Herpes viridae HSV 1,2 and VZV

12,273 views

Published on

Herpes viridae HSV 1,2 and VZV

Published in: Health & Medicine, Technology
4 Comments
25 Likes
Statistics
Notes
  • hello everybody, i don't just know the reason why some people is finding it difficult to believe that there is a cure for HERPES, i have been suffering from HERPES since last three years with my boyfriend but today i am happy that am cure from it with the herbal medicine of DR SEBI the great healer,i was browsing the internet searching for help when i came across a testimony shared by someone on how DR SEBI cure her HERPES i was so much in need of getting his treatment but after all DR SEBI brought a smile to my face with his herbal medicine. i am so much happy today that we have someone like this great healer out there, so my people out there kindly contact this great healer on his website: http://drsebispelltemple.wixsite.com/spelltemple please sir keep your good work cause there are people out there who is in need of your healing medicine.once more contact him now: drsebispelltemple@gmail.com you can call him or whatsApp his number +2348153863900 thanks DR SEBI for your great works this are also the diseases DR SEBI cures HIV/AIDS HERPES DIABETES ASTHMA SYPHLIES
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Thanks a lot Dr for this information.i have downloaded a lot of your lectures on the net and it is helpful.God bless you
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Thanks for the support, many in Developing suffer with Herpes 1 and 2 due to lack hygiene, education, and poverty, we will use your information Dr.T.V.Rao MD
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Shock!!!! My friend who is living with herpes told me a report from CNN said that the world's largest herpes dating and support site MeetHerpes.com which is powered by plenty of fish now has more than 1,100,000 members. Also, more than 80% of members on the site are good looking and sexy.
    The report also indicated that herpes rates soar worldwide and CDC had granted CSU $1.9M for herpes education to lower the rates of herpes transmission.
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total views
12,273
On SlideShare
0
From Embeds
0
Number of Embeds
23
Actions
Shares
0
Downloads
999
Comments
4
Likes
25
Embeds 0
No embeds

