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HERPES VIRUS
CONTENTS 
INTRODUCTION 
SIMPLEX 1 
SIMPLEX 2 
VARICELLA 
EPSTEIN-BARR 
CYTOMEGALOVIRUS 
HHV-6 
HHV-7 
KAPOSI’S SARCOMA VIR...
INTRODUCTION 
Herpes viruses 
•Structure and Composition 
oSpherical iscoahedron, 150-200 nm 
oDouble-stranded DNA, linear...
•Three subfamilies: 
oAlphaherpesviruses - HSV-1, HSV-2, VZV 
(Short replicative cycle : 12-18 hours –sensory 
(ganglia ) ...
Species 
•Simplex 1 (HHV-1) (alpha) 
•Simplex 2 (HHV-2) (alpha) 
•Varicella (HHV-3) (alpha) 
•Epstein-Barr (HHV-4) (gamma)...
Herpes simplex
Clinical Manifestations 
HSV is involved in a variety of clinical manifestations which 
includes ;- 
1. Acute gingivostoma...
MUCOSAL 
ACUTE GINGIVOSTOMATITIS 
•Acute gingivostomatitis is the commonest manifestation 
of primary herpetic infection. ...
MUCOSAL 
HERPES LABIALIS (COLD SORE) 
•Herpes labialis (cold sore) is a 
recurrence of oral HSV. 
•45% of orally infected ...
SYMPTOMS 
•The symptoms can be mild or severe and may include: 
Sores on the inside of the cheeks or gums 
Fever 
General ...
HSV – Cold Sore
OCULAR HERPES 
HSV causes corneal blindness. 
Diseases caused include the following:- 
– Primary HSV keratitis – 
– Dendri...
KERATOCONJUNCTIVITIS 
• Keratoconjunctivitis is inflammation of the cornea and 
conjunctiva. 
• Primary infection typicall...
Keratoconjunctivitis
HERPES SIMPLEX ENCEPHALITIS 
• Herpes Simplex encephalitis is one of the most 
serious complications of herpes simplex dis...
•Focal disease – the temporal lobe is most commonly 
affected. This form of the disease appears in children and 
adults. I...
Herpes Simplex Encephalitis 
CT Scan Autopsy
MENINGITIS 
• Most commonly associated with primary HSV-2 
infection; less likely with recurrences of genital 
herpes 
• B...
GENITAL HERPES 
• Genital lesions may be primary, recurrent or initial. 
• Many sites can be involved which includes the p...
GENITAL HERPES 
•Dysuria is a common complaint, in severe cases, there 
may be urinary retention. 
•60% of patients with g...
HSV – CONGENITAL/PERINATAL 
• Perinatal infection: 
• 75% are due to HSV 2; acquired during delivery 
• Post natal infecti...
HERPETIC WHITLOW 
• A herpetic whitlow is a lesion (whitlow) on a finger or 
thumb caused by the herpes simplex virus. 
• ...
Laboratory Diagnosis 
• Direct Detection 
 Electron microscopy of vesicle fluid - rapid 
result but cannot distinguish be...
Cytopathic Effect of HSV 
in cell culture: Note the 
ballooning of cells. 
Positive immunofluorescence 
test for HSV antig...
Laboratory Diagnosis 
Virus Isolation 
• Viral culture (gold standard) 
• Preferred test if genital ulcers or other 
mucoc...
Laboratory Diagnosis 
Polymerase Chain Reaction (PCR) 
• More sensitive than viral culture; has been used instead 
of cult...
TYPE-SPECIFIC SEROLOGIC TESTS 
• Type-specific and nonspecific antibodies to HSV 
develop during the first several weeks t...
HERPES B VIRUS 
•Formerly known as Herpes simiae 
•Officially known as cercopithecine herpesvirus 1 
•Almost always fatal ...
MANAGEMENT 
• There is no method to eradicate herpes virus from the 
body, but antiviral medications can reduce the 
frequ...
