 29. Dr.T.V.Rao MD 29
  30. 30. Clinical Manifestations • Oropharyngeal Disease Buccal Gingival Mucosa Incubation 3 to 5 days • May last for 2-3 weeks • Gingvo stomatitis Sub mandibular lymphadenopathy • Present with painful ulcers. Dr.T.V.Rao MD 30
  31. 31. Recurrent Blisters in Herpes simplex 1 Dr.T.V.Rao MD 31
  32. 32. Herpes lesions in the oral cavity Dr.T.V.Rao MD 32
  33. 33. Eye Infections and Genital Infections. • Corneal ulcerations pacifications • Blindness • Vesiculo ulcerative Lesions penis, Cervix, Vulva and Vagina. Manifest with Painful lesions. Dr.T.V.Rao MD 33
  34. 34. Herpes simplex 1 infecting eye Dr.T.V.Rao MD 34
  35. 35. Herpes 2 producing Genital Lesions Dr.T.V.Rao MD 35
  36. 36. Skin InfectionsSkin Infections • Infect abrasions • Dentists, ( Herpetic Whitlow) Health care workers, • Eczema , Burns Dr.T.V.Rao MD 36
  37. 37. Neonatal Herpes. • In Uterus • At Birth • After Birth. • Delivery By Caesarean Section Reduces the Infection Dr.T.V.Rao MD 37
  38. 38. Neonatal Infection – Normal delivery Dr.T.V.Rao MD 38
  39. 39. OtherManifestations. • Meningitis, • Encephalitis • Multi organ Involvement • Increased incidence in Immune compromised AIDS, • Haematological Malignancies. Dr.T.V.Rao MD 39
  40. 40. Recurrent infections in HSV 1 andRecurrent infections in HSV 1 and 22 Dr.T.V.Rao MD 40
  41. 41. Immunity • Mothers Ig G protects for 6 months. • Primarily Ig M Later Ig g produced. Main Participants in Immunity. C M I and Killer Cells and Interferon play major role in immunity Dr.T.V.Rao MD 41
  42. 42. Laboratory Diagnosis • Microscopy, • Antigen Detection • DNA detection PCR. • Viral Isolation. • Serology Dr.T.V.Rao MD 42
  43. 43. Dr.T.V.Rao MD 43
  44. 44. Microscopy, • Tzanck Smear • Intranuclear Type A Inclusion Bodies • Electron Microscopy • Fluorescent Antibody Dr.T.V.Rao MD 44
  45. 45. Specimens for Diagnosis. •Saliva. •CSF •Vesicle fluid. Dr.T.V.Rao MD 45
  46. 46. Viral Isolation • Chick embryo • In Tissue Cultures Primary Embryonic Kidney Human Amnion Dr.T.V.Rao MD 46
  47. 47. Serology, •ELISA Test • Neutralization Tests • Complement Fixation Tests Dr.T.V.Rao MD 47
  48. 48. Chemotherapy • Idoxuridine used topically in eye and skin infections – first successful antiviral agent. • Acyclovir and vidarabine helps in systemic infections • Other Drugs – Valaciclovir, Famiciclovir, • Orally effective • Foscarnet. Dr.T.V.Rao MD 48
  49. 49. Epidemiology. • World Wide Distribution • HSV 1 early in life 6 months to 3 years. • 70% to 90% Adults have Antibodies • Poor Living Conditions • HSV 2 Sexually transmitted. • Risk to mother and foetus • Abortions < 20 weeks gestation • HSV 2 increases predisposition to HIV infection Dr.T.V.Rao MD 49
  50. 50. • Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Students for Global education on Infectious Diseases • Email • doctortvrao@gmail.com Dr.T.V.Rao MD 50

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