No notes for slide

Herpes viridae HSV 1,2 and VZV

  1. 1. Herpesviridae HSV 1,2 and VZV 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 Dr.T.V.Rao MD 3 treatment.
  4. 4. CLASSIFICATION (Human pathogens)• 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 MD Dr.T.V.Rao EBV 4
  5. 5. Infecting Humans.Herpes Simplex virus 1 and 2Varicella Zoster VirusesCytomegalovirus virusEpstein Barr virusHuman Herpes viruses 6, 7.Kaposis 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 Glycoproteins 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 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 8
  9. 9. Herpes Simplex 1 and 2 Dr.T.V.Rao MD 9
  10. 10. Herpesviridae• Group:Group I Family:Herpesviridae Subfamily:Alphaherpe svirinae Genus:Simplexvirus• Species• Herpes simplex virus 1 (HWJ-1) Herpes simplex virus 2 (HWJ-2) Dr.T.V.Rao MD 10
  11. 11. Herpes Simplex Virus• HSV are spherical in shape• Ds DNA• 35 proteins Dr.T.V.Rao MD 11
  12. 12. 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 12
  13. 13. Pathogenesis of HSV 1 &2replication Sensory ganglia Initial infection Migration through Neuron site Reactivation is through stress stimuli such as UV light, fever, hormonal changes, surgical trauma to the neuron latency Antibodies do not prevent reactivation HSV-1: trigeminal ganglia Dr.T.V.Rao MD 13 HSV-2: sacral ganglia
  14. 14. 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, Kerato conjunctivitis• Encephalitis Genital diseases,• New Born Infections, Latent Infections in Nerve Cells,• Recurrence. Dr.T.V.Rao MD 14
  15. 15. 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 Dr.T.V.Rao get both the can MD 15 infections
  16. 16. Properties of Herpes Simplex Viruses Type 1 and 2• 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 16
  17. 17. 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 17
  18. 18. • About 75% of the adults show +ve for HSV 1 infection• HSV 1 infections include -i. Oropharyngeal . Children - very painful . due to kissing of elders . acute gingivostomatitis . problem of feeding Dr.T.V.Rao MD 18
  19. 19. 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 19
  20. 20. Sources of infection- Saliva- Skin lesions Oropharyngeal lesions- Carriers Dr.T.V.Rao MD 20
  21. 21. Transmission• Close contact• Skin and epithelial contact,• Defects in Mucosal membrane• Multiples Locally,• Enters through cutaneous nerve fibers• Intraaxonally to Ganglion• Centrifugal Migration• Recurrent manifestation in Skin and Mucosa. Dr.T.V.Rao MD 21
  22. 22. Dr.T.V.Rao MD 22
  23. 23. Pathogenesis.• Most Common Human Viral Infection• Causes cytolytic 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 23
  24. 24. PathogenesisEntry by skin or mucous membranesviral multiplication sensory nervelysis of cells root ganglia COLDvesicles latency FEVER SURGERY REACTIVATION UNKNOWNulcers Dr.T.V.Rao MD 24
  25. 25. Dr.T.V.Rao MD 25
  26. 26. 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 26
  27. 27. Dr.T.V.Rao MD 27
  28. 28. Dr.T.V.Rao MD 28
  29. 29. Dr.T.V.Rao MD 29
  30. 30. Dr.T.V.Rao MD 30
  31. 31. 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 31
  32. 32. Recurrent Blisters in Herpes simplex 1 Dr.T.V.Rao MD 32
  33. 33. Herpes lesions in the oral cavity Dr.T.V.Rao MD 33
  34. 34. 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 34
  35. 35. Herpes simplex 1 infecting eye Dr.T.V.Rao MD 35
  36. 36. Herpes 2 producing Genital Lesions Dr.T.V.Rao MD 36
  37. 37. Skin Infections• Infect abrasions• Dentists, ( Herpetic Whitlow) Health care workers,• Eczema , Burns Dr.T.V.Rao MD 37
  38. 38. Neonatal Herpes.• In Uterus• At Birth• After Birth.• Delivery By Caesarean Section Reduces the Infection Dr.T.V.Rao MD 38
  39. 39. Neonatal Infection – Normal delivery Dr.T.V.Rao MD 39
  40. 40. Other Manifestations.• Meningitis,• Encephalitis• Multi organ Involvement• Increased incidence in Immune compromised AIDS,• Haematological Malignancies. Dr.T.V.Rao MD 40
  41. 41. Recurrent infections in HSV 1 and 2 Dr.T.V.Rao MD 41
  42. 42. 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 42
  43. 43. Laboratory Diagnosis• Microscopy,• Antigen Detection• DNA detection PCR.• Viral Isolation.• Serology Dr.T.V.Rao MD 43
  44. 44. Laboratory Diagnosis• Specimen: Vesicular fluid- Corneal scrapping1- Direct Virus Demonstration:a) L/M:1. Tzanck smear – from the base of vesicles, 1% aq. soln. of toluidine blue ‘O’ shows multinucleated giant cells with faceted nuclei & homogenously stained ‘ground glass’ chromatin (Tzanck cells)2. Giemsa stained smear – intranuclear Cowdry type A inclusion bodies Dr.T.V.Rao MD 44