ANTIVIRAL 
There are several antivirals that are effective for treating 
herpes including: 
• Aciclovir (acyclovir), 
• Va...
Varicella zoster
VARICELLA 
• Primary infection results in varicella (chickenpox) 
• Incubation period of 14-21 days 
• Presents fever, lym...
•Complications are rare but occurs more frequently and with 
greater severity in adults and immunocompromised patients. 
•...
NEONATAL VARICELLA 
• VZV can cross the placenta in the late stages of 
pregnancy to infect the fetus congenitally. 
• Neo...
NEONATAL VARICELLA 
•Zoster immunoglobulin should be given to susceptible 
pregnant women who had contact with suspected c...
LABORATORY DIAGNOSIS 
The clinical presentations of varicella or zoster are so 
characteristic that laboratory confirmatio...
LABORATORY DIAGNOSIS 
Direct detection - electron microscopy may be used for 
vesicle fluids but cannot distinguish betwee...
PROPHYLAXIS 
• V – Z immunoglobulins. 
• Live attenuated varicella vaccine. 
•Preventive measures should be considered for...
HERPES ZOSTER 
 Zoster is the manifestation of recurrent infection 
following a primary attack of chicken pox. 
 Both ch...
 Pain precedes the rash (vesicles). 
 Shingles causes severe pain, and commonly occurs on 
the trunk on one side. 
 The...
•Lesions localized to one side, within the distribution of any 
of the divisions of the trigeminal nerve and in the mouth ...
TREATMENT 
 in severe case : oral acyclovir 800 mg five times daily 
for 7-10 days should be given at the earliest possib...
RAMSAY HUNT SYNDROME 
• Involvement of facial nerve with VZV 
• Facial nerve palsy 
• Vesicles in external auditory meatus...
CYTOMEGALO VIRUS 
• Belong to the beta herpesvirus subfamily of 
herpesviruses 
• Double stranded DNA enveloped virus 
• N...
CLINICAL FEACTURES 
Cytomegalic Inclusion disease of Newborn(10%) 
characterised by varied type of clinical manifestations...
Primary infection- 
Usually asymptomatic. 
In a minority of cases, the syndrome of infectious 
mononucleosis may develop...
Immunocompromised patients such as transplant 
recipients and AIDS patients are prone to severe CMV 
disease such as pneu...
Labotary Diagnosis 
Adults: Urine, Saliva, Semen & Cervical 
secretions. 
Neonate: Urine 
1. Microscopy: 
Centrifuged depo...
PREVENTION 
• No vaccine is available. 
• Live attenuated vaccine known as the Towne 125, AD 
169 stains , and purified CM...
EPSTEIN – BARR (EB) VIRUS 
•Burkitt's lymphoma in 1964 . 
•Affinity for B – lymphocytes (CD 21 receptors.) 
•80 – 90% of c...
INFECTIOUS MONONUCLEOSIS 
Incubation period : 4 – 8weeks 
(Glandular disease, Kissing disease) 
•Acute self limiting illne...
Sore throat 
Cervical lymphadenopathy Hepatosplenomegaly
BURKITT’S LYMPHOMA 
• Burkitt's lymphoma (BL) occurs endemically in parts 
of Africa (where it is the commonest childhood ...
NASOPHARYNGEAL CARCINOMA 
• Nasopharyngeal carcinoma (NPC) is a malignant 
tumour of the squamous epithelium of the nasoph...
LAB DIAGNOSIS 
1.Blood smear examination :Atypical Lymphocytosis. 
2.Paul - Bunnel test: 
Heterophile antibody detection t...
HHV – 6 & HHV -7 
Isolated in 1986 
Transmission through Oral secretions. 
It is thought that HHV-6 and HHV-7 are related ...
HUMAN HERPES VIRUS 8 
• Originally isolated from cells of Kaposi’s sarcoma (KS) 
• Firmly associated with Kaposi’s sarcoma...
