Herpes Viruses

1. General Features
a. Enveloped: not resistant to bile, (won’t survive long outside
b. DNA virus
c. replicate in the nucleus
d. Associated with latency and reactivation
e. Only vaccine we have is for Varicella Zoster Virus
f. Most negative effects are associated with the immunopathology of the condition
g. Diagnosis: usually done with PCR, there are antigen tests, and serology, or
histopathology (syncytium large multinucleated cells are a histologic marker on
Tzank stain
2. HSV 1 and HSV 2
a. HSV 1: oral
i. Usually newborns get it with day care
ii. Presentation with gigiovstiois: mouth hurts, and difficult swallowing
iii. Latency in the trigeminal nerve
iv. Cold sores (sometimes prodrome i.e. pain while incubating)
v. Can lead to HSV encephalitis diagnosed with RBCs in CSF, and mixed
pleocytosis (damage to the temporal lobe and behavioral changes)
b. HSV 2: Genital (ulcers they aren’t warts)
i. Spread associated with the asymptomatic shedding (they don’t know
they have)
ii. Formation of painful grouped vesicles on red base
iii. Generally will recur within 1 year of primary time; however won’t be as
bad, (sometimes given acyclovir prophalcticly)
c. Diagnosed with AB to glycoprotein G
d. Latent in sensory ganglia (while EBV is latent in B-cells)
e. Neonatal Herpes:
i. Encephaltis
ii. Dissemeniated
iii. SEM: skin, eyes, and mouth
f. Potential complications
i. Bell’s Palsy
ii. Recurrent Aseptic Meningitis
iii. Dendritic Ulcers (on the cornea)
iv. Ecyzema herpitcum
g. Treated with Acyclovir
h. Alpha type
3. VSV:
a. Alpha type
b. Respiratory transmission only herpes virus transmitted in this fashion
c. Recurrence= shingles (immunocompromised disseminated shingles)
d. Rash with chicken pox: all the pustules are in different stages
 i. Vessicles
ii. Pustules
iii. Crusted (all the vesicles must be crusted before you are considered non-
contagious)
e. Treatment:
i. neonates given the Varicella Zoster Ig with acyclovir
ii. pediatric cases not treated
iii. adults and adolsecents treated with acyclovir
iv. Pregnant women get Chicken Pox chicken pox pneumonia
v. Only Herpes there is a vaccine for (Varivax)
f. Shingles: a result of latent VSV recurrence
i. Dysesthesias= lightning pain
ii. Rash at level of dermatome or adjacent dermatomes
iii. Usually at thoracic, or lumbar vertebrae
iv. Most painful is the trigeminal
v. Post Herpetic Neuralgia: after shingles resolves there is accompanying
pain
vi. Shingles vaccine
1. shingrix (good vaccine not live, there are side effects, shing wins
2. Zostavix (live virus not that effective)
4. EBV (gamma virus oncogenic virus)
a. Causes:
i. Infectious mononucleosis
ii. Burket’s lymphoma
iii. Oral hairy leukoplakia
iv. Dukin’s syndrome: associate with EBV
b. Disease progression
i. Pediatric cases= non-sympotmatic
ii. Adolescence= infectious mononucleosis
c. Pathogensis of Infectious mononucleosis
i. Oropharynx (saliva and epithelium)
ii. Nonunique Symptoms: erythematous throat, fever, malaise
iii. Mimics strep throat, ampicillin rash **(buzzword)
iv. Diagnosis can be made with atypical Cd 8+ T-cells >10%, and leukocytosis
v. + Heterotopic antigens (CMV mono will be – for this)
vi. can cause anemia
d. Latency in B-cells (not in sensory ganglia like the rest of them)
e. Rest is key because of risk of splenic punctures
5. CMV:
a. Close contact
b. Common in day cares
c. CMV mono Diagnosis
i. Atypical CD8+ lymphocytes (<10%)
ii. Negative herophile AB
 d. Congenital CMV
i. Perinatal transmission @birth (breast feeding)
ii. Cytomegalic Inclusion with mother infection
e. Key association Bone or Organ transplants
f. Key association: Owl eyes histology
g. Diagnosis
i. PCR
ii. Maternal igM serology (indicates acute maternal disease and risk of
cytomegalic inclusion with infant)
h. Treatment: Ganiclovir, and Letermovir prevents reactivation
6. HHV 6: roseloa
a. Healthy infants with high fever
b. May be accompanied with febrile symptoms like seizures
c. Followed by rash
7. HHV7: infects CD4+ t-cells
8. HHV-8: kapsoi sarcoma
a. Key association: primary effusion lymphoma
b. Key association: multicentric castleman’s disease
9. Pox Virus:
a. DNA virus (replicates in cytoplasm)
b. Not technical a herpes virus
c. Key association: pet prairie dogs monkeypox
d. Vaccina Virus is the immunization
e. Variola Virus is the small pox virus
f. Very infectious: respiratory (class A bioterrism agent)