  45. 45. • B) Direct Immunofluorescence:• Cell scrapings from lesions are stained with monoclonal antibodies conjugated with a fluorescence dye. Viral inclusion bodies appear in UV microscope as a bright green Intranuclear particles Dr.T.V.Rao MD 45
  46. 46. • 2- Viral Isolation: tissue culture: human diploid fibroblasts, human amnion, human embryonic kidney: CPC (syncytium formation) seen in 24-48 hrs.• 3) Serology: useful in the diagnosis of primary infection, Ab (IgM) detection by ELISA, NT or CFT. Dr.T.V.Rao MD 46
  47. 47. Laboratory diagnosis• Childhood infections common• Second peak at onset of sexual activity• Viral shedding – persons with recurrences –infected but asymptomatic persons Dr.T.V.Rao MD 47
  48. 48. • Useful – genital & eye infections – HVZ & HSV in immunocompromised patients – herpes encephalitis• Specimens – aspirate from vesicle – scraping from base of ulcer – serum / CSF for antibody Dr.T.V.Rao MD 48
  49. 49. Microscopy,• Tzanck Smear• Intranuclear Type A Inclusion Bodies• Electron Microscopy• Fluorescent Antibody Dr.T.V.Rao MD 49
  50. 50. Specimens for Diagnosis.•Saliva.•CSF•Vesicle fluid. Dr.T.V.Rao MD 50
  51. 51. Viral Isolation in• Chick embryo• In Tissue Cultures Primary Embryonic Kidney Human Amnion Dr.T.V.Rao MD 51
  52. 52. Serology,• ELISA Test• Neutralization Tests• Complement Fixation Tests Dr.T.V.Rao MD 52
  53. 53. 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 53
  54. 54. 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 fetus• Abortions < 20 weeks gestation• HSV 2 increases predisposition to HIV infection Dr.T.V.Rao MD 54
  55. 55. Varicella Zoster Dr.T.V.Rao MD 55
  56. 56. History of Chickenpox• The name chicken pox because the blisters that appeared seemed like the skin that has been pecked by the chicken.. Dr.T.V.Rao MD 56
  57. 57. Herpes Virus Dr.T.V.Rao MD 57
  58. 58. Properties of Virus.• Like Herpes Virus• Icosahedrons shape ds DNA Dr.T.V.Rao MD 58
  59. 59. Varicella Zoster ( Herpes Virus) DNA Virus• Varicella -Chicken pox.• Contagious Disease• Mainly Children Generalized Vesicular eruptions on Skin and Mucous membranesSevere manifestations in Adults and Immune compromised. Dr.T.V.Rao MD 59
  60. 60. HERPES VARICELLA ZOSTER HVZ• Causes chicken pox -fever + characteristic rash• variable incubation period 14-21 days• usually mild in children and more severe in adults• complications – secondary infection - uncommon – varicella pneumonia – secondary bacterial pneumonia S aureus & pneumococci – post-infetious encephalitis – generalised varicella (in immunocompromised patients) – congenital and neonatal varicella Dr.T.V.Rao MD 60
  61. 61. Dr.T.V.Rao MD 61
  62. 62. Varicella (Chicken Pox)• Mild, highly contagious disease chiefly affecting children• Mode of transmission:- airborne droplets and direct contact from varicella patients- Vesicular fluid of Zoster patients can be the source of Varicella in susceptible children Dr.T.V.Rao MD 62
  63. 63. Shingles (Herpes Zoster )‫‏‬Rash Limited to Distribution of Single Sensory Ganglion In Adults and immune compromised Sporadic Dr.T.V.Rao MD 63
  64. 64. Varicella –Zoster Virus (VZV)Causes 2 major diseases• Varicella (chicken pox): primary infection usually in childhood• Zoster ( shingles): reactivation of an earlier varicella Dr.T.V.Rao MD 64
  65. 65. Dr.T.V.Rao MD 65
  66. 66. HERPES VARICELLA ZOSTER HVZ• Causes chicken pox -fever + characteristic rash• variable incubation period 14-21 days• usually mild in children and more severe in adults• complications – secondary infection - uncommon – varicella pneumonia – secondary bacterial pneumonia S aureus & pneumococci – post-infectious encephalitis – generalized varicella (in immunocompromised patients) – congenital and neonatal varicella Dr.T.V.Rao MD 66
  67. 67. Herpes Zoster• Primary Contact - Chicken Pox• Reactivation - Zoster (Partially Immune )‫‏‬ Dr.T.V.Rao MD 67
  68. 68. Culturing virus• Grows in Human embryonic Tissue Produce inclusion bodies No difference in virus In Chicken pox and zoster infection Dr.T.V.Rao MD 68
  69. 69. Pathogenesis and Pathology• Varicella virus enter through URT/Conjunctiva. Lymph nodes Viremia Liver and spleenSecondary viremiaInfects Mononuclear CellsRash Vesicle formation Dr.T.V.Rao MD 69
  70. 70. Pathogenesis:• VZV infects the mucosa of the upper respiratory tract• Multiplies in the regional LNs• Primary viremia and spread to liver and spleen• Secondary viremia follows with viral spread to the skin• Typical rash occurs• VZV remains latent in the dorsal root ganglia for lifeDr.T.V.Rao MD 70
  71. 71. Clinical Picture:• Incubation period: 10-21 days• Symptoms: mild fever & rash• Rash: first appears on the trunk, then face and limbs• Flat macules become papules then vesicles• Followed by crust formation• The crust is often shed off and heals without scarring• Cropping is a characteristic feature of varicella rash: fresh vesicles appear in crops, so that all stages of macules, papules, vesicles & crusts are seen at the same time• More severe in adults Dr.T.V.Rao MD 71