HERPES VIRUS
HERPES VIRUS
HERPES VIRUS
HERPES VIRUS
HERPES VIRUS
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HERPES VIRUS

herpes virus is common virus which have variety of clinical presentations, like oral herpes lesions or cutaneous lesions ...

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HERPES VIRUS

  1. 1. HERPES VIRUS
  2. 2. CONTENTS INTRODUCTION SIMPLEX 1 SIMPLEX 2 VARICELLA EPSTEIN-BARR CYTOMEGALOVIRUS HHV-6 HHV-7 KAPOSI’S SARCOMA VIRUS
  3. 3. INTRODUCTION Herpes viruses •Structure and Composition oSpherical iscoahedron, 150-200 nm oDouble-stranded DNA, linear oMore than 35 proteins oEnveloped oReplication from nucleus (budding)
  4. 4. •Three subfamilies: oAlphaherpesviruses - HSV-1, HSV-2, VZV (Short replicative cycle : 12-18 hours –sensory (ganglia ) oBetaherpesviruses - CMV, HHV-6, HHV-7 (> 24 hours :salivary glands and other organs ) oGammaherpesviruses - EBV, HHV-8 ( narrow host range , lympho blastoid cells )
  5. 5. Species •Simplex 1 (HHV-1) (alpha) •Simplex 2 (HHV-2) (alpha) •Varicella (HHV-3) (alpha) •Epstein-Barr (HHV-4) (gamma) •Cytomegalovirus (HHV-5) (beta) •HHV-6 (beta) •HHV-7 (beta) •Kaposi’s sarcoma virus (HHV-8) (gamma)
  6. 6. Herpes simplex
  7. 7. Clinical Manifestations HSV is involved in a variety of clinical manifestations which includes ;- 1. Acute gingivostomatitis 2. Herpes Labialis (cold sore) 3. Ocular Herpes 4. Herpes Genitalis 5. Other forms of cutaneous herpes 7. Meningitis 8. Encephalitis 9. Neonatal herpes
  8. 8. MUCOSAL ACUTE GINGIVOSTOMATITIS •Acute gingivostomatitis is the commonest manifestation of primary herpetic infection. •The patient experiences pain and bleeding of the gums. 1 - 8 mm ulcers with necrotic bases are present •Neck glands are commonly enlarged accompanied by fever. •Usually a self limiting disease which lasts around 13 days.
  9. 9. MUCOSAL HERPES LABIALIS (COLD SORE) •Herpes labialis (cold sore) is a recurrence of oral HSV. •45% of orally infected individuals will experience reactivation. The actual frequency of recurrences varies widely between individuals. •Tingling, warmth or itching at the site usually heralds the recurrence. About 12 hours later, redness appears followed by papules and then vesicles.
  10. 10. SYMPTOMS •The symptoms can be mild or severe and may include: Sores on the inside of the cheeks or gums Fever General discomfort, uneasiness, or ill feeling Very sore mouth with no desire to eat Halitosis (bad breath Not able to chew or swallow)
  11. 11. HSV – Cold Sore
  12. 12. OCULAR HERPES HSV causes corneal blindness. Diseases caused include the following:- – Primary HSV keratitis – – Dendritic ulcers – Recurrent HSV keratitis – HSV conjunctivitis – Acute necrotising retinitis, chorioretinitis are un common but serious manifestations
  13. 13. KERATOCONJUNCTIVITIS • Keratoconjunctivitis is inflammation of the cornea and conjunctiva. • Primary infection typically presents as swelling of the conjunctiva and eyelids (blepharo conjunctivitis), accompanied by small white itchy lesions on the surface of the cornea. • The effect of the lesions varies, from minor damage to the epithelium (superficial punctate keratitis), to formation of dendritic ulcers.
