Herpes

Pathophysiology of infection1. Acute infection results in multinucleated cells (syncytia), ballooning degeneration of epithelial cells, necrosis, inclusion bodies, inflammatory response, cell to cell spread, latent infection of ganglia2. Latent infection does not destroy ganglia; viral genome persists as circular DNA; reactivation of virus replication leads to recurrent disease3. Recurrence triggered by stress, ultraviolet light, hormonal flux4. Spreads from cell to cell in presence of antibody5. Cell-mediated immunity contributes to symptoms and resolution

Clinical manifestations of HSV-1 infection1. Primary infection often asymptomatic; 50-90% of population is seropositive2. Primary gingivostomatitis—fever, irritability, painful vesicular lesions on buccalmucosa, tongue, gums, throat, 1-2 weeks duration3. Recurrent infection characterized by prodrome, followed by unilateral vesicles of 1week duration4. Ocular lesions can lead to permanent corneal scarring5. Causes 10% of viral encephalitis with 70% mortality if untreated

Clinical manifestations of HSV-2 infection1. Primary infection presents as papules progressing to vesicles and pustules,lymphadenopathy and tenderness, 3-4 weeks duration2. Recurrent infection characterized by prodrome followed by groups of vesicles on external genitalia, 1-2 weeks duration3. Neonatal herpes usually due to HSV-2 acquired by passage through infected birthcanal; 60% mortality with survivors suffering neurologic sequelae; disseminated vesicular lesions with internal organ involvement

Most definitive

Scrape the lesion

Antigen detection

Only for primary infection

Where in the world will you find Herpes?What is the reservoir?

Herpevacdl5-29

Valacyclovir or "Valtrex" is a prodrug of...

Decreases severity of primary infectionI.V. for encephalitis and neonatal infections

When resistant to acyclovir

Atypical lymphocytes

All of these may serve as buzzwords

Where is it endemic?

Where would you find a high incidence of African Burkitt's lymphoma?

Heterophile antibodies

leads to..

Enlargement of infected cells with pronuclear inclusions

Most common transplacentally transmitted infection in the U.S.

For Ag detection

Where does replication occur?