  72. 72. Dr.T.V.Rao MD 72
  73. 73. Herpes Zoster• Skin Lesions• Inflammation of Sensory Nerves and Ganglia• Single Ganglion• Dorsal root Ganglion Dr.T.V.Rao MD 73
  74. 74. Entry of Varicella Zoster virus Dr.T.V.Rao MD 74
  75. 75. Skin lesions showing different stages Dr.T.V.Rao MD 75
  76. 76. Clinical Findings.• Varicella, Incubation 10-20 days• Fever, Malaise• Rash Trunk –Face –Limbs – Buccal and Pharyngeal mucosa• Lesions at all stages Macules, Papules, Vesicles, Crusts,May last 5 days, Hundreds of eruptions. Dr.T.V.Rao MD 76
  77. 77. Skin lesions of chickenpox Dr.T.V.Rao MD 77
  78. 78. Chicken pox lesions in the buccal cavity Dr.T.V.Rao MD 78
  79. 79. Herpes Zoster involving a Nerve segment Dr.T.V.Rao MD 79
  80. 80. Complications• 1- pneumonia especially in adults, may be fatal• 2- rarely: fulminant encephalitis, which may be a manifestation of Reye’s syndrome that occurs as a consequence of salicylates intake during infection Dr.T.V.Rao MD 80
  81. 81. Congenital Varicella Syndrome & Neonatal Varicella• Primary maternal infection during the 1st trimester may lead to congenital varicella syndrome ( serious & fatal): skin lesions, hypoplasia of limbs, chorioretinitis & CNS defects• Primary maternal infection near the time of birth can lead to widely disseminated infection in the new born with mortality rate of 35%• If rash began a week or more before delivery, maternal Abs transferred via placenta – baby gets the infection but escapes clinical disease Dr.T.V.Rao MD 81
  82. 82. Immune compromised• HIV / AIDS• Malignancies.• Organ transplantations• Corticosteroid usage• Leukaemias. Dr.T.V.Rao MD 82
  83. 83. HERPES VARICELLA ZOSTER HVZ• Causes chicken pox -fever + characteristic rash• variable incubation period 14-21 days• usually mild in children and more severe in adults• complications – secondary infection - uncommon – varicella pneumonia – secondary bacterial pneumonia S aureus & pneumococci – post-infectious encephalitis – generalized varicella (in immunocompromised patients) – congenital and neonatal varicella Dr.T.V.Rao MD 83
  84. 84. Pain and hyperaesthesia Dr.T.V.Rao MD 84
  85. 85. Pain and hyperaesthesia Dr.T.V.Rao MD 85
  86. 86. Pain and hyperaesthesia Dr.T.V.Rao MD 86
  87. 87. HERPES ZOSTER• Reactivation of HVZ• dermatomal distribution• may recur• can disseminate in immunocompromised patients• complications – post herpetic pain – ophthalmic zoster -corneal scarring and loss of vision DIAGNOSIS CLINICAL EM of vesicle fluid SEROLOGY Dr.T.V.Rao MD 87 IgM detection
  88. 88. Zoster.• Associated with Immune compromised.• Manifest with severe pain• Vesicles on trunk , head, neck Trigeminal Neuralgia Dr.T.V.Rao MD 88
  89. 89. Zoster (shingles)• Sporadic disease in adults or immunocompromised patients• Results from reactivation of latent VZV• Rash similar to varicella but limited to a nerve distribution to the skin innervated by a dorsal root ganglion (dermatom) Dr.T.V.Rao MD 89
  90. 90. Pain and hyperaesthesia Dr.T.V.Rao MD 90
  91. 91. Other Complications.• Encephalitis,• Mother to Child transmission• Varicella Pneumonia.• Fatal Complications. Dr.T.V.Rao MD 91
  92. 92. Laboratory Diagnosis.• Smears --Scrapings from Lesions Demonstration of Multi nucleated giant cells Tzanck smearsDNA DemonstrationCell cultures,Fluorescent –antibodyELISA PCR Dr.T.V.Rao MD 92
  93. 93. Epidemiology• Communicable Disease• World wide prevalence• Common in < 10 year olds.• Zoster in Adults Droplet spread Dr.T.V.Rao MD 93
  94. 94. Treatment• Specific treatment is indicated mainly in Immunodeficient and elderly subjects and also in complicated with Varicella pneumonia,encephalitis,and disseminated zoster• Acyclovir and Famiciclovir. Dr.T.V.Rao MD 94
  95. 95. Prevention of Chickenpox Do nothing Susceptible population Immunize children live attenuatedadults living in close proximity vaccine Protect if contact with patient with chickenpox and at risk of severe disease Zoster Immune Globulin (ZIG) Dr.T.V.Rao MD 95
  96. 96. Vaccine available • A live modified Varicella virus lyophilised vaccine which can be stored at low temp is available for protection • Children 1 -12 years given single dose. • >12 years 2 doses 2 -6 weeks apart • High titre serum from convalescing from herpes zoster protect Immunocompromised children. • But not useful for treatment Dr.T.V.Rao MD 96
  97. 97. Programme created by Dr.T.V.Rao MD forMedical and Paramedical Students in the Developing World Email doctortvrao@gmail.com Dr.T.V.Rao MD 97

×