  14. 14. Keratoconjunctivitis
  15. 15. HERPES SIMPLEX ENCEPHALITIS • Herpes Simplex encephalitis is one of the most serious complications of herpes simplex disease. There are two forms: • Neonatal – there is global involvement and the brain is almost liquefied. The mortality rate approaches 100%.
  16. 16. •Focal disease – the temporal lobe is most commonly affected. This form of the disease appears in children and adults. It is possible that many of these cases arise from reactivation of virus. The mortality rate is high (70%) without treatment. •It is of most importance to make a diagnosis of HSE early. It is general practice that IV acyclovir is given in all cases of suspected HSE before laboratory results are available.
  17. 17. Herpes Simplex Encephalitis CT Scan Autopsy
  18. 18. MENINGITIS • Most commonly associated with primary HSV-2 infection; less likely with recurrences of genital herpes • Benign, self-limited (contrast with encephalitis) • Usually affects sexually active young adults • No neurologic sequelae; not clear if acyclovir treatment alters course of mild meningitis
  19. 19. GENITAL HERPES • Genital lesions may be primary, recurrent or initial. • Many sites can be involved which includes the penis, vagina, cervix, anus, vulva, bladder, the sacral nerve routes, the spinal and the meninges. • The lesions of genital herpes are particularly prone to secondary bacterial infection eg. S.aureus, Streptococcus, Trichomonas and Candida Albicans.
  20. 20. GENITAL HERPES •Dysuria is a common complaint, in severe cases, there may be urinary retention. •60% of patients with genital herpes will experience recurrences. Recurrent lesions in the perianal area tend to be more numerous and persists longer than their oral HSV-1 counterparts.
  21. 21. HSV – CONGENITAL/PERINATAL • Perinatal infection: • 75% are due to HSV 2; acquired during delivery • Post natal infection • HSV-1 acquired from maternal genital, oral or breast lesions or nosocomial infection from other infected babies
  22. 22. HERPETIC WHITLOW • A herpetic whitlow is a lesion (whitlow) on a finger or thumb caused by the herpes simplex virus. • Herpes whitlow can be caused by infection by HSV-1 or HSV-2. • HSV-1 whitlow is often contracted by health care workers that come in contact with the virus; it is most commonly contracted by dental workers and medical workers exposed to oral secretions.
  23. 23. Laboratory Diagnosis • Direct Detection  Electron microscopy of vesicle fluid - rapid result but cannot distinguish between HSV and VZV  Immunofluorescence of skin scrappings - can distinguish between HSV and VZV  PCR - now used routinely for the diagnosis of herpes simple encephalitis
  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. Laboratory Diagnosis Virus Isolation • Viral culture (gold standard) • Preferred test if genital ulcers or other mucocutaneous lesions are present • Highly specific (>99%) • Sensitivity depends on stage of lesion; declines rapidly as lesions begin to heal • Positive more often in primary infection (80%– 90%) than with recurrences (30%)
  26. 26. Laboratory Diagnosis Polymerase Chain Reaction (PCR) • More sensitive than viral culture; has been used instead of culture in some settings; however PCR tests are not widely available • Preferred test for detecting HSV in spinal fluid
  27. 27. TYPE-SPECIFIC SEROLOGIC TESTS • Type-specific and nonspecific antibodies to HSV develop during the first several weeks to few months following infection and persist indefinitely • Presence of HSV-2 antibody indicates anogenital infection • Presence of HSV-1 does not distinguish anogenital from orolabial infection 30
  28. 28. HERPES B VIRUS •Formerly known as Herpes simiae •Officially known as cercopithecine herpesvirus 1 •Almost always fatal in humans oHas high propensity for central nervous system and causes substantial damage oSurvivors usually have neurological disorders •No effective treatment
  29. 29. MANAGEMENT • There is no method to eradicate herpes virus from the body, but antiviral medications can reduce the frequency, duration, and severity of outbreaks. • Analgesics such as ibuprofen and acetaminophen can reduce pain and fever. • Topical anesthetic treatments such as prilocaine, lidocaine, benzocaine or tetracaine can also relieve itching and pain
  30. 30. ANTIVIRAL There are several antivirals that are effective for treating herpes including: • Aciclovir (acyclovir), • Valaciclovir (valacyclovir), • Famciclovir, • Penciclovir.
  31. 31. Varicella zoster
  32. 32. VARICELLA • Primary infection results in varicella (chickenpox) • Incubation period of 14-21 days • Presents fever, lymphadadenopathy. a widespread vesicular rash. • The features are so characteristic that a diagnosis can usually be made on clinical grounds alone.
  33. 33. •Complications are rare but occurs more frequently and with greater severity in adults and immunocompromised patients. •Most common complication is secondary bacterial infection of the vesicles. •Severe complications which may be life threatening include viral pneumonia, encephalititis, and haemorrhagic chickenpox.
  34. 34. NEONATAL VARICELLA • VZV can cross the placenta in the late stages of pregnancy to infect the fetus congenitally. • Neonatal varicella may vary from a mild disease to a fatal disseminated infection. • If rash in mother occurs more than 1 week before delivery, then sufficient immunity would have been transferred to the fetus.
  35. 35. NEONATAL VARICELLA •Zoster immunoglobulin should be given to susceptible pregnant women who had contact with suspected cases of varicella. •Zoster immunoglobulin should also be given to infants whose mothers develop varicella during the last 7 days of pregnancy or the first 14 days after delivery.
  36. 36. LABORATORY DIAGNOSIS The clinical presentations of varicella or zoster are so characteristic that laboratory confirmation is rarely required. Laboratory diagnosis is required only for atypical presentations, particularly in the immunocompromised. – Virus Isolation - rarely carried out as it requires 2-3 weeks for a results.
  37. 37. LABORATORY DIAGNOSIS Direct detection - electron microscopy may be used for vesicle fluids but cannot distinguish between HSV and VZV. Immunofluorescense on skin scrappings can distinguish between the two. Serology - the presence of VZV IgG is indicative of past infection and immunity. The presence of IgM is indicative of recent primary infection.
  38. 38. PROPHYLAXIS • V – Z immunoglobulins. • Live attenuated varicella vaccine. •Preventive measures should be considered for individuals at risk of contracting severe varicella infection e.g. leukaemic children, neonates, and pregnant women •Where urgent protection is needed, passive immunization should be given. Zoster immunoglobulin (ZIG) is the preparation of choice but it is very expensive. Where ZIG is not available, HNIG should be given instead.
  39. 39. HERPES ZOSTER  Zoster is the manifestation of recurrent infection following a primary attack of chicken pox.  Both chicken pox and herpes zoster (shingles) are caused by varicella.  Unlike herpes labialis, repeated recurrences of zoster are very rare.  Infection typically affect adult of middle age or over.
  40. 40.  Pain precedes the rash (vesicles).  Shingles causes severe pain, and commonly occurs on the trunk on one side.  The trigeminal nerve is affected in about 15% of cases of shingles.
  41. 41. •Lesions localized to one side, within the distribution of any of the divisions of the trigeminal nerve and in the mouth up to the midline. •Malaise can be severe. •Regional lymph node are enlarged and can be life-threatening in HIV disease.
  42. 42. TREATMENT  in severe case : oral acyclovir 800 mg five times daily for 7-10 days should be given at the earliest possible moment, together with analgesic.
  43. 43. RAMSAY HUNT SYNDROME • Involvement of facial nerve with VZV • Facial nerve palsy • Vesicles in external auditory meatus • Vesicles on palate • Symptoms :dizziness, loss of taste. • In most cases, this is self limiting condition but rarely in some patients there may be permanent facial weakness.
  44. 44. CYTOMEGALO VIRUS • Belong to the beta herpesvirus subfamily of herpesviruses • Double stranded DNA enveloped virus • Nucleocapsid 105nm in diameter, 162 capsomers
  45. 45. CLINICAL FEACTURES Cytomegalic Inclusion disease of Newborn(10%) characterised by varied type of clinical manifestations. •Hepatospleenomegaly •Jaundice •Thrombocytopenic purpura •Haemolytic anaemia •Microcephaly •Cerebral calcifications. •Mental retardation. 49
  46. 46. Primary infection- Usually asymptomatic. In a minority of cases, the syndrome of infectious mononucleosis may develop which consists of fever, lymphadenopathy, and splenomegaly.
  47. 47. Immunocompromised patients such as transplant recipients and AIDS patients are prone to severe CMV disease such as pneumonitis, retinitis, colitis, and encephalopathy. Reactivation or reinfection with CMV is usually asymptomatic except in immunocompromised patients.
  48. 48. Labotary Diagnosis Adults: Urine, Saliva, Semen & Cervical secretions. Neonate: Urine 1. Microscopy: Centrifuged deposits of secretions. Giemsa stain: Cytomegalic cells 52
  49. 49. PREVENTION • No vaccine is available. • Live attenuated vaccine known as the Towne 125, AD 169 stains , and purified CMV polypeptide vaccine ) • Prevention of CMV disease in transplant recipients o Screening and matching the CMV status of the donor and recipient o Use of CMV negative blood for transfusions o Administration of CMV immunoglobulin to seronegative recipients prior to transplant o Give antiviral agents such as acyclovir and ganciclovir prophylactically.
  50. 50. EPSTEIN – BARR (EB) VIRUS •Burkitt's lymphoma in 1964 . •Affinity for B – lymphocytes (CD 21 receptors.) •80 – 90% of children by three years of age. •Asymptomatic. •Not highly contagious. •Droplets are not infectious. Source : Saliva, Oropharyngeal secretions 54
  51. 51. INFECTIOUS MONONUCLEOSIS Incubation period : 4 – 8weeks (Glandular disease, Kissing disease) •Acute self limiting illness. •Fever, sore throat. •Lymphadenopathy. •Sub clinical Hepatitis, • Tender spleenomegaly 55
  52. 52. Sore throat Cervical lymphadenopathy Hepatosplenomegaly
  53. 53. BURKITT’S LYMPHOMA • Burkitt's lymphoma (BL) occurs endemically in parts of Africa (where it is the commonest childhood tumour) and Papua New Guinea. • It usually occurs in children aged 3-14 years. It respond favorably to chemotherapy.
  54. 54. NASOPHARYNGEAL CARCINOMA • Nasopharyngeal carcinoma (NPC) is a malignant tumour of the squamous epithelium of the nasopharynx. • It is very prevalent in S. China, where it is the commonest tumour in men and the second commonest in women. • NPC usually presents late and thus the prognosis is poor.
  55. 55. LAB DIAGNOSIS 1.Blood smear examination :Atypical Lymphocytosis. 2.Paul - Bunnel test: Heterophile antibody detection test. Inactivated serum + 1% sheep RBC suspension  370C  4 hrs  Agglutination (>100) 3. EBV Specific antibodies: EBNA Ab EBNA Ig M VCA, Ig G VCA 4. PCR: More sensitive. 59
  56. 56. HHV – 6 & HHV -7 Isolated in 1986 Transmission through Oral secretions. It is thought that HHV-6 and HHV-7 are related to each other in a similar manner to HSV-1 and HSV-2. Roseola infantum (Exanthema subitum) •High fever with generalized rash. •Chronic fatigue syndrome. 60
  57. 57. HUMAN HERPES VIRUS 8 • Originally isolated from cells of Kaposi’s sarcoma (KS) • Firmly associated with Kaposi’s sarcoma • Most patients with KS have antibodies against HHV